Annals of surgery最新文献

{"title":"Change Is Hardest Right Before the Glass Ceiling Breaks: An Update on Women Pursuing Careers in Academic Surgery at a National Level.","authors":"Haley Harris, Isabelle Tan, Yuqing Qiu, Julianna Brouwer, Jonathan Abelson, Julie Ann Sosa, Heather Yeo","doi":"10.1097/SLA.0000000000006718","DOIUrl":"10.1097/SLA.0000000000006718","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to provide a comprehensive update on the representation of women in academic surgery by specialty, measuring progress and opportunity with regard to women \"breaking\" the glass ceiling at the trainee, faculty, and department chair levels.</p><p><strong>Background: </strong>Over the past 2 decades, initiatives have contributed to educational awareness, culture shifts, and a focus on inclusive excellence in surgery, leading to an increase in the number of women surgeons. Despite progress, a persistent gender gap in surgical faculty positions remains, and projections suggest that it will take more than a century to reach parity at the highest levels of academic surgery.</p><p><strong>Methods: </strong>Data from the Association of American Medical Colleges' FACTS and Faculty Rosters and the American Medical Colleges' Graduate Medical Education reports from 2006 to 2023 were analyzed to assess gender representation in surgery. Linear regression analyses were used to describe trends in the proportions of women who were promoted along the professional development pathway (resident to faculty to department chair) from 2006 to 2023.</p><p><strong>Results: </strong>Over our 17-year study period, all included surgical subspecialties increased in the proportion of women trainees, with the largest average annual increases observed in pediatric, plastic, and vascular surgery training programs. Although all surgical faculty levels experienced growth in the proportion of women faculty, the average annual change in the proportion of women decreased as seniority increased. At the observed trend, it is projected that surgical department chairs will not achieve equal proportions of men and women until the year 2102.</p><p><strong>Conclusions: </strong>Across the board, the proportion of women in surgery has increased. However, there remains opportunity for improvement, particularly at the senior faculty and department chair levels.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"176-183"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatic Artery Infusion Chemotherapy Compared to Transarterial Radioembolization For Unresectable Colorectal Liver Metastases.","authors":"Lily V Saadat,Joanne Chou,Mithat Gonen,Rachel M Lee,Shishir K Maithel,Amy Li,George A Poultsides,Taylor J Aiken,Patrick B Schwartz,Ece Meram,Daniel E Abbott,Keenan J Robbins,Ryan C Fields,Ashwini Paranjpe,Jashodeep Datta,Louise C Connell,Leonard Saltz,Andrea Cercek,Nancy Kemeny,Daniel Y Sze,Hooman Yarmohammadi,Constantinos T Sofocleous,William Jarnagin,Michael D'Angelica","doi":"10.1097/sla.0000000000006851","DOIUrl":"https://doi.org/10.1097/sla.0000000000006851","url":null,"abstract":"OBJECTIVEThis study evaluates outcomes for patients with unresectable colorectal liver metastases (CRLM) undergoing hepatic artery infusion chemotherapy (HAI) and transarterial radioembolization (TARE).SUMMARY BACKGROUND DATAThe most common liver-directed therapies for unresectable CRLM include HAI and TARE.METHODSIn this retrospective cohort study, patients with unresectable CRLM treated with HAI at one high-volume center were compared with patients treated with TARE at five other institutions. Propensity score matching was performed within lines of chemotherapy received prior to treatment (treatment-naïve; 1-line; 2-lines; 3-4 lines) using baseline demographics, extrahepatic disease (EHD), prior chemotherapy, disease-free interval, and interval from primary diagnosis to HAI/TARE. Overall survival (OS) analysis was conducted to compare the matched groups.RESULTSA total of 708 HAI patients and 481 TARE patients were identified. The majority of patients (84%) received chemotherapy prior to HAI/TARE. HAI patients