Annals of surgery最新文献

{"title":"Population-Level Reduction in Ovarian Cancer Through Performance of Opportunistic Salpingectomy at the Time of Cholecystectomy.","authors":"Jason D Wright,Ling Chen,Carly Tymm,Xiao Xu,Jennifer S Ferris,Dawn L Hershman,Andrea R Hagemann,Dionne Skeete,Thomas Curran,Maggie Westfal,David Flum,Katherine Fischkoff","doi":"10.1097/sla.0000000000006940","DOIUrl":"https://doi.org/10.1097/sla.0000000000006940","url":null,"abstract":"OBJECTIVEWe estimated the population-level magnitude of reduction in incident ovarian cancer if opportunistic salpingectomy (OS) was implemented at the time of cholecystectomy (CCK).SUMMARY BACKGROUND DATAOpportunistic salpingectomy (OS), prophylactic removal of the fallopian tubes, is a primary prevention strategy to reduce the risk of ovarian cancer.METHODSWe developed a methodological framework to estimate the benefit of OS-CCK for women. Population-level statistics were used to estimate the number of CCKs performed annually in the U.S. as well as the expected number of ovarian cancers, while accounting for competing risks of death. OS reduces the risk of ovarian cancer by 65%. We simulated the effect on ovarian cancer for up to 50 years if OS was performed in 40-80% of women undergoing CCK.RESULTSImplementation of OS in 40% of the CCKs women 40-44 years of age would prevent 6 cases of ovarian cancer within 5 years of follow-up, 41 cases within 20 years and 139 cases after 50 years of follow-up. If OS were performed in 80% of CCKs in this population, the corresponding cases prevented rises to 12 at 5 years, 81 at 20 years and 279 after 50 years follow-up. If OS were performed in 40% of all women ≥40 years of age who underwent CCK in given year, there would be 111 cases of ovarian cancer prevented after 5 years, 349 cases after 15 years, 660 cases after 30 years and 850 lifetime cases prevented.CONCLUSIONOS at the time of cholecystectomy has the potential to significantly reduce the burden of ovarian cancer in the United States.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"27 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059043","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 Novel Predictive Model for Cancer-Specific Surgical Risk Stratification of Patients Undergoing High-Risk Upper Gastrointestinal Oncologic Resections.","authors":"Miseker Abate,Sabrina T Lin,Nicolas Toumbacaris,Marinela Capanu,Meghana Mehta,Brandon Bosch,David Jones,William R Jarnagin,Daniel G Coit,Jeffrey Drebin,Thomas Barber,Anoushka Afonso,Daniela Molena,Alice Wei,Vivian E Strong","doi":"10.1097/sla.0000000000006939","DOIUrl":"https://doi.org/10.1097/sla.0000000000006939","url":null,"abstract":"OBJECTIVEHigh-risk oncologic resections are the primary curative interventions for solid upper gastrointestinal (GI) tumors; however, there are no cancer-specific risk-stratification models available for these operations.METHODSWe studied 2823 Memorial Sloan Kettering Cancer Center patients (2015-2022) undergoing upper GI oncologic resections including gastrectomy, esophagectomy, distal pancreatectomy, and pancreaticoduodenectomy for adenocarcinoma. Univariable analyses assessed risk factors for length of stay (LOS) and complications, with multivariable analyses incorporating covariates significant on univariable analysis and procedure type. Nomograms were built using multivariable models to predict surgical complications and LOS. Model performance was evaluated using discrimination (C-index for complications, Kendall's Tau for LOS) and calibration plots and was internally validated with 1000 bootstrap replicates to obtain average performance metrics and 95% confidence intervals.RESULTSThe median LOS was 7.0 (IQR:6.0,10.0), and the overall 30-day postoperative complication rates were 31%. Multivariable analysis identified age, ASA>3, COPD, renal failure, and operation length as independent risk factors for increased LOS (OR>1, P<0.05). Neoadjuvant chemotherapy (NAC) and pre-incision antibiotics reduced LOS (OR<1, P<0.05). The complication nomogram demonstrated a C-index of 0.66, while the LOS nomogram showed a Kendall's Tau of 0.39. Procedure type, age, and history of COPD and NAC had the greatest discriminatory values for LOS on the nomograms; procedure type, race, and BMI had the greatest impact on 30-day surgical complications.CONCLUSIONOur cancer-specific pre- and postoperative nomograms for LOS and postoperative complications provide an important tool to appropriately estimate risks and treatment outcomes for patients undergoing high-risk GI oncologic resections.