Annals of surgery最新文献

{"title":"The PAncreatic Surgery Composite Endpoint (PACE): Development and Validation of a Clinically Relevant Endpoint Requiring Lower Sample Sizes.","authors":"Felix Nickel, Christoph Kuemmerli, Philip C Müller, Mona W Schmidt, Leon P Schmidt, Philipp Wise, Rosa Klotz, Christine Tjaden, Markus Diener, Pascal Probst, Thilo Hackert, Markus W Büchler","doi":"10.1097/SLA.0000000000006194","DOIUrl":"10.1097/SLA.0000000000006194","url":null,"abstract":"<p><strong>Objective: </strong>To provide a composite endpoint in pancreatic surgery.</p><p><strong>Background: </strong>Single endpoints in prospective and randomized studies have become impractical due to their low frequency and the marginal benefit of new interventions.</p><p><strong>Methods: </strong>Data from prospective studies were used to develop (n=1273) and validate (n=544) a composite endpoint based on postoperative pancreatic fistula, postpancreatectomy hemorrhage, as well as reoperation and reinterventions. All patients had pancreatectomies of different extents. The association of the developed PAncreatic surgery Composite Endpoint (PACE) with prolonged length of hospital stay >75th percentile and mortality was assessed. A single-institution database was used for external validation (n=2666). Sample size calculations were made for single outcomes and the composite endpoint.</p><p><strong>Results: </strong>In the internal validation cohort, the PACE demonstrated an area under the curve of 78.0%, a sensitivity of 90.4%, and a specificity of 67.6% in predicting a prolonged length of hospital stay. In the external cohort, the area under the curve was 76.9%, a sensitivity of 73.8%, and a specificity of 80.1%. The 90-day mortality rate was significantly different for patients with a positive versus a negative PACE both in the development and internal validation cohort (5.1% vs 0.9%; P < 0.001), as well as in the external validation cohort (8.5% vs 1.2%, P < 0.001). The PACE enabled sample size reductions of up to 80.5% compared to single outcomes.</p><p><strong>Conclusions: </strong>The PACE performed well in predicting prolonged hospital stays and can be used as a standardized and clinically relevant endpoint for future prospective trials enabling lower sample sizes and therefore improved feasibility compared to single outcome parameters.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"496-500"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139429530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Repair of 100 Urgent and Emergent Free or Contained Thoracoabdominal Aortic Aneurysms Ruptures. An International Multicenter Trans-Atlantic Experience.","authors":"Paolo Spath, Nikolaos Tsilimparis, Enrico Gallitto, Daniel Becker, Andrea Vacirca, Bärbel Berekoven, Giuseppe Panuccio, Angelos Karelis, Andrea Kahlberg, Germano Melissano, Nuno Dias, Tilo Kölbel, Martin Austermann, Gianluca Faggioli, Gustavo Oderich, Mauro Gargiulo","doi":"10.1097/SLA.0000000000006231","DOIUrl":"10.1097/SLA.0000000000006231","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the outcomes of urgent/emergent endovascular aortic repair of patients with free/contained ruptured thoracoabdominal aortic aneurysms (rTAAA).</p><p><strong>Background: </strong>Endovascular repair of rTAAA has been scarcely described in emergent setting.</p><p><strong>Methods: </strong>An international multicenter retrospective observational study (ClinicalTrials.govID:NCT05956873) from January 2015 to January 2023 in 6 European and 1 US Vascular Surgery Centers. Primary end points were technical success, 30-day and/or in-hospital mortality, and follow-up survival.</p><p><strong>Results: </strong>A total of 100 rTAAA patients were included (75 male; mean age 73 years). All patients (86 contained and 14 free ruptures) were symptomatic and treated within 24 hours from diagnosis: multibranched off-the-shelf devices (Zenith t-branch, Cook Medical Inc., Bjaeverskov, Denmark) in 88 patients, physician-modified endografts in 8, patient-specific device or parallel grafts in 2 patients each. Primary technical success was achieved in 89 patients, and 30-day and/or in-hospital mortality was 24%. Major adverse events occurred in 34% of patients (permanent dialysis and paraplegia in 4 and 8 patients, respectively). No statistical differences were detected in mortality rates between free and contained ruptured patients (43% vs 21%; P =0.075). Multivariate analysis revealed contained rupture favoring technical success [odds ratio (OR): 10.1; 95% CI: 3.0-33.6; P <0.001]. Major adverse events (OR: 9.4; 95% CI: 2.8-30.5; P <0.001) and pulmonary complications (OR: 11.3; 95% CI: 3.0-41.5; P <0.001) were independent risk factors for 30-day and/or in-hospital mortality. The median follow-up time was 13 months (interquartile range 5-24); 1-year survival rate was 65%. Aneurysm diameter >80 mm (hazard ratio: 2.0; 95% CI: 1.0-30.5; P =0.037), technical failure (hazard ratio: 2.6; 95% CI: 1.1-6.5; P =0.045) and pulmonary complications (hazard ratio: 3.0; 95% CI: 1.2-7.9; P =0.021) were independent risk factors for follow-up mortality.