Pub Date : 2025-12-08DOI: 10.1016/j.surg.2025.109914
Pooja Podugu, Arnav Mahajan, Allison Mo, Megen Simpson, Sarah A Sweeney, Vanessa P Ho
Background: Neighborhood-level indices serve as proxies for social risk in clinical research, although self-reported social determinants of health may better identify vulnerable patients, especially in the context of traumatic injury. We hypothesized that self-reported social determinants of health have stronger predictive value for short-term trauma outcomes than neighborhood aggregates.
Methods: Adult inpatients with trauma tic injury (2020-2024) who completed hospital-administered social determinants of health screeners were assigned Social Vulnerability Index, Area Deprivation Index, and Environmental Justice Index scores based on census tract and categorized as high risk/low risk using median splits. Patients were also categorized as at risk/no risk across the 8 self-reported social determinants of health domains, measured by the screener. Primary outcomes were 30-day readmissions and hospital length of stay. Regression models measured the association of social determinants of health measures with outcomes, adjusting for injury and patient factors.
Results: A total of 3,115 patients completed social determinants of health screeners with 917 screened pre-trauma (median 152 days) and 2,198 screened post-trauma (median 17 days). Social Vulnerability Index and Environmental Justice Index predicted readmission risk (odds ratio 1.41 [95% confidence interval 1.07-1.86], P = .014, and 1.37 [1.00-1.87], P = .047). Social isolation was associated with significantly greater odds of readmission (odds ratio 2.17 [95% confidence interval 1.12-4.76], P = .032). No other social determinants of health domains predicted readmissions. Social isolation and stress were associated with longer length of stay (β = 1.44 days [95% confidence interval 0.36-2.52], P = .009, and β = 1.31 days [95% confidence interval 0.37-2.24], P = .006). No neighborhood measures predicted length of stay.
Conclusions: Social isolation demonstrated a stronger association with 30-day readmissions than neighborhood measures for trauma inpatients. Both social isolation and stress predicted hospital length of stay. Interventions to mitigate isolation and to increase outpatient support after discharge may be effective in reducing readmission in high-risk trauma patients.
{"title":"Predictive value of individual social risk versus neighborhood-level social vulnerability for trauma outcomes.","authors":"Pooja Podugu, Arnav Mahajan, Allison Mo, Megen Simpson, Sarah A Sweeney, Vanessa P Ho","doi":"10.1016/j.surg.2025.109914","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109914","url":null,"abstract":"<p><strong>Background: </strong>Neighborhood-level indices serve as proxies for social risk in clinical research, although self-reported social determinants of health may better identify vulnerable patients, especially in the context of traumatic injury. We hypothesized that self-reported social determinants of health have stronger predictive value for short-term trauma outcomes than neighborhood aggregates.</p><p><strong>Methods: </strong>Adult inpatients with trauma tic injury (2020-2024) who completed hospital-administered social determinants of health screeners were assigned Social Vulnerability Index, Area Deprivation Index, and Environmental Justice Index scores based on census tract and categorized as high risk/low risk using median splits. Patients were also categorized as at risk/no risk across the 8 self-reported social determinants of health domains, measured by the screener. Primary outcomes were 30-day readmissions and hospital length of stay. Regression models measured the association of social determinants of health measures with outcomes, adjusting for injury and patient factors.</p><p><strong>Results: </strong>A total of 3,115 patients completed social determinants of health screeners with 917 screened pre-trauma (median 152 days) and 2,198 screened post-trauma (median 17 days). Social Vulnerability Index and Environmental Justice Index predicted readmission risk (odds ratio 1.41 [95% confidence interval 1.07-1.86], P = .014, and 1.37 [1.00-1.87], P = .047). Social isolation was associated with significantly greater odds of readmission (odds ratio 2.17 [95% confidence interval 1.12-4.76], P = .032). No other social determinants of health domains predicted readmissions. Social isolation and stress were associated with longer length of stay (β = 1.44 days [95% confidence interval 0.36-2.52], P = .009, and β = 1.31 days [95% confidence interval 0.37-2.24], P = .006). No neighborhood measures predicted length of stay.</p><p><strong>Conclusions: </strong>Social isolation demonstrated a stronger association with 30-day readmissions than neighborhood measures for trauma inpatients. Both social isolation and stress predicted hospital length of stay. Interventions to mitigate isolation and to increase outpatient support after discharge may be effective in reducing readmission in high-risk trauma patients.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109914"},"PeriodicalIF":2.7,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716021","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 : 2025-12-05DOI: 10.1016/j.surg.2025.109909
Anna Levine, Hayden Wood, Ibukunoluwa Omole, Amie M Hop, G Paul Wright, Jessica L Thompson
Background: Approximately 20% of women diagnosed with ductal carcinoma in situ on core biopsy will be upstaged to invasive disease on final pathology. Sentinel lymph node biopsy at the time of mastectomy for ductal carcinoma in situ is the current standard of care. However, the underlying invasive cancer is frequently of low grade with favorable biology, bringing into question the necessity of sentinel lymph node biopsy to help guide clinical treatment recommendations. The primary study objective was to determine how often sentinel lymph node biopsy at the time of mastectomy for ductal carcinoma in situ alters adjuvant therapy recommendations.
