Pub Date : 2026-04-01Epub Date: 2026-01-30DOI: 10.1016/j.surg.2025.110072
Patrick Goldhawk-White BSc , Kevin White MD, PhD , Manish Chand MBA, PhD , Danny A. Sherwinter MD , Steven Wexner MD, PhD(Hon)
Background
Indocyanine green fluorescence angiography is being increasingly used in colorectal surgery to reduce anastomotic leak risk, but few studies have analyzed its cost efficacy. In this study, cost modeling was used to compare costs in the United States using versus not using indocyanine green fluorescence angiography.
Methods
Exhaustive searches of PubMed/MEDLINE, EMBASE, and Scopus were used to identify all meta-analyses and randomized controlled trials assessing the effectiveness of indocyanine green fluorescence angiography in reducing anastomotic leaks. Additionally, we conducted our own meta-analysis restricted to randomized controlled trials with ≥100 patients in both indocyanine green fluorescence angiography and control groups. Three years (2021–2023) of Medicare Provider Analysis and Review billing data were then employed to identify direct health care costs. Minimum, intermediate, and maximum cost analysis models were created using indocyanine green fluorescence angiography–associated anastomotic leak reduction rates identified by synthesizing the results of meta-analyses and randomized controlled trials, procedural and complication-related costs identified via Medicare Provider Analysis and Review, and $225 as the per-unit cost of indocyanine green administration.
Results
Synthesis of the results of our own and 19 published meta-analyses revealed a 51.9% reduction in anastomotic leak rate with indocyanine green fluorescence angiography, whereas 5 meta-analyses restricted to randomized controlled trials, including our own, revealed level 1 evidence of at least a 36.5% reduction. Minimum and maximum cost analysis models were generated using conservative anastomotic leak reduction rates of 35% and 50%, from which mean per-patient cost reductions ranged from $962 to $1,138, and overall health care system savings ranged from $71 million to $84 million.
Conclusion
For anastomotic assessments in colorectal surgery, indocyanine green fluorescence angiography reduces direct per-patient health care costs in the United States by $962 to $1,138. Additional savings may be derived from reduced rehospitalization and reoperation rates.
{"title":"Analyzing costs versus savings using fluorescence angiography with indocyanine green for colorectal surgery in the United States: Multifaceted meta-analysis and cost analysis","authors":"Patrick Goldhawk-White BSc , Kevin White MD, PhD , Manish Chand MBA, PhD , Danny A. Sherwinter MD , Steven Wexner MD, PhD(Hon)","doi":"10.1016/j.surg.2025.110072","DOIUrl":"10.1016/j.surg.2025.110072","url":null,"abstract":"<div><h3>Background</h3><div>Indocyanine green fluorescence angiography is being increasingly used in colorectal surgery to reduce anastomotic leak risk, but few studies have analyzed its cost efficacy. In this study, cost modeling was used to compare costs in the United States using versus not using indocyanine green fluorescence angiography.</div></div><div><h3>Methods</h3><div>Exhaustive searches of PubMed/MEDLINE, EMBASE, and Scopus were used to identify all meta-analyses and randomized controlled trials assessing the effectiveness of indocyanine green fluorescence angiography in reducing anastomotic leaks. Additionally, we conducted our own meta-analysis restricted to randomized controlled trials with ≥100 patients in both indocyanine green fluorescence angiography and control groups. Three years (2021–2023) of Medicare Provider Analysis and Review billing data were then employed to identify direct health care costs. Minimum, intermediate, and maximum cost analysis models were created using indocyanine green fluorescence angiography–associated anastomotic leak reduction rates identified by synthesizing the results of meta-analyses and randomized controlled trials, procedural and complication-related costs identified via Medicare Provider Analysis and Review, and $225 as the per-unit cost of indocyanine green administration.</div></div><div><h3>Results</h3><div>Synthesis of the results of our own and 19 published meta-analyses revealed a 51.9% reduction in anastomotic leak rate with indocyanine green fluorescence angiography, whereas 5 meta-analyses restricted to randomized controlled trials, including our own, revealed level 1 evidence of at least a 36.5% reduction. Minimum and maximum cost analysis models were generated using conservative anastomotic leak reduction rates of 35% and 50%, from which mean per-patient cost reductions ranged from $962 to $1,138, and overall health care system savings ranged from $71 million to $84 million.</div></div><div><h3>Conclusion</h3><div>For anastomotic assessments in colorectal surgery, indocyanine green fluorescence angiography reduces direct per-patient health care costs in the United States by $962 to $1,138. Additional savings may be derived from reduced rehospitalization and reoperation rates.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110072"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Surgical management of inflammatory colitis often requires a staged approach with multiple procedures. Data on incidence, risk factors, and management of parietal complications remain limited.
Methods
All adult patients who underwent surgery for inflammatory colitis between March 2010 and May 2024 were included. The primary endpoint was the incidence of incisional hernia, parastomal hernia, or stoma prolapse after complete surgical treatment. Risk factors were assessed, with age, body mass index ≥25 kg/m2, and permanent stoma retained for multivariate analysis.
