Surgery最新文献

{"title":"Factors associated with the feasibility and margin quality of sublobar resection for peripheral small-sized non–small cell lung cancer","authors":"Shusheng Zhu MM ,&nbsp;Zhihua Li MM ,&nbsp;Wenzheng Xu MD ,&nbsp;Zhicheng He MD ,&nbsp;Liang Chen MD ,&nbsp;Weibing Wu MD","doi":"10.1016/j.surg.2025.110080","DOIUrl":"10.1016/j.surg.2025.110080","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to identify factors associated with the feasibility and margin quality of sublobar resection for peripheral small-sized non–small cell lung cancer (NSCLC).</div></div><div><h3>Methods</h3><div>Patients with peripheral small-sized non–small cell lung cancer (≤2 cm) who underwent sublobar resection or lobectomy between 2020 and 2023 were screened. Surgical procedures were determined through discussion under the guidance of 3-dimensional computed tomography bronchography and angiography. A surgical margin equal to or larger than the maximum tumor diameter was considered sufficient. Logistic regression analyses were used to screen factors associated with the feasibility and margin quality of sublobar resection. Predictive nomograms were developed for segmentectomy and wedge based on independent factors, respectively.</div></div><div><h3>Results</h3><div>There were 383 (51.3%), 286 (38.3%), and 78 patients (10.4%) undergoing wedge resection, segmentectomy, and lobectomy, respectively. The likelihood of achieving sufficient margins was 90.9% for segmentectomy and 74.4% for wedge resection. Overall, 545 of 747 patients (73.0%) received sublobar resection with sufficient margins. The multivariable logistic regression analysis (segmentectomy with insufficient margins or lobectomy = 1, segmentectomy with sufficient margins = 0) showed that tumor size, radiologic types, located lobes, tumor-to-segmental bronchus distance, and subsegmental attribution were significantly associated with the feasibility and margin quality of segmentectomy. For wedge resection, tumor size and Lewis types were significantly associated with its feasibility or margin quality. The predictive models exhibited good performance, with an area under the curve of 0.821 for segmentectomy and 0.765 for wedge resection.</div></div><div><h3>Conclusion</h3><div>Tumor size, radiologic types, located lobe, tumor-to-segmental bronchus distance, Lewis types, and subsegmental attribution types were associated with the feasibility and margin quality of sublobar resection.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110080"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047059","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}

{"title":"Surgical advocacy in action: The fight for coverage for lung cancer screening.","authors":"Douglas E Wood","doi":"10.1016/j.surg.2025.110067","DOIUrl":"10.1016/j.surg.2025.110067","url":null,"abstract":"<p><p>Advocacy by professional societies, patient organizations, coalitions, and individuals has been pivotal to each inflection point in US lung cancer screening policy. After the National Lung Screening Trial that demonstrated a 20% reduction in lung cancer mortality with screening, 2012 guidelines from the National Comprehensive Cancer Network recommended lung cancer screening for individuals at high risk for lung cancer. However, guidelines did not change policy or insurance coverage, and individuals continued to be denied access to early lung cancer detection. In 2012-2014, advocates helped to translate the National Lung Screening Trial evidence into a US Preventive Services Task Force grade B recommendation and a first-ever Medicare national coverage determination that formalized eligibility and quality safeguards. As further experience accrued, the National Comprehensive Cancer Network guidelines evolved, and a second wave of advocacy leveraged new evidence and equity analyses to expand eligibility in the US Preventive Services Task Force recommendation and to modernize Medicare coverage. The National Comprehensive Cancer Network created the first guidelines recommending lung cancer screening and has continued to set the standard of eligibility for others to follow. The National Comprehensive Cancer Network guidelines have helped advocates educate and influence policymakers and have progressively simplified guidelines to help improve access to screening. The American Cancer Society National Lung Cancer Round Table has brought together diverse organizations that have helped further the implementation of early detection but also the full continuum of care for patients with lung cancer. This article synthesizes advocacy mechanisms (public comments, coalition letters, implementation toolkits, and media campaigns) and traces their imprint on policy text and program operations.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"110067"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994564","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}

