Annals of surgery最新文献

{"title":"Ethical Considerations for Resource Allocation Towards Sustainable Surgery.","authors":"David Blitzer, Robert M Sade, Brandi Scully","doi":"10.1097/SLA.0000000000006325","DOIUrl":"10.1097/SLA.0000000000006325","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"933-934"},"PeriodicalIF":7.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847200","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":"Coaching Program to Address Burnout, Well-being, and Professional Development in Pediatric Surgery Trainees: A Randomized Controlled Trial.","authors":"Eunice Y Huang, Rebecca A Saberi, Kerri Palamara, Danielle Katz, Heidi Chen, Holly L Neville","doi":"10.1097/SLA.0000000000006257","DOIUrl":"10.1097/SLA.0000000000006257","url":null,"abstract":"<p><strong>Objective: </strong>To assess impact of participation in a positive psychology coaching program on trainee burnout and well-being.</p><p><strong>Background: </strong>Coaching using principles of positive psychology can improve well-being and reduce physician burnout. We hypothesized that participation in a coaching program would improve pediatric surgery trainee well-being.</p><p><strong>Methods: </strong>With IRB approval, a coaching program was implemented during the COVID-19 pandemic (September 2020 to July 2021) in the American Pediatric Surgical Association. Volunteer pediatric surgery trainees (n=43) were randomized to receive either one-on-one quarterly virtual coaching (n=22) from a pediatric surgeon trained in coaching skills or wellness reading materials (n=21). Participants completed prestudy and poststudy surveys containing validated measures, including positive emotion, engagement, relationships, meaning, accomplishment, professional fulfillment, burnout, self-valuation, gratitude, coping skills, and workplace experiences. Results were analyzed using the Wilcoxon rank sum test, Kruskal-Wallis test, or χ 2 test.</p><p><strong>Results: </strong>Forty trainees (93%) completed both the baseline and year-end surveys and were included in the analysis. Twenty-five (64%) were female, mean age 35.7 (SD 2.3), and 65% were first-year fellows. Coached trainees showed an improved change in positive emotion, engagement, relationships, meaning, accomplishment ( P =0.034), burnout ( P =0.024), and gratitude ( P =0.03) scores from precoaching to postcoaching compared with noncoached trainees. Coping skills also improved. More coaching sessions were associated with higher self-valuation scores ( P =0.042), and more opportunities to reflect were associated with improved burnout and self-valuation.</p><p><strong>Conclusions: </strong>Despite the stress and challenges of medicine during COVID-19, a virtual positive psychology coaching program provided benefits in well-being and burnout to pediatric surgery trainees. Coaching should be integrated into existing wellness programs to support the acquisition of coping skills that help trainees cope with the stressors they will face during their careers.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"938-944"},"PeriodicalIF":7.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140058505","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":"Same-day Ileostomy Closure Discharge Reduces Costs Without Compromising Outcomes: An Economic Analysis.","authors":"Davide Ferrari, Tommaso Violante, James P Moriarty, Bijan J Borah, Amit Merchea, Luca Stocchi, David W Larson","doi":"10.1097/SLA.0000000000006285","DOIUrl":"10.1097/SLA.0000000000006285","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to assess the costs of a same-day discharge (SDD) enhanced recovery pathway for diverting loop ileostomy (DLI) closure compared with a standard institutional enhanced recovery protocol.</p><p><strong>Background: </strong>Every year, 50,155 patients in the United States undergo temporary stoma reversal. While ambulatory stoma closure has shown promise, widespread adoption remains slow. This study builds on previous research, focusing on the costs of a novel SDD protocol introduced in 2020.</p><p><strong>Methods: </strong>A retrospective case-control study was conducted at Mayo Clinic, Rochester, Minnesota, and Mayo Clinic, Jacksonville, Florida, comparing patients undergoing SDD DLI closure from August 2020 to February 2023 to those in a matched cohort receiving standard inpatient enhanced recovery protocol. Patients were matched based on age, sex, american society of anesthesiologists score, surgery period, and hospital. Primary outcomes included direct hospitalization and additional costs in the 30 days postdischarge.</p><p><strong>Results: </strong>The SDD group (n = 118) demonstrated a significant reduction in median index episode hospitalization and 30-day postoperative costs compared with the inpatient group (n = 236), with savings of $4827 per patient. Complication rates were similar, and so were readmission and reoperation rates.