</p><p><strong>Conclusions: </strong>Endovascular repair of rTAAA shows high technical success; the presence of free rupture alone appear not to correlate with early mortality. Effective prevention/management of postoperative complications is crucial for survival.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"522-531"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139696748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Provider Perceptions Regarding Cardiopulmonary Resuscitation in Surgical Patients With Frailty.","authors":"Matthew B Allen, Amanda J Reich, Patrick Collins, Karen Chahal, Maria Moustaqim-Barrette, Rachelle E Bernacki, Zara Cooper, Angela M Bader","doi":"10.1097/SLA.0000000000006214","DOIUrl":"10.1097/SLA.0000000000006214","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the perceptions of surgeons, anesthesiologists, and geriatricians regarding perioperative cardiopulmonary resuscitation (CPR) in surgical patients with frailty.</p><p><strong>Background: </strong>The population of patients undergoing surgery is growing older and more frail. Despite a growing focus on goal-concordant care, frailty assessment, and debate regarding the appropriateness of CPR in patients with frailty, providers' views regarding frailty and perioperative CPR are unknown.</p><p><strong>Methods: </strong>We performed qualitative thematic analysis of transcripts from semistructured interviews of anesthesiologists (8), surgeons (10), and geriatricians (9) who care for high-risk surgical patients at 2 academic medical centers in Boston, MA. The interview guide elicited clinicians' understanding of frailty, approach to decision-making regarding perioperative CPR, and perceptions of perioperative CPR in frail surgical patients.</p><p><strong>Results: </strong>We identified 5 themes: (1) perceptions of perioperative CPR in patients with frailty vary by provider specialty, (2) judgments regarding the appropriateness of CPR in surgical patients with frailty are typically multifactorial and include patient goals, age, comorbidities, and arrest etiology, (3) resuscitation in patients with frailty is sometimes associated with moral distress, (4) biases, such as ableism and ageism, may skew clinicians' perceptions of the appropriateness of perioperative CPR in patients with frailty, and (5) evidence to guide risk stratification for patients with frailty undergoing perioperative CPR is inadequate.</p><p><strong>Conclusions: </strong>Anesthesiologists, surgeons, and geriatricians offer different accounts of frailty's relevance to judgments regarding CPR in surgical patients. Divergent views regarding frailty and perioperative CPR may impede efforts to deliver goal-concordant care and suggest a need for research to inform risk stratification, predict patient-centered outcomes, and understand the role of potential biases, such as ageism and ableism.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"438-444"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139519452","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":"Complexity and Experience Grading to Guide Patient Selection for Minimally Invasive Pancreatoduodenectomy: An International Study Group for Pancreatic Surgery (ISGPS) Consensus.","authors":"S George Barreto, Oliver Strobel, Roberto Salvia, Giovanni Marchegiani, Christopher L Wolfgang, Jens Werner, Cristina R Ferrone, Mohammed Abu Hilal, Ugo Boggi, Giovanni Butturini, Massimo Falconi, Carlos Fernandez-Del Castillo, Helmut Friess, Giuseppe K Fusai, Christopher M Halloran, Melissa Hogg, Jin-Young Jang, Jorg Kleeff, Keith D Lillemoe, Yi Miao, Yuichi Nagakawa, Masafumi Nakamura, Pascal Probst, Sohei Satoi, Ajith K Siriwardena, Charles M Vollmer, Amer Zureikat, Nicholas J Zyromski, Horacio J Asbun, Christos Dervenis, John P Neoptolemos, Markus W Büchler, Thilo Hackert, Marc G Besselink, Shailesh V Shrikhande","doi":"10.1097/SLA.0000000000006454","DOIUrl":"10.1097/SLA.0000000000006454","url":null,"abstract":"<p><strong>Objective: </strong>To develop a universally accepted complexity and experience grading system to guide the safe implementation of robotic and laparoscopic minimally invasive pancreatoduodenectomy (MIPD).</p><p><strong>Background: </strong>Despite the perceived advantages of MIPD, its global adoption has been slow due to the inherent complexity of the procedure and challenges to acquiring surgical experience. Its wider adoption must be undertaken with an emphasis on appropriate patient selection according to adequate surgeon and center experience.</p><p><strong>Methods: </strong>The International Study Group for Pancreatic Surgery (ISGPS) developed a complexity and experience grading system to guide patient selection for MIPD based on an evidence-based review and a series of discussions.