Methods: A single-institution cancer registry retrospectively identified women treated with mastectomy for a preoperative diagnosis of ductal carcinoma in situ between November 2017 and November 2023, excluding those with a previous history of ipsilateral breast cancer. The impact of pathologic nodal status on adjuvant treatment was evaluated.
Results: The study population included 175 patients with a total of 38 invasive cancers identified. Of those with pT1 malignancies, 3 had a positive sentinel node. One patient was recommended for additional adjuvant treatment, in the form of radiation therapy, as a result of axillary staging. No patients were recommended for chemotherapy based solely on sentinel lymph node biopsy results.
Conclusion: Despite current recommendations to perform sentinel lymph node biopsy in ductal carcinoma in situ treated with mastectomy in the event invasive cancer is identified on final pathology, our outcomes suggest nodal status has limited impact on adjuvant therapy offerings. These findings indicate that sentinel lymph node biopsy may not be requisite for every patient undergoing mastectomy for ductal carcinoma in situ.
{"title":"Axillary staging outcomes in women undergoing mastectomy for ductal carcinoma in situ in the era of gene expression assays.","authors":"Anna Levine, Hayden Wood, Ibukunoluwa Omole, Amie M Hop, G Paul Wright, Jessica L Thompson","doi":"10.1016/j.surg.2025.109909","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109909","url":null,"abstract":"<p><strong>Background: </strong>Approximately 20% of women diagnosed with ductal carcinoma in situ on core biopsy will be upstaged to invasive disease on final pathology. Sentinel lymph node biopsy at the time of mastectomy for ductal carcinoma in situ is the current standard of care. However, the underlying invasive cancer is frequently of low grade with favorable biology, bringing into question the necessity of sentinel lymph node biopsy to help guide clinical treatment recommendations. The primary study objective was to determine how often sentinel lymph node biopsy at the time of mastectomy for ductal carcinoma in situ alters adjuvant therapy recommendations.</p><p><strong>Methods: </strong>A single-institution cancer registry retrospectively identified women treated with mastectomy for a preoperative diagnosis of ductal carcinoma in situ between November 2017 and November 2023, excluding those with a previous history of ipsilateral breast cancer. The impact of pathologic nodal status on adjuvant treatment was evaluated.</p><p><strong>Results: </strong>The study population included 175 patients with a total of 38 invasive cancers identified. Of those with pT1 malignancies, 3 had a positive sentinel node. One patient was recommended for additional adjuvant treatment, in the form of radiation therapy, as a result of axillary staging. No patients were recommended for chemotherapy based solely on sentinel lymph node biopsy results.</p><p><strong>Conclusion: </strong>Despite current recommendations to perform sentinel lymph node biopsy in ductal carcinoma in situ treated with mastectomy in the event invasive cancer is identified on final pathology, our outcomes suggest nodal status has limited impact on adjuvant therapy offerings. These findings indicate that sentinel lymph node biopsy may not be requisite for every patient undergoing mastectomy for ductal carcinoma in situ.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109909"},"PeriodicalIF":2.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696314","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}
Opioids are essential for perioperative analgesia, yet their impact on postoperative cognitive dysfunction remains unclear. Evidence is limited in older adults undergoing laparoscopic cholecystectomy and hernia repair. We sought to evaluate the association between perioperative opioid dose, expressed as morphine milligram equivalents, and postoperative cognitive dysfunction, assessed using Addenbrooke's Cognitive Examination-III at 24 hours and 30 days.