Results
One hundred nine patients underwent surgery for refractory colitis (n = 32; 29%), severe acute colitis (n = 58; 54%), and dysplasia (n = 19; 17%). Single or staged procedures resulted in 73 ileal pouch-anal anastomoses (67%), 23 ileorectal anastomoses (21%), and 13 nonrestorative proctocolectomies with end ileostomy (12%). Eighty-four patients (77%) had temporary stomas, and 19 (17%) had permanent stomas. The median follow-up was 44 (interquartile range: 21–91) months. Twenty-five patients (23%) developed parietal complications after a median of 25 (interquartile range: 11–35) months: 22 (20%) incisional hernia, 4 (3.6%) parastomal hernia, and 3 (2.8%) stoma prolapse. None of the 4 patients with prophylactic biological mesh placement during stoma closure developed complications. Twenty patients underwent abdominal wall repair, with 6 (30%) recurrences and 3 (15%) redo surgeries. Permanent stoma was the only independent risk factor (odds ratio = 4.35, 95% confidence interval: 1.24–15.7; P = .022).
Conclusion
Nearly one-quarter of patients with inflammatory colitis develop parietal complications after surgery, with high recurrence after repair. Prophylactic mesh placement during stoma closure should be studied.
{"title":"Long-term parietal complications following surgery for inflammatory colitis: An underestimated issue","authors":"Océane Lelièvre MD , Solafah Abdalla MD, PhD , Aurélien Amiot MD, PhD , Antoine Meyer MD, PhD , Franck Carbonnel MD, PhD , Christophe Penna MD, PhD , Stéphane Benoist MD, PhD , Antoine Brouquet MD, PhD","doi":"10.1016/j.surg.2026.110082","DOIUrl":"10.1016/j.surg.2026.110082","url":null,"abstract":"<div><h3>Background</h3><div>Surgical management of inflammatory colitis often requires a staged approach with multiple procedures. Data on incidence, risk factors, and management of parietal complications remain limited.</div></div><div><h3>Methods</h3><div>All adult patients who underwent surgery for inflammatory colitis between March 2010 and May 2024 were included. The primary endpoint was the incidence of incisional hernia, parastomal hernia, or stoma prolapse after complete surgical treatment. Risk factors were assessed, with age, body mass index ≥25 kg/m<sup>2</sup>, and permanent stoma retained for multivariate analysis.</div></div><div><h3>Results</h3><div>One hundred nine patients underwent surgery for refractory colitis (<em>n</em> = 32; 29%), severe acute colitis (<em>n</em> = 58; 54%), and dysplasia (<em>n</em> = 19; 17%). Single or staged procedures resulted in 73 ileal pouch-anal anastomoses (67%), 23 ileorectal anastomoses (21%), and 13 nonrestorative proctocolectomies with end ileostomy (12%). Eighty-four patients (77%) had temporary stomas, and 19 (17%) had permanent stomas. The median follow-up was 44 (interquartile range: 21–91) months. Twenty-five patients (23%) developed parietal complications after a median of 25 (interquartile range: 11–35) months: 22 (20%) incisional hernia, 4 (3.6%) parastomal hernia, and 3 (2.8%) stoma prolapse. None of the 4 patients with prophylactic biological mesh placement during stoma closure developed complications. Twenty patients underwent abdominal wall repair, with 6 (30%) recurrences and 3 (15%) redo surgeries. Permanent stoma was the only independent risk factor (odds ratio = 4.35, 95% confidence interval: 1.24–15.7; <em>P</em> = .022).</div></div><div><h3>Conclusion</h3><div>Nearly one-quarter of patients with inflammatory colitis develop parietal complications after surgery, with high recurrence after repair. Prophylactic mesh placement during stoma closure should be studied.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110082"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
As the population ages, more octogenarians are diagnosed with colorectal cancer. Their high comorbidity and mortality risk complicate decisions on adjuvant therapy and surveillance. This study compared outcomes of right hemicolectomy in older versus younger patients and identified predictors of noncancer mortality.
Methods
We retrospectively analyzed 400 patients undergoing elective laparoscopic right hemicolectomy for stage I–III right-sided colon cancer at a tertiary center (2017–2024). Patients were stratified by age (<80 vs ≥80 years); those aged ≥70 years were screened for frailty. Outcomes included short-term morbidity, disease-free survival, overall survival, and noncancer mortality. Fine-Gray regression identified predictors of noncancer death.
Results
Of 400 patients, 180 (45%) were aged ≥80 years. Octogenarians had higher comorbidity (Age-Adjusted Charlson Comorbidity Index >6 in 68.3% vs 22.3%, P < .001). Laparoscopic surgery was safe across groups, with similar conversion and leak rates but different 90-day mortality (4.4% vs 0%, P = .002). Disease-free survival was comparable (55.2 vs 54.6 months, P = 1.000), but overall survival was lower in older patients (62 vs 91 months, P < .001). Age ≥80 years (subdistribution hazard ratio 4.55, 95% confidence interval 1.63–12.7) and Age-Adjusted Charlson Comorbidity Index >6 (subdistribution hazard ratio 2.45, 95% confidence interval 1.15–6.0) independently predicted noncancer mortality, which reached 40.4% at 5 years in patients aged ≥80 years with high comorbidity.
Conclusions
Laparoscopic right hemicolectomy is safe in octogenarians, with recurrence outcomes comparable to younger patients. However, competing noncancer mortality in those with significant comorbidities limits the benefit of adjuvant therapy and intensive surveillance. Postoperative management should be tailored to comorbidity burden rather than age alone.