</p><p><strong>Results: </strong>The ISGPS complexity and experience grading system for MIPD is subclassified into patient-related risk factors and provider experience-related variables. The patient-related risk factors include anatomic (main pancreatic and common bile duct diameters), tumor-specific (vascular contact), and conditional (obesity and previous complicated upper abdominal surgery/disease) factors, all incorporated in an A-B-C classification, graded as no, a single, and multiple risk factors. The surgeon and center experience-related variables include surgeon total MIPD experience (cutoffs 40 and 80) and center annual MIPD volume (cutoffs 10 and 30), all also incorporated in an A-B-C classification.</p><p><strong>Conclusions: </strong>This ISGPS complexity and experience grading system for robotic and laparoscopic MIPD may enable surgeons to optimally select patients after duly considering specific risk factors known to influence the complexity of the procedure. This grading system will likely allow for a thoughtful and stepwise implementation of MIPD and facilitate a fair comparison of outcomes between centers and countries.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"417-429"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733441","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 Role of High-Resolution Manometry Before and Following Antireflux Surgery: The Padova Consensus: Erratum.","authors":"","doi":"10.1097/SLA.0000000000006618","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006618","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"281 3","pages":"e2"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397788","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":"Factors Impacting Academic Productivity and Satisfaction of Surgeon-scientists: A Nationwide Survey.","authors":"Paula Marincola Smith, Amy Martinez, Rebecca Irlmeier, Carmen C Solórzano, Deepa Magge, Fei Ye, James R Goldenring","doi":"10.1097/SLA.0000000000006254","DOIUrl":"10.1097/SLA.0000000000006254","url":null,"abstract":"<p><strong>Objective: </strong>To identify factors related to research success for academic surgeons.</p><p><strong>Background: </strong>Many recognize mounting barriers to scientific success for academic surgeons, but little is known about factors that predict success for individual surgeons.</p><p><strong>Methods: </strong>A phase 1 survey was emailed to department chairpersons at highly funded U.S. departments of surgery. Participating chairpersons distributed a phase 2 survey to their faculty surgeons. Training and faculty-stage exposures and demographic data were collected and compared with participant-reported measures of research productivity. Five primary measures of productivity were assessed, including the number of grants applied for, grants funded, papers published, first/senior author papers published, and satisfaction with research.</p><p><strong>Results: </strong>Twenty chairpersons and 464 faculty surgeons completed the survey, and 444 faculty responses were included in the final analysis. Having a research-focused degree was significantly associated with more grants applied for [Doctor of Philosophy, incidence rate ratio (IRR) = 6.93; Masters, IRR = 4.34] and funded (Doctor of Philosophy, IRR = 4.74; Masters, IRR = 4.01) compared with surgeons with only clinical degrees (all P < 0.01). Having a formal research mentor was significantly associated with more grants applied for (IRR = 1.57, P = 0.03) and higher satisfaction in research (IRR = 2.22, P < 0.01). Contractually protected research time was significantly associated with more grants applied for (IRR = 3.73), grants funded (IRR = 2.14), papers published (IRR = 2.12), first/senior authors published (IRR = 1.72), and research satisfaction (odds ratio = 2.15; all P < 0.01). The primary surgeon-identified barrier to research productivity was lack of protection from clinical burden.</p><p><strong>Conclusions: </strong>Surgeons pursuing research-focused careers should consider the benefits of attaining a research-focused degree, negotiating for contractually protected research time, and obtaining formal research mentorship.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"445-453"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140027193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pilot Study Using Machine-learning Algorithms and Wearable Technology for the Early Detection of Postoperative Complications After Cardiothoracic Surgery.","authors":"Jorind Beqari, Joseph R Powell, Jacob Hurd, Alexandra L Potter, Meghan L McCarthy, Deepti Srinivasan, Danny Wang, James Cranor, Lizi Zhang, Kyle Webster, Joshua Kim, Allison Rosenstein, Zeyuan Zheng, Tung Ho Lin, Zhengyu Fang, Yuhang Zhang, Alex Anderson, James Madsen, Jacob Anderson, Anne Clark, Margaret E Yang, Andrea Nurko, Jing Li, Areej R El-Jawahri, Thoralf M Sundt, Serguei Melnitchouk, Arminder S Jassar, David D'Alessandro, Nikhil Panda, Lana Y Schumacher, Cameron D Wright, Hugh G Auchincloss, Uma M Sachdeva, Michael Lanuti, Yolonda L Colson, Nathaniel B Langer, Asishana Osho, Chi-Fu Jeffrey Yang, Xiao Li","doi":"10.1097/SLA.0000000000006263","DOIUrl":"10.1097/SLA.0000000000006263","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether a machine-learning algorithm (ie, the \"NightSignal\" algorithm) can be used for the detection of postoperative complications before symptom onset after cardiothoracic surgery.