</p><p><strong>Conclusions: </strong>Implementation of the SDD for DLI closure is associated with substantial cost savings without compromising patient outcomes. The study advocates for a shift towards SDD protocols, offering economic benefits and potential improvements in health care resource utilization.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"973-978"},"PeriodicalIF":7.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140304462","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":"Too Big to Fail: Volumetric Analyses and Incidence of Posthepatectomy Liver Failure in 125 Major Hepatectomies in Children.","authors":"Juri Fuchs, Lucas Rabaux-Eygasier, Thomas Husson, Virginie Fouquet, Florent Guerin, Geraldine Hery, Sophie Branchereau","doi":"10.1097/SLA.0000000000006595","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006595","url":null,"abstract":"<p><strong>Objective: </strong>To assess the incidence of posthepatectomy liver failure (PHLF) and the role of the future liver remnant (FLR) in children undergoing major hepatectomy.</p><p><strong>Summary background data: </strong>Incidence and risk factors of PHLF in children are unclear, with no validated definition for this age group. Consequently, the role of the FLR in pediatric hepatectomy and evidence-based preoperative guidelines remain undefined.</p><p><strong>Methods: </strong>All pediatric patients undergoing major hepatectomy at a tertiary care center over a 10-year study period were analyzed. Preoperative imaging was used for volumetry. The incidence of PHLF was assessed applying predefined definitions, and the prognostic impact of the FLR on PHLF and complications was evaluated.</p><p><strong>Results: </strong>125 children underwent major hepatectomy, including 35 trisectionectomies. There was a strong correlation between imaging-based measured total liver volume and calculated standard liver volume (r=0.728, P<0.001). The median total liver volume-to-body weight (BW) ratio was 3.4%, the median FLR/BW ratio was 1.5%. The median FLR-to-total liver volume ratio was 44% (range 18%-97%). No clinically relevant PHLF occurred. FLR/total liver volume and FLR/BW ratios had low predictive value for postoperative liver dysfunction and morbidity.</p><p><strong>Conclusion: </strong>This is the largest reported single-center series of pediatric major hepatectomies. PHLF is exceedingly rare in children. The liver volume-to-body weight ratio is higher in children compared to adults, and the FLR is sufficient even in extreme resections with less than 20% of liver remnant. These findings strongly question the use of ALPPS, portal vein embolization, or transplantation based on suspected insufficient liver remnant in children.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708665","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":"Target Artery Outcomes Following Endovascular versus Open Surgical Repair of Thoracoabdominal Aortic Aneurysms - A Single Center Comparative Study.","authors":"Ying Huang, Jill Colglazier, Bernardo C Mendes, Alberto Pochettino, Manju Kalra, Kevin L Greason, Emanuel R Tenorio, William S Harmsen, Gustavo S Oderich","doi":"10.1097/SLA.0000000000006594","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006594","url":null,"abstract":"<p><strong>Objective: </strong>To compare target artery (TA) outcomes after fenestrated or branched endovascular aortic repair (FB-EVAR) versus open surgical repair (OSR) of thoracoabdominal aortic aneurysms (TAAAs).</p><p><strong>Background: </strong>Few studies have compared TA outcomes after endovascular incorporation and open reconstruction.</p><p><strong>Methods: </strong>Among consecutive patients who underwent elective OSR or FB-EVAR of TAAAs (2008-2020), we reviewed those who had postoperative imaging studies evaluating TA. Data of FB-EVAR patients were obtained from a prospectively maintained institutional database. TAs included celiac, superior mesenteric, right and left renal arteries treated during TAAA repairs. Primary endpoint was TA patency (primary and secondary).</p><p><strong>Results: </strong>There were 131 patients (487 TAs) treated by OSR and 350 (1,300 TAs) by FB-EVAR. In the OSR group, 440 TAs (90.3%) were reconstructed by bypasses, and 47 (9.7%) by reimplantation. In the FB-EVAR group, 841 TAs (64.7%) were incorporated by fenestrations, and 459 (35.3%) by DBs. Thirty-day TA primary patency rates were not significantly different between FB-EVAR and OSR (99.4%% vs. 99.0%, P=0.36), but secondary patency rate was higher after FB-EVAR (99.8% vs. 99.0%, P=0.02). Three-year primary patency rates were 95.9% (95% confidence interval [CI], 94.7-97.2%) and 94.7% (95% CI, 92.2-97.2%), respectively; secondary patency rates were 98.5% (95% CI, 97.7-99.2%) and 94.7% (95% CI, 95.7-99.2%), respectively. There were no significant differences in late primary patency and secondary patency between groups (each P<0.05).