随着人口老龄化，越来越多的八十多岁老人被诊断为结直肠癌。他们的高合并症和死亡风险使辅助治疗和监测的决定复杂化。本研究比较了老年和年轻患者的右半结肠切除术的结果，并确定了非癌症死亡率的预测因素。方法回顾性分析2017-2024年在某三级中心行选择性腹腔镜右半结肠切除术的I-III期右侧结肠癌患者400例。患者按年龄分层（80岁vs≥80岁）；年龄≥70岁者进行虚弱筛查。结果包括短期发病率、无病生存期、总生存期和非癌症死亡率。细灰色回归确定了非癌症死亡的预测因子。结果400例患者中，年龄≥80岁的有180例（45%）。80多岁老人的合并症较高（年龄校正Charlson合并症指数>；6分别为68.3%和22.3%,P < 001）。腹腔镜手术在各组中是安全的，转换率和漏出率相似，但90天死亡率不同（4.4% vs 0%, P = 0.002）。无病生存期相当（55.2个月vs 54.6个月，P = 1.000），但老年患者的总生存期较低（62个月vs 91个月，P < 0.001）。年龄≥80岁（亚分布风险比4.55,95%可信区间1.63-12.7）和年龄校正Charlson共病指数>；6（亚分布风险比2.45,95%可信区间1.15-6.0）独立预测非癌性死亡率，年龄≥80岁高共病患者5岁时非癌性死亡率达到40.4%。结论腹腔镜右半结肠切除术对80多岁老人是安全的，其复发结果与年轻患者相当。然而，具有显著合并症的非癌症死亡率限制了辅助治疗和强化监测的益处。术后管理应根据合并症负担而不是年龄进行调整。
{"title":"Questioning adjuvant therapy and surveillance in octogenarians after right hemicolectomy","authors":"Giovanni Taffurelli MD, PhD , Isacco Montroni MD, PhD , Federico Ghignone MD , Francesca Sivieri MD , Davide Zattoni MD , Giacomo Frascaroli MD , Federico Mazzotti MD , Giampaolo Ugolini MD, PhD","doi":"10.1016/j.surg.2025.110053","DOIUrl":"10.1016/j.surg.2025.110053","url":null,"abstract":"<div><h3>Background</h3><div>As the population ages, more octogenarians are diagnosed with colorectal cancer. Their high comorbidity and mortality risk complicate decisions on adjuvant therapy and surveillance. This study compared outcomes of right hemicolectomy in older versus younger patients and identified predictors of noncancer mortality.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 400 patients undergoing elective laparoscopic right hemicolectomy for stage I–III right-sided colon cancer at a tertiary center (2017–2024). Patients were stratified by age (<80 vs ≥80 years); those aged ≥70 years were screened for frailty. Outcomes included short-term morbidity, disease-free survival, overall survival, and noncancer mortality. Fine-Gray regression identified predictors of noncancer death.</div></div><div><h3>Results</h3><div>Of 400 patients, 180 (45%) were aged ≥80 years. Octogenarians had higher comorbidity (Age-Adjusted Charlson Comorbidity Index >6 in 68.3% vs 22.3%, <em>P</em> < .001). Laparoscopic surgery was safe across groups, with similar conversion and leak rates but different 90-day mortality (4.4% vs 0%, <em>P</em> = .002). Disease-free survival was comparable (55.2 vs 54.6 months, <em>P</em> = 1.000), but overall survival was lower in older patients (62 vs 91 months, <em>P</em> < .001). Age ≥80 years (subdistribution hazard ratio 4.55, 95% confidence interval 1.63–12.7) and Age-Adjusted Charlson Comorbidity Index >6 (subdistribution hazard ratio 2.45, 95% confidence interval 1.15–6.0) independently predicted noncancer mortality, which reached 40.4% at 5 years in patients aged ≥80 years with high comorbidity.</div></div><div><h3>Conclusions</h3><div>Laparoscopic right hemicolectomy is safe in octogenarians, with recurrence outcomes comparable to younger patients. However, competing noncancer mortality in those with significant comorbidities limits the benefit of adjuvant therapy and intensive surveillance. Postoperative management should be tailored to comorbidity burden rather than age alone.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110053"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-08DOI: 10.1016/j.surg.2025.110043
Bennet S. Cho MD , Nguyen K. Le MD, MS , Troy Coaston BS , Esteban Z. Aguayo MD , Oh Jin Kwon MD , Saad Mallick MD , Giselle Porter BS , Peyman Benharash MD, MS
Background
Redo coronary arterial bypass grafting is a high-risk operation associated with significant morbidities. Although conduit selection remains a critical factor influencing post–coronary arterial bypass grafting outcomes, the trends in vessel utilization in redo operations remain poorly characterized. We used a nationally representative database to examine contemporary trends in conduit selection in redo versus first-time coronary arterial bypass grafting and risk factors of mortality among patients with repeat bypasses.
Methods
Using the 2016–2021 Nationwide Readmissions Database, we identified adult patients undergoing isolated coronary arterial bypass grafting, stratified into First-time and Redo cohorts. The primary outcome was in-hospital mortality; secondary outcomes included perioperative complications, postoperative length of stay, hospitalization costs, nonhome discharge, and 30-day nonelective readmissions. Temporal trends in conduit use (internal mammary artery, radial artery, and saphenous vein) were assessed.
