Annals of surgery最新文献

{"title":"Temporary Portal Vein Bypass for Resection of Pancreatic Neoplasms.","authors":"Max Heckler, Souhaylah Abdallah, Benedict Kinny-Köster, Christoph Berchtold, Mohammed Al-Saeedi, Arianeb Mehrabi, Thilo Hackert, Ulf Hinz, Thomas Hank, Christoph W Michalski, Markus W Büchler, Martin Loos","doi":"10.1097/SLA.0000000000006662","DOIUrl":"10.1097/SLA.0000000000006662","url":null,"abstract":"<p><strong>Objective: </strong>To analyze perioperative outcomes of patients undergoing pancreatectomy with portal vein resection for pancreatic cancer using temporary intraoperative mesoportal or mesocaval (MC) bypass.</p><p><strong>Background: </strong>Pancreatectomy for advanced pancreatic cancer with long-segment involvement or complete occlusion of the mesoportal venous axis and cavernous transformation represents a major technical challenge. To avoid major bleeding as well as to overcome severe bowel congestion or ischemia due to long portal venous clamping, a mesoportal or MC venous bypass graft first approach has been proposed. If an additional hepatic arterial resection needs to be considered, the mesoportal bypass seems preferable to ensure portal venous flow avoiding complete temporary vascular exclusion of the liver. However, the MC approach appears to be a technically easier alternative.</p><p><strong>Methods: </strong>All consecutive patients who underwent pancreatectomy with venous bypass were identified from a prospectively maintained database. Patient characteristics, perioperative data, and postoperative short-term outcomes were analyzed.</p><p><strong>Results: </strong>Between 2011 and 2024, 63 patients were operated with temporary construction of an alloplastic venous bypass, including 34 patients with mesoportal and 29 patients with MC bypass. Severe complications (Clavien-Dindo >3a) occurred in 16 of 63 patients (25.4%). No postoperative liver failure was observed. The median length of intensive care unit and hospital stays were 2 and 21 days, respectively. The 90-day mortality rate was 6.3%. There were no differences in complication rates, median length of stays, and 90-day mortality rates between mesoportal and MC shunts.</p><p><strong>Conclusions: </strong>Temporary intraoperative venous bypass graft first techniques are important surgical approaches for safe resection of advanced pancreatic tumors. Mesoportal and MC shunts are both safe with comparable postoperative morbidity and mortality rates. The decision for mesoportal versus MC bypass should be made according to the anatomy, particularly taking into account the extent of arterial involvement and the potential need for concomitant arterial resection.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"e73-e78"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381608","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 Impact of Robotics on Benchmarking Criteria for the Surgical Treatment of Esophageal Cancer in Western Centers– An Evaluation Using the IDEAL Framework","authors":"Dolores T. Krauss,Pieter S.L. van der Sluis,Lars M. Schiffmann,Hans A. Schlößer,Hans F. Fuchs,Jelle P. Ruurda,Peter P. Grimminger,Richard van Hillegersberg,Christiane J. Bruns","doi":"10.1097/sla.0000000000007230","DOIUrl":"https://doi.org/10.1097/sla.0000000000007230","url":null,"abstract":"Objective/Background: Robotic-assisted minimally invasive esophagectomy (RAMIE) has significantly improved the quality of surgery, reflecting in better functional outcomes, faster recovery, less postoperative morbidity, and even improved oncological results in patients with locally advanced cancer of the esophagus compared with an open approach. Methods: The IDEAL (idea, development, exploration, assessment, long-term study) Framework provides a structured, staged approach to evaluating surgical innovations. Results: The Stage 1 studies describe the introduction of this technique published in 2003 and 2006 (Horgan et al, van Hillegersberg et al) as a proof of concept already showing an acceptable benchmarking for early implementation (48% pulmonary complication rate, 5% mortality). The Stage 2 Exploration phase followed, showing oncological long-term follow-up with 48% 5-year survival rates. The Stage 3 trials (ie, ROBOT Trial) have proven RAMIE to not only be equivalent, but significantly superior for overall complications, pain scores, and quality of life compared with an open approach. Long-term follow-up revealed no differences in survival, making RAMIE oncologically equivalent at a minimum. The Stage 4 evaluation phase started in 2017 with the foundation of the Upper GI International Robotic Association (UGIRA) global registry, which as of November 2025 has 58 contributing sites worldwide and collected 5567 RAMIE cases. With textbook outcome of 41-61%, contemporary leak rates of 11-16% in the most recent UGIRA cohort depending on technique and mortality &lt;4%, RAMIE was safely implemented and is increasingly becoming the primary technique of choice at high-volume tertiary centers. Conclusion: The foundation of the international UGIRA registry has provided compelling evidence regarding standardized training pathways and guidelines and already serves as a scientific template for future technical evolution in upper GI surgery.