</p><p><strong>Background: </strong>Methods that enable the early detection of postoperative complications after cardiothoracic surgery are needed.</p><p><strong>Methods: </strong>This was a prospective observational cohort study conducted from July 2021 to February 2023 at a single academic tertiary care hospital. Patients aged 18 years or older scheduled to undergo cardiothoracic surgery were recruited. Study participants wore a Fitbit watch continuously for at least 1 week preoperatively and up to 90 days postoperatively. The ability of the NightSignal algorithm-which was previously developed for the early detection of Covid-19-to detect postoperative complications was evaluated. The primary outcomes were algorithm sensitivity and specificity for postoperative event detection.</p><p><strong>Results: </strong>A total of 56 patients undergoing cardiothoracic surgery met the inclusion criteria, of which 24 (42.9%) underwent thoracic operations and 32 (57.1%) underwent cardiac operations. The median age was 62 (Interquartile range: 51-68) years and 30 (53.6%) patients were female. The NightSignal algorithm detected 17 of the 21 postoperative events at a median of 2 (Interquartile range: 1-3) days before symptom onset, representing a sensitivity of 81%. The specificity, negative predictive value, and positive predictive value of the algorithm for the detection of postoperative events were 75%, 97%, and 28%, respectively.</p><p><strong>Conclusions: </strong>Machine-learning analysis of biometric data collected from wearable devices has the potential to detect postoperative complications-before symptom onset-after cardiothoracic surgery.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"514-521"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgeon Gender and Early Complications in Elective Surgery: A Systematic Review and Meta-analysis.","authors":"Ilaria Caturegli, Ana Maria Pachano Bravo, Israa Abdellah, Moomtahina Fatima, Andrea Chao Bafford, Suci Ardini Widyaningsih, Ons Kaabia","doi":"10.1097/SLA.0000000000006450","DOIUrl":"10.1097/SLA.0000000000006450","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association between surgeon gender and early postoperative complications, including 30-day death and readmission, in elective surgery.</p><p><strong>Background: </strong>Variations between male and female surgeon practice patterns may be a source of bias and gender inequality in the surgical field, perhaps impacting the quality of care. However, there are limited and conflicting studies regarding the association between surgeon gender and postoperative outcomes.</p><p><strong>Methods: </strong>MEDLINE and Embase were searched in October 2023 for observational studies, including patients who underwent elective surgery requiring general or regional anesthesia across multiple surgical specialties. Multiple independent blinded reviewers oversaw the data selection, extraction, and quality assessment according to the PRISMA, MOOSE, and Newcastle Ottawa Scale guidelines. Data were pooled as odds ratios, using a generic inverse-variance random-effects model.</p><p><strong>Results: </strong>Of 944 abstracts screened, 11 studies were included in this systematic review and meta-analysis. A total of 4,440,740 postoperative patients were assessed for a composite primary outcome of mortality, readmission, and other complications within 30 days of elective surgery, with a total of 325,712 (7.3%) surgeries performed by 7072 (10.9%) female surgeons. There was no association between surgeon gender and the composite of mortality, readmission, and/or complications (odds ratio=0.97, 95% CI 0.95-1.00; I2 =64.9%; P =0.001).</p><p><strong>Conclusions: </strong>These results support that surgeon gender is not associated with early postoperative outcomes, including mortality, readmission, or other complications in elective surgery. These findings encourage patients, health care providers, and stakeholders not to consider surgeon gender as a risk factor for postoperative complications.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"404-416"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141750862","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":"Trends in Opioid Prescribing and New Persistent Opioid Use After Surgery in the United States.","authors":"Alexandra O Luby, Dominic Alessio-Bilowus, Hsou Mei Hu, Chad M Brummett, Jennifer F Waljee, Mark C Bicket","doi":"10.1097/SLA.0000000000006461","DOIUrl":"10.1097/SLA.0000000000006461","url":null,"abstract":"<p><strong>Objective: </strong>To define recent trends in opioid prescribing after surgery and new persistent opioid use in the United States.