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"36 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043580","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":"Assessing the Importance and Availability of Family Planning Policies for Surgical Residency Programs: A Review.","authors":"Kathleen S Botterbush,Logan Muzyka,Jenna K Koenig,MaKayla F Cox,Regan M Shanahan,Martina Mustroph,Anna R Kimata,Karen Malacon,Rachel S F Moor,Hannah Weiss,Nora Kim,Maryam Rahman,Sharona Ben-Haim, ","doi":"10.1097/sla.0000000000006937","DOIUrl":"https://doi.org/10.1097/sla.0000000000006937","url":null,"abstract":"OBJECTIVETo assess the availability and quality of family-planning resources available to surgical trainees.SUMMARY BACKGROUND DATAThe overlap of residency with reproductive years creates significant challenges for those who wish to build a family. Trainees in the three longest residencies - neurosurgery, plastic surgery, and cardiothoracic surgery - report increased rates of infertility, complications, and challenges with childrearing. Despite recent recommendations surrounding parental leave, there remains a paucity of widely accepted guidelines related to fertility and family planning, leaving critical gaps for trainees.METHODSA cross-sectional study was conducted to query the GME offices of all institutions with a categorical neurosurgery, integrated cardiothoracic, or plastic surgery residency for policies related to family-planning, fertility, or child-bearing. Analyses were performed to assess the relative availability and quality of these resources in general, and among institutions.RESULTSOf 115 institutions, Western programs consistently outperformed the rest of the US, offering the most comprehensive resources, including robust insurance plans (P=0.025), lactation and adoption policies (P<0.001), and radiation exposure policies for pregnant residents (P=0.041). High-performing institutions showed superior availability of information on insurance benefits; guidelines for paid parental leave; guides for childrearing; and generous childcare programs.CONCLUSIONSDespite recent guidelines, there remains marked variability in the availability and quality of policies and resources related to family planning for physician trainees. It is imperative that governing bodies and institutions take steps toward creating more consistent training environments through improvement through such initiatives as the development of publicly accessible institutional resources, advocacy for fair access to fertility preservation, and expansion of institutional services and programming.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"19 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043583","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":"Long-Term Survival on Extent of Lymphadenectomy for Right-Sided Colon Cancer: Five-Year Follow-up Results of a Randomized Controlled Trial (RELARC Trial).","authors":"Kexuan Li,Hongbo Li,Aiwen Wu,Lu Zang,Guannan Zhang,Lai Xu,Junyang Lu,Jiadi Xing,Bo Feng,Yueming Sun,Xiaohui Du,Pan Chi,Jianmin Xu,Ziqiang Wang,Yuelun Zhang,Zhongtao Zhang,Minhua Zheng,Xiangqian Su,Yi Xiao, ","doi":"10.1097/sla.0000000000006941","DOIUrl":"https://doi.org/10.1097/sla.0000000000006941","url":null,"abstract":"OBJECTIVETo compare the overall survival (OS) and cancer-specific survival (CSS) of right-sided colon cancer patients undergoing CME versus D2 surgery after 5 years of follow-up, and to assess the heterogeneity of treatment effectiveness of CME between different subgroups.SUMMARY BACKGROUND DATAThe 3-year result of the Radical Extent of lymphadenectomy of Laparoscopic Right Colectomy for colon cancer (RELARC) trial showed that standard D2 dissection should be performed in right-sided colon cancer patients. In patients with lymph node metastasis, complete mesocolic excision (CME) showed potentially favorable results.METHODSThe parallel, open label, randomized controlled trial was conducted between January, 2016 to December, 2019 in 17 hospitals in China. Of a total of 1072 eligible patients enrolled, 995 patients were included in the modified intention-to-treat analysis. In the present study, the primary outcome was 5-year OS and the secondary outcome was 5-year CSS. The trial is registered with ClinicalTrials.gov (Identifier: NCT02619942).RESULTS995 patients were included in the final analysis. There was no significant difference between the 5-year OS (HR: 0.74, 95%CI: 0.51-1.07, P=0.105) or