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"15 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088182","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":"Axillary Nodal Upstaging in cT1N0 Invasive Lobular Carcinoma: Evaluating Applicability of SOUND Trial Results.","authors":"Thomas Amburn, Anita Mamtani, Jane J Chen, Varadan Sevilimedu, Sherry Shen, Komal Jhaveri, Monica Morrow","doi":"10.1097/SLA.0000000000007227","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007227","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether sentinel lymph node biopsy (SLNB) omission is applicable to stage 1 invasive lobular breast cancer (ILC).</p><p><strong>Background: </strong>The SOUND and INSEMA randomized controlled trials demonstrated that SLNB omission is noninferior to performing SLNB in early-stage, clinically node-negative (cT1-2N0), hormone receptor-positive/HER2-negative (HR+/HER2-) patients with breast cancer with negative preoperative axillary ultrasound. However, the applicability of SLNB omission in ILC has been uncertain.</p><p><strong>Methods: </strong>We retrospectively identified patients with cT1N0, HR+/HER2- pure ILC, and normal axillary ultrasound who underwent upfront surgery with SLNB between 2009 and 2024. Clinicopathologic characteristics and pathologic nodal burden were evaluated.</p><p><strong>Results: </strong>Six hundred thirty-nine patients met the inclusion criteria, of whom the majority were postmenopausal women (72%) with low- to intermediate-grade (88%) and/or classic-type (84%) ILC. Axillary nodal metastases were identified on surgical pathology in 113 (17.7%) patients: 24 (3.8%) pN1mic, 74 (11.6%) pN1, 8 (1.2%) pN2, and 7 (1.1%) pN3. Node-positive patients were more often younger, premenopausal (36% vs. 26%, P=0.035), and presented with larger pathologic tumor size (46.7% vs. 18.3% pT2-3, P<0.001) and lymphovascular invasion (LVI) (19% vs. 3.2%, P<0.001). On univariate analysis, premenopausal status, high grade, and LVI were independently associated with nodal positivity. On multivariate analysis, only LVI remained independently associated with nodal positivity.</p><p><strong>Conclusions: </strong>Among patients with SOUND-eligible ILC, 17.7% had axillary nodal metastasis and only 2.3% had extensive axillary nodal metastasis. These findings are comparable to the node-positive rates reported in the SLNB arm of the SOUND (13.7%) and INSEMA (15.1%) trials. High-risk features such as LVI and high grade were associated with nodal positivity.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069405","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":"Artificial Intelligence and the Future of Surgery.","authors":"Dimitrios Moris, Theodore N Pappas","doi":"10.1097/SLA.0000000000007225","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007225","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982172","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":"Patterns of Index Endovascular Compared With Surgical Revascularization for Femoropopliteal Disease in Patients With Claudication Using Medicare-linked Data.","authors":"Tiffany R Bellomo, Xinyan Zheng, Shravan Animilli, Yuanyuan Zhao, Srihari K Lella, Bianca Mulaney, Brandon Gaston, Aiden Lui, Anahita Dua, Nikolaos Zacharias","doi":"10.1097/SLA.0000000000007211","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007211","url":null,"abstract":"<p><strong>Objective: </strong>To compare outcomes of endovascular versus open infrainguinal bypass in patients with claudication.</p><p><strong>Summary of background data: </strong>PAD research has focused largely on CLTI, yet 20% of patients present with claudication and may not improve with medical therapy alone. Durability of endovascular intervention remains uncertain.</p><p><strong>Methods: </strong>Patients undergoing bypass for femoropopliteal disease were propensity matched to endovascular procedures using demographics, cardiovascular comorbidities, and center volume quartiles. Primary outcomes (CLTI, MALE) were ascertained via VISION-Medicare linkage. Secondary outcomes included reintervention and mortality. Kaplan-Meier and Cox models quantified associations between intervention and outcome. Sensitivity analysis used inverse probability weighting and Fine-Gray models.</p><p><strong>Results: </strong>Seven hundred twenty open bypass procedures were matched to 3259 endovascular procedures (median follow-up 2.8 y, IQR 1.6-4.4). Median age was 72 versus 70 years (open vs. endovascular, P<0.001); most patients were non-Hispanic White (91.1% vs. 85.6%, P<0.001) and male (74.4% vs. 61.3%, P<0.001). MALE rates were higher with endovascular intervention at 1 year (33.4% vs. 37.3%, P=0.015), but not at 3 (49.5% vs. 49.1%, P=0.172), or 5 years (57.0% vs. 59.1%, P=0.149). CLTI progression, reintervention rates, and mortality were similar at 5 years. Endovascular intervention was not associated with MALE (HR 1.13, 95% CI: 0.97-1.32), CLTI progression (HR 0.90, 95% CI: 0.72-1.13), reintervention (HR 1.13, 95% CI: 0.97-1.32), or mortality (HR 0.86, 95% CI: 0.66-1.12).</p><p><strong>Conclusion: </strong>Open bypass and endovascular intervention demonstrated similar long-term MALE and progression to CLTI through 5 years, suggesting endovascular intervention may offer comparable outcomes in appropriately selected patients with claudication.