{"title":"Comparative midterm ramifications of one anastomosis gastric bypass, Roux-en-Y gastric bypass, and sleeve gastrectomy: A retrospective cohort study of 6,234 patients","authors":"Adi Vinograd MD, MPH ,&nbsp;Lital Keinan Boker MD, PhD ,&nbsp;Rita Dichtiar MPH ,&nbsp;Alina Rosenberg PhD ,&nbsp;Orly Romano-Zelekha PhD ,&nbsp;Inbal Globus PhD","doi":"10.1016/j.surg.2026.110083","DOIUrl":"10.1016/j.surg.2026.110083","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> &lt; .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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110083"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078794","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}

{"title":"A cost comparison analysis of environmentally sustainable interventions in colorectal surgery","authors":"Rabiya Aseem MBBS, MSc, MRCS ,&nbsp;Siya Lodhia MBBS, MRCS ,&nbsp;Timothy Rockall MBBS, MD, FRCS ,&nbsp;Daniel Jackson BSc, MSc, PhD","doi":"10.1016/j.surg.2025.110054","DOIUrl":"10.1016/j.surg.2025.110054","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110054"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078864","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}

{"title":"External validation of prognostic multivariable risk models for surgical site infections after open lower extremity revascularization for peripheral arterial disease","authors":"Eden Singh BA ,&nbsp;Hana Shafique BS, BA ,&nbsp;Anish Karpurapu BS ,&nbsp;Christina Cui MD ,&nbsp;Young Kim MD ,&nbsp;Leila Mureebe MD, MPH ,&nbsp;Adam Johnson MD, MPH","doi":"10.1016/j.surg.2025.110077","DOIUrl":"10.1016/j.surg.2025.110077","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgical site infections are common after open lower extremity revascularization for peripheral arterial disease, increasing morbidity, limb loss, mortality, and costs. Although universal bundles reduce surgical site infection rates, some prophylactic measures carry risks and costs, making targeted use in high-risk patients essential. Several multivariable prognostic models for surgical site infections after lower extremity revascularization exist, but few have undergone external validation.</div></div><div><h3>Methods</h3><div>We assessed 10 published surgical site infection risk models using 2 national registries: National Surgical Quality Improvement Program and Vascular Quality Initiative. Discrimination was evaluated with area under the receiver operating characteristic curve, and calibration with visual plots and expected calibration error, applying 200-fold bootstrapping for 95% confidence intervals. Sensitivity analyses examined severe surgical site infections and subgroup calibration.</div></div><div><h3>Results</h3><div>Ten models published between 2012 and 2024 were identified: 4 from single institutions, 5 from national registries, and 1 from an international prospective study. In the National Surgical Quality Improvement Program, 8.5% of 61,586 patients developed surgical site infections; in the Vascular Quality Initiative, 11.2% of 75,193 patients developed surgical site infections. Across all models and datasets, the area under the receiver operating characteristic curve ranged from 0.50 to 0.60, indicating poor discrimination. Wiseman, Eslami, and Gwilym models performed best for discrimination, whereas Wiseman, Xu, and Gwilym showed relatively better calibration by expected calibration error. Visual inspection revealed poor calibration overall, with most models underestimating risk in low-risk patients and overestimating risk in high-risk patients.</div></div><div><h3>Conclusion</h3><div>Existing surgical site infection risk models demonstrate inadequate discrimination and calibration on external validation, limiting clinical utility. Poor performance likely reflects differences in cohorts, outcome definitions, and missing variables. Transparent, interpretable reporting and rigorous, independent external validation are essential before clinical implementation.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110077"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038968","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}

