IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-02-09 DOI: 10.1016/j.surg.2025.109976

Chris Varghese, Ashok Choudhary, Patrick Starlinger, Michael Kendrick, Rory Smoot, Susanne G Warner, Mark Truty, Elizabeth B Habermann, Hojjat Salehinejad, Cornelius A Thiels

Background: Length of hospital admission after major oncologic surgery is often highly variable. Although in carefully selected patients, early discharge can be safe, few automated systems exist to prospectively identify eligible patients. We aimed to develop and validate a predictive model to provide dynamic discharge predictions through each postoperative day.

Methods: Electronic medical record data from the day of operation through to postoperative day 3 from adult patients who underwent elective pancreas resections between 2001 and 2021 were used. The final model used tabular prior data fitted networks. Early discharge was defined as length of stay <6 days with 90-day readmission as a counterbalance measure. Models were assessed via 10-fold cross validation in an 80% training and validation set and applied to a 20% hold-out test set.

Results: A total of 3,081 consecutive patients (median age 64; 46.5% female) were included. All metrics improved as information accrued from postoperative day 0 to 3, with the tabular prior data fitted network performing best: area under the receiver operating characteristic curve of 0.90 (95% confidence interval 0.89-0.91), average precision of 0.80 (0.77-0.83), and Brier score of 0.12 (0.11-0.13) during cross-validation. The area under the receiver operating characteristic curve was 0.93 (95% confidence interval 0.91-0.94), average precision was 0.84 (0.80-0.89), and Brier score was 0.10 (0.08-0.11) in hold-out testing. Readmission rates were lower in those predicted suitable for early discharging (23.9% vs 34.2%).

Conclusion: This dynamic predictive model to predict early discharge after major oncologic surgery based on automatically abstractable electronic medical record data is now suitable for prospective evaluation.

背景：肿瘤大手术后的住院时间变化很大。虽然在精心挑选的患者中，早期出院是安全的，但很少有自动化系统可以前瞻性地识别符合条件的患者。我们的目标是开发并验证一个预测模型，以提供术后每一天的动态出院预测。方法：使用2001年至2021年间接受择期胰腺切除术的成年患者手术当日至术后第3天的电子病历数据。最后的模型采用了表格式先验数据拟合网络。结果：共纳入连续3081例患者（中位年龄64岁，女性46.5%）。从术后第0天到第3天，随着信息的积累，所有指标都有所改善，其中表格式先验数据拟合网络表现最佳：交叉验证时，受试者工作特征曲线下面积为0.90(95%置信区间0.89-0.91)，平均精度为0.80 (0.77-0.83)，Brier评分为0.12（0.11-0.13）。受试者工作特征曲线下面积为0.93(95%置信区间0.91 ~ 0.94)，平均精密度为0.84 (0.80 ~ 0.89)，Brier评分为0.10（0.08 ~ 0.11）。预测适合提前出院的患者再入院率较低（23.9% vs 34.2%）。结论：基于自动提取的电子病历数据建立的肿瘤大手术早期出院动态预测模型适合于前瞻性评估。

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引用次数: 0

Tabular foundation models as a new portable standard in local surgical risk prediction 表格基础模型作为局部手术风险预测的便携式新标准。

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-02-09 DOI: 10.1016/j.surg.2025.110078

Chris Varghese MBChB, BMedSc(Hons) , Elizabeth Habermann PhD , Kristine Hanson MPH , Ashok Choudhary PhD , Hojjat Salehinejad PhD , Cornelius Thiels DO, MBA

Introduction

Surgical risk is locality-specific, and database infrastructure to support accurate preoperative risk stratification is limited globally. Recently, foundation models for risk prediction trained on large corpus of synthetic data that are ready for domain-specific applications have emerged. We aimed to evaluate the role of a tabular foundation model in widening access to high-accuracy local risk stratification in emergency surgery.