Methods
This prospective observational study enrolled patients >60 years undergoing elective laparoscopic surgery (80 cholecystectomies and 20 hernia repairs) from March 2023 and January 2024. Patients with pre-existing cognitive impairment, open conversion, or early discharge were excluded. Total perioperative opioid dose (morphine milligram equivalents/kg) was the primary predictor, and postoperative cognitive dysfunction (Addenbrooke's Cognitive Examination–III decline at 24 h and 30 days) was the outcome. Analysis included t tests, Fisher exact test, Pearson correlation, and multivariable regression with subgroup comparison.
Results
Of 102 patients, 100 were analyzed (80 cholecystectomy, 20 hernia repair; mean age 67.8 ± 6.3 years). Postoperative cognitive dysfunction occurred in 36% at 24 hours and 12% at 30 days. Incidence was 35% versus 40% at 24 hours and 13.8% versus 5% at 30 days for cholecystectomy and hernia, respectively. Greater opioid doses correlated with lower Addenbrooke's Cognitive Examination–III scores (r = –0.6439, P < .0001). Multivariable analysis showed increased odds of early postoperative cognitive dysfunction with greater opioid use (odds ratio, 1.59; 95% confidence interval, 1.30–1.96, P < .0001), whereas greater body mass index and male gender were protective.
Conclusions
Greater opioid doses were significantly associated with early postoperative cognitive dysfunction, whereas greater body mass index and male gender appeared protective. Larger studies are needed to confirm these findings.
{"title":"Dose-dependent effects of perioperative opioids on cognitive outcomes in older adults undergoing laparoscopic cholecystectomy and hernia repair: A prospective observational study","authors":"Dipayan Mistry MBBS , Nitin Choudhary MD , Ankita Maheshwari PhD , Rohit Verma MD , Rahul Kumar Anand MD , Bikash Ranjan Ray MD , Akhil Kant Singh MD , Ajay Singh MSc , Puneet Khanna MD","doi":"10.1016/j.surg.2025.109922","DOIUrl":"10.1016/j.surg.2025.109922","url":null,"abstract":"<div><h3>Background</h3><div>Opioids are essential for perioperative analgesia, yet their impact on postoperative cognitive dysfunction remains unclear. Evidence is limited in older adults undergoing laparoscopic cholecystectomy and hernia repair. We sought to evaluate the association between perioperative opioid dose, expressed as morphine milligram equivalents, and postoperative cognitive dysfunction, assessed using Addenbrooke's Cognitive Examination-III at 24 hours and 30 days.</div></div><div><h3>Methods</h3><div>This prospective observational study enrolled patients >60 years undergoing elective laparoscopic surgery (80 cholecystectomies and 20 hernia repairs) from March 2023 and January 2024. Patients with pre-existing cognitive impairment, open conversion, or early discharge were excluded. Total perioperative opioid dose (morphine milligram equivalents/kg) was the primary predictor, and postoperative cognitive dysfunction (Addenbrooke's Cognitive Examination–III decline at 24 h and 30 days) was the outcome. Analysis included <em>t</em> tests, Fisher exact test, Pearson correlation, and multivariable regression with subgroup comparison.</div></div><div><h3>Results</h3><div>Of 102 patients, 100 were analyzed (80 cholecystectomy, 20 hernia repair; mean age 67.8 ± 6.3 years). Postoperative cognitive dysfunction occurred in 36% at 24 hours and 12% at 30 days. Incidence was 35% versus 40% at 24 hours and 13.8% versus 5% at 30 days for cholecystectomy and hernia, respectively. Greater opioid doses correlated with lower Addenbrooke's Cognitive Examination–III scores (r = –0.6439, <em>P</em> < .0001). Multivariable analysis showed increased odds of early postoperative cognitive dysfunction with greater opioid use (odds ratio, 1.59; 95% confidence interval, 1.30–1.96, <em>P</em> < .0001), whereas greater body mass index and male gender were protective.</div></div><div><h3>Conclusions</h3><div>Greater opioid doses were significantly associated with early postoperative cognitive dysfunction, whereas greater body mass index and male gender appeared protective. Larger studies are needed to confirm these findings.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"190 ","pages":"Article 109922"},"PeriodicalIF":2.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690866","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 : 2025-12-05DOI: 10.1016/j.surg.2025.109926
Aslam Mohamed Haroon MBBS , Ahmed Ghani , Abdullah R. Ayesh BSc , Maria M. Witkowiak MD , Marios Alogakos MBBS , James Burns MBBS , Christian A. Than MBBS, PhD , Basim Wahba MBBCh , Hayato Nakanishi MBBS, MS , Travis McKenzie MD
Background
Iodine solution has been used preoperatively in patients with Graves disease undergoing a total thyroidectomy to reduce the vascularization and its associated risk of complications. This meta-analysis aimed to investigate the safety and efficacy of preoperative administration of iodine solution in patients with Graves disease undergoing a total thyroidectomy.