CSS (HR: 0.72, 95%CI: 0.49-1.06, P=0.091) in the CME and D2 groups. CME appears to improve 5-year outcomes in patients with stage III disease (OS: HR: 0.58, 95% CI: 0.37-0.93, P=0.023; CSS: HR: 0.59, 95% CI: 0.37-0.94, P=0.028), particularly in those with pN2 (OS: HR: 0.25, 95% CI: 0.11-0.57, P=0.001; CSS: HR: 0.25, 95% CI: 0.11-0.57, P=0.001), where a statistically significant interaction was identified. Patients with lymphovascular invasion also demonstrated favorable outcomes with CME with significant interaction effect (OS: HR: 0.34, 95% CI: 0.17-0.70; interaction P=0.009; CSS: HR: 0.32, 95% CI: 0.15-0.67, interaction P=0.008).CONCLUSIONThe standard D2 dissection provides oncologic outcomes comparable to CME on the 5-year follow-up. However, CME seems to improve 5-year outcomes in patients with stage III, particularly those with pN2 status, and may confer benefit in patients with LVI.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"34 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043582","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":"Patient and Caregiver Experiences with Surgical Decision-Making in the Context of Dementia.","authors":"Rachel R Adler,Richard E Chunga,Joely A Centracchio,Zeba N Ahmad,Karen R Sepucha,Christina Sheu,Sasha Boyers,Samir K Shah,Clancy Clark,Dae Kim,Susan L Mitchell,Emily Finlayson,Zara Cooper,John Hsu,Joel S Weissman,Lara Traeger","doi":"10.1097/sla.0000000000006936","DOIUrl":"https://doi.org/10.1097/sla.0000000000006936","url":null,"abstract":"OBJECTIVETo explore patient and caregiver experiences of surgical decision-making for patients living with dementia (PLWD).SUMMARY BACKGROUND DATAPLWD face heightened risks of poor surgical outcomes. For PLWD, surgical decisions are often made in collaboration with caregivers (family or close others who support the PLWD), yet there is limited research examining PLWD and caregiver experiences of surgical decision-making.METHODSWe conducted in-depth interviews with nationally recruited PLWD (n=11) and caregivers (n=36) facing a surgical decision within the past two years. Interviews explored surgical decision-making experiences. Using reflexive thematic analysis, we coded the transcribed interview data and developed themes related to decision-making priorities, strategies, experiences, and satisfaction.RESULTSThe following themes were identified: (1) PLWD and caregivers prioritized quality-of-life outcomes, (2) They struggled to anticipate benefits and risks of treatment options for the PLWD, (3) Caregivers felt a heavy burden to make the \"right\" decision when PLWD were unable to participate in decision-making, and (4) Decisional regret stemmed from a lack of alignment between the decision and what the caregiver felt the PLWD would have wanted.CONCLUSIONSPLWD and caregivers navigated fraught surgical decisions and sought the 'right' balance between potential cognitive and functional tradeoffs of surgical and non-surgical options. Findings highlight the need for targeted decisional support for PLWD as well as caregivers who face decision-making on behalf of PLWD. Results inform potential mechanisms for improving surgical decision-making quality and outcomes.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"47 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043579","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":"Advancing Pediatric Trauma Quality Assessment Through Collaboration, Harmonization, and Improved Data Systems.","authors":"Shawn J Rangel","doi":"10.1097/sla.0000000000006938","DOIUrl":"https://doi.org/10.1097/sla.0000000000006938","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"48 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145035737","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":"Anatomical Risk Factors for Portal Vein Complications Following Right Hepatectomy in Living Donors.","authors":"Young-In Yoon,Dong-Hwan Jung,Shin Hwang,Ki-Hun Kim,Chul-Soo Ahn,Deok-Bog Moon,Tae-Yong Ha,Gi-Won Song,Gil-Chun Park,Sung-Gyu Lee","doi":"10.1097/sla.0000000000006935","DOIUrl":"https://doi.org/10.1097/sla.0000000000006935","url":null,"abstract":"OBJECTIVETo determine the incidence, clinical outcomes, and anatomical risk factors of portal vein (PV)-related complications after right lobe donor hepatectomy (RLDH).SUMMARY BACKGROUND DATAWith the increase in living donor liver transplantation, large-scale studies on donor morbidity have been conducted to ensure donor safety. However, reports evaluating PV-related complications