were younger (median age:54 vs. 62) and more likely to have evidence of EHD at time of treatment (65% vs. 60%). Of the 493 patients who received 1-line of chemotherapy, 166 (34%) were matched. Among matched patients who received 1-line (HAI:83, TARE:83) or 2-lines of chemotherapy (HAI:80, TARE:80), TARE patients had a significantly increased risk of all-cause mortality compared to HAI [HR:1.46 (95%CI:1.02-2.08) and HR:1.96 (95%CI:1.32-2.89)]. More frequent conversion to resection and use of concurrent systemic chemotherapy were also seen in the HAI cohort. Among matched patients who received 3-4 lines of chemotherapy (HAI:50, TARE:50), there was no difference in OS between HAI and TARE [HR:0.88 (95%CI:0.57-1.35)] and rate of conversion to surgery was 4% for both groups.CONCLUSIONSWithin matched cohorts stratified by lines of therapy, there appear to be differences in survival for patients treated with HAI and TARE after first or second-line chemotherapy. Outcomes after TARE and HAI are not significantly different in the refractory setting.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"23 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Outcomes in Open Versus Minimally Invasive Gastrectomy For Gastric Cancer: A European Multicenter Study Based on the GASTRODATA Registry.","authors":"Maria Bencivenga,Kammy Keywani,Lorena Torroni,Federica Filippini,Simone Giacopuzzi,Giuseppe Verlato,Arnulf Hoelscher,Domenico D'ugo,Guillaume Piessen,Bas Wijnhoven,Paul Schneider,Manuel Pera,Uberto Fumagalli Romario,Piotr Kołodziejczyk,Karol Rawicz-Pruszynski,Johanna Van Sandick,Lucio Lara Santos,William Allum,Riccardo Rosati,Andrew Davies,Daniel Reim,Stefan Moenig,Ines Gockel,Gian Luca Baiocchi,Paulo Matos Da Costa,Rossella Reddavid,Wojciech Kielan,Carlotta Fiammenghi,Mark van Berge Henegouwen,Giovanni De Manzoni,Paolo Morgagni,Suzanne Gisbertz","doi":"10.1097/sla.0000000000006854","DOIUrl":"https://doi.org/10.1097/sla.0000000000006854","url":null,"abstract":"OBJECTIVETo evaluate morbidity and mortality after minimally invasive (MIG) versus open gastrectomy (OG) for gastric cancer (GC) in a large European population, with a subgroup analysis comparing total and subtotal gastrectomy.SUMMARY BACKGROUND DATAReal-world European studies comparing postoperative outcomes between MIG and OG are lacking.METHODSThis retrospective study included GC patients undergoing curative-intent gastrectomy between 2017 and 2021 at 24 high-volume European centers participating in the GASTRODATA registry. The primary outcome was the perioperative complication rate after MIG versus OG. Propensity score matching (PSM) was performed to adjust for potential confounders.RESULTSOf 2430 patients, 1,800 (74%) underwent OG and 630 (26%) MIG. MIG was performed in patients with smaller tumors, earlier stages, and less frequently receiving neoadjuvant treatment (P<0.001). MIG was associated with higher R0 resection rate (96.5% vs. 92.4% in OG), shorter hospital stay, lower perioperative complication rate (23.0% vs. 31.6%, P<0.001), and reduced 30-day and 90-day mortality rates (1.6% vs. 3.3%, [P=0.026] and 1.9% vs. 4.7%, [P=0.001], respectively). In sub-group analysis, MIG had fewer perioperative complications in subtotal (17.9% vs. 25.3%, P=0.005), but not total gastrectomy (31.5% vs. 36.1%, P=0.201). After PSM, MIG remaind significantly associated with lower perioperative complication rates compared to OG only in subtotal (OR=0.49, 95% CI, 0.30-0.80; P=0.005), but not in total gastrectomy (OR=1.15, 95% CI, 0.62-2.17; P=0.645).CONCLUSIONSMinimally invasive subtotal gastrectomy was associated with fewer perioperative complications than OG, while this association was not observed for total gastrectomy. Minimally invasive subtotal gastrectomy should be considered a viable option in specialized European centers.