Methods

We applied a transformer-based tabular pretrained foundation model with comparison to logistic regression and gradient boosting methods in our institutional data from the American College of Surgeons National Surgical Quality Improvement Program database of patients undergoing emergency surgery. We first compared performance overall, then at individual sites (n = 5), followed by comparison of the tabular prior-data fitted network model trained on site-level data against logistic regression and XGBoost models trained on all available multisite data not used for testing. Outcomes of interest were 30-day mortality and morbidity.

Results

Among 7,281 emergency surgery patients (4.8% mortality, 30.2% morbidity), tabular prior-data fitted network achieved the highest area under the receiver operating characteristic curve (0.82, 95% confidence interval 0.81–0.83, for morbidity; 0.89, 95% confidence interval 0.89–0.90, for mortality) and under the precision-recall curve (0.68, 95% confidence interval 0.66–0.7, for morbidity; 0.35, 95% confidence interval 0.29–0.39, for mortality), and best calibration (Brier score 0.15 for morbidity and 0.04 for mortality) compared with logistic regression and XGBoost models. The tabular prior-data fitted network's excellent performance persisted in smaller site-specific cohorts. A tabular prior-data fitted network model trained only on a single site's data performed comparable to logistic regression and XGBoost models trained on all available multisite data (P < .4).

Conclusions

Access to high-performance surgical risk stratification can be improved through a tabular foundation model. This portable approach offers flexibility to missing data, and strong comparative performance in smaller data sets.

手术风险是局部特异性的，支持准确术前风险分层的数据库基础设施在全球范围内是有限的。最近，针对特定领域应用的大型合成数据语料库进行风险预测训练的基础模型已经出现。我们的目的是评估表格基础模型在急诊手术中扩大获得高精度局部风险分层的作用。方法：我们采用基于变压器的表格预训练基础模型，并对来自美国外科医师学会国家外科质量改进计划数据库的急诊手术患者的机构数据进行了逻辑回归和梯度增强方法的比较。我们首先比较了整体性能，然后在单个站点（n = 5）进行了比较，然后比较了在站点级数据上训练的表格先验数据拟合网络模型与逻辑回归和在所有可用的未用于测试的多站点数据上训练的XGBoost模型。感兴趣的结局是30天死亡率和发病率。结果：在7281例急诊手术患者（死亡率4.8%，发病率30.2%）中，表格式先验数据拟合网络在患者工作特征曲线下（发病率0.82,95%置信区间0.81-0.83；死亡率0.89,95%置信区间0.89-0.90）和精确召回曲线下（发病率0.68,95%置信区间0.66-0.7；死亡率0.89,95%置信区间0.89-0.90）的面积最大。0.35, 95%置信区间0.29-0.39，死亡率)，与logistic回归和XGBoost模型相比，最佳校准（发病率Brier评分0.15，死亡率0.04）。表格先验数据拟合网络的优异性能在较小的特定地点队列中持续存在。仅在单个站点数据上训练的表格式先验数据拟合网络模型的表现与在所有可用的多站点数据上训练的逻辑回归和XGBoost模型相当（P < .4）。结论：通过表格式基础模型可以提高手术风险分层的可及性。这种可移植的方法为丢失数据提供了灵活性，并且在较小的数据集中具有很强的比较性能。

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引用次数: 0

Lymph node metastasis mapping and identification of high-risk stations in pathological T1-2 esophageal squamous cell carcinoma: A retrospective cohort study. 病理T1-2型食管鳞状细胞癌的淋巴结转移定位和高危部位鉴定：一项回顾性队列研究。

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-02-09 DOI: 10.1016/j.surg.2025.110024

Kai-Yuan Jiang, Jing Chen, Jin-Zhu Nan, Wen-Long Hu, Heng-Tao Lin, Dai-Yuan Ma, Kai-Di Li, Hai-Ning Zhou, Long-Qi Chen, Dong Tian

Background: Lymph node metastasis is a crucial factor in predicting the prognosis of patients with pathologic T1-2 esophageal squamous cell carcinoma, but the optimal extent of lymphadenectomy remains unclear. This study aims to determine the prognostic significance of high-risk lymph node stations and identify risk factors for high-risk lymph node station involvement.