Results
Among 928,925 patients, 5.3% underwent redo coronary arterial bypass grafting. From 2016 to 2021, the use of the internal mammary artery, radial artery, and saphenous vein increased in both cohorts (P < .001). Redo status was associated with higher likelihood of developing complications, longer length of stay (β + 6.2 days), and increased costs (β + $11,100), but lower odds of in-hospital mortality (adjusted odds ratio: 0.75). Internal mammary artery use was independently associated with reduced odds of mortality (adjusted odds ratio: 0.57).
Conclusion
Redo coronary arterial bypass grafting is modestly increasing nationwide and remains associated with greater morbidity and resource use, compared with first-time coronary arterial bypass grafting. Nonetheless, adjusted mortality is lower in redo coronary arterial bypass grafting, potentially reflecting careful patient selection and intensive perioperative care. Arterial conduit use, especially internal mammary artery, may confer survival benefits and warrants further study in the redo setting.
{"title":"National trends in conduit selection for redo coronary arterial bypass grafting","authors":"Bennet S. Cho MD , Nguyen K. Le MD, MS , Troy Coaston BS , Esteban Z. Aguayo MD , Oh Jin Kwon MD , Saad Mallick MD , Giselle Porter BS , Peyman Benharash MD, MS","doi":"10.1016/j.surg.2025.110043","DOIUrl":"10.1016/j.surg.2025.110043","url":null,"abstract":"<div><h3>Background</h3><div>Redo coronary arterial bypass grafting is a high-risk operation associated with significant morbidities. Although conduit selection remains a critical factor influencing post–coronary arterial bypass grafting outcomes, the trends in vessel utilization in redo operations remain poorly characterized. We used a nationally representative database to examine contemporary trends in conduit selection in redo versus first-time coronary arterial bypass grafting and risk factors of mortality among patients with repeat bypasses.</div></div><div><h3>Methods</h3><div>Using the 2016–2021 Nationwide Readmissions Database, we identified adult patients undergoing isolated coronary arterial bypass grafting, stratified into <em>F</em><em>irst-time</em> and <em>R</em><em>edo</em> cohorts. The primary outcome was in-hospital mortality; secondary outcomes included perioperative complications, postoperative length of stay, hospitalization costs, nonhome discharge, and 30-day nonelective readmissions. Temporal trends in conduit use (internal mammary artery, radial artery, and saphenous vein) were assessed.</div></div><div><h3>Results</h3><div>Among 928,925 patients, 5.3% underwent redo coronary arterial bypass grafting. From 2016 to 2021, the use of the internal mammary artery, radial artery, and saphenous vein increased in both cohorts (<em>P</em> < .001). Redo status was associated with higher likelihood of developing complications, longer length of stay (β + 6.2 days), and increased costs (β + $11,100), but lower odds of in-hospital mortality (adjusted odds ratio: 0.75). Internal mammary artery use was independently associated with reduced odds of mortality (adjusted odds ratio: 0.57).</div></div><div><h3>Conclusion</h3><div>Redo coronary arterial bypass grafting is modestly increasing nationwide and remains associated with greater morbidity and resource use, compared with first-time coronary arterial bypass grafting. Nonetheless, adjusted mortality is lower in redo coronary arterial bypass grafting, potentially reflecting careful patient selection and intensive perioperative care. Arterial conduit use, especially internal mammary artery, may confer survival benefits and warrants further study in the redo setting.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110043"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transient hypoparathyroidism is a common complication after total thyroidectomy, prolonging hospitalization and necessitating calcium and/or vitamin D replacement. Evidence from prospective randomized trials on preventive supplementation remains limited. This study aimed to evaluate whether prophylactic calcium and vitamin D supplementation reduces transient hypoparathyroidism and shortens hospital stay after total thyroidectomy.
Methods
In this single-center, prospective, randomized, controlled, open-label trial, 600 patients undergoing total thyroidectomy without central neck dissection were randomized to receive prophylactic oral calcium carbonate/gluconate and alfacalcidol (group A, n = 300) or standard postoperative care (group B, n = 300). Primary outcomes were biochemical and symptomatic hypocalcemia and the need for intravenous calcium. Secondary outcomes included postoperative serum calcium levels and length of hospital stay. Statistical analyses used χ2, Student’s t test, Mann-Whitney U test, and odds ratio and 95% confidence interval.
Results
Laboratory hypocalcemia (serum calcium <8.5 mg/dL) occurred significantly less often in group A (16.9% vs 39.9%; odds ratio 0.305, 95% confidence interval 0.207–0.451, P < .001). Symptomatic hypocalcemia was also reduced (5.6% vs 12.3%; odds ratio 0.427, 95% confidence interval 0.232–0.785, P < .005), as was the need for intravenous calcium (1.8% vs 9.3%; odds ratio 0.175, 95% confidence interval 0.070–0.441, P < .001). Group A demonstrated higher mean serum calcium levels on postoperative days 1 and 2 (P < .001) and a shorter hospital stay (1.25 days vs 1.7 days, P < .001). Supplementation benefits were consistent across subgroups stratified by malignancy status and preoperative vitamin D levels.
Conclusion
Routine calcium and vitamin D supplementation after total thyroidectomy significantly reduces transient hypoparathyroidism and shortens hospitalization. These findings support its use as a standard postoperative strategy to enhance recovery and reduce health care resource utilization.
