Pub Date : 2025-11-26DOI: 10.1001/jamasurg.2025.5179
Sean Perez,Adir Mancebo,Patricia Lopez,Leslie Joe,Paul Benavidez,Zhihan Li,Mehri Sadri,Eduardo Spiegel-Pinzon,Ryan Lopez,Bryan Clary,Christopher A Longhurst,Kristin Mekeel,Karandeep Singh
ImportanceThe substantial variation and excess of supplies requested by surgeons for each case using surgical preference cards represents an opportunity for cost reduction through optimization.ObjectiveTo optimize preference cards based on historical supply use captured through surgical receipts.Design, Setting, and ParticipantsThis quality improvement study took place in a large, tertiary, multi-hospital academic health system from January 1, 2019, through December 31, 2023. It included urology, colorectal, and surgical oncology services. These data were analyzed from January 2024 to August 2024.ExposuresSeparate linear time-series ordinary least squares regression models were fit for each surgical receipt item to estimate the optimal number of that item based on data from past cases between January 1, 2019, and December 31, 2023. Optimal surgical preference cards were constructed and compared after collating item-level estimates by optimizing items listed on existing surgical preference cards, creating new preference cards for each procedure, and creating new preference cards that stratify existing preference cards by procedure.Main outcome and measuresThe number of unique and total items on the cards before and after optimization were calculated at the 3 levels. Baseline waste was estimated in existing preference cards as the difference between the total cost of all items on the current surgical preference card and total cost of the surgical receipt associated with the case, averaged across all eligible cases from January 1, 2024, to May 31, 2024. Baseline waste was also compared against the estimated waste, using the optimized surgical preference card at each of the 3 levels.ResultsA total of 1298 preference cards and 432 procedures were evaluated, accounting for 3088 unique preference card-procedure combinations. The current surgical preference cards incurred a mean (SD) cost per case of unused items of $1294.41 ($2307.17), amounting to $3 716 251.11 across all cases in the study. All 3 optimization strategies reduced the cost of unused items and produced less intraoperative burden. The greatest relative reduction in the cost of unused items was seen in colorectal surgery, where cost savings of $488 774.88 reflected a 55.8% reduction.Conclusions and RelevanceOptimization of surgical preference cards with regression models has the potential to reduce surgical waste, with the greatest reduction in waste seen with optimizing existing cards after stratifying at the procedure level.
{"title":"Data and the Art of Surgical Preference Card Maintenance.","authors":"Sean Perez,Adir Mancebo,Patricia Lopez,Leslie Joe,Paul Benavidez,Zhihan Li,Mehri Sadri,Eduardo Spiegel-Pinzon,Ryan Lopez,Bryan Clary,Christopher A Longhurst,Kristin Mekeel,Karandeep Singh","doi":"10.1001/jamasurg.2025.5179","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5179","url":null,"abstract":"ImportanceThe substantial variation and excess of supplies requested by surgeons for each case using surgical preference cards represents an opportunity for cost reduction through optimization.ObjectiveTo optimize preference cards based on historical supply use captured through surgical receipts.Design, Setting, and ParticipantsThis quality improvement study took place in a large, tertiary, multi-hospital academic health system from January 1, 2019, through December 31, 2023. It included urology, colorectal, and surgical oncology services. These data were analyzed from January 2024 to August 2024.ExposuresSeparate linear time-series ordinary least squares regression models were fit for each surgical receipt item to estimate the optimal number of that item based on data from past cases between January 1, 2019, and December 31, 2023. Optimal surgical preference cards were constructed and compared after collating item-level estimates by optimizing items listed on existing surgical preference cards, creating new preference cards for each procedure, and creating new preference cards that stratify existing preference cards by procedure.Main outcome and measuresThe number of unique and total items on the cards before and after optimization were calculated at the 3 levels. Baseline waste was estimated in existing preference cards as the difference between the total cost of all items on the current surgical preference card and total cost of the surgical receipt associated with the case, averaged across all eligible cases from January 1, 2024, to May 31, 2024. Baseline waste was also compared against the estimated waste, using the optimized surgical preference card at each