Methods: Patients with pathologic T1-2 esophageal squamous cell carcinoma who underwent esophagectomy with lymph node dissection were enrolled between January 2014 and December 2019. The incidence of metastasis at each regional lymph node station was assessed, and the efficacy index was calculated to evaluate the therapeutic value of dissection.

Results: In total, 695 patients with T1-2 esophageal squamous cell carcinoma were included. Lymph node stations 2, 7, 8, 16, and 17 were defined as high-risk stations, with metastasis rates of 6.47%, 4.17%, 11.37%, 5.90%, and 7.34%, respectively, which were greater than those of the other stations. Patients with high-risk lymph node station metastasis exhibited elevated efficacy index values (1.67-5.44) and significantly worse overall survival (P < .001). High-risk lymph node station metastasis was an independent prognostic factor (hazard ratio, 1.986; 95% confidence interval, 1.452-2.716, P < .001). Logistic regression identified body mass index, tumor differentiation, tumor size, and tumor location as independent risk factors for high-risk lymph node station involvement.

Conclusion: Lymph node stations 2, 7, 8, 16, and 17 were high-risk stations associated with poor prognosis and high therapeutic value. Identification of these high-risk lymph node stations may guide a more tailored lymphadenectomy strategy in patients with T1-2 esophageal squamous cell carcinoma.

背景：淋巴结转移是预测病理性T1-2型食管鳞状细胞癌患者预后的重要因素，但淋巴结切除的最佳范围尚不清楚。本研究旨在确定高危淋巴结站的预后意义，并确定高危淋巴结站受累的危险因素。方法：选取2014年1月至2019年12月间行食管切除术并淋巴结清扫的病理性T1-2型食管鳞状细胞癌患者。评估各区域淋巴结站的转移发生率，计算疗效指数，评价清扫术的治疗价值。结果：共纳入695例T1-2型食管鳞状细胞癌患者。2、7、8、16、17淋巴结为高危淋巴结，转移率分别为6.47%、4.17%、11.37%、5.90%、7.34%，高于其他淋巴结。高危淋巴结站转移患者疗效指数升高（1.67 ~ 5.44），总生存期明显差（P < 0.001）。高危淋巴结转移是独立的预后因素（风险比1.986；95%可信区间1.452 ~ 2.716,P < 0.001）。Logistic回归发现体重指数、肿瘤分化、肿瘤大小和肿瘤位置是高危淋巴结浸润的独立危险因素。结论：淋巴结2、7、8、16、17为高危淋巴结，预后差，治疗价值高。识别这些高危淋巴结可以指导T1-2食管鳞状细胞癌患者更有针对性的淋巴结切除术策略。

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引用次数: 0

Beyond the no-show: A case study highlighting the hidden scope of barriers to radiotherapy adherence in cancer care 超越缺席：一个案例研究突出了癌症治疗中放疗依从性障碍的隐藏范围。

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-02-06 DOI: 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.

背景：尽管在获得医疗保健服务方面存在普遍的系统性障碍，弗吉尼亚梅森医疗中心的Floyd & Delores Jones癌症研究所在应对障碍方面一直采取零敲碎打的方法。为了坚持该组织的使命，他们于2023年参加了癌症委员会的“打破障碍”国家质量改善协作，调查癌症患者放疗不依从性的可预测和可改变的原因。方法：2023年3月1日至12月15日，多学科质量改进团队前瞻性收集18-99岁计划接受14-15次放疗的患者数据，不包括姑息治疗和超放射治疗方案。该团队使用REDCap进行双月报告，并使用多种调查方法，包括社区评估、患者图表回顾、患者叙述和利益相关者输入会议。利用已建立的质量改进框架系统地评估了影响交通通道的环境和社区因素。社会工作活动数据也被收集，以量化机构资源分配。结果：在最初的研究期间，104名符合条件的患者中，85.6%的患者完成了所有预定的预约，14.4%的患者至少错过了一次预约，3.8%的患者至少错过了3次预约。到2023年底，总机构缺席率为5.2%，交通事故仅占所有错过放疗预约的5.3%。然而，肿瘤社会工作者花了14.8%的时间来解决交通需求。到2023年12月，与交通相关的未赴约率降至3.7%，而社会工作干预措施阻止了许多潜在的未赴约记录。结论：该项目揭示了一个“冰山问题”，即交通不安全的真正严重性仍然隐藏在以结果为导向的缺席指标之下。与交通相关的低失约率（5.3%）和高社会工作时间分配（14.8%）之间的巨大差异表明，缺勤率掩盖了维持治疗依从性所需的大量机构工作量。社会工作时间作为一种更敏感、更新颖的障碍脆弱性指标出现，它将问题从以患者为中心的失败重新定义为系统级资源需求。卫生保健组织应该实施主动的、数据驱动的障碍管理系统，在开发可持续的、多层次的干预措施以确保公平的癌症护理获取的同时，考虑到隐藏的工作量。