背景：一过性甲状旁腺功能减退是全甲状腺切除术后常见的并发症，延长住院时间，需要补钙和/或维生素D。预防性补充剂的前瞻性随机试验证据仍然有限。本研究旨在评估预防性补充钙和维生素D是否能减少甲状腺全切除术后短暂性甲状旁腺功能减退并缩短住院时间。方法在这项单中心、前瞻性、随机、对照、开放标签的试验中，600例行甲状腺全切除术但未行中央性颈部清扫术的患者被随机分为预防性口服碳酸钙/葡萄糖酸盐和阿法骨化醇组（A组，n = 300）或标准术后护理组（B组，n = 300）。主要结局是生化和症状性低钙血症以及静脉补钙的需要。次要结局包括术后血钙水平和住院时间。统计分析采用χ2、Student’s t检验、Mann-Whitney U检验、优势比和95%置信区间。结果A组实验室低钙血症（血钙≥8.5 mg/dL）发生率明显低于对照组（16.9% vs 39.9%；优势比0.305,95%可信区间0.207 ~ 0.451,P < 0.001）。症状性低钙血症也减少了（5.6% vs 12.3%；优势比0.427,95%可信区间0.232-0.785,P < 0.005），静脉补钙需求也减少了（1.8% vs 9.3%；优势比0.175,95%可信区间0.070-0.441,P < 0.001）。A组患者术后第1天和第2天平均血钙水平较高（P < 0.001），住院时间较短（1.25天vs 1.7天，P < 0.001）。根据恶性肿瘤状态和术前维生素D水平分层的亚组中，补充维生素D的益处是一致的。结论甲状腺全切除术后常规补充钙和维生素D可显著减少甲状旁腺功能减退，缩短住院时间。这些发现支持其作为标准的术后策略，以提高恢复和减少卫生保健资源的利用。
{"title":"Calcium and vitamin D reduce hypoparathyroidism and hospital stay after thyroidectomy: A randomized controlled trial","authors":"Vasileios Gkanis MD, MSc , Konstantinos Nastos MD, PhD , Konstantinos Ntalaperas MD , Evangelia Agianni MD , Spyridon Lainas MD , Panagiota Raikou MD , Nikolaos Dafnios MD, PhD , Ioannis Papakonstantinou MD, PhD , Sophocles Lanitis MD, PhD","doi":"10.1016/j.surg.2025.110071","DOIUrl":"10.1016/j.surg.2025.110071","url":null,"abstract":"<div><h3>Background</h3><div>Transient hypoparathyroidism is a common complication after total thyroidectomy, prolonging hospitalization and necessitating calcium and/or vitamin D replacement. Evidence from prospective randomized trials on preventive supplementation remains limited. This study aimed to evaluate whether prophylactic calcium and vitamin D supplementation reduces transient hypoparathyroidism and shortens hospital stay after total thyroidectomy.</div></div><div><h3>Methods</h3><div>In this single-center, prospective, randomized, controlled, open-label trial, 600 patients undergoing total thyroidectomy without central neck dissection were randomized to receive prophylactic oral calcium carbonate/gluconate and alfacalcidol (group A, <em>n</em> = 300) or standard postoperative care (group B, <em>n</em> = 300). Primary outcomes were biochemical and symptomatic hypocalcemia and the need for intravenous calcium. Secondary outcomes included postoperative serum calcium levels and length of hospital stay. Statistical analyses used χ<sup>2</sup>, Student’s <em>t</em> test, Mann-Whitney <em>U</em> test, and odds ratio and 95% confidence interval.</div></div><div><h3>Results</h3><div>Laboratory hypocalcemia (serum calcium <8.5 mg/dL) occurred significantly less often in group A (16.9% vs 39.9%; odds ratio 0.305, 95% confidence interval 0.207–0.451, <em>P</em> < .001). Symptomatic hypocalcemia was also reduced (5.6% vs 12.3%; odds ratio 0.427, 95% confidence interval 0.232–0.785, <em>P</em> < .005), as was the need for intravenous calcium (1.8% vs 9.3%; odds ratio 0.175, 95% confidence interval 0.070–0.441, <em>P</em> < .001). Group A demonstrated higher mean serum calcium levels on postoperative days 1 and 2 (<em>P</em> < .001) and a shorter hospital stay (1.25 days vs 1.7 days, <em>P</em> < .001). Supplementation benefits were consistent across subgroups stratified by malignancy status and preoperative vitamin D levels.</div></div><div><h3>Conclusion</h3><div>Routine calcium and vitamin D supplementation after total thyroidectomy significantly reduces transient hypoparathyroidism and shortens hospitalization. These findings support its use as a standard postoperative strategy to enhance recovery and reduce health care resource utilization.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110071"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-02-06DOI: 10.1016/j.surg.2026.110087
Camille A. Biggins MHA, Laurie J. Kirstein MD, FACS, Eileen Reilly MSW, Kathryn Swingle MSW, LICSW, Kelly Christensen MSW, LICSW, Laura Marquez MSW, LSWAIC, Mark Daniels BS
Background
Despite prevalent systemic barriers to accessing healthcare services, Virginia Mason Medical Center’s Floyd & Delores Jones Cancer Institute has historically taken a piecemeal approach in responding to barriers. To uphold the organization’s mission, they participated in the Commission on Cancer’s “Breaking Barriers” national quality improvement collaborative in 2023 to investigate the predictable and modifiable reasons for radiotherapy nonadherence among their patients with cancer.