of the 3 levels.ResultsA total of 1298 preference cards and 432 procedures were evaluated, accounting for 3088 unique preference card-procedure combinations. The current surgical preference cards incurred a mean (SD) cost per case of unused items of $1294.41 ($2307.17), amounting to $3 716 251.11 across all cases in the study. All 3 optimization strategies reduced the cost of unused items and produced less intraoperative burden. The greatest relative reduction in the cost of unused items was seen in colorectal surgery, where cost savings of $488 774.88 reflected a 55.8% reduction.Conclusions and RelevanceOptimization of surgical preference cards with regression models has the potential to reduce surgical waste, with the greatest reduction in waste seen with optimizing existing cards after stratifying at the procedure level.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"6 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599656","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}
Pub Date : 2025-11-26DOI: 10.1001/jamasurg.2025.5162
George Ferzli,Yannis Karamitas,Damien Lazar
{"title":"Safeguarding Laparoscopic Training in the Robotic Era.","authors":"George Ferzli,Yannis Karamitas,Damien Lazar","doi":"10.1001/jamasurg.2025.5162","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5162","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"97 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599697","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}
Pub Date : 2025-11-26DOI: 10.1001/jamasurg.2025.5176
Ashley Y Williams,Joshua L J Jones,Daphney R Portis
{"title":"Zeroing in on Firearm Injury Prevention Efforts-Practice and Policy.","authors":"Ashley Y Williams,Joshua L J Jones,Daphney R Portis","doi":"10.1001/jamasurg.2025.5176","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5176","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"193 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599654","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}
Pub Date : 2025-11-26DOI: 10.1001/jamasurg.2025.5168
Ann M Polcari,Anthony D Douglas,Justin S Hatchimonji,Diane N Haddad,Tanya L Zakrison,Selwyn O Rogers,Andrew J Benjamin
ImportanceFirearm injury remains a pressing public health crisis in the US, yet the relative influence of neighborhood deprivation and state firearm laws is not well understood.ObjectiveTo assess the associations of neighborhood deprivation, state firearm law strength, and urbanicity with firearm injury rates across the US.Design, Setting, and ParticipantsThis was a population-based cross-sectional study conducted at the Census block group level across the entire US from January 2018 through December 2022. Gun Violence Archive data were used to identify and include fatal and nonfatal firearm injuries in individuals of all ages. Suicide-related firearm injuries were excluded. Data were analyzed from March to June 2025.ExposureNeighborhood deprivation measured by the 2020 Area Deprivation Index at the census block group level, state firearm law strength determined by the 2020 Giffords Law Center Annual Gun Law Scorecard, and urbanicity (urban, mixed, and rural categories) based on 2020 Census Bureau urban-rural classifications. A spatial lag variable for neighboring state firearm law strength was also included.Main Outcomes and MeasuresFirearm injury rates per 1000 population in a Census block group was evaluated using negative binomial regression to estimate incident rate ratios (IRR). Spatial autocorrelation was assessed using bivariate Moran I statistics.ResultsAcross 233 386 Census block groups, 206 082 shooting incidents were analyzed (81 241 fatalities and 176 179 nonfatal injuries). On multivariable analysis, each decile increase in Area Deprivation Index (ADI) was associated with a 25% increase in firearm injury rates (IRR, 1.25; 95% CI, 1.25-1.26; P < .001) while incremental strengthening of state firearm law grade was associated with a 5% decrease (IRR, 0.95; 95% CI, 0.95-0.96; P < .001). Neighboring state law strength had a weaker association (IRR, 0.99; 95% CI, 0.99-1.00; P < .001). Compared to urban block groups, mixed (IRR, 0.39; 95% CI, 0.37-0.41) and rural (IRR, 0.22; 95% CI, 0.22-0.23) block groups had significantly lower rates (P < .001 for both). Bivariate global Moran I confirmed positive spatial autocorrelation between ADI and shooting incidents (I, 0.76; P < .001).Conclusions and RelevanceIn this national cross-sectional study, neighborhood deprivation demonstrated a substantially stronger statistical association with firearm injury rates than did state firearm law strength. While firearm legislation is crucial, strategies that prioritize investment in socially and economically deprived communities, especially in urban settings, may yield more meaningful reductions in firearm injuries overall.