</p><p><strong>Conclusion: </strong>Target artery primary and secondary patency rates following elective OSR or FB-EVAR were high. Endovascular repair was not associated with loss of primary patency and late secondary patency.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708750","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":"Real-world Application of Endoscopic Resection for Early-stage Esophageal Cancer: do we need to rethink the guidelines?","authors":"Smita Sihag","doi":"10.1097/SLA.0000000000006593","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006593","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674996","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":"Competency, Proficiency, and Mastery: Learning Curves for Robotic Distal Pancreatectomy at 16 International Expert Centers.","authors":"Philip C Müller, Christoph Kuemmerli, Adrian T Billeter, Baiyong Shen, Jiabin Jin, Felix Nickel, Cristiano Guidetti, Emanuele Kauffmann, Julia Purchla, Christoph Tschuor, Paul Suno Krohn, Stefan K Burgdorf, Jan Philipp Jonas, Felix J Bussmann, Olivier Saint-Marc, Abdallah Iben-Khayat, Paul C M Andel, Izaak Quintus Molenaar, Ulrich Wellner, Tobias Keck, Beat Moeckli, Christian Toso, Fabrizio Di Benedetto, Valentina Valle, Pier Giulianotti, Didier Roulin, John B Martinie, Martina Rama, Harish Lavu, Charles Yeo, Parit T Mavani, Mihir M Shah, David A Kooby, Jin He, Ugo Boggi, Thilo Hackert, Inne H M Borel-Rinkes, Beat P Müller, Pierre-Alain Clavien","doi":"10.1097/SLA.0000000000006592","DOIUrl":"10.1097/SLA.0000000000006592","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate the different phases of the learning curve for robotic distal pancreatectomy (RDP) in international expert centers.</p><p><strong>Summary background data: </strong>RDP is an emerging minimally invasive approach; however, only limited, mostly single center data are available on its safe implementation, including the learning curve.</p><p><strong>Methods: </strong>Consecutive patients undergoing elective RDP from 16 expert centers across three continents were included to assess the learning curve. Based on the first 100 RDPs at each center, three cutoffs were used to define the learning curve: operative time for competency, major complications (Clavien-Dindo grade ≥III) for proficiency, and textbook outcome for mastery. Clinical outcomes before and after the cutoffs were compared.</p><p><strong>Results: </strong>The learning curve analysis was conducted on 1109 of 2403 RDPs. Competency, proficiency, and mastery, respectively, were reached after 46, 63, and 73 RDP procedures. After competency, operative time decreased from 245 to 235 minutes (P=0.002). Attaining proficiency was reflected by a reduction in the rate of major complications from 20% to 15% (P=0.012), and mastery was associated with a higher proportion of patients with textbook outcome (71% vs. 63%; P=0.028). The postoperative pancreatic fistula rate remained stable along the learning curve, ranging between 18.5% and 21.5%. Previous laparoscopic experience accelerated the learning process by virtue of reduced operative time and an earlier decrease in major complications.</p><p><strong>Conclusion: </strong>Competency, proficiency, and mastery for RDP were reached after 46, 63, and 73 procedures, respectively, at international expert centers. The findings highlight that the learning curves for intraoperative parameters are completed earlier; however, extensive experience is needed to master RDP.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666940","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":"Metabolic Surgery: Progenitor of Effective Therapy for Atherosclerotic Cardiovascular Disease, Cancer, Type 2 Diabetes, and Obesity.","authors":"Henry Buchwald","doi":"10.1097/SLA.0000000000006588","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006588","url":null,"abstract":"<p><p>Metabolic surgery - operating on a normal organ for a beneficial metabolic gain - is not only an emerging discipline of surgery but the progenitor of therapy for the major global afflictions of atherosclerotic cardiovascular disease, cancer, type 2 diabetes, and obesity, as well as at least 18 other disease entities.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613516","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":"Postoperative Exercise Training in Patients with Colorectal Liver Metastases A Randomized Controlled Trial.","authors":"Simon Nørskov Thomsen, Rikke Krabek, Christina Yfanti, Stine Sjöberg, Anna Sundberg, Ditte Munch Dalsgaard, Laura Mølgaard Thomsen, Eske Kvanner Aasvang, Camilla Qvortrup, Morten Mau-Sørensen, Bente Klarlund Pedersen, Peter Nørgaard Larsen, Martin Hylleholt Sillesen, Nicolai Aagaard Schultz, Jesper Frank Christensen, Casper Simonsen","doi":"10.1097/SLA.0000000000006587","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006587","url":null,"abstract":"<p><strong>Background: </strong>Postoperative morbidity can reduce quality of life, physical performance, and tolerability of postoperative chemotherapy in patients with colorectal liver metastases (CRLM). Exercise can improve these outcomes in some cancer populations. However, it remains unknown whether exercise can be delivered in the early postoperative period following surgery for CRLM without increasing the risk of harms.