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148962911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Continuation of Code-status Limitations and Early Postoperative Mortality: A Retrospective Cohort Study.","authors":"Matthew B Allen, Jocelyn L Streid, Elizabeth J Lilley, Christy E Cauley, Rachelle E Bernacki, Amanda J Reich, Preeti R John, David L Hepner, Angela M Bader, Sachin J Shah","doi":"10.1097/SLA.0000000000007219","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007219","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to determine whether perioperative continuation of code status limitations is associated with early postoperative mortality and to characterize postoperative code-status trajectories preceding early deaths.</p><p><strong>Summary background data: </strong>Decisions about perioperative management of do-not-resuscitate (DNR) orders are common, yet their relationship to early postoperative outcomes remains poorly understood.</p><p><strong>Methods: </strong>This was a retrospective cohort study conducted from March 2024 to June 2025 across 5 hospitals within a single academic health system. We included adults aged 18 years or older who presented for a procedure under anesthesia with a code status other than full code. The exposure was perioperative code status (reversal to full code vs. not full code). The primary outcome was all-cause mortality within 3 days of the procedure. The secondary outcome was use of invasive hemodynamic monitoring. Associations were estimated using multivariable logistic regression.</p><p><strong>Results: </strong>Among 2833 eligible patients, none were excluded. The median age was 79 years (IQR, 70-86), and 59% were women. Of 2833 patients, 2323 (82%) reversed to full code perioperatively, and 510 (18%) remained not full code. Forty-four patients (1.6%) died within 3 days. Three-day mortality occurred in 15 of 510 patients (2.9%) who remained not full code and in 29 of 2,323 patients (1.2%) who reversed to full code. After adjustment for age, sex, ASA physical status, operative stress score, and race, not full code status was associated with higher odds of 3-day mortality (adjusted odds ratio, 2.18; 95% CI, 1.14-4.16), corresponding to an adjusted absolute risk difference of 1.43% (95% CI, 0.06%-2.95%). Among patients who died within 3 days and remained hospitalized, 34 of 42 (81%) died after transition to comfort-focused care. Invasive hemodynamic monitoring was more common among patients who remained not full code (adjusted absolute risk difference, 3.74%; 95% CI, 0.91%-6.93%).</p><p><strong>Conclusions: </strong>Among adults presenting for a procedure with code-status limitations, continuation of a nonfull code status was associated with higher early postoperative mortality. This pattern reflects downstream clinical trajectories and treatment decisions rather than missed opportunities for perioperative rescue.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148928805","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":"Cost-effectiveness of Near-infrared Autofluorescence (NIRAF) in Total Thyroidectomy","authors":"Pallavi Kulkarni,Christopher S. Hollenbeak,David Goldenberg,Neerav Goyal","doi":"10.1097/sla.0000000000007220","DOIUrl":"https://doi.org/10.1097/sla.0000000000007220","url":null,"abstract":"Objective: Hypocalcemia is a common complication following total thyroidectomy. Near-infrared autofluorescence (NIRAF) is a newer technology that aids in intraoperative identification of parathyroid glands. In this study, we aim to estimate the cost-effectiveness of NIRAF relative to naked-eye visualization of parathyroid glands during total thyroidectomy from a third-party payor perspective. Study Design: Cost-effectiveness analysis. Setting: Decision analysis. Methods: A decision tree was used to model costs, quality-adjusted life years (QALY), and cost-effectiveness of NIRAF. The model was parameterized using the best available literature on the probability of hypocalcemia, likelihood of hospitalization, cost of treatment for hypocalcemia, and utilities for transient and permanent hypocalcemia. Expected costs and utility were estimated over a 1-year time horizon, and cost-effectiveness was measured using the incremental cost-effectiveness ratio (ICER) with a willingness-to-pay threshold of $100,000 per additional QALY gained. Results: In the base case, the expected 1-year cost for naked-eye thyroidectomy was $122.51, which was lower than that of NIRAF ($566.99). NIRAF yielded more QALYs (0.994 vs. 0.989). The ICER for NIRAF was $85,042 per QALY gained, which is below the assumed willingness-to-pay threshold. Sensitivity analyses suggested that NIRAF remained cost-effective, as long as the price remained below $578.00. Conclusions: Cost-effectiveness of NIRAF is highly sensitive to the price and a payor’s willingness-to-pay threshold as well as the true rate of transient or permanent hypocalcemia. To our knowledge, this is the first cost-effectiveness analysis of NIRAF during total thyroidectomy in the United States.