{"title":"Neighborhood Deprivation, State Laws, and Firearm Injury in the US.","authors":"Ann M Polcari,Anthony D Douglas,Justin S Hatchimonji,Diane N Haddad,Tanya L Zakrison,Selwyn O Rogers,Andrew J Benjamin","doi":"10.1001/jamasurg.2025.5168","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5168","url":null,"abstract":"ImportanceFirearm injury remains a pressing public health crisis in the US, yet the relative influence of neighborhood deprivation and state firearm laws is not well understood.ObjectiveTo assess the associations of neighborhood deprivation, state firearm law strength, and urbanicity with firearm injury rates across the US.Design, Setting, and ParticipantsThis was a population-based cross-sectional study conducted at the Census block group level across the entire US from January 2018 through December 2022. Gun Violence Archive data were used to identify and include fatal and nonfatal firearm injuries in individuals of all ages. Suicide-related firearm injuries were excluded. Data were analyzed from March to June 2025.ExposureNeighborhood deprivation measured by the 2020 Area Deprivation Index at the census block group level, state firearm law strength determined by the 2020 Giffords Law Center Annual Gun Law Scorecard, and urbanicity (urban, mixed, and rural categories) based on 2020 Census Bureau urban-rural classifications. A spatial lag variable for neighboring state firearm law strength was also included.Main Outcomes and MeasuresFirearm injury rates per 1000 population in a Census block group was evaluated using negative binomial regression to estimate incident rate ratios (IRR). Spatial autocorrelation was assessed using bivariate Moran I statistics.ResultsAcross 233 386 Census block groups, 206 082 shooting incidents were analyzed (81 241 fatalities and 176 179 nonfatal injuries). On multivariable analysis, each decile increase in Area Deprivation Index (ADI) was associated with a 25% increase in firearm injury rates (IRR, 1.25; 95% CI, 1.25-1.26; P < .001) while incremental strengthening of state firearm law grade was associated with a 5% decrease (IRR, 0.95; 95% CI, 0.95-0.96; P < .001). Neighboring state law strength had a weaker association (IRR, 0.99; 95% CI, 0.99-1.00; P < .001). Compared to urban block groups, mixed (IRR, 0.39; 95% CI, 0.37-0.41) and rural (IRR, 0.22; 95% CI, 0.22-0.23) block groups had significantly lower rates (P < .001 for both). Bivariate global Moran I confirmed positive spatial autocorrelation between ADI and shooting incidents (I, 0.76; P < .001).Conclusions and RelevanceIn this national cross-sectional study, neighborhood deprivation demonstrated a substantially stronger statistical association with firearm injury rates than did state firearm law strength. While firearm legislation is crucial, strategies that prioritize investment in socially and economically deprived communities, especially in urban settings, may yield more meaningful reductions in firearm injuries overall.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"19 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599657","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}
Pub Date : 2025-11-19DOI: 10.1001/jamasurg.2025.5055
Alexandra Hernandez, Nina M. Clark, Jamie Olapo, Charles Liu, Rhea Udyavar, Jonathan G. Sham, Ali Rowhani-Rahbar, Joseph L. Dieleman, John W. Scott
Importance Affordable access to surgical procedures remains elusive for many in the US. However, the financial hardship attributable to surgical procedures is not well understood at the national level. Objective To evaluate the association between surgical procedures and financial hardship among working-aged adults in the US, compare changes in financial hardship after elective vs emergency surgery, and examine variation by payer and income. Design, Setting, and Participants This retrospective cohort study of the Medical Expenditure Panel Survey (MEPS) included respondents from 2014 to 2021. The MEPS is a nationally representative survey of noninstitutionalized US civilians. All adults aged 18 to 64 years old who reported undergoing a surgical procedure were matched to a cohort of nonsurgical control patients using coarsened exact matching on age, sex, race, ethnicity, income, payer, census region, comorbidities, and year. These data were analyzed from January 2025 to August 2025. Exposures The primary exposure was surgical procedure(s) within the last 12 months; secondary exposure was emergency vs elective surgical procedures. Main Outcomes and Measures The primary outcome of interest was financial hardship, defined as problems paying medical bills or delaying needed care due to cost. Secondary outcome was family out-of-pocket (OOP) spending. Results The weighted sample included 40 million working-aged (18-64 years) adults (62% female and 38% male) who underwent surgical procedures. Overall, 37.9% of surgical patients experienced financial hardship in the year after surgery. On difference-in-differences analysis, surgical procedures were associated with a 5.4–percentage point increase (95% CI, 1.8-9.0) in financial hardship, a 16% relative increase. Uninsured patients had a 23.7–percentage point increase (95% CI, 5.1-42.2), privately insured patients had an 8.4–percentage point increase (95% CI, 3.6-13.1), and those with Medicaid had no significant change. OOP spending increased by $708 (95% CI, $576-$839) after operations, with the highest increases among emergency surgeries and non-Medicaid insurance type. Conclusions and Relevance Surgical procedures were associated with substantial financial hardship for working-aged adults in the US, especially after emergency surgery and among the uninsured and privately insured. The finding that Medicaid enrollees were protected against increases in financial hardship after surgical procedures suggests that policies that restrict Medicaid eligibility may increase financial hardship among working-aged surgical patients, unless other changes are made to improve financial risk protection.