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引用次数: 0

Comparative midterm ramifications of one anastomosis gastric bypass, Roux-en-Y gastric bypass, and sleeve gastrectomy: A retrospective cohort study of 6,234 patients 一次吻合胃旁路术、Roux-en-Y胃旁路术和袖式胃切除术的中期后果比较：6234例患者的回顾性队列研究

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-01-31 DOI: 10.1016/j.surg.2026.110083

Adi Vinograd MD, MPH , Lital Keinan Boker MD, PhD , Rita Dichtiar MPH , Alina Rosenberg PhD , Orly Romano-Zelekha PhD , Inbal Globus PhD

Background

One-anastomosis gastric bypass is a commonly performed metabolic bariatric surgery, yet comprehensive comparisons of its midterm outcomes with Roux-en-Y gastric bypass and sleeve gastrectomy remain limited. The study aimed to assess midterm outcomes, including weight loss and 3-year post–metabolic bariatric surgery complications, in a nationwide cohort.

Methods

This retrospective cohort study included patients aged ≥18 years who underwent one-anastomosis gastric bypass, Roux-en-Y gastric bypass, or sleeve gastrectomy between 2016 and 2019, using data from the National Metabolic Bariatric Surgery Registry and Maccabi Health Services, the second largest health provider. Adjusted odds ratios for study outcomes were estimated using multivariable logistic regressions and propensity score matching.

Results

The study comprised 2,249 one-anastomosis gastric bypass (36.1%), 447 Roux-en-Y gastric bypass (7.2%), and 3,538 sleeve gastrectomy (56.8%) patients. Preoperative mean body mass index values were 41.3 ± 4.9, 40.4 ± 4.7, and 41.6 ± 4.9 kg/m² for one-anastomosis gastric bypass, Roux-en-Y gastric bypass, and sleeve gastrectomy, respectively. One-anastomosis gastric bypass achieved the greatest weight-loss efficacy of 30.9% at 3 years of follow-up (P < .001). One-anastomosis gastric bypass was associated with higher odds of anal fissure (adjusted odds ratio, 1.85; 95% confidence interval, 1.38–2.49) alongside lower odds of constipation (adjusted odds ratio, 0.62; 95% confidence interval, 0.49–0.79), compared with sleeve gastrectomy. Both one-anastomosis gastric bypass and Roux-en-Y gastric bypass were associated with a higher likelihood of abdominal pain, diarrhea, and stomach ulcers compared with sleeve gastrectomy, after adjustment for potential confounders.

Conclusion

One-anastomosis gastric bypass demonstrated a greater magnitude of weight loss compared with sleeve gastrectomy but was associated with a higher incidence of specific gastrointestinal complications. These findings suggest additional considerations when selecting the optimal metabolic bariatric surgery approach, alongside tailored postoperative surveillance.