Methods
Ovid MEDLINE, CINAHL, Ovid Embase, and the Cochrane Library were searched for articles since its inception to August 2024. The review was registered prospectively on the PROSPERO database (CRD42024585797).
Results
From the 2,243 studies screened, 11 studies met the eligibility criteria, with a total of 2,257 patients with Graves disease undergoing a total thyroidectomy either with iodine solution (n = 760) or control (n = 1,497) groups. Our study demonstrated that the iodine solution group had similar outcomes compared with the control group with regard to intraoperative estimated blood loss (mean difference = –24.6 mL, 95% confidence interval: –56.2, 7.0; I2 = 82%), operative time (mean difference = –2.3 minutes, 95% confidence interval: –10.6, 6.0; I2 = 68%), endocrine-related complications (odds ratio = 0.85, 95% confidence interval: 0.42, 1.74; I2 = 76%), hypocalcemia (odds ratio = 1.11, 95% confidence interval: 0.65, 1.91; I2 = 61%), hematoma (odds ratio = 1.44, 95% confidence interval: 0.39, 5.29; I2 = 58%) or recurrent laryngeal nerve injury (odds ratio = 0.70, 95% confidence interval: 0.26, 1.93; I2 = 53%).
Conclusion
This meta-analysis demonstrates that preoperative iodine solution and control groups had similar clinical outcomes when undergoing total thyroidectomy for Graves disease. Further randomized control trials with larger samples and robust selection criteria are necessary to ascertain the perioperative effects of iodine solution in total thyroidectomy for patients with Graves disease.
{"title":"The effect of iodine solution in total thyroidectomy for patients with Graves disease: A meta-analysis","authors":"Aslam Mohamed Haroon MBBS , Ahmed Ghani , Abdullah R. Ayesh BSc , Maria M. Witkowiak MD , Marios Alogakos MBBS , James Burns MBBS , Christian A. Than MBBS, PhD , Basim Wahba MBBCh , Hayato Nakanishi MBBS, MS , Travis McKenzie MD","doi":"10.1016/j.surg.2025.109926","DOIUrl":"10.1016/j.surg.2025.109926","url":null,"abstract":"<div><h3>Background</h3><div>Iodine solution has been used preoperatively in patients with Graves disease undergoing a total thyroidectomy to reduce the vascularization and its associated risk of complications. This meta-analysis aimed to investigate the safety and efficacy of preoperative administration of iodine solution in patients with Graves disease undergoing a total thyroidectomy.</div></div><div><h3>Methods</h3><div>Ovid MEDLINE, CINAHL, Ovid Embase, and the Cochrane Library were searched for articles since its inception to August 2024. The review was registered prospectively on the PROSPERO database (CRD42024585797).</div></div><div><h3>Results</h3><div>From the 2,243 studies screened, 11 studies met the eligibility criteria, with a total of 2,257 patients with Graves disease undergoing a total thyroidectomy either with iodine solution (<em>n</em> = 760) or control (<em>n</em> = 1,497) groups. Our study demonstrated that the iodine solution group had similar outcomes compared with the control group with regard to intraoperative estimated blood loss (mean difference = –24.6 mL, 95% confidence interval: –56.2, 7.0; <em>I</em><sup>2</sup> = 82%), operative time (mean difference = –2.3 minutes, 95% confidence interval: –10.6, 6.0; <em>I</em><sup>2</sup> = 68%), endocrine-related complications (odds ratio = 0.85, 95% confidence interval: 0.42, 1.74; <em>I</em><sup>2</sup> = 76%), hypocalcemia (odds ratio = 1.11, 95% confidence interval: 0.65, 1.91; <em>I</em><sup>2</sup> = 61%), hematoma (odds ratio = 1.44, 95% confidence interval: 0.39, 5.29; <em>I</em><sup>2</sup> = 58%) or recurrent laryngeal nerve injury (odds ratio = 0.70, 95% confidence interval: 0.26, 1.93; <em>I</em><sup>2</sup> = 53%).</div></div><div><h3>Conclusion</h3><div>This meta-analysis demonstrates that preoperative iodine solution and control groups had similar clinical outcomes when undergoing total thyroidectomy for Graves disease. Further randomized control trials with larger samples and robust selection criteria are necessary to ascertain the perioperative effects of iodine solution in total thyroidectomy for patients with Graves disease.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"190 ","pages":"Article 109926"},"PeriodicalIF":2.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690867","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 : 2025-12-05DOI: 10.1016/j.surg.2025.109898