following right hepatectomy in living donors are lacking.METHODSWe analyzed the medical records of 4720 consecutive donors who underwent RLDH from July 1997 to December 2020 at our institution. The PV angle was classified according to the angulation between the main and left PV. Outcomes included the incidence of postoperative PV-related complications in living donors who underwent right hepatectomy and risk factors for PV-related complications after RLDH.RESULTSThe incidence of PV-related complications following RLDH was 1.9% (n=88), including PV thrombosis (n=9) and stenosis (n=79). Donors with PV-related complications exhibited higher peak alanine aminotransferase levels than those without PV complications (P=0.023); however, peak total bilirubin (P=0.055), peak international normalized ratio (P=0.395), and postoperative hospital stays (P=0.117) were similar. Multivariate logistic regression revealed an angle between the main and left PV of <60° as a significant independent risk factor for PV-related complications (odds ratio: 6.250; P<0.001). Additionally, variant PV anatomy, absence of falciform ligament fixation, and a body mass index of >30 kg/m2 were identified as independent risk factors (P<0.001, P<0.001, and P=0.002, respectively).CONCLUSIONSAcute angulation between the main and left PV or variant PV anatomy is associated with an increased incidence of PV-related complications following RLDH.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"72 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031722","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":"An Exploration of Culture in General Surgery Training Programs: A Scoping Review.","authors":"Katrina Monton,Olivia Monton,Ann-Margret Ervin,Alexandria L Frank,Stella M Seal,Caryn J Block,Fabian M Johnston","doi":"10.1097/sla.0000000000006932","DOIUrl":"https://doi.org/10.1097/sla.0000000000006932","url":null,"abstract":"OBJECTIVEThe objective of this study was to systematically explore how culture has been conceptualized, investigated, and measured within general surgery residency training programs.SUMMARY BACKGROUND DATAResearch on the culture of general surgery residency training programs has primarily focused on examining individual parameters, such as mistreatment and burnout, rather than comprehensively analyzing the overall culture, climate, or learning environment.METHODSFive databases (PubMed, Embase, Cochrane, CINAHL, APA PsycInfo) were searched. The searches included a combination of controlled vocabulary and keyword terms related to culture, environment, climate, and general surgery training. Two reviewers performed title and abstract screening and full text review. A narrative synthesis was performed.RESULTSSeven studies met the eligibility criteria and were included. Most studies (n=6, 85.7%) were conducted in the United States. Four studies (57.1%) were single-center and three (42.9%) were multi-center studies. Only two studies defined and three measured culture, climate, or the learning environment using validated instruments. The included studies explored various components and outcomes of culture, including teaching, training, and learning opportunities; workload, resources, and support; well-being, stress, and suicidal ideation; duty hour violations and burnout; mistreatment, harassment, discrimination, and abuse; and job satisfaction and attrition.CONCLUSIONSThis scoping review revealed significant heterogeneity in the ways in which culture has been evaluated and characterized within the general surgery training literature. A more unified approach to exploring organizational culture in general surgery training programs would allow for advancement of the field.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"71 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025552","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":"Anatomic Location Predicts Response Rates: Real World Outcomes with Over 1,100 Cycles of Talimogene Laherparepvec (TVEC) Description: A Retrospective Review of a Prospectively Maintained Database.","authors":"Kristen E Dougherty,Gray B Peery,Chris B Agala,Veronica P Pham,Morgan E Gwynn,Michael O Meyers,Karyn B Stitzenberg,Jonathan D Sorah,Patricia K Long,C Paige Jones,Frances A Collichio,David W Ollila","doi":"10.1097/sla.0000000000006931","DOIUrl":"https://doi.org/10.1097/sla.0000000000006931","url":null,"abstract":"OBJECTIVEWe hypothesized that anatomic location of metastatic melanoma is associated with the degree of therapeutic response to