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"53 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized Controlled Trial of New Oral Anticoagulants Versus Warfarin for Post Cardiac Surgery Atrial Fibrillation: The NEWAF Trial.","authors":"Philicia Moonsamy,Yunong Zhao,Adham Makarem,Dane C Paneitz,Stanley Wolfe,Isabella Turco,Katia M Colon,Breanna R Ethridge,Selena S Li,Gregory Leya,Serena Verma,David A D'Alessandro,Arminder S Jassar,Nathaniel B Langer,George Tolis,Mauricio A Villavicencio,Serguei I Melnitchouk,Jordan P Bloom,Eriberto Michel,Antonia Kreso,Seyed Alireza Rabi,Oluwaseun Akeju,Thoralf M Sundt,Asishana A Osho","doi":"10.1097/sla.0000000000006853","DOIUrl":"https://doi.org/10.1097/sla.0000000000006853","url":null,"abstract":"OBJECTIVETo determine whether anticoagulation for new onset atrial fibrillation (AF) with rivaroxaban decreases length of stay compared to warfarin.SUMMARY OF BACKGROUND DATADirect Oral Anticoagulants (DOACs) have been shown to be noninferior to warfarin for stroke prevention in nonsurgical patients with atrial fibrillation. There are no published randomized trials comparing DOACs to warfarin in cardiac surgery patients, and DOACs are yet to be widely adopted in this population.METHODSIn a pragmatic, prospective, clinical trial, 100 patients with new-onset AF after cardiac surgery were randomized to receive rivaroxaban (n=50) or warfarin (n=50). Patients were followed for 30 days post-discharge, with patient-reported outcomes assessed two weeks after discharge using the Perception of Anticoagulant Treatment Questionnaire and the EuroQol-5D-3L survey.RESULTSThe primary endpoint, length of stay (LOS) from day of surgery to discharge (days, IQR), was 7 (6-9) for rivaroxaban and 8 (6-9) for warfarin (P=0.460). LOS from initiation of anticoagulation to discharge was 2 (1-4) days for rivaroxaban and 2 (1-3) days for warfarin (P=0.738). The mean INR at discharge in the warfarin group was 1.68 (SD 0.5). No major bleeding events, strokes, or other arterial thromboembolism events occurred in either group. Minor bleeding events were reported in 3/50 (6%) patients in the rivaroxaban group versus 1/50 (2%) in the warfarin group (P=0.617), none of which required blood transfusion. One patient (2%) in the rivaroxaban group developed a pericardial effusion requiring drainage, compared to none in the warfarin group (P=1.000). Patients taking rivaroxaban reported significantly higher scores for convenience (P<0.001) and better overall perception of their anticoagulation experience (P=0.006), though both groups reported similar treatment satisfaction (P=0.494). Mobility issues were reported by 42.2% of patients taking rivaroxaban compared to 18.6% of those taking warfarin (P=0.021). All outcomes were consistent in both the intention-to-treat and as-treated populations.CONCLUSIONSTreatment with rivaroxaban in new-onset atrial fibrillation after cardiac surgery did not decrease length of stay compared to warfarin. However, patients treated with rivaroxaban reported significantly better convenience and a more favorable overall perception of their anticoagulation experience compared to warfarin. Given similar safety profiles, these findings support incorporating rivaroxaban as an option for shared-decision-making when selecting anticoagulation therapy for this patient population.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"17 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Conceptual Framework on Integrating a Large and Growing Academic Health System.","authors":"Akhil Chawla,Fabian M Johnston,Michael J Rosen","doi":"10.1097/sla.0000000000006850","DOIUrl":"https://doi.org/10.1097/sla.0000000000006850","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"673 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precision Medicine in Surgery: Immunomodulation and Cellular Regeneration Strategies for Immunologic and Surgical Diseases.","authors":"Mingyang Ma,Preeti Chhabra,Jack H Cook,Gordon W Laurie,Kenneth L Brayman","doi":"10.1097/sla.0000000000006849","DOIUrl":"https://doi.org/10.1097/sla.0000000000006849","url":null,"abstract":"OBJECTIVEThis article presents a methodological framework for studying the effects of lacritin peptide on β-cell proliferation, islet viability, and immune modulation using a combination of in vitro and in vivo models.SUMMARY OF BACKGROUND DATAImmunological and inflammatory diseases, including autoimmune disorders and organ-specific injuries, present significant therapeutic challenges owing to persistent inflammation and limited tissue regeneration. Therapies that combine immunomodulation and cellular regeneration may address this need in conditions such as Crohn's disease, heart failure, pulmonary fibrosis, chronic kidney disease, and neurological injuries. 