Chase J Wehrle, Ahmed F Sayed Ahmed, Emily Knott, Hanna Hong, Melis Uysal, Andrea Schlegel, Eren Berber, R Matthew Walsh, JaeKeun Kim, Federico Aucejo, David C H Kwon
<p><strong>Background: </strong>Histotripsy is a novel, nonionizing, nonthermal, noninvasive method using focused ultrasound waves to mechanically destroy liver tumors. It received FDA clearance in October 2023. We report the first years' experience at our academic center including, to our knowledge, the first evidence of medium-term oncologic efficacy, reporting local tumor control with this novel approach.</p><p><strong>Methods: </strong>All patients receiving histotripsy were included (December 20, 2023-November 30, 2024). Contrast-enhanced postoperative day 1, 30-, and 90-day scans are obtained in all patients. Tumor viability was determined by Response Evaluation Criteria in Solid Tumours/modified Response Evaluation Criteria in Solid Tumours criteria. Viable tumor on postoperative day 1 imaging was considered inadequate treatment; patients with nonviable tumors on postoperative day 1 were assessed for tumor control at postoperative day 30 and 90. Tumors with intentional partial treatment of a lesion were excluded from local control analyses. Palliative intent treatment refers to attempted immunologic antitumor priming and is pursued in very advanced tumor cases with no chance at curative therapy. All systemic therapy and anticoagulation are continued in the periprocedural period.</p><p><strong>Results: </strong>In all, 109 lesions in 71 patients were treated with histotripsy, with 9% receiving curative intent treatment and 66% treated palliatively. Among those treated with curative intent, 70% showed nonviable lesions at both 30- and 90-day follow-ups, suggesting effective tumor ablation. Overall, 75% of treatments were aimed at complete lesion ablation. Complications were rare, with only 1 (1%) classified as Clavien grade ≥3. In cases of proper targeting, tumor control was excellent: 60 lesions were nonviable on postoperative day 1, all demonstrating nonviable tumors at 30 days. Among these, 23 also had postoperative day 90 imaging; 100% maintained tumor nonviability. Unfortunately, lesion targeting was imperfect, with 60 (74%) of the 82 lesions intended for complete treatment demonstrating postoperative day 1 tumor nonviability. Notably, 19 (23%) of the 82 lesions were treated with palliative intent, whereas 3 (4%) were treated with curative intent. Ten patients were treated with curative intent; 70% (n = 7) had nonviable tumors on postoperative day 1. All such patients demonstrated persistent nonviability on postoperative days 30 and 90. Thus, 70% of patients treated with curative intent achieved no evidence of disease with 1 treatment, whereas 30% had persistent disease. Of these 3 cases, 2 were retreated with histotripsy and converted to no radiologic evidence of disease, with a total rate of no evidence of disease at 90%. There was a slight, although not significant improvement in targeting as providers gained more experience.</p><p><strong>Discussion: </strong>Histotripsy is a safe procedure that is starting to demonstrate promise in
{"title":"The first full year of histotripsy for liver tumors: Local tumor control and preliminary oncologic efficacy.","authors":"Chase J Wehrle, Ahmed F Sayed Ahmed, Emily Knott, Hanna Hong, Melis Uysal, Andrea Schlegel, Eren Berber, R Matthew Walsh, JaeKeun Kim, Federico Aucejo, David C H Kwon","doi":"10.1016/j.surg.2025.109898","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109898","url":null,"abstract":"<p><strong>Background: </strong>Histotripsy is a novel, nonionizing, nonthermal, noninvasive method using focused ultrasound waves to mechanically destroy liver tumors. It received FDA clearance in October 2023. We report the first years' experience at our academic center including, to our knowledge, the first evidence of medium-term oncologic efficacy, reporting local tumor control with this novel approach.