背景：吻合式胃旁路术是一种常用的代谢性减肥手术，但其中期结果与Roux-en-Y胃旁路术和袖式胃切除术的综合比较仍然有限。该研究旨在评估中期结果，包括体重减轻和3年后代谢减肥手术并发症，在全国范围内进行。方法本回顾性队列研究纳入了2016年至2019年期间接受单吻合术胃分流术、Roux-en-Y胃分流术或袖式胃切除术的年龄≥18岁的患者，数据来自国家代谢减肥手术登记处和第二大医疗服务提供者马卡比健康服务中心。使用多变量logistic回归和倾向评分匹配估计研究结果的调整优势比。结果共纳入单吻合术胃旁路2249例（36.1%），Roux-en-Y胃旁路447例（7.2%），套管胃切除术3538例（56.8%）。单吻合式胃旁路术、Roux-en-Y胃旁路术和袖式胃切除术术前平均体重指数分别为41.3±4.9、40.4±4.7和41.6±4.9 kg/m2。经3年随访，单吻合术胃旁路术的减重效果最高，达30.9% （P < .001）。与套式胃切除术相比，单吻合式胃旁路术发生肛裂的几率较高（校正优势比为1.85,95%可信区间为1.38-2.49），发生便秘的几率较低（校正优势比为0.62,95%可信区间为0.49-0.79）。调整潜在混杂因素后，单吻合术胃旁路术和Roux-en-Y胃旁路术与袖式胃切除术相比，腹痛、腹泻和胃溃疡的可能性更高。结论与套筒胃切除术相比，单吻合术胃旁路术体重减轻幅度更大，但特异性胃肠道并发症发生率更高。这些发现表明，在选择最佳的代谢减肥手术方法时，除了量身定制的术后监测外，还需要考虑其他因素。

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引用次数: 0

Analyzing costs versus savings using fluorescence angiography with indocyanine green for colorectal surgery in the United States: Multifaceted meta-analysis and cost analysis 在美国使用吲哚菁绿荧光血管造影进行结直肠手术的成本与节省分析：多方面的荟萃分析和成本分析

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-01-30 DOI: 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.

多菁绿荧光血管造影越来越多地应用于结直肠手术，以降低吻合口漏风险，但很少有研究分析其成本效益。在这项研究中，成本模型被用来比较美国使用与不使用吲哚菁绿色荧光血管造影术的成本。方法对PubMed/MEDLINE、EMBASE和Scopus进行全面检索，确定所有评估吲哚菁绿荧光血管造影减少吻合口瘘有效性的meta分析和随机对照试验。此外，我们进行了自己的荟萃分析，限制在≥100例患者的随机对照试验中，包括吲哚菁绿荧光血管造影组和对照组。然后使用三年（2021-2023）的医疗保险提供者分析和审查账单数据来确定直接医疗保健成本。通过综合meta分析和随机对照试验的结果确定的与吲哚菁绿荧光血管造影相关的吻合口漏减少率，通过医疗保险提供者分析和审查确定的程序和并发症相关成本，以及225美元作为吲哚菁绿给药的单位成本，建立了最小、中间和最大成本分析模型。结果：综合我们自己和19项已发表的荟萃分析的结果显示，吲哚菁绿荧光血管造影术的吻合口漏率降低了51.9%，而5项限于随机对照试验的荟萃分析，包括我们自己的荟萃分析，显示了至少降低36.5%的一级证据。最小和最大成本分析模型使用保守的吻合器泄漏减少率35%和50%生成，由此平均每位患者成本减少从962美元到1138美元不等，整体医疗保健系统节省从7100万美元到8400万美元不等。结论：在美国，对于结直肠手术的吻合口评估，吲哚菁绿荧光血管造影可使每位患者的直接医疗保健费用减少962美元至1138美元。再住院率和再手术率的降低可能带来额外的节省。

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引用次数: 0

Long-term parietal complications following surgery for inflammatory colitis: An underestimated issue 炎性结肠炎手术后的长期顶叶并发症：一个被低估的问题

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-01-30 DOI: 10.1016/j.surg.2026.110082

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

Background

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.