'Lacritin' displays both immunomodulatory and regenerative activities, and is significantly deficient in T1 diabetics.METHODSPancreatic islet in-vitro testing, mass cytometry (CyTOF), imaging mass cytometry (IMC), and single-cell RNA sequencing (scRNAseq) to assess immune cell interactions. Additionally, in-vivo transplantation of lacritin peptide treated islets into diabetic mouse recipients and immunological studies in the Nonobese Diabetic (NOD) mouse model support the pre-clinical evaluation of lacritin in its therapeutic potential.RESULTSIn this article, we discuss the increasing need for precision medicine for immunological and surgical diseases. Within our experimental framework, we generate valuable insights into immune cell behavior, tissue architecture, and regenerative dynamics with lacritin intervention at the pre-clinical stage.CONCLUSIONThrough this study, we aimed to facilitate further investigations into future precision medicine strategies, including lacritin peptide and other peptide-based therapeutics for immunologic and surgical diseases.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"52 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Traditional and new Surgical Wait Time Targets and Survival for Curative-intent Colorectal Cancer Surgery: A Population-based Cohort Study.","authors":"Adom Bondzi-Simpson,Rinku Sutradhar,Frances C Wright,Tiago Ribeiro,Wing C Chan,Sheron Perera,Andrea Covelli,Aisha Lofters,Rebecca A Snyder,Callisia N Clarke,Natalie G Coburn,Julie Hallet","doi":"10.1097/sla.0000000000006846","DOIUrl":"https://doi.org/10.1097/sla.0000000000006846","url":null,"abstract":"BACKGROUNDWait time (WT) to surgery is a common quality indicator for colorectal cancer (CRC). However, the definition of WT targets and its association with clinically relevant outcomes remains poorly defined. We assessed the association between WT to CRC surgery and overall survival (OS) for curative-intent surgery.METHODSWe conducted a population-based retrospective cohort study of adults undergoing resection for stage I-III CRC (between 2007-2020), using health administrative data in Ontario, Canada. The exposure was WT, measured as the time from the decision to operate to surgery (in days). The outcome was OS, measured as time from surgery to death. Restricted cubic spline regression (RCS) examined the relationship between WT and hazards of death to identify meaningful WT thresholds. WT was then categorized as a) traditional WT target (≤ 28 days) or b) new data-informed target defined by RCS. Multivariable Cox proportional hazards explored the association between each WT target and the hazards of death after adjusting for confounders established a priori.RESULTSOf 35,533 patients, 27,102 (76.3%) underwent surgery within the traditional WT target. The median WT was 19 days (interquartile range 12-28). RCS revealed an inflection point around 45 days associated with increasing hazards of death. After adjusting for age, sex, co-morbidity, cancer site, stage, neo-adjuvant or adjuvant therapy, and year of surgery, having surgery within the traditional WT target (≤ 28 days) was not associated with OS (Hazards Ratio, [HR] 0.97; 95% confidence interval, [CI] 0.92-1.02). Having surgery within the new WT target (≤ 45 days) was independently associated with superior OS (HR 0.90, 95% CI 0.82-0.99).CONCLUSIONIn patients undergoing curative-intent resection for stage I-III CRC, having surgery within traditional WT target of 28 days was not associated with OS. However, having surgery within a WT target of 45 days was independently associated with superior OS. These data highlight the need to reconsider WT targets for quality monitoring by linking to clinically meaningful outcomes.