</p><p><strong>Methods: </strong>All patients receiving histotripsy were included (December 20, 2023-November 30, 2024). Contrast-enhanced postoperative day 1, 30-, and 90-day scans are obtained in all patients. Tumor viability was determined by Response Evaluation Criteria in Solid Tumours/modified Response Evaluation Criteria in Solid Tumours criteria. Viable tumor on postoperative day 1 imaging was considered inadequate treatment; patients with nonviable tumors on postoperative day 1 were assessed for tumor control at postoperative day 30 and 90. Tumors with intentional partial treatment of a lesion were excluded from local control analyses. Palliative intent treatment refers to attempted immunologic antitumor priming and is pursued in very advanced tumor cases with no chance at curative therapy. All systemic therapy and anticoagulation are continued in the periprocedural period.</p><p><strong>Results: </strong>In all, 109 lesions in 71 patients were treated with histotripsy, with 9% receiving curative intent treatment and 66% treated palliatively. Among those treated with curative intent, 70% showed nonviable lesions at both 30- and 90-day follow-ups, suggesting effective tumor ablation. Overall, 75% of treatments were aimed at complete lesion ablation. Complications were rare, with only 1 (1%) classified as Clavien grade ≥3. In cases of proper targeting, tumor control was excellent: 60 lesions were nonviable on postoperative day 1, all demonstrating nonviable tumors at 30 days. Among these, 23 also had postoperative day 90 imaging; 100% maintained tumor nonviability. Unfortunately, lesion targeting was imperfect, with 60 (74%) of the 82 lesions intended for complete treatment demonstrating postoperative day 1 tumor nonviability. Notably, 19 (23%) of the 82 lesions were treated with palliative intent, whereas 3 (4%) were treated with curative intent. Ten patients were treated with curative intent; 70% (n = 7) had nonviable tumors on postoperative day 1. All such patients demonstrated persistent nonviability on postoperative days 30 and 90. Thus, 70% of patients treated with curative intent achieved no evidence of disease with 1 treatment, whereas 30% had persistent disease. Of these 3 cases, 2 were retreated with histotripsy and converted to no radiologic evidence of disease, with a total rate of no evidence of disease at 90%. There was a slight, although not significant improvement in targeting as providers gained more experience.</p><p><strong>Discussion: </strong>Histotripsy is a safe procedure that is starting to demonstrate promise in","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109898"},"PeriodicalIF":2.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696388","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 : 2025-12-04DOI: 10.1016/j.surg.2025.109924
Yeon Su Kim MD , Seung Yoon Yang MD , Na Reum Kim MD , Im Kyung Kim MD, PhD , Eun Joo Jung MD, PhD , Yoo Min Kim MD, PhD , Sung Hyun Kim MD, MS
Background
The Clavien-Dindo classification has been widely used to evaluate postoperative complications; however, it captures only the most severe event and may underestimate the overall morbidity burden. The Comprehensive Complication Index, developed to address this limitation, aggregates all complications into a single continuous score. Comprehensive evaluations of the Clavien-Dindo classification and Comprehensive Complication Index across diverse major abdominal surgical procedures are scarce, with most existing studies limited by relatively small cohorts and a focus on specific diseases.
Methods
We retrospectively analyzed 824 patients who underwent elective major abdominal surgeries (total gastrectomy, colorectal surgery with liver resection, major hepatectomy, and pancreatoduodenectomy) at a single tertiary center between January 2020 and December 2022. The Clavien-Dindo classification and Comprehensive Complication Index were calculated for each patient using postoperative data, and their correlation with length of hospital stay and cost was assessed. The correlation power between the Comprehensive Complication Index and Clavien-Dindo classification was compared.
Results
Pearson correlation analysis revealed a strong correlation between the Comprehensive Complication Index and Clavien-Dindo classification (r = 0.795, P < .001). When examined in relation to clinical outcomes using correlation coefficients, the Comprehensive Complication Index showed a stronger correlation with length of hospital stay and cost than the Clavien-Dindo classification did (Comprehensive Complication Index versus Clavien-Dindo classification: length of hospital stay (r) 0.770 vs 0.571, P < .001; cost (r) 0.784 vs 0.645, P < .001).