背景：炎性结肠炎的外科治疗通常需要分阶段进行多种手术。关于顶板并发症的发生率、危险因素和管理的数据仍然有限。方法纳入2010年3月至2024年5月期间接受炎性结肠炎手术治疗的所有成年患者。主要终点是手术治疗后切口疝、造口旁疝或造口脱垂的发生率。评估危险因素，年龄，体重指数≥25kg /m2，保留永久性造口进行多因素分析。结果顽固性结肠炎（32例，占29%）、严重急性结肠炎（58例，占54%）、发育不良（19例，占17%）共109例。单次或分期手术导致73例回肠袋-肛门吻合术（67%），23例回肠吻合术（21%），13例非恢复性直结肠切除术合并末端回肠造口术（12%）。84例（77%）为暂时性造口，19例（17%）为永久性造口。中位随访时间为44个月（四分位数间距：21-91）。25例患者（23%）在中位25个月（四分位间距：11-35）后出现顶骨并发症：22例（20%）切口疝，4例（3.6%）造口旁疝，3例（2.8%）造口脱垂。4例在造口术中预防性放置生物补片的患者均无并发症发生。20例患者接受腹壁修复，6例（30%）复发，3例（15%）重做手术。永久性造口是唯一的独立危险因素（优势比= 4.35,95%可信区间：1.24-15.7;P = 0.022）。结论近1 / 4的炎性结肠炎患者术后出现顶叶并发症，术后复发率高。应研究在造口过程中预防性放置补片。

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引用次数: 0

A missed opportunity to discuss treatment costs? A qualitative analysis of preoperative conversations about thyroid cancer treatment 错过了讨论治疗费用的机会？甲状腺癌治疗术前对话的定性分析

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-01-29 DOI: 10.1016/j.surg.2025.110075

Emily V. Crowley MS , Catherine B. Jensen MD, MSc , Elizabeth M. Bacon MPH , Benjamin C. James MD, MS , Susan C. Pitt MD, MPHS

引用次数: 0

Integration of spatiotemporal features into machine learning assessment of open surgical skills 将时空特征整合到开放手术技能的机器学习评估中

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-01-28 DOI: 10.1016/j.surg.2025.110079

Armin Alipour MS , Jeffrey Balian BS , Kevin Tabibian BS , Oh Jin Kwon MD , Nguyen Le MS , Areti Tillou MD , Peyman Benharash MD

Introduction

Accurate and objective assessment of operative skills is essential for improving training paradigms, patient safety, and quality of surgery. Advances in machine learning have facilitated automated assessment of minimally invasive and robotic operations. This study aims to develop a novel machine learning model for evaluation of open surgical proficiency.

Methods

This study used the AIxSuture data set. A global rating score was assigned for each video, categorizing individuals into novice (n = 119), intermediate (n = 79), and proficient (n = 116) classes. Hybrid convolutional neural network and long-short-term-memory networks were employed to train the video classifier model. ResNet50, an image classification model, served as a spatial feature extractor to perform nonlinear transformations. Long-short-term-memory networks selectively retained and discarded both significant and insignificant changes in frame sets that capture the subject's movements. The class-wise F1 score was measured to assess harmonic performance.

Results

Our assessment achieved a mean F1 score of 80.1% in determining the performance level of each subject, outperforming previous models. Additionally, the model classified performance with 90.1% accuracy for the novice group, 65.7% for the intermediate group, and 86.3% for the proficient group. Despite lower accuracy in the intermediate class, this metric outperformed other models in this group by nearly 10%. The present model classified each video into appropriate skill levels at an estimated 10.2 ± 0.4 seconds.

Conclusions

Our machine learning model provides a robust framework for skill assessment in open surgery. The application of machine learning in clinical practice should be considered to evaluate surgeons' skills and help improve training and outcomes.

准确和客观的手术技能评估对于改善培训模式、患者安全和手术质量至关重要。机器学习的进步促进了微创手术和机器人手术的自动评估。本研究旨在开发一种新的机器学习模型来评估开放手术的熟练程度。方法本研究采用AIxSuture数据集。为每个视频分配一个全局评分，将个人分为新手（n = 119），中级（n = 79）和精通（n = 116）班。采用混合卷积神经网络和长短期记忆网络对视频分类器模型进行训练。利用图像分类模型ResNet50作为空间特征提取器进行非线性变换。长短期记忆网络选择性地保留和丢弃捕捉受试者运动的帧集中的重要和不重要的变化。测量班级一级F1分数以评估和声性能。结果我们的评估在确定每个受试者的表现水平方面的平均F1得分为80.1%，优于以往的模型。此外，该模型对新手组的分类准确率为90.1%，中级组为65.7%，熟练组为86.3%。尽管在中级类别中准确率较低，但该指标在该组中比其他模型高出近10%。目前的模型在10.2±0.4秒内将每个视频分类为适当的技能水平。结论我们的机器学习模型为开放性手术的技能评估提供了可靠的框架。应该考虑在临床实践中应用机器学习来评估外科医生的技能，并帮助改善培训和结果。