Methods
From March 1 to December 15, 2023, a multidisciplinary quality improvement team prospectively collected data on patients aged 18–99 years scheduled to receive 14–15 fractions of radiotherapy, excluding palliative care and ultrafractionation regimens. The team employed REDCap for bimonthly reporting and used multiple investigative methods including community assessments, patient chart reviews, patient narratives, and stakeholder input sessions. Environmental and community factors affecting transportation access were systematically evaluated using established quality improvement frameworks. Social work activity data were also collected to quantify institutional resource allocation.
Results
Among 104 eligible patients during the initial study period, 85.6% completed all scheduled appointments, 14.4% missed at least 1 appointment, and 3.8% met the no-show threshold of missing at least 3 appointments. By the end of 2023, the total institutional no-show rate was 5.2%, with transportation accounting for only 5.3% of all missed radiotherapy appointments. However, oncology social workers spent 14.8% of their time addressing transportation needs. Transportation-related missed appointments decreased to 3.7% by December 2023, while social work interventions prevented numerous potential no-shows from being recorded.
Conclusion
This project reveals an “iceberg problem” where transportation insecurity’s true magnitude remains hidden beneath outcome-oriented no-show metrics. The substantial discrepancy between low rates of transportation-related missed appointments (5.3%) and high social work time allocation (14.8%) demonstrates that no-show rates mask significant institutional workload required to maintain treatment adherence. Social work time emerges as a more sensitive, novel indicator of barrier vulnerability that reframes the problem from patient-centric failure to system-level resource demands. Health care organizations should implement proactive, data-driven barrier management systems that account for hidden workloads while developing sustainable, multilevel interventions to ensure equitable cancer care access.
{"title":"Beyond the no-show: A case study highlighting the hidden scope of barriers to radiotherapy adherence in cancer care","authors":"Camille A. Biggins MHA, Laurie J. Kirstein MD, FACS, Eileen Reilly MSW, Kathryn Swingle MSW, LICSW, Kelly Christensen MSW, LICSW, Laura Marquez MSW, LSWAIC, Mark Daniels BS","doi":"10.1016/j.surg.2026.110087","DOIUrl":"10.1016/j.surg.2026.110087","url":null,"abstract":"<div><h3>Background</h3><div>Despite prevalent systemic barriers to accessing healthcare services, Virginia Mason Medical Center’s Floyd & Delores Jones Cancer Institute has historically taken a piecemeal approach in responding to barriers. To uphold the organization’s mission, they participated in the Commission on Cancer’s “Breaking Barriers” national quality improvement collaborative in 2023 to investigate the predictable and modifiable reasons for radiotherapy nonadherence among their patients with cancer.</div></div><div><h3>Methods</h3><div>From March 1 to December 15, 2023, a multidisciplinary quality improvement team prospectively collected data on patients aged 18–99 years scheduled to receive 14–15 fractions of radiotherapy, excluding palliative care and ultrafractionation regimens. The team employed REDCap for bimonthly reporting and used multiple investigative methods including community assessments, patient chart reviews, patient narratives, and stakeholder input sessions. Environmental and community factors affecting transportation access were systematically evaluated using established quality improvement frameworks. Social work activity data were also collected to quantify institutional resource allocation.</div></div><div><h3>Results</h3><div>Among 104 eligible patients during the initial study period, 85.6% completed all scheduled appointments, 14.4% missed at least 1 appointment, and 3.8% met the no-show threshold of missing at least 3 appointments. By the end of 2023, the total institutional no-show rate was 5.2%, with transportation accounting for only 5.3% of all missed radiotherapy appointments. However, oncology social workers spent 14.8% of their time addressing transportation needs. Transportation-related missed appointments decreased to 3.7% by December 2023, while social work interventions prevented numerous potential no-shows from being recorded.</div></div><div><h3>Conclusion</h3><div>This project reveals an “iceberg problem” where transportation insecurity’s true magnitude remains hidden beneath outcome-oriented no-show metrics. The substantial discrepancy between low rates of transportation-related missed appointments (5.3%) and high social work time allocation (14.8%) demonstrates that no-show rates mask significant institutional workload required to maintain treatment adherence. Social work time emerges as a more sensitive, novel indicator of barrier vulnerability that reframes the problem from patient-centric failure to system-level resource demands. Health care organizations should implement proactive, data-driven barrier management systems that account for hidden workloads while developing sustainable, multilevel interventions to ensure equitable cancer care access.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110087"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-10DOI: 10.1016/j.surg.2025.110042
Lia D. Delaney MD, MS , Heather Day MS , Katherine Arnow MS , Robin M. Cisco MD , Dan Eisenberg MD, MS , Manjula Kurella Tamura MD, MPH , Insoo Suh MD , Electron Kebebew MD , Carolyn D. Seib MD, MAS
{"title":"Utilization of thyroid ultrasound and surgery after glucagon-like peptide-1 receptor agonist prescription","authors":"Lia D. Delaney MD, MS , Heather Day MS , Katherine Arnow MS , Robin M. Cisco MD , Dan Eisenberg MD, MS , Manjula Kurella Tamura MD, MPH , Insoo Suh MD , Electron Kebebew MD , Carolyn D. Seib MD, MAS","doi":"10.1016/j.surg.2025.110042","DOIUrl":"10.1016/j.surg.2025.110042","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110042"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-27DOI: 10.1016/j.surg.2025.110070
Zhi Ven Fong MD, MPH, DrPH , Chee-Chee Stucky MD , Po Hong Tan MBBS , Dillon Cheung MD , Stephanie Yu MD , Anita M. Moyer RN, OCN , Julie L. Hildebrand PA-C, MS , Hoe Yan Hor MBBS , Melody Tu MBBS , Rick Bold MD, MBA , Yu-Hui Chang MS, PhD , Nabil Wasif MD, MPH
Background
The robotic platform is being increasingly utilized to perform pancreatoduodenectomy, but implementation can be associated with a steep learning curve, and large number of cases is required to surmount it. We detail an approach for implementation of a robotic pancreatoduodenectomy program that incorporates a liberal patient selection and conversion strategy to achieve proficiency while maintaining outcomes.