TVEC.SUMMARYTVEC is the first FDA-approved injectable oncolytic virus to treat unresectable stage IIIB-IV metastatic melanoma patients. Previously published real-world outcomes demonstrated a 39% complete response (CR) rate to TVEC.METHODSA prospective single-center melanoma database of patients treated with TVEC from December 2015-December 2023 was analyzed. Patients were categorized into groups based on treated anatomic sites. Patient characteristics were summarized using frequencies, means, medians, comparisons, and tests of proportions using chi-square, Fisher's exact, and Wilcoxon rank sum tests. We used unadjusted generalized estimating equation models with repeated measures to estimate relative risk ratios for local treatment response and anatomic sites.RESULTS173 patients were included: median age 75 years; majority male (n=112, 64.7%) and white (n=170, 98.3%). We analyzed 190 therapeutic plans of TVEC with a total of 1,133 cycles, median 6 cycles/patient (1-18). Median follow-up was 41 months (11-107). Of the anatomic sites treated, 73 were head/neck (38.4%), 73 lower extremity (38.4%), 25 torso (13.2%), and 19 upper extremity (10%). CR was seen in 79 (41.6%), partial response (PR) in 41 (21.6%), mixed response/stable disease in 37 (19.5%), and disease progression in 33 (17.4%). In the CR group, 40 (50.6%) responses were head/neck, 24 (30.4%) lower extremity, 11 (13.9%) torso, and 4 (5.1%) upper extremity.CONCLUSIONSThis is the largest prospective cohort evaluating real-world outcomes of metastatic melanoma patients treated with TVEC based on anatomic location. TVEC is a well-tolerated, durable treatment for advanced staged melanoma. Our findings demonstrate head/neck metastases have the greatest CR rate and should be considered as a possible first-line therapy in select patients.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"49 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025553","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":"Clinical Momentum: An Observational Study Identifying Latent Forces Driving Surgical Interventions for Older Adults Near the End of Life.","authors":"Melanie L Fritz,Michael A Jaeb,Sarah I Zaza,Alex Dudek,Kristine L Kwekkeboom,Anne Buffington,Leah M Gober,Margaret L Schwarze","doi":"10.1097/sla.0000000000006934","DOIUrl":"https://doi.org/10.1097/sla.0000000000006934","url":null,"abstract":"OBJECTIVEWe evaluated the empirical fit of our model of clinical momentum for older adults with life-limiting illness undergoing unplanned surgery.BACKGROUNDOlder adults often undergo surgery near the end of life, in contrast to generally stated preferences. Systems forces promoting intervention may produce nonbeneficial treatment despite advances in communication. We conducted an observational study to understand how a conceptual model of clinical momentum might apply to patients with life-limiting illnesses having surgery.METHODSWe interviewed 29 interdisciplinary clinicians caring for 8 patients age 65+ with life-limiting illness who underwent unplanned surgical intervention. We evaluated physical, cognitive, and social behavioral processes related to the course of care. We used content analysis to code interview transcripts and higher-level analysis to understand the empirical fit of the conceptual model.RESULTSWe found evidence of model components, including \"fix it\" and \"recognition-primed decision-making\" that related to actual clinical events and processes that occurred for patients, promoting a default of surgical intervention followed by an accumulating \"cascade\" of interventions that generated a perception of \"sunk costs.\" We identified novel momentum accelerators including binary options and care fragmentation. Clinicians expressed concerns that surgery was nonbeneficial but were unable to disrupt this momentum in the moment of decision-making around surgery. We identified momentum disruption when the patient's abnormality could not be fixed and additional surgery was not considered or offered.CONCLUSIONSClinical momentum characterizes systems forces leading to acute surgical intervention for patients with life-limiting illnesses despite surgeon concerns that the treatment does more harm than good. These forces are difficult to disrupt and may require interventions beyond improved communication to reduce nonbeneficial therapy.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"54 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145026026","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}