{"title":"Outcomes and quality of life in very elderly patients after ventral hernia repair","authors":"Courtney M. Collins MD ,&nbsp;William T. Head MD ,&nbsp;Li-Ching Huang PhD ,&nbsp;Sharon Phillips MSPH ,&nbsp;Benjamin Poulose MD ,&nbsp;Courtney E. Collins MD","doi":"10.1016/j.surg.2025.110050","DOIUrl":"10.1016/j.surg.2025.110050","url":null,"abstract":"<div><h3>Background</h3><div>Elderly patients have higher risk of perioperative and postoperative complications. As the US life expectancy continues to increase, more patients aged ≥75 years are undergoing surgical procedures. We chose to evaluate postoperative and quality of life outcomes in elderly versus very elderly patients undergoing elective ventral hernia repair.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed with data from the Abdominal Core Health Collaborative from 2013 to 2020. Patients were aged ≥65 years who underwent elective ventral hernia repair with retromuscular mesh placement. Those missing 30-day follow-up or without baseline and 30-day Hernia-Related Quality-of-Life Survey scores were excluded. Propensity score matching was used, and statistical analyses were performed with Fisher exact test, Pearson test, and Wilcoxon test.</div></div><div><h3>Results</h3><div>Of 1,514 patients, 1,219 (81%) were 65–75 years old (elderly) and 295 (19%) were 76–90 years old (very elderly). There was no difference in 30-day mortality, readmissions, hernia recurrences, surgical site infections, surgical site occurrences, or other complications. The very elderly cohort had higher Hernia-Related Quality-of-Life Survey scores at baseline (<em>P</em> = .031), 30 days (<em>P</em> &lt; .001), and 1 year (<em>P</em> = .007). Baseline and 1-year Patient-Reported Outcomes Measurement Information System pain 3A <em>t</em> scores were not different. The 30-day Patient-Reported Outcomes Measurement Information System pain 3A <em>t</em> scores were lower in the very elderly cohort (<em>P</em> = .016) and had greater decrease from baseline (<em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>The risk profile and outcomes associated with ventral hernia repair were comparable between cohorts. Very elderly patients achieved equitable, if not greater, quality of life improvements.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110050"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980614","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}

{"title":"Operating room communication and teamwork: An observational pilot study comparing objective and perceived collaboration","authors":"Valerie L. Armstrong MD ,&nbsp;Patricia G. Lu MD ,&nbsp;Eleanor R. Johnson MD, MPH ,&nbsp;Richard D. Butterfield MA ,&nbsp;Anagha Deshpande MD ,&nbsp;Vikram S. Gill MD ,&nbsp;Yihuai Qu BS ,&nbsp;Sayi P. Boddu MS ,&nbsp;Dawn E. Peters MSW ,&nbsp;Julia A. Files MD ,&nbsp;Chee-Chee H. Stucky MD","doi":"10.1016/j.surg.2025.109719","DOIUrl":"10.1016/j.surg.2025.109719","url":null,"abstract":"<div><h3>Background</h3><div>Patient safety in the operating room requires effective teamwork and communication. The purpose of this observational pilot study is to identify trends and potential biases of perceived communication effectiveness and teamwork in the operating room, such that education and interventions can be provided for improved teamwork, patient safety, and workplace satisfaction.</div></div><div><h3>Methods</h3><div>Trained observers attended randomly assigned surgical cases over a 3-month period to analyze effectiveness of teamwork, communication, and leadership skills among surgeon, anesthesia, and circulating/scrub nurse teams and complete objective surveys. Subjective surveys were completed anonymously by every member of the team to gauge perceived teamwork, cooperation, and communication among those present. Results were analyzed using <em>t</em> test and analysis of variance.</div></div><div><h3>Results</h3><div>From 14 cases, 28 objective, and 97 subjective surveys were completed. There were no differences between objective and subjective impressions by respondent age, gender, role, or involvement. However, when the respondent and lead surgeon were the opposite gender, the surgeon was rated less favorably in all categories. Cases longer than 3 hours scored lower on all categories. Circulating/scrub staff scored greatest on completion of checklist items (<em>P</em> &lt; .0001) and communication (<em>P</em> &lt; .001) while surgeons scored highest on teamwork (<em>P</em> &lt; .0001) and leadership (<em>P</em> &lt; .0001).</div></div><div><h3>Conclusion</h3><div>Gender and age were not factors leading to significant differences between subjective and objective evaluations; however, attending surgeon gender specifically and case duration were associated with subjective communication and teamwork scores. These results identify opportunities for education and training to reduce bias in the operating room.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 109719"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038967","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}