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"4 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148923223","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":"Impact of Number of Lymph Nodes Sampled and Density of Positive Nodes on Outcomes Among Over 2000 Patients With Stage I to III Favorable Histology Wilms Tumor Enrolled on AREN03B2: A Children's Oncology Group Renal Tumor Study.","authors":"Jennifer H Aldrink, Lindsay A Renfro, Kathleen Kieran, Ian C Tfirn, Peter F Ehrlich, Kenneth W Gow, Richard D Glick, Robert C Shamberger, Geetika Khanna, Amy Treece, Jeffrey S Dome, Conrad V Fernandez, James I Geller, Elizabeth A Mullen, Nicholas G Cost","doi":"10.1097/SLA.0000000000007210","DOIUrl":"10.1097/SLA.0000000000007210","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether the number of lymph nodes (LNs) sampled, LN positivity, and LN density impact event-free survival (EFS) or overall survival (OS) in patients with favorable histology Wilms tumor (FHWT).</p><p><strong>Background: </strong>LN sampling is a core component of the surgical staging used to assign appropriate therapy in FHWT. LN sampling has also been independently associated with decreased recurrence and improved survival in FHWT.</p><p><strong>Methods: </strong>Patients with stage I to III FHWT enrolled on the Children's Oncology Group AREN03B2 study with upfront nephrectomy, confirmed LN sampling, and available follow-up and treatment data were included. Cox proportional hazards models with restricted cubic splines were used to visualize the effects of each continuous LN variable on the outcome.</p><p><strong>Results: </strong>A total of 2310 patients met the inclusion criteria. Among stage I to III LN-negative patients, the number of LNs sampled was associated with OS (P=0.001) but did not impact EFS or vary by stage. In stage III LN-positive patients, neither the number of positive LNs nor LN density was associated with EFS or OS. EFS was significantly worse in stage III patients with LN-positive disease (LN-negative 4 y EFS: 93.7%, LN-positive 4 y EFS: 87.2%; P=0.0079), but OS did not differ significantly (LN-negative 4 y OS: 97.0%, LN-positive 4 y OS: 96.8%; P=0.61).</p><p><strong>Conclusion: </strong>While this analysis confirmed the negative prognostic impact of LN positivity on EFS and the association of OS and the number of LN sampled, these findings strongly underscore the need for standardized approaches to nodal sampling in FHWT. Such standardization is ongoing in current COG renal tumor trials.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918251","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":"Revisional Metabolic Bariatric Surgery: Significant Heterogeneity.","authors":"Jarrod Olafson, Christopher Ducoin","doi":"10.1097/SLA.0000000000007223","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007223","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918254","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":"Nonoperative Management in Emergency General Surgery: Does It Matter for Surgical Quality Benchmarking in Older Adults?","authors":"Manuel Castillo-Angeles, Tanujit Dey, Ali Salim, Joaquim M Havens","doi":"10.1097/SLA.0000000000007218","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007218","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to assess the association between hospital operative-to-nonoperative management ratio (ONR) and home discharge for older adults undergoing Emergency General Surgery (EGS).</p><p><strong>Summary background data: </strong>There is an increasing number of patients being managed nonoperatively, particularly older adults, which have often been excluded from quality benchmarking. The ONR might serve as a better marker of hospital quality, instead of the traditional morbidity/mortality, which do not fully capture institutional practice patterns nor what matters most to older adults (ie, their ability to return home).</p><p><strong>Methods: </strong>This was a retrospective analysis of the National Inpatient Sample database (2015-2018). For each hospital, we calculated a risk-adjusted ONR for adults >=65 years with common EGS diagnoses (diverticulitis, bowel obstruction, acute pancreatitis, peptic ulcer, ischemic bowel, appendicitis, and cholecystitis) who underwent urgent/emergent surgery within 48 hours. Hospital operative volume was also calculated to serve as comparison to ONR. Both metrics were then divided into tertiles. Our primary outcome was home discharge. Multivariable regression analyses evaluated the impact of ONR/Operative volume on our main outcome.</p><p><strong>Results: </strong>Among 1,470,114 EGS admissions, 207,270 (14.1%) older adults underwent EGS. The mean ONR was 0.28 (SD 0.07). After adjusted analysis, care at hospitals within the highest ONR tertile was significantly associated with higher odds of home discharge (OR 1.10, 95% CI: 1.06-1.14). Hospital operative volume was not associated with discharge to home.</p><p><strong>Conclusions: </strong>An increased hospital operative-to-nonoperative management ratio of EGS conditions in the geriatric population is strongly associated with increased odds of a favorable discharge home.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918166","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}