{"title":"Financial Hardship After Surgical Procedures","authors":"Alexandra Hernandez, Nina M. Clark, Jamie Olapo, Charles Liu, Rhea Udyavar, Jonathan G. Sham, Ali Rowhani-Rahbar, Joseph L. Dieleman, John W. Scott","doi":"10.1001/jamasurg.2025.5055","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5055","url":null,"abstract":"Importance Affordable access to surgical procedures remains elusive for many in the US. However, the financial hardship attributable to surgical procedures is not well understood at the national level. Objective To evaluate the association between surgical procedures and financial hardship among working-aged adults in the US, compare changes in financial hardship after elective vs emergency surgery, and examine variation by payer and income. Design, Setting, and Participants This retrospective cohort study of the Medical Expenditure Panel Survey (MEPS) included respondents from 2014 to 2021. The MEPS is a nationally representative survey of noninstitutionalized US civilians. All adults aged 18 to 64 years old who reported undergoing a surgical procedure were matched to a cohort of nonsurgical control patients using coarsened exact matching on age, sex, race, ethnicity, income, payer, census region, comorbidities, and year. These data were analyzed from January 2025 to August 2025. Exposures The primary exposure was surgical procedure(s) within the last 12 months; secondary exposure was emergency vs elective surgical procedures. Main Outcomes and Measures The primary outcome of interest was financial hardship, defined as problems paying medical bills or delaying needed care due to cost. Secondary outcome was family out-of-pocket (OOP) spending. Results The weighted sample included 40 million working-aged (18-64 years) adults (62% female and 38% male) who underwent surgical procedures. Overall, 37.9% of surgical patients experienced financial hardship in the year after surgery. On difference-in-differences analysis, surgical procedures were associated with a 5.4–percentage point increase (95% CI, 1.8-9.0) in financial hardship, a 16% relative increase. Uninsured patients had a 23.7–percentage point increase (95% CI, 5.1-42.2), privately insured patients had an 8.4–percentage point increase (95% CI, 3.6-13.1), and those with Medicaid had no significant change. OOP spending increased by $708 (95% CI, $576-$839) after operations, with the highest increases among emergency surgeries and non-Medicaid insurance type. Conclusions and Relevance Surgical procedures were associated with substantial financial hardship for working-aged adults in the US, especially after emergency surgery and among the uninsured and privately insured. The finding that Medicaid enrollees were protected against increases in financial hardship after surgical procedures suggests that policies that restrict Medicaid eligibility may increase financial hardship among working-aged surgical patients, unless other changes are made to improve financial risk protection.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"101 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145545425","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}
Pub Date : 2025-11-19DOI: 10.1001/jamasurg.2025.5074
Hannah Bae,Kurt R Sweat,Marc L Melcher,Itai Ashlagi