{"title":"The importance of young surgeons in surgical health policy advocacy engagement","authors":"Amy E. Liepert MD ,&nbsp;Anthony Douglas MD ,&nbsp;Alexandra Johns MD, MPH ,&nbsp;Jay J. Doucet MD ,&nbsp;Christina Colosimo DO, MS","doi":"10.1016/j.surg.2025.110066","DOIUrl":"10.1016/j.surg.2025.110066","url":null,"abstract":"<div><h3>Background</h3><div>Despite its critical importance, health policy advocacy remains vastly underutilized among surgeons and represents a critical area for professional development. Yet, interest is growing among younger physicians, particularly early-career surgeons who increasingly view advocacy as integral to patient care. Amid a rapidly evolving health care landscape, advocacy is defined as physician efforts to influence social, economic, and political factors affecting health and is essential for addressing systemic challenges.</div></div><div><h3>Methods</h3><div>Millennials and GenZ are now entering in early to mid-stages of surgical practice and are transforming advocacy approaches. These generational cohorts have been shaped by digital technology, health care and insurance debates, and public health emergencies (eg firearm violence and COVID-19). They bring new energy and methods to health policy advocacy engagement. These digital natives prefer multichannel communication and virtual platforms, both of which facilitate participation while reducing clinical disruptions. Younger physicians see advocacy not as an optional task, but a professional responsibility aligned with leadership, autonomy, and systemic change.</div></div><div><h3>Results</h3><div>Despite support from competency frameworks such as Accreditation Council for Graduate Medical Education, formal training in advocacy remains limited, often relying on mentorship or experiential learning. It is imperative that we improve our engagement and education of surgeons interested in advocacy as we know there are benefits for the surgeons themselves, the surgical community, and society as a whole. Engaging in policy can help young surgeons influence major legislative and hospital-level decisions. It also builds skills in leadership, negotiation, and communication, while fostering resilience and reducing moral injury through agency and systemic change, and allows young surgeons to shape the future of their profession.</div></div><div><h3>Conclusion</h3><div>Engagement of young surgeons in advocacy is vital for improving patient care, ensuring professional autonomy and sustainability, and translating science into impactful health policy. Academic surgery programs can contribute to the improvement in education of residents and early-career surgeons with mentorship programs and collaborations with other departments to develop a robust network of surgeon health policy advocates.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110066"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078868","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}

{"title":"Lateral laryngeal ultrasound for vocal cord evaluation in neck surgery: A mutually double-blind comparative study with laryngoscopy","authors":"Jung-Woo Woo MD ,&nbsp;Jun Ho Lee MD, PhD ,&nbsp;Han Shin Lee MD, PhD ,&nbsp;Hyunsuk Suh MD ,&nbsp;Eun Jung Jung MD, PhD","doi":"10.1016/j.surg.2025.110074","DOIUrl":"10.1016/j.surg.2025.110074","url":null,"abstract":"<div><h3>Background</h3><div>Vocal cord dysfunction is a significant complication after thyroid surgery, typically evaluated with invasive laryngoscopy. This study assessed diagnostic accuracy and feasibility of lateral laryngeal ultrasound as a noninvasive alternative.</div></div><div><h3>Methods</h3><div>In a prospective, double-blind study at Gyeongsang National University Changwon Hospital (February 2016 to June 2023), 718 patients underwent preoperative and postoperative vocal cord assessment using laryngoscopy and lateral laryngeal ultrasound. Both patients and assessors were blinded to the counterpart modality. Sensitivity, specificity, and visualization rates were analyzed.</div></div><div><h3>Results</h3><div>Lateral laryngeal ultrasound visualized vocal cords in 99.6% of cases (715/718), with 100% sensitivity and 99.5% specificity for detecting vocal cord paralysis compared with laryngoscopy. No adverse effects were reported.</div></div><div><h3>Conclusions</h3><div>Lateral laryngeal ultrasound is a reliable, noninvasive tool for perioperative vocal cord evaluation, offering a patient-friendly alternative that may reduce the need for laryngoscopy in thyroid surgery.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110074"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019633","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}