Methods
Consecutive patients undergoing pancreatoduodenectomy from January 2018 to June 2025 were identified. A robotic pancreatoduodenectomy program was implemented in October 2023. Difference-in-difference models with patients identified in the National Surgical Quality Improvement Program during the same period as a control cohort were used.
Results
A total of 205 patients underwent pancreatoduodenectomy, 127 in the preimplementation period and 78 in the postimplementation period. Of the 78 pancreatoduodenectomies performed in the postimplementation period, 62 (79.5%) were performed robotically with a conversion rate of 19.4%. Compared with the preimplementation cohort, the postimplementation cohort had similar complication and mortality rates but shorter median length of stay (5 days vs 8 days, P < .0001). On difference-in-difference analyses, the institutional cohort was associated with an increase in robotic use after program implementation (+74.8%, P < .001) compared with the National Surgical Quality Improvement Program control cohort. The institutional cohort was also associated with fewer pancreatic fistulas (−12.3%, P = .02), shorter length of stay (−2.0 days, P < .001), and similar 30-day major morbidity (−9.3%, P = .14) and readmission (+7.3%, P = .13), as well as mortality rates (−1.7%, P = .45) after program implementation.
Conclusion
A robotic pancreatoduodenectomy program with a liberal patient selection and conversion strategy can be safely implemented while preserving overall outcomes compared with National Surgical Quality Improvement Program benchmarks.
{"title":"Implementation of a robotic pancreatoduodenectomy program: Navigating the learning curve with a liberal patient selection and conversion strategy","authors":"Zhi Ven Fong MD, MPH, DrPH , Chee-Chee Stucky MD , Po Hong Tan MBBS , Dillon Cheung MD , Stephanie Yu MD , Anita M. Moyer RN, OCN , Julie L. Hildebrand PA-C, MS , Hoe Yan Hor MBBS , Melody Tu MBBS , Rick Bold MD, MBA , Yu-Hui Chang MS, PhD , Nabil Wasif MD, MPH","doi":"10.1016/j.surg.2025.110070","DOIUrl":"10.1016/j.surg.2025.110070","url":null,"abstract":"<div><h3>Background</h3><div>The robotic platform is being increasingly utilized to perform pancreatoduodenectomy, but implementation can be associated with a steep learning curve, and large number of cases is required to surmount it. We detail an approach for implementation of a robotic pancreatoduodenectomy program that incorporates a liberal patient selection and conversion strategy to achieve proficiency while maintaining outcomes.</div></div><div><h3>Methods</h3><div>Consecutive patients undergoing pancreatoduodenectomy from January 2018 to June 2025 were identified. A robotic pancreatoduodenectomy program was implemented in October 2023. Difference-in-difference models with patients identified in the National Surgical Quality Improvement Program during the same period as a control cohort were used.</div></div><div><h3>Results</h3><div>A total of 205 patients underwent pancreatoduodenectomy, 127 in the preimplementation period and 78 in the postimplementation period. Of the 78 pancreatoduodenectomies performed in the postimplementation period, 62 (79.5%) were performed robotically with a conversion rate of 19.4%. Compared with the preimplementation cohort, the postimplementation cohort had similar complication and mortality rates but shorter median length of stay (5 days vs 8 days, <em>P</em> < .0001). On difference-in-difference analyses, the institutional cohort was associated with an increase in robotic use after program implementation (+74.8%, <em>P</em> < .001) compared with the National Surgical Quality Improvement Program control cohort. The institutional cohort was also associated with fewer pancreatic fistulas (−12.3%, <em>P</em> = .02), shorter length of stay (−2.0 days, <em>P</em> < .001), and similar 30-day major morbidity (−9.3%, <em>P</em> = .14) and readmission (+7.3%, <em>P</em> = .13), as well as mortality rates (−1.7%, <em>P</em> = .45) after program implementation.</div></div><div><h3>Conclusion</h3><div>A robotic pancreatoduodenectomy program with a liberal patient selection and conversion strategy can be safely implemented while preserving overall outcomes compared with National Surgical Quality Improvement Program benchmarks.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110070"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-14DOI: 10.1016/j.surg.2025.110069
Johnathan V. Torikashvili BS, Rachel L. Wolansky MD, Emily A. Grimsley MD, Tyler Zander MD, Joseph Sujka MD, Paul C. Kuo MD, MS, MBA, Melissa A. Kendall MD
{"title":"Local infiltration of liposomal bupivacaine is associated with reduced postoperative admission in anterior abdominal hernia repair","authors":"Johnathan V. Torikashvili BS, Rachel L. Wolansky MD, Emily A. Grimsley MD, Tyler Zander MD, Joseph Sujka MD, Paul C. Kuo MD, MS, MBA, Melissa A. Kendall MD","doi":"10.1016/j.surg.2025.110069","DOIUrl":"10.1016/j.surg.2025.110069","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110069"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Postoperative skin tears are an underrecognized complication following pancreatectomy and often result from the removal of adhesive surgical drapes. Despite a negative impact on recovery, limited strategies are available for their prevention.