{"title":"Organ Procurement Following the Centers for Medicare and Medicaid Services Performance Evaluations.","authors":"Hannah Bae,Kurt R Sweat,Marc L Melcher,Itai Ashlagi","doi":"10.1001/jamasurg.2025.5074","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5074","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"7 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145545136","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}
Pub Date : 2025-11-12DOI: 10.1001/jamasurg.2025.4941
Philip C Müller,Caroline Berchtold,Christoph Kuemmerli,Eva Breuer,Zhihao Li,Alessia Vallorani,Carsten Hansen,Cristiano Guidetti,Janina Eden,Brady A Campbell,Pengfei Wu,Sara Nicole Cecchetto,Hallbera Gudmundsdottir,Michael Kendrick,Patrick P Starlinger,Nicolò Pecorelli,Giovanni Guarneri,Waqas Farooqui,Christoph Tschuor,Stefan Kobbelgaard Burgdorf,Julia Mühlhäusser,Jörn-Markus Gass,Brian K P Goh,Ye-Xin Koh,Artur Rebelo,Jörg Kleeff,Tomas Seip,Martin Santibanes,Letizia Todeschini,Giovanni Marchegiani,Nadiya Belfil,Mickaël Lesurtel,Marcel Machado,Ugo Boggi,Emanuele Kauffmann,Marie Cappelle,Bas Groot Koerkamp,Fabrizio Di Benedetto,Keith Roberts,Avinoam Nevler,Harish Lavu,Philipp Dutkowski,Felix Nickel,Thilo Hackert,Jin He,Massimo Falconi,Mark Truty,Adrian T Billeter,Beat P Müller, ,James Halle-Smith,Valentina Valle,Pier Giulianotti,Fabio Giannone,Patrick Pessaux,Patricia Sánchez-Velázquez,Prabin Bikram Thapa,Dhiresh Maharjan,Orlando Torres,Matta Kuzman,Sanjay Pandanaboyana
ImportanceTotal pancreatectomy (TP) is indicated for advanced pancreatic cancer or multifocal tumors. Furthermore, TP may be performed to avoid the risk of pancreatic fistula in selected patients to improve the perioperative risk profile.ObjectiveTo define reference values for TP based on a low-risk cohort treated at expert centers.Design, Setting, and ParticipantsThis multicenter study analyzed outcomes from patients undergoing primary TP for malignant or benign lesions from 25 international expert centers from January 2017 to November 2023. Low-risk patients undergoing TP (LR-TP) were without vascular resections or significant comorbidities.ExposuresTP.Main Outcomes and MeasuresTwenty reference values were derived from the 75th or the 25th percentile of the median values of all centers. Outcomes of LR-TP were compared with a cohort of TP with vascular resection, TP due to high-risk pancreatic anastomosis, and the benchmark values for low-risk pancreatoduodenectomy.ResultsOf 994 patients, 333 (33.5%; median [IQR] age, 66 [58-72] years; 171 male [51.4%]) qualified as the LR-TP cohort. Reference values included blood loss (≤1000 mL), major complications (≤37%), 3-month postoperative mortality (<6%), and retrieved lymph nodes (≥29). Compared with TP with vascular resections, reference cutoffs were not met for major complications (51% vs LR-TP ≤37%) and 90-day mortality (11% vs LR-TP ≤6%). For TP due to high-risk anastomosis, failure to rescue rate (38% vs ≤6%) and 90-day mortality (11% vs LR-TP ≤6%) were not met. Compared with pancreatoduodenectomy, reference values for postoperative mortality were 3 times higher for LR-TP (≤2% vs ≤6%) and less for resected lymph nodes (≥16 vs ≥29).Conclusions and RelevanceThis case-control study provided global reference values for TP, indicating significantly higher postoperative morbidity and mortality compared with pancreatoduodenectomy. Perioperative morbidity of TP was especially increased in patients with vascular resections. These reference values can serve for quality control of pancreatic surgery.