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"14 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Super Learner Enhances Postoperative Complication Prediction in Colorectal Surgery.","authors":"Tommaso Violante,Davide Ferrari,Marco Novelli,William R Perry,Kellie L Mathis,Eric J Dozois,David W Larson","doi":"10.1097/sla.0000000000006847","DOIUrl":"https://doi.org/10.1097/sla.0000000000006847","url":null,"abstract":"OBJECTIVETo determine if a Super Learner (SL) machine learning approach could improve the predictive accuracy of the American College of Surgeons Risk Calculator (ACS-RC) for postoperative complications in patients undergoing colorectal surgery.SUMMARY OF BACKGROUND DATAMachine learning (ML) has shown significant potential to advance medical fields, including surgical risk prediction. Current tools, like the ACS-RC which uses logistic regression and extreme gradient boosting, are standard but may be enhanced by more advanced ML ensembles.METHODSThis retrospective study analyzed colorectal surgery cases from the 2018-2022 ACS National Surgical Quality Improvement Program (NSQIP) database. An SL model, which combines multiple ML algorithms, was developed to predict fourteen postoperative outcomes. Its performance was compared against traditional logistic regression (LOG) and extreme gradient boosting (XGB) models. Key performance metrics included discrimination (AUROC, AUPRC) and calibration (Brier score, Hosmer-Lemeshow test).RESULTSThe SL model demonstrated superior performance across all predicted complications when compared to both LOG and XGB. It showed superior discrimination for severe outcomes, achieving an AUROC greater than 0.94 for predicting mortality. The SL model was also more accurate in predicting infectious complications and length of stay, and its calibration metrics indicated a better overall fit and accuracy.CONCLUSIONSThe Super Learner model enhances the accuracy of postoperative risk prediction in colorectal surgery. Its superior performance suggests it is a promising tool for improving personalized patient counseling, aiding clinical decision-making, and optimizing resource allocation.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"115 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A New Era of Decision Making in Liver Transplantation: A Prospective Validation and Cost-Effectiveness Analysis of FMN-Guided Liver Viability Assessment During Normothermic Machine Perfusion.","authors":"Chase J Wehrle,Sangeeta Satish,Elizabeth Dewey,Muhammad A Nadeem,Keyue Sun,Chunbao Jiao,Mazhar Khalil,Alejandro Pita,Jaekeun Kim,Federico Aucejo,David Ch Kwon,Masato Fujiki,Antonio D Pinna,Belinda Udeh,Charles Miller,Koji Hashimoto,Andrea Schlegel, ","doi":"10.1097/sla.0000000000006822","DOIUrl":"https://doi.org/10.1097/sla.0000000000006822","url":null,"abstract":"OBJECTIVESFlavin mononucleotide (FMN), a marker of mitochondrial complex 1 injury, has not yet been validated for its predictive value of outcomes and economic impact.SUMMARY OF BACKGROUND DATANormothermic machine perfusion (NMP) is the only ex-situ perfusion technique currently approved for liver transplantation in the US. Optimal graft viability assessment on this approach remains controversial.METHODSAll liver transplants at our center were included, divided into static-cold storage (SCS, n=418), NMP (OrganOx Metra) with traditional viability criteria (10/2022-1/2024, n=213) and prospective viability assessment using FMN (NMP+FMN, 1/2024-87/2024, n=143). Perfusate fluorescence spectroscopy was performed to quantify FMN during NMP. Spectroscopy results were correlated with tissue analyses. Standard risk factors and clinically relevant core outcomes were collected for analysis. Groups were propensity-matched, and posttransplant outcomes including economics were assessed using inverse-probability of treatment weighting (IPTW). Mixed-effects models assessed complications, graft loss and FMN-guided liver utilization. A decision-analytic model was used to assess the cost-benefit of NMP and FMN-testing.RESULTSGraft loss was predicted best by perfusate FMN (&gt;1700 