Conclusion
The Comprehensive Complication Index shows a stronger correlation with length of hospital stay and costs than the Clavien-Dindo classification did in major abdominal surgeries, supporting its use as a more informative and comprehensive tool for assessing postoperative morbidity.
背景：Clavien-Dindo分类已被广泛用于评估术后并发症；然而，它只捕获了最严重的事件，可能低估了总体发病率负担。综合并发症指数是为了解决这一局限性而开发的，它将所有并发症汇总为一个连续的评分。对不同主要腹部外科手术的Clavien-Dindo分类和综合并发症指数的综合评估很少，大多数现有研究受相对较小的队列限制，并且侧重于特定疾病。方法：我们回顾性分析了2020年1月至2022年12月在单一三级中心接受选择性腹部大手术（全胃切除术、结直肠手术合并肝切除术、肝大切除术和胰十二指肠切除术）的824例患者。利用术后资料计算每位患者的Clavien-Dindo分级和综合并发症指数，并评估其与住院时间和费用的相关性。比较综合并发症指数与Clavien-Dindo分级的相关性。结果：Pearson相关分析显示，综合并发症指数与Clavien-Dindo分型相关性较强（r = 0.795, P < 0.001）。当使用相关系数检查与临床结果的关系时，综合并发症指数与住院时间和费用的相关性比Clavien-Dindo分类强(综合并发症指数与Clavien-Dindo分类：住院时间(r) 0.770 vs 0.571, P < 0.001；成本(r) 0.784 vs 0.645, P < 0.001)。结论：在腹部大手术中，综合并发症指数与住院时间和费用的相关性比Clavien-Dindo分级更强，支持其作为评估术后发病率的更全面、更全面的工具。
{"title":"Comparing the Comprehensive Complication Index and Clavien-Dindo classification for evaluating postoperative complication severity in major abdominal surgery","authors":"Yeon Su Kim MD , Seung Yoon Yang MD , Na Reum Kim MD , Im Kyung Kim MD, PhD , Eun Joo Jung MD, PhD , Yoo Min Kim MD, PhD , Sung Hyun Kim MD, MS","doi":"10.1016/j.surg.2025.109924","DOIUrl":"10.1016/j.surg.2025.109924","url":null,"abstract":"<div><h3>Background</h3><div>The Clavien-Dindo classification has been widely used to evaluate postoperative complications; however, it captures only the most severe event and may underestimate the overall morbidity burden. The Comprehensive Complication Index, developed to address this limitation, aggregates all complications into a single continuous score. Comprehensive evaluations of the Clavien-Dindo classification and Comprehensive Complication Index across diverse major abdominal surgical procedures are scarce, with most existing studies limited by relatively small cohorts and a focus on specific diseases.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 824 patients who underwent elective major abdominal surgeries (total gastrectomy, colorectal surgery with liver resection, major hepatectomy, and pancreatoduodenectomy) at a single tertiary center between January 2020 and December 2022. The Clavien-Dindo classification and Comprehensive Complication Index were calculated for each patient using postoperative data, and their correlation with length of hospital stay and cost was assessed. The correlation power between the Comprehensive Complication Index and Clavien-Dindo classification was compared.</div></div><div><h3>Results</h3><div>Pearson correlation analysis revealed a strong correlation between the Comprehensive Complication Index and Clavien-Dindo classification (<em>r</em> = 0.795, <em>P</em> < .001). When examined in relation to clinical outcomes using correlation coefficients, the Comprehensive Complication Index showed a stronger correlation with length of hospital stay and cost than the Clavien-Dindo classification did (Comprehensive Complication Index versus Clavien-Dindo classification: length of hospital stay (<em>r</em>) 0.770 vs 0.571, <em>P</em> < .001; cost (<em>r</em>) 0.784 vs 0.645, <em>P</em> < .001).</div></div><div><h3>Conclusion</h3><div>The Comprehensive Complication Index shows a stronger correlation with length of hospital stay and costs than the Clavien-Dindo classification did in major abdominal surgeries, supporting its use as a more informative and comprehensive tool for assessing postoperative morbidity.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"190 ","pages":"Article 109924"},"PeriodicalIF":2.7,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688243","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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