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引用次数: 0

A cost comparison analysis of environmentally sustainable interventions in colorectal surgery 结直肠手术中环境可持续干预措施的成本比较分析

IF 2.7 2区医学 Q1 SURGERY

Surgery

Pub Date : 2026-01-28 DOI: 10.1016/j.surg.2025.110054

Rabiya Aseem MBBS, MSc, MRCS , Siya Lodhia MBBS, MRCS , Timothy Rockall MBBS, MD, FRCS , Daniel Jackson BSc, MSc, PhD

Background

Operating theaters are significant contributors to hospital carbon emissions, with colorectal surgery offering substantial opportunities for sustainable transformations. Financial assessments are critical to aid sustainable implementation within health care organizations. We conducted a cost comparison analysis of substituting disposable surgical items with their reusable counterparts in colorectal surgeries.

Methods

This was a prospective cost comparison study across 65 consecutive elective laparoscopic colorectal resections at a single UK center. Interventions included reusable laparoscopic ports/trocars, a reusable harmonic device, and reusable textiles (gowns, drapes, and slide sheets). Costs were analyzed using a per-case unit (capital amortized over expected lifetime + per-use sterilization/laundering). We also conducted a two-way sensitivity analysis and a threshold (break-even) analysis with 6% discounting over a 5-year life span.

Results

The total observed savings across 65 cases were £14,239.03. The reusable harmonic device remained cost-saving in all two-way combinations, with savings of £24.7k–£28.5k over 65 cases (baseline of £26.6k). Reusable textiles were consistently cheaper than disposables across modeled volumes. Reusable ports did not demonstrate cost savings at observed volumes and prices and did not reach parity on threshold analysis. Findings were driven by processing costs, capital price, and utilization.

Conclusion

Selectively adopted reusables can deliver measurable financial savings, particularly the harmonic device and theatre textiles, whereas other items may remain cost-increasing at current volumes and prices. The per-case, two-way sensitivity framework is transferable and can be populated with local inputs to inform implementation decisions aligned with sustainability aims.

手术室是医院碳排放的重要贡献者，结直肠手术为可持续转型提供了大量机会。财务评估对于帮助卫生保健组织内的可持续实施至关重要。我们对结直肠手术中一次性手术用品与可重复使用手术用品替代的成本进行了比较分析。方法：这是一项前瞻性成本比较研究，在英国的一个中心进行了65例连续的选择性腹腔镜结肠直肠癌切除术。干预措施包括可重复使用的腹腔镜口/套管针、可重复使用的谐波装置和可重复使用的纺织品（长袍、窗帘和幻灯片）。成本分析采用个案单位（按预期寿命摊销的资本+每次使用的消毒/洗涤）。我们还进行了双向敏感性分析和阈值（盈亏平衡）分析，在5年的生命周期中有6%的折扣。结果65例观察到的总节省为14239.03英镑。可重复使用的谐波装置在所有双向组合中都节省了成本，在65例中节省了24.7万至28.5万英镑（基线为26.6万英镑）。在整个模型中，可重复使用的纺织品始终比一次性纺织品便宜。可重复使用的端口在观察到的数量和价格上没有显示出成本节约，并且在阈值分析中没有达到平价。结果是由加工成本、资本价格和利用率驱动的。有选择地采用可重复使用的材料可以节省可观的资金，尤其是谐波设备和剧院纺织品，而其他物品在当前的数量和价格下可能仍然会增加成本。每个案例的双向敏感性框架是可转移的，可以与当地的投入相结合，为符合可持续发展目标的实施决策提供信息。

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引用次数: 0