{"title":"Surgical versus transcatheter aortic valve replacement in patients with prior coronary artery bypass graft surgery","authors":"Esteban Aguayo MD ,&nbsp;Oh Jin Kwon MD ,&nbsp;Joseph Song BS ,&nbsp;Troy Coaston BS ,&nbsp;Saad Mallick MD ,&nbsp;Amulya Vadlakonda MD ,&nbsp;Joseph Hadaya MD, PhD ,&nbsp;Yas Sanaiha MD ,&nbsp;Peyman Benharash MD","doi":"10.1016/j.surg.2026.110086","DOIUrl":"10.1016/j.surg.2026.110086","url":null,"abstract":"<div><h3>Background</h3><div>With the aging US population and improvements in diagnostics, the prevalence of aortic stenosis is rising, including among patients with prior coronary artery bypass graft surgery. This study examined acute outcomes of transcatheter aortic valve replacement versus surgical aortic valve replacement in a national cohort of patients with prior coronary artery bypass graft surgery.</div></div><div><h3>Methods</h3><div>Using the 2016–2021 Nationwide Readmissions Database, we identified adult patients (≥18 years old) with prior coronary artery bypass graft surgery undergoing transcatheter or surgical aortic valve replacement. Patients with concomitant cardiac procedures were excluded. Outcomes included in-hospital mortality, postoperative complications, hospitalization costs, length of stay, and 30-day nonelective readmissions. Multivariable regression models were employed to evaluate associations.</div></div><div><h3>Results</h3><div>Among an estimated 566,705 patients, 3.0% of surgical aortic valve replacement recipients and 10.4% of transcatheter aortic valve replacement recipients had prior coronary artery bypass graft surgery. Use of surgical aortic valve replacement declined from 1,347 cases in 2016 to 593 cases in 2021, whereas transcatheter procedures increased from 8,464 to 10,821 cases (both Cuzick's test for trends &lt; .001). After multivariable adjustment and surgical aortic valve replacement as reference, transcatheter aortic valve replacement was associated with reduced odds of in-hospital mortality (adjusted odds ratio 0.22, 95% confidence interval 0.10–0.46) and intraoperative (adjusted odds ratio 0.46, 95% confidence interval 0.24–0.89), respiratory (adjusted odds ratio 0.37, 95% confidence interval 0.26–0.53), and renal (adjusted odds ratio 0.50, 95% confidence interval 0.33–0.75) complications, along with shorter hospital length of stay (−2.7 days, 95% confidence interval −3.1 to −2.2 days) and lower costs (−$32,000, 95% confidence interval −$62,000 to −$180). No significant differences in 30-day readmissions were noted (adjusted odds ratio 0.68, 95% confidence interval 0.42–1.10).</div></div><div><h3>Conclusion</h3><div>Transcatheter aortic valve replacement offers lower mortality, fewer complications, and reduced costs compared with surgical aortic valve replacement, supporting its role as a favorable treatment for aortic stenosis in patients with prior coronary artery bypass graft surgery.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110086"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146166519","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}