Annals of surgery最新文献

{"title":"Association of Hospital System Affiliation With Spending and Postoperative Outcomes: A Longitudinal Study of Hospital Mergers And Acquisitions From 2010 To 2018.","authors":"Adrian Diaz, Usha Nuliyalu, Andrew M Ryan, Justin B Dimick, Andrew M Ibrahim, Hari Nathan","doi":"10.1097/SLA.0000000000006431","DOIUrl":"10.1097/SLA.0000000000006431","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether hospital system affiliation was associated with changes in surgical episode spending or postoperative outcomes.</p><p><strong>Background: </strong>Over 70% of US hospitals are now part of a hospital system. The presumed benefits of hospital consolidation include concentrating volume and expertise, care integration, and investment in quality improvement. However, there is conflicting evidence as to whether expanding hospital systems are actually reducing health spending or improving quality. These observations call into question whether systems are leveraging their collective volume and experience to standardize care and maximize efficiencies.</p><p><strong>Methods: </strong>The American Hospital Association Annual Survey was used to identify whether a hospital was part of a system and in which year a hospital joined the respective system. Using 100% Medicare claims data, we identified fee-for-service Medicare patients undergoing elective inpatient coronary artery bypass graft colon resection, lung resection, hip replacement, or knee replacement from 2010 to 2018. We used a difference-in-differences framework to evaluate hospital spending and outcomes before and after joining a system. The primary outcome was Medicare 30-day episode spending, with specific attention to the total episode payment, index hospitalization, and post-acute care components. Secondary outcomes included serious complications, 30-day mortality, and 30-day readmission.</p><p><strong>Results: </strong>The cohort included 3,395,565 Medicare beneficiaries who underwent surgery between 2010 and 2018. Patients were treated at 3961 hospitals, of which 1097 (27.7%) were never in a system, 2262 (57.1%) were always in a system, and 602 (15.2%) joined a system during the study period. By 1 year after system affiliation, 30-day episode spending had decreased by $303 (95% CI: 63, 454, P =0.01), and after 5 years, 30-day episode spending decreased by $429 (95% CI: 5, 853, P =0.04). One year after system association, index hospitalization spending was not statistically different from before system affiliation ($-30, 95% CI: -160, 100, P =0.65). Conversely, 1 year after system association, postacute care spending decreased by $268 (95% CI: 107, 429, P <0.01) and remained lower for ≥5 years. There was no significant change in hospitals serious complications (-0.14, 95% CI: -0.40, 0.11, P =0.27), 30-day readmission (-0.14, 95% CI:-0.52, 0.25, P =0.48), or 30-day mortality (-0.08, 95% CI: -0.18, 0.03, P =0.17), 1 year after joining a system; similar patterns were observed at three and ≥5 years.</p><p><strong>Conclusions: </strong>system affiliation was associated with a small decrease in 30-day episode spending, driven by decreased spending in postacute care services. Notably, there was no difference in postoperative outcomes after system affiliation.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"952-959"},"PeriodicalIF":7.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554096","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":"From Moral Injury Vulnerability to Protective Equity: The Voyage Every Surgeon Must Take.","authors":"Praveen Vimalathas, Elisa J Gordon, Jason A Nieuwsma, Keith Meador, Sunil K Geevarghese","doi":"10.1097/SLA.0000000000006607","DOIUrl":"10.1097/SLA.0000000000006607","url":null,"abstract":"<p><strong>Objective: </strong>To examine the relationship between moral injury and surgical practice, further explore the concept of protective equity, and understand its role in mitigating the impact of morally injurious events throughout a surgical career.</p><p><strong>Background: </strong>Moral injury in health care settings has evolved from Jonathan Shay's original definition, modified by Brett Litz and others, to encompass the psychological impact of adverse patient outcomes on medical practitioners. Early career surgeons may be particularly susceptible to moral injury, yet the factors influencing this vulnerability remain poorly understood.</p><p><strong>Methods: </strong>An analysis of existing literature on moral injury in health care, combined with an examination of surgical career trajectories and outcome reporting was conducted. The concepts of protective equity and vulnerability are introduced, defined, and theoretically extrapolated across a surgical career.</p><p><strong>Results: </strong>Evidence suggests that surgical complications significantly contribute to moral injury, particularly among early-career surgeons. We propose a model wherein protective equity accumulates over a surgical career, whereas vulnerability follows an M-shaped curve with peaks in early and late careers.