</p><p><strong>Background: </strong>New persistent opioid use after surgery among opioid-naive individuals has emerged as an important postoperative complication. In response, initiatives to promote more appropriate postoperative opioid prescribing have been adopted in recent years. However, current estimates of opioid prescribing and new persistent opioid use following surgery remain unknown.</p><p><strong>Methods: </strong>A retrospective cohort study of opioid-naive privately insured adult patients undergoing 17 common surgical procedures between 2013 and 2021 was conducted utilizing multi-payer claims data from the Health Care Cost Institute (HCCI). Initial opioid prescription size in oral morphine equivalents (OMEs) and new persistent opioid use were the outcomes of interest. Trends in opioid prescribing and rates of new persistent opioid use were evaluated across the study period. Mixed effects logistic regression was performed to evaluate independent predictors of new persistent opioid use while adjusting for patient-level factors and year.</p><p><strong>Results: </strong>Among 989,354 opioid-naive individuals, the adjusted initial opioid prescription size decreased from 282 mg OME to 164 mg OME, a reduction of 118 mg OME (95% CI: 116-120). The adjusted incidence of new persistent opioid use decreased from 2.7% in 2013 (95% CI: 2.6%-2.8%) to 1.1% in 2021 (95% CI: 1.0%-1.2%). For every 30 OME increase in initial opioid prescription size, new persistent opioid use increased by 3.1%. Other predictors of new persistent opioid use included preoperative nonopioid controlled substances fills [31-365 days: adjusted odds ratio (aOR)=1.78, 95% CI: 1.70-1.86; 0-30 days: aOR=2.71, 95% CI: 2.59-2.84] and undergoing orthopedic procedures [total knee arthroplasty (aOR=3.43, 95% CI: 3.15-3.72); shoulder arthroscopy (aOR=2.39, 95% CI: 2.24-2.56)].</p><p><strong>Conclusions: </strong>Both opioid prescription size after surgery and new persistent opioid use decreased over the last decade, suggesting that opioid stewardship practices had favorable effects on the risk of long-term opioid use.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"347-352"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11785817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141858883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Change in Sizing Protocol on Outcome of Magnetic Sphincter Augmentation.","authors":"Inanc S Sarici, Sven E Eriksson, Ping Zheng, Olivia Moore, Blair A Jobe, Shahin Ayazi","doi":"10.1097/SLA.0000000000006249","DOIUrl":"10.1097/SLA.0000000000006249","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate and compare magnetic sphincter augmentation (MSA) device sizing protocols on postoperative outcomes and dysphagia.</p><p><strong>Background: </strong>Among predictors of dysphagia after MSA, device size is the only factor that may be modified. Many centers have adopted protocols to increase device size. However, there are limited data on the impact of MSA device upsizing protocols on surgical outcomes.</p><p><strong>Methods: </strong>Patients who underwent MSA were implanted with 2 or 3 beads above the sizing device's pop-off point (POP). Clinical and objective outcomes >1 year after surgery were compared between patients implanted with POP+2-versus-POP+3 sizing protocols. Multiple subgroups were analyzed for the benefit of upsizing. Preoperative and postoperative characteristics were compared between the size patients received, regardless of protocol.</p><p><strong>Results: </strong>A total of 388 patients were implanted under POP+2 and 216 under POP+3. At a mean of 14.2 (7.9) months, pH normalization was 73.6% and 34.1% required dilation, 15.9% developed persistent dysphagia, and 4.0% required removal. The sizing protocol had no impact on persistent dysphagia ( P =0.908), pH normalization ( P =0.822), or need for dilation ( P =0.210) or removal ( P =0.191). Subgroup analysis found that upsizing reduced dysphagia in patients with <80% peristalsis (10.3% vs 31%, P =0.048) or distal contractile integral >5000 (0% vs 30.4%, P =0.034). Regardless of sizing protocol, as device size increased there was a stepwise increase in the percent male sex ( P <0.0001), body mass index >30 ( P <0.0001), and preoperative hiatal hernia >3 cm ( P <0.0001), Los Angeles grade C/D esophagitis ( P <0.0001), and DeMeester score ( P <0.0001). Increased size was associated with decreased pH normalization ( P <0.0001) and need for dilation ( P =0.043) or removal ( P =0.014).</p><p><strong>Conclusions: </strong>Upsizing from POP+2 to POP+3 does not reduce dysphagia or affect other MSA outcomes; however, patients with poor peristalsis or hypercontractile esophagus do benefit. Regardless of sizing protocol, preoperative clinical characteristics varied among device sizes, suggesting size is not a modifiable factor, but a surrogate for esophageal circumference.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"454-461"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139929698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}