samples; c-statistic AUC 0-4hrs NMP: 0.96, 95%CI:0.93-0.97, P&lt;0.0001) versus traditional viability markers. High FMN grafts demonstrated significantly more mitochondrial injury measured in tissues at the end of NMP. Since implemented prospectively, FMN-based viability assessment during NMP lead to a comparable liver utilization rate of NMP=94 vs. NMP+FMN=90% (P=0.346) despite higher overall donor and recipient risk. Over one-third (n=43, 35%) were livers from donation after circulatory death donors (DCD). Elevated perfusate FMN of &gt;1.75μg/mL at 4hours was independently associated with reduced graft survival and death-censored graft survival. Liver transplants in the FMN-era were independently associated with improved graft survival on cox regression (HR:6.841, 95%CI:1.447-37.300, P&lt;0.001). Risk-adjusted outcomes including biliary and overall complications, major (Clavien&gt;IIIA) complications, liver-related major complications, and graft loss were improved with FMN-based viability testing. Overall morbidity measured by comprehensive complications index (CCI) was reduced with NMP but did significantly decrease with additional FMN-use compared to SCS. Such results were upheld when DBD and DCD grafts were evaluated independently. Liver transplantations with high FMN livers demonstrated greater cumulative costs (P&lt;0.001). On mixed-effects modelling, 44% percent of transplant-related cost variation was explained by FMN in the top quintile (&gt;1.75μg/mL). Risk-matched FMN-tested DBD grafts specifically demonstrated incremental 16% reduction in major complications with net $33,657 saving per graft in the decision-analytic model while DCD grafts demonstrated 30% improvement in major complications and an ","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"4 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social Vulnerability Hinders Clinical Trial Participation in Gastrointestinal Cancer Surgery Patients.","authors":"Shruthi R Perati,Sana M Mohayya,Henry A Pitt,Ernie Shippey,Howard S Hochster,Steven K Libutti,Mariam F Eskander","doi":"10.1097/sla.0000000000006843","DOIUrl":"https://doi.org/10.1097/sla.0000000000006843","url":null,"abstract":"OBJECTIVEThis study examines how neighborhood social vulnerability impacts clinical trial participation for gastrointestinal (GI) cancer surgery patients.SUMMARY BACKGROUND DATAClinical trials are critical to cancer care but often exclude disadvantaged groups.METHODSThe Vizient Clinical Database (CDB), which captures 98% of academic medical centers, 110+cancer hospitals and 700+community hospitals, was queried for gastroesophageal, pancreatic, and colorectal cancer patients who underwent surgical resection from July 2018-June 2023. The Vizient Vulnerability Index (VVI), comprised of 9 census tract-level domains, was used to study the association between social vulnerability and trial participation.RESULTS399,446 patients were identified, 7,680 (1.9%) of whom participated in a clinical trial. Clinical trial participants were less likely to be socially vulnerable (OR 0.71, P<0.0001), particularly in the VVI domains of economic and education, and to have undergone resection at a community hospital (OR 0.38, P<0.0001). High social vulnerability decreased the odds of enrollment for patients who underwent surgery at community hospitals by a greater degree than those who underwent surgery at academic/specialized centers (OR 0.52 vs. 0.75; P<0.0001 for interaction). Trial participants were less likely to be female (OR 0.84, P<0.0001), Black (OR 0.69, P=0.0002), and have Medicaid insurance (OR 0.81, P<0.0001).CONCLUSIONSAmong gastrointestinal cancer surgery patients, female sex, Black race, Medicaid insurance, and neighborhood social vulnerability, particularly economic and education vulnerability, were associated with lower odds of clinical trial enrollment. The factor that most inhibited trial enrollment was surgery at a community hospital, and this influence was compounded by social vulnerability.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"52 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}