</p><p><strong>Conclusions: </strong>Early career surgeons face a precarious imbalance of low protective equity and high vulnerability, especially immediately posttraining. Strategies to address this dynamic include providing: specific education when onboarding faculty, and longitudinal peer support by senior, trained surgeons.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"903-905"},"PeriodicalIF":7.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845508","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":"Comparison of TEG Parameters Between Clopidogrel-resistant Resistant and Non-resistant Groups.","authors":"Adriana A Rodriguez Alvarez, Isabella Ferlini Cieri, Mounika Naidu Boya, Sasha Suarez Ferreira, Shiv Patel, Jeongin Jang, Kellie Machlus, Anahita Dua","doi":"10.1097/SLA.0000000000006771","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006771","url":null,"abstract":"<p><strong>Objective: </strong>Compare TEG parameters between clopidogrel-resistant and clopidogrel-non-resistant groups.</p><p><strong>Summary background data: </strong>Graft or stent thrombosis affects 1 in 5 patients within six months post-revascularization and is a leading cause of amputation in the elderly. Clopidogrel resistance occurs in 5-44% of patients.</p><p><strong>Methods: </strong>This prospective observational study evaluated patients with PAD undergoing revascularization and taking clopidogrel between 2022 and 2024. Whole blood samples were analyzed using thromboelastography (TEG) and VerifyNow testing. Patients were categorized based on their clopidogrel response: clopidogrel-resistant (>180 P2Y12 Reaction Units (PRU)) and non-resistant (<180 PRU). Fisher's exact and Wilcoxon tests were used to compare the groups for categorical and continuous variables, respectively. Spearman's correlation coefficient was used to determine the relationship between platelet function and clopidogrel response (VerifyNow).</p><p><strong>Results: </strong>Fifty-three patients were analyzed, 70% were male, and 23% were clopidogrel-resistant. Clopidogrel-resistant exhibited higher platelet reactivity (PRU 224.2 vs. 74.9, P<0.0001), faster clot formation (1.14min vs. 1.22min, P<0.0001), clot strength (ADP-MA 54.9 mm vs. 39.8 mm, P<0.0001), and reduced clot lysis (0.97min vs. 0.69min, P=0.0005) compared to non-resistant. Additionally, these patients showed a higher percentage of platelet aggregation (74.0% vs. 44.0%, P<0.0001) and a lower platelet inhibition (26.0% vs. 56.0%, P<0.0001), indicating a diminished response to clopidogrel and an increased risk of thrombosis.</p><p><strong>Conclusion: </strong>Clopidogrel-resistant group exhibited faster clot formation, greater clot strength, and higher platelet aggregation. Incorporating TEG into clinical practice could help identify patients at risk of inadequate clopidogrel response.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172443","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":"The Road from NIH-training Grants for Surgeons: What is the Return on Investment?","authors":"Lindsay A Demblowski, Carolina Larrain, Anna Coxen, Helina Somervell, Hyoyoung Choo-Wosoba, Seth M Steinberg, Martha A Zeiger","doi":"10.1097/SLA.0000000000006769","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006769","url":null,"abstract":"<p><strong>Objective: </strong>This study examines the success of surgeon-scientists to non-surgeon physician-scientists in obtaining NIH funding after participation on a research training grant.</p><p><strong>Summary background data: </strong>Dedicated research time during postgraduate training for physician-scientists is advantageous for obtaining future independent funding from NIH.</p><p><strong>Methods: </strong>NIH Reporter was used to identify F32 and T32 grants awarded to internal medicine and surgery departments from 2005-2015, and an internal NIH database was used to determine funding outcomes. Success rates were recorded for surgeon vs. internist PIs who applied for either a mentored career grant or research project grant (RPG). The median time in years from the final year of the training grant and clinical graduation to the first awarded grant was investigated. Chi-squared tests, Fisher's exact tests, and Wilcoxon rank sum tests were used.</p><p><strong>Results: </strong>A greater proportion of surgeons transitioned directly to an RPG, 27% (68 internist PIs) compared to 72% (63 surgeon PIs) (P<0.001). Both T32 and F32 trained surgeons were able to obtain an RPG sooner than internists, taking a median of 5 years from the end of clinical training vs. a median of 7 years for internists [P=0.033 (F32), P=0.034 (T32)].</p><p><strong>Conclusions: </strong>Although fewer F32 and T32-funded surgeons apply for subsequent NIH-funding compared to non-surgeons, more surgeons apply for an RPG instead of a K-grant. Remarkably, surgeons obtained independent funding sooner after clinical graduation compared to internists, despite the extensive gap in time between post-graduate training and first faculty appointment, an amazing accomplishment given their clinical training and surgical practice challenges.