重要性全胰腺切除术（TP）适用于晚期胰腺癌或多灶性肿瘤。此外，在特定的患者中，TP可以避免胰瘘的风险，以改善围手术期的风险概况。目的根据专家中心治疗的低危队列确定TP的参考值。设计、环境和参与者本多中心研究分析了2017年1月至2023年11月25个国际专家中心因恶性或良性病变接受原发性TP治疗的患者的结果。接受TP （LR-TP）的低危患者无血管切除或显著合共病。主要结局和测量方法20个参考值来自所有中心中位数的第75或第25百分位。将低风险胰十二指肠切除术的预后与胰十二指肠切除术合并血管切除术的预后、胰十二指肠吻合术的预后以及低风险胰十二指肠切除术的预后进行比较。结果994例患者中，333例（33.5%；中位[IQR]年龄66[58-72]岁；171例男性[51.4%]）符合LR-TP队列。参考值包括出血量（≤1000ml）、主要并发症（≤37%）、术后3个月死亡率（<6%）和淋巴结清扫（≥29）。与TP +血管切除术相比，主要并发症（51% vs LR-TP≤37%）和90天死亡率（11% vs LR-TP≤6%）均未达到参考截止值。对于吻合术高危的TP，未达到抢救失败率（38% vs≤6%）和90天死亡率（11% vs LR-TP≤6%）。与胰十二指肠切除术相比，LR-TP的术后死亡率参考值高出3倍（≤2% vs≤6%），而切除淋巴结的死亡率参考值更低（≥16 vs≥29）。结论与意义本病例对照研究为TP提供了全球参考价值，表明TP术后发病率和死亡率明显高于胰十二指肠切除术。围手术期TP的发病率在血管切除患者中尤为明显。这些参考值可为胰腺手术质量控制提供参考。
{"title":"International Reference Values for Surgical Outcomes of Total Pancreatectomy.","authors":"Philip C Müller,Caroline Berchtold,Christoph Kuemmerli,Eva Breuer,Zhihao Li,Alessia Vallorani,Carsten Hansen,Cristiano Guidetti,Janina Eden,Brady A Campbell,Pengfei Wu,Sara Nicole Cecchetto,Hallbera Gudmundsdottir,Michael Kendrick,Patrick P Starlinger,Nicolò Pecorelli,Giovanni Guarneri,Waqas Farooqui,Christoph Tschuor,Stefan Kobbelgaard Burgdorf,Julia Mühlhäusser,Jörn-Markus Gass,Brian K P Goh,Ye-Xin Koh,Artur Rebelo,Jörg Kleeff,Tomas Seip,Martin Santibanes,Letizia Todeschini,Giovanni Marchegiani,Nadiya Belfil,Mickaël Lesurtel,Marcel Machado,Ugo Boggi,Emanuele Kauffmann,Marie Cappelle,Bas Groot Koerkamp,Fabrizio Di Benedetto,Keith Roberts,Avinoam Nevler,Harish Lavu,Philipp Dutkowski,Felix Nickel,Thilo Hackert,Jin He,Massimo Falconi,Mark Truty,Adrian T Billeter,Beat P Müller, ,James Halle-Smith,Valentina Valle,Pier Giulianotti,Fabio Giannone,Patrick Pessaux,Patricia Sánchez-Velázquez,Prabin Bikram Thapa,Dhiresh Maharjan,Orlando Torres,Matta Kuzman,Sanjay Pandanaboyana","doi":"10.1001/jamasurg.2025.4941","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.4941","url":null,"abstract":"ImportanceTotal pancreatectomy (TP) is indicated for advanced pancreatic cancer or multifocal tumors. Furthermore, TP may be performed to avoid the risk of pancreatic fistula in selected patients to improve the perioperative risk profile.ObjectiveTo define reference values for TP based on a low-risk cohort treated at expert centers.Design, Setting, and ParticipantsThis multicenter study analyzed outcomes from patients undergoing primary TP for malignant or benign lesions from 25 international expert centers from January 2017 to November 2023. Low-risk patients undergoing TP (LR-TP) were without vascular resections or significant comorbidities.ExposuresTP.Main Outcomes and MeasuresTwenty reference values were derived from the 75th or the 25th percentile of the median values of all centers. Outcomes of LR-TP were compared with a cohort of TP with vascular resection, TP due to high-risk pancreatic anastomosis, and the benchmark values for low-risk pancreatoduodenectomy.ResultsOf 994 patients, 333 (33.5%; median [IQR] age, 66 [58-72] years; 171 male [51.4%]) qualified as the LR-TP cohort. Reference values included blood loss (≤1000 mL), major complications (≤37%), 3-month postoperative mortality (<6%), and retrieved lymph nodes (≥29). Compared with TP with vascular resections, reference cutoffs were not met for major complications (51% vs LR-TP ≤37%) and 90-day mortality (11% vs LR-TP ≤6%). For TP due to high-risk anastomosis, failure to rescue rate (38% vs ≤6%) and 90-day mortality (11% vs LR-TP ≤6%) were not met. Compared with pancreatoduodenectomy, reference values for postoperative mortality were 3 times higher for LR-TP (≤2% vs ≤6%) and less for resected lymph nodes (≥16 vs ≥29).Conclusions and RelevanceThis case-control study provided global reference values for TP, indicating significantly higher postoperative morbidity and mortality compared with pancreatoduodenectomy. Perioperative morbidity of TP was especially increased in patients with vascular resections. These reference values can serve for quality control of pancreatic surgery.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"101 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145491708","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}
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