</p><p><strong>Objective: </strong>The primary objective was to compare the number of serious adverse events (SAEs) with exercise intervention versus control. The secondary objectives were to compare non-SAEs, chemotherapy dose modifications, patient-reported outcomes, cardiorespiratory fitness, and physical performance.</p><p><strong>Methods: </strong>Patients with CRLM scheduled to open surgery with or without postoperative chemotherapy were randomized 2:1 to intervention or control. The intervention group performed 30-50 min low-to-high intensity exercise 5 times/week for 8 weeks, initiated one day after postoperative hospital discharge. The primary outcome was SAEs. The secondary outcomes were SAEs; chemotherapy dose modifications; patient-reported outcomes; cardiorespiratory fitness; and physical performance.</p><p><strong>Results: </strong>Fifty-five participants were randomized. The number of SAEs was similar between the groups (between-group difference [95% CI]: -0.07 [-0.59; 0.43] events), whereas the number of non-SAEs was lower in intervention (between-group difference [95% CI]: -4.65 [-9.14; -0.17] events). We found between-group differences in time to postoperative chemotherapy (intervention: 25 days, control; 42 days) and chemotherapy dose modifications (RR [95%CI]: 0.55 [0.35; 0.88]). Additionally, we found between-group differences in quality of life, cardiorespiratory fitness, and physical performance, in favor of intervention.</p><p><strong>Conclusions: </strong>Early-onset postoperative exercise exhibit a favorable harms-benefit profile in patients with CRLM. This warrants further investigation in larger randomized controlled trials.</p><p><strong>Trial registration: </strong>Prospectively registered at clinicaltrials.gov (NCT04751773).</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613517","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 Between Racial Marginalization with Direct Healthcare Expenditure, Time at Home and Rehabilitation Access Following Moderate to Severe Traumatic Brain Injury.","authors":"Armaan K Malhotra, Avery B Nathens, Husain Shakil, Adom Bondzi-Simpson, Tiago Ribeiro, Ahmad Essa, Yingshi He, Christopher D Witiw, Kevin Thorpe, Abhaya V Kulkarni, Jefferson R Wilson","doi":"10.1097/SLA.0000000000006584","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006584","url":null,"abstract":"<p><strong>Objective: </strong>To determine the association between residence in racialized neighborhoods with direct healthcare expenditure and days at home (DAH) after moderate to severe traumatic brain injury (TBI).</p><p><strong>Summary background data: </strong>Differences in ethno-racial background have been associated with health outcome disparities. Much of this prior research was conducted in settings without universal healthcare coverage. The influence of ethno-racial background on health outcomes after TBI in universal healthcare settings remains unclear.</p><p><strong>Methods: </strong>This retrospective multicenter cohort study utilized linked administrative health data to identify adults sustaining moderate to severe TBI between 2009-2021. The primary exposure was an area-level index corresponding to the degree of racialized and immigrant populations within neighborhoods of residence (Q1-least racialized; Q5-most racialized). Co-primary outcomes were direct healthcare expenditure and DAH365days after injury. Secondary outcomes included discharge to rehabilitation and functional independence measure (FIM) scores at rehabilitation discharge.</p><p><strong>Results: </strong>6,188 patients met inclusion criteria. Patients in the most racialized neighborhoods incurred higher crude and adjusted direct healthcare costs compared to those in the least racialized neighborhoods. This effect was driven predominantly by physician claims and acute care costs. There were no significant differences in crude or adjusted DAH across quintiles. Access to rehabilitation and discharge FIM scores were comparable for patients residing different racialized neighborhood quintiles.</p><p><strong>Conclusions: </strong>Despite differences in healthcare expenditure, this study found similar home time, access to rehab and discharge FIM scores for TBI patients according to racialized neighborhood residence. Recognizing the limitations of area-level indices, our findings suggest equitable care delivery in a publicly funded universal care environment.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602835","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}