Methods
We retrospectively analyzed data for 348 patients who underwent pancreatectomy at our institution from April 2019 to December 2021. In this cohort, 71 patients had received a preoperative sterile coating agent (intervention group), and 277 patients had not (control group). The incidence, severity, and treatment duration of postoperative skin tears were compared between these 2 groups, and univariate and multivariate analyses were performed to identify risk factors. Propensity score matching also was conducted, and receiver operating characteristic curve analysis was used to evaluate operative time thresholds.
Results
Skin tears occurred in 19.0% of patients. The incidence was significantly lower in the intervention group compared with the control group (9.9% vs 21.3%, P = .02). Multivariate and propensity score matching analyses identified a prolonged operative time and absence of coating agent as independent risk factors for tears. Treatment duration was significantly shorter in the intervention group (P = .03). Receiver operating characteristic analysis identified a longer threshold operative time for skin tear occurrence in the intervention group (673 minutes versus 656 minutes in the control group), suggesting improved skin tolerance.
Conclusion
A sterile preoperative coating agent significantly reduces the risk of postoperative skin tears following pancreatectomy and may improve skin tolerance during prolonged procedures. Clinical use of this agent should be considered in high-risk surgical patients.
背景：术后皮肤撕裂是胰腺切除术后未被充分认识的并发症，通常是由于移除手术黏附膜所致。尽管对恢复有负面影响，但可用于预防的战略有限。方法回顾性分析2019年4月至2021年12月在我院行胰腺切除术的348例患者的资料。在本队列中，71例患者术前使用了无菌包衣剂（干预组），277例患者未使用无菌包衣剂（对照组）。比较两组患者术后皮肤撕裂的发生率、严重程度和治疗时间，并进行单因素和多因素分析，以确定危险因素。同时进行倾向评分匹配，并采用受试者工作特征曲线分析评估手术时间阈值。结果19.0%的患者出现皮肤撕裂。干预组的发生率明显低于对照组（9.9% vs 21.3%, P = 0.02）。多变量分析和倾向评分匹配分析表明，手术时间延长和缺乏包衣剂是导致撕裂的独立危险因素。干预组治疗时间明显缩短（P = 0.03）。受试者操作特征分析发现，干预组皮肤撕裂发生的阈值手术时间较长（673分钟，对照组为656分钟），表明皮肤耐受性得到改善。结论术前无菌包衣剂可显著降低胰腺切除术后皮肤撕裂的风险，并可提高长时间手术过程中皮肤的耐受性。临床应考虑高危外科患者使用本品。
{"title":"Effect of a preoperative coating agent on postoperative skin tears in pancreatectomy","authors":"Masahiko Kubo MD, PhD , Eri Iwai RN , Hirofumi Akita MD, PhD , Kunihito Gotoh MD, PhD , Yasunari Fukuda MD, PhD , Hisateru Komatsu MD, PhD , Kei Yamamoto MD, PhD , Ryota Mori MD , Masatoshi Kitakaze MD, PhD , Norihiro Matsuura MD, PhD , Yasunori Masuike MD, PhD , Takahito Sugase MD, PhD , Yuki Ushimaru MD, PhD , Masaaki Mio MD, PhD , Yoshitomo Yanagimoto MD, PhD , Takashi Kanemura MD, PhD , Toshinori Sueda MD, PhD , Yoshinori Kagawa MD, PhD , Kazuyoshi Yamamoto MD, PhD , Junichi Nishimura MD, PhD , Shogo Kobayashi MD, PhD","doi":"10.1016/j.surg.2025.110039","DOIUrl":"10.1016/j.surg.2025.110039","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative skin tears are an underrecognized complication following pancreatectomy and often result from the removal of adhesive surgical drapes. Despite a negative impact on recovery, limited strategies are available for their prevention.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data for 348 patients who underwent pancreatectomy at our institution from April 2019 to December 2021. In this cohort, 71 patients had received a preoperative sterile coating agent (intervention group), and 277 patients had not (control group). The incidence, severity, and treatment duration of postoperative skin tears were compared between these 2 groups, and univariate and multivariate analyses were performed to identify risk factors. Propensity score matching also was conducted, and receiver operating characteristic curve analysis was used to evaluate operative time thresholds.</div></div><div><h3>Results</h3><div>Skin tears occurred in 19.0% of patients. The incidence was significantly lower in the intervention group compared with the control group (9.9% vs 21.3%, <em>P</em> = .02). Multivariate and propensity score matching analyses identified a prolonged operative time and absence of coating agent as independent risk factors for tears. Treatment duration was significantly shorter in the intervention group (<em>P</em> = .03). Receiver operating characteristic analysis identified a longer threshold operative time for skin tear occurrence in the intervention group (673 minutes versus 656 minutes in the control group), suggesting improved skin tolerance.</div></div><div><h3>Conclusion</h3><div>A sterile preoperative coating agent significantly reduces the risk of postoperative skin tears following pancreatectomy and may improve skin tolerance during prolonged procedures. Clinical use of this agent should be considered in high-risk surgical patients.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110039"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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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