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155888","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":"Can Women Surgeons Have It All? If Not Now, When?","authors":"Heather A Lillemoe, Rebecca A Snyder","doi":"10.1097/SLA.0000000000006768","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006768","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155887","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":"Being Waitlisted is not Enough-Identification of Pseudo-access to Kidney Transplantation in the United States.","authors":"Lauren E Matevish, Madhukar S Patel, Deepa Ravindra, Jigesh A Shah, David Wojciechowski, Herbert J Zeh, Parsia A Vagefi","doi":"10.1097/SLA.0000000000006770","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006770","url":null,"abstract":"<p><strong>Objective: </strong>We sought to determine how kidney transplant center volume impacts waitlisted candidate access to transplant.</p><p><strong>Summary background data: </strong>Over 90,000 candidates await a kidney transplant, of which we hypothesized that waitlist access is subject to significant program-level variation, potentially resulting in pseudo-access: a state where the waitlisted candidate does not achieve expected transplantation.</p><p><strong>Methods: </strong>Center-level data on all U.S. adult kidney transplant programs was collected using the Scientific Registry of Transplant Recipients program-specific reports, updated through 12/31/23. Programs (N=196) were stratified into quartiles by yearly deceased donor kidney transplant volume (Q1 lowest, Q4 highest); program acceptance practices and outcomes were compared.</p><p><strong>Results: </strong>Compared to lower volume programs, Q4 programs transplanted a higher proportion of their waitlist (30.5% vs 13.1% for Q1;P<0.001) with a higher transplant rate ratio (1.41 vs 0.74 for Q1;P<0.001), and an accelerated time to transplant (median time to transplant ratio: 0.79 vs 1.2 for Q1;P=0.008). Offer acceptance ratios were significantly higher at Q4 programs, particularly for marginal allografts (KDRI>1.75: 1.51 vs 0.46 for Q1;P<0.001) and hard-to-place kidneys (>100 offers: 1.18 vs 0.25 for Q1;P<0.001). Despite increased utilization of more marginal grafts, Q4 programs demonstrated shorter post-transplant hospital lengths of stay (median 4 days [4-5] vs 6 [5-7] for Q1; P<0.001).</p><p><strong>Conclusion: </strong>High-volume (HV) programs excel through aggressive organ utilization, while low-volume (LV) programs often provide pseudo-access to transplantation, characterized by low transplant rate ratios, conservative offer acceptance practices, and prolonged wait times. To increase kidney allograft utilization, LV programs unable to improve acceptance practices should consider consolidation or the development of access programs to facilitate candidate migration to HV centers.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155886","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":"Repeat versus Single Quadratus Lumborum Block to Reduce Opioids After Open Pancreatectomy (RESQU-BLOCK): A Randomized Clinical Trial.","authors":"Brittany C Fields,Jose M Soliz,Barbra Bryce Speer,Shannon Hancher-Hodges,Keyuri U Popat,Semhar J Ghebremichael,Antoinette Van Meter,Uduak U Williams,Xuemei Wang,Hyunsoo Hwang,Morgan L Bruno,Whitney L Dewhurst,Elsa M Arvide,Naruhiko Ikoma,Jessica E Maxwell,Michael P Kim,Matthew H G Katz,Ching-Wei D Tzeng,Timothy E Newhook","doi":"10.1097/sla.0000000000006767","DOIUrl":"https://doi.org/10.1097/sla.0000000000006767","url":null,"abstract":"OBJECTIVEThe primary aim was to compare the proportion of opioid-free discharges between two postoperative analgesia bundles distinguished by receipt of a single-block versus a second, \"rescue\" block. Secondary outcomes included differences in discharge prescription oral morphine equivalents (OME) and patient-reported outcomes.SUMMARY BACKGROUNDAfter a preoperative quadratus lumborum (QL) block, our historical discharge opioid prescription for open pancreatectomy was 300mg OME, with only 5% patients discharged opioid-free. We hypothesized an opioid-reduction bundle with repeat block on postoperative day (POD)4 could increase opioid-free discharges while reducing symptom burden.METHODSThis was a single-institution, unblinded phase II randomized clinical trial, analyzed by intent-to-treat and post hoc Bayesian analyses. Patients undergoing open pancreatectomy were randomized 1:1 to receive a standardized analgesic bundle with or without the addition of the rescue-block on POD4.RESULTSAmong 106 patients randomized (44.3% female; median age 66.5 years; 84% pancreatoduodenectomy; median 5-day stay), 104 completed the trial (52 per arm). By intent-to-treat, 52% of second-block patients were discharged opioid-free versus 36.5% single-block. Median discharge OME was 0mg versus 25mg, respectively. Improved (lower) patient-reported pain and life interference scores were observed in the second-block arm at discharge and 1-month.CONCLUSIONSAddition of a second, \"rescue\" block to an opioid reduction bundle did not significantly improve opioid-free discharges after open pancreatectomy and was not required to discharge >1/3 of patients opioid-free. Nevertheless, considering improvements in symptom inventory and the high threshold of opioid-free discharge, the concept of a rescue-block to purposefully wean patients to zero use is feasible.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"33 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144146167","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 Systematic Review and Meta-analysis of the Efficacy and Safety of Lytic and Non-lytic Early Thrombus Removal Technologies for Iliofemoral Deep Vein Thrombosis.","authors":"Benedict R H Turner,Sara Jasionowska,Jessica Shea,Avik Ghosh,Matthew Machin,Adam M Gwozdz,Stephen A Black,Alun H Davies","doi":"10.1097/sla.0000000000006765","DOIUrl":"https://doi.org/10.1097/sla.0000000000006765","url":null,"abstract":"OBJECTIVESThis systematic review and meta-analysis compared the effectiveness and safety of lytic and non-lytic early thrombus removal strategies in addition to anticoagulation versus anticoagulation alone.SUMMARY BACKGROUND DATAEarly thrombus removal strategies have been developed to prevent post-thrombotic syndrome (PTS) following acute iliofemoral deep vein thrombosis (DVT).METHODSThis review followed PRISMA guidelines using a registered protocol (CRD42023437158). The MEDLINE and Embase databases, as well as trial registries, were searched without limitations. Head-to-head or single-armed trials or studies that reported the rate of PTS in patients with iliofemoral DVT (symptomatic for <28 d) and early thrombus removal were included. The rates of PTS, moderate-severe PTS, major bleeding, risk-benefit ratio, DVT recurrence and mortality were pooled in meta-analysis with fixed or random effects.RESULTSAcross all study designs (20 studies), the rate of PTS was 24.5% (95% CI 19.5.1-30.3%) for lytic therapies, 18.8% (1 study) for non-lytic therapy and 40.4% (95% CI 35.3-45.7) for anticoagulation alone. The number needed to treat was 6 for PTS and 15 for moderate-severe PTS. In randomised trials, the odds of major bleeding with lytic therapies was 4.9 (95% CI 1.3-19.1) compared to anticoagulation; the number needed to harm was 33. There was no major bleeding for mechanical thrombectomy.CONCLUSIONSEarly thrombus removal reduces PTS and moderate-severe PTS, whilst increasing non-fatal major bleeding. Mechanical thrombectomy removes major bleeding risk but efficacy evidence is limited to one observational study.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"51 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144146169","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":"Enabling Long Term Follow up After Ventral Hernia Repair Through Clinical Registry and Medicare Claims Linkage.","authors":"Andrew Varone, Xinyan Zheng, Jialin Mao, Art Sedrakyan, Michael J Rosen, Dylan S Goto, Benjamin K Poulose","doi":"10.1097/SLA.0000000000006766","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006766","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the feasibility of linking short-term clinical data from a disease specific registry with longitudinal Medicare claims to improve long-term follow-up and examine hernia recurrence rates.</p><p><strong>Background: </strong>Disease-specific registries provide rich perioperative data on ventral hernia repairs (VHR), but long-term follow-up remains challenging.</p><p><strong>Methods: </strong>This observational cohort study linked patients in the Abdominal Core Health Quality Collaborative (ACHQC) aged≥65 or with Medicare who underwent VHR (2014-2019) to Medicare Fee-for-service claims using a sequential linkage algorithm. Follow-up duration and recurrence rates, defined as reoperation for hernia recurrence (RHR), were analyzed.</p><p><strong>Results: </strong>Of 10,757 ACHQC patients, 7,418 (69%) were successfully linked to Medicare claims data. Median follow-up increased from 32 days (IQR 18-83 d) to 778 days (IQR 383-1216) (P<0.001). Linked patients had a median age of 69 years (IQR 65-74), 48% women and median BMI of 30 kg/m2 (IQR 27-35). Most underwent incisional (74%) or umbilical (18%) repair in clean (83%) situations. Mean hernia width was 5 cm (IQR 3-10) with 31% undergoing recurrent repair. Open (67%) and robotic (16%) approaches were most common. Myofascial release was performed in 39% with a fascial closure rate of 91%. Mesh was used in 88% (91% permanent synthetic mesh, 4% biologic, 4% resorbable synthetic). At 4 years, estimated RHR was 10.8%, varied by mesh type: biologic 19.3%, resorbable synthetic 16.4%, no mesh 11.1%, permanent synthetic 10.1%.</p><p><strong>Conclusion: </strong>Linking clinical registry data with Medicare claims data can increase long-term follow-up after VHR and improve health services research and post market surveillance of hernia mesh.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141299","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":"Surgical Health Services Research as a Path to Health System Leadership.","authors":"Kristy K Broman,Rachel Greenup,Lesly A Dossett,Amir Ghaferi","doi":"10.1097/sla.0000000000006764","DOIUrl":"https://doi.org/10.1097/sla.0000000000006764","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"4 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122257","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}