Pub Date : 2025-12-08DOI: 10.1016/j.sopen.2025.12.001
Giselle Porter BS , Sara Sakowitz MD MBA MPH , Syed Shaheer Ali , Troy Coaston MSCR , Konmal Ali , Amulya Vadlakonda MD , Zihan Gao MHSc , Peyman Benharash MD
Introduction
Prior work has linked severe psychiatric illness (SPI) with greater postoperative mortality and complications following several elective operations. However, this relationship has not been defined in the setting of emergency general surgery (EGS).
Methods
The 2016–2021 United States Nationwide Readmissions Database was used to identify all non-elective adult EGS hospitalizations performed within 48 h of admission. SPI was defined using ICD-10 codes for bipolar disorder and schizophrenia. Patients with severe psychiatric illness comprised the SPI cohort (others: Non-SPI). Multivariable linear and logistic regression models were developed to evaluate the independent association of severe psychiatric illness with in-hospital mortality, perioperative complications, and costs.
Results
Of 2,124,284 EGS patients, 52,130 (2.5 %) were categorized as SPI. On adjusted analysis, SPI was associated with greater odds of in-hospital mortality (Adjusted Odds Ratio [AOR] 1.21; 95 % Confidence Interval [CI]:1.11–1.31), hospitalization costs (+$2304; 95 %CI: +1950, +2658), as well as a 3-fold increase in relative risk of non-home discharge (AOR 3.18, 95 % CI: 3.05–3.31).
Conclusions
Among EGS patients, severe psychiatric illness was linked with inferior clinical and financial outcomes. Improved psychiatric screening and care may allow for early intervention and targeted postoperative care, potentially mitigating complications and costs for these vulnerable patients.
{"title":"Association of psychiatric illness with acute outcomes following emergency general surgery","authors":"Giselle Porter BS , Sara Sakowitz MD MBA MPH , Syed Shaheer Ali , Troy Coaston MSCR , Konmal Ali , Amulya Vadlakonda MD , Zihan Gao MHSc , Peyman Benharash MD","doi":"10.1016/j.sopen.2025.12.001","DOIUrl":"10.1016/j.sopen.2025.12.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Prior work has linked severe psychiatric illness (SPI) with greater postoperative mortality and complications following several elective operations. However, this relationship has not been defined in the setting of emergency general surgery (EGS).</div></div><div><h3>Methods</h3><div>The 2016–2021 United States Nationwide Readmissions Database was used to identify all non-elective adult EGS hospitalizations performed within 48 h of admission. SPI was defined using ICD-10 codes for bipolar disorder and schizophrenia. Patients with severe psychiatric illness comprised the SPI cohort (others: Non-SPI). Multivariable linear and logistic regression models were developed to evaluate the independent association of severe psychiatric illness with in-hospital mortality, perioperative complications, and costs.</div></div><div><h3>Results</h3><div>Of 2,124,284 EGS patients, 52,130 (2.5 %) were categorized as SPI. On adjusted analysis, SPI was associated with greater odds of in-hospital mortality (Adjusted Odds Ratio [AOR] 1.21; 95 % Confidence Interval [CI]:1.11–1.31), hospitalization costs (+$2304; 95 %CI: +1950, +2658), as well as a 3-fold increase in relative risk of non-home discharge (AOR 3.18, 95 % CI: 3.05–3.31).</div></div><div><h3>Conclusions</h3><div>Among EGS patients, severe psychiatric illness was linked with inferior clinical and financial outcomes. Improved psychiatric screening and care may allow for early intervention and targeted postoperative care, potentially mitigating complications and costs for these vulnerable patients.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"29 ","pages":"Pages 1-6"},"PeriodicalIF":1.7,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145753683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.sopen.2025.11.006
Longchang Chen , Yan Sun , Quanda Liu
{"title":"Isolated right hepatic duct dilation – Type VI of Mirizzi syndrome?","authors":"Longchang Chen , Yan Sun , Quanda Liu","doi":"10.1016/j.sopen.2025.11.006","DOIUrl":"10.1016/j.sopen.2025.11.006","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 98-100"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recently, renewed concern has been centered on the role of the mesentery in the development of Crohn's disease (CD). However, there are minimal data supporting the extended mesenteric excision (EME), which may lead to reticence in the adoption of this surgical option. This systematic review and meta-analysis aimed to compare the post-operative outcomes in patients undergoing EME vs limited mesenteric excision (LME) for CD.
Methods
We conducted a systematic search from January 2018 to January 2025 for studies reporting outcomes in patients undergoing EME compared with LME for CD. A pooled meta-analysis was performed. The risk of bias was examined using the ROBINS-I v2 and RoB2 tool.
Results
Nine studies were included in final analysis, comprising two randomized controlled trials, enrolling a total of 4823 patients. Definitions of EME differ, with some studies preserving the ileocolic trunk and others resecting the mesentery with proximal ligation. No significant difference in surgical or endoscopic recurrence was observed between EME and LME. Concerning secondary outcomes, including overall morbidity, intra-abdominal abscess, anastomotic leak and hospital stay, the two groups showed no significant differences.
Conclusions
EME appears as safe as the LME in terms of morbidity, but does not significantly reduce surgical or endoscopic recurrence. Due to the absence of a precise definition of the EME procedure in CD and the need of further high-quality research, the approach of EME still lacks sufficient validation and cannot be broadly recommended for routine clinical practice.
{"title":"Mesenteric inclusion in Crohn's disease surgery: Promising breakthrough or tempest in a teapot? An updated meta-analysis","authors":"Mohamed Maatouk MD, MS , Mohamed Ben Khalifa MD , Nada Essid MD , Aymen Mabrouk MD , Mariem Nouira MD , Moez Boudokhane MD , Mounir Ben Moussa MD, PhD","doi":"10.1016/j.sopen.2025.10.010","DOIUrl":"10.1016/j.sopen.2025.10.010","url":null,"abstract":"<div><h3>Background</h3><div>Recently, renewed concern has been centered on the role of the mesentery in the development of Crohn's disease (CD). However, there are minimal data supporting the extended mesenteric excision (EME), which may lead to reticence in the adoption of this surgical option. This systematic review and meta-analysis aimed to compare the post-operative outcomes in patients undergoing EME vs limited mesenteric excision (LME) for CD.</div></div><div><h3>Methods</h3><div>We conducted a systematic search from January 2018 to January 2025 for studies reporting outcomes in patients undergoing EME compared with LME for CD. A pooled meta-analysis was performed. The risk of bias was examined using the ROBINS-I v2 and RoB2 tool.</div></div><div><h3>Results</h3><div>Nine studies were included in final analysis, comprising two randomized controlled trials, enrolling a total of 4823 patients. Definitions of EME differ, with some studies preserving the ileocolic trunk and others resecting the mesentery with proximal ligation. No significant difference in surgical or endoscopic recurrence was observed between EME and LME. Concerning secondary outcomes, including overall morbidity, intra-abdominal abscess, anastomotic leak and hospital stay, the two groups showed no significant differences.</div></div><div><h3>Conclusions</h3><div>EME appears as safe as the LME in terms of morbidity, but does not significantly reduce surgical or endoscopic recurrence. Due to the absence of a precise definition of the EME procedure in CD and the need of further high-quality research, the approach of EME still lacks sufficient validation and cannot be broadly recommended for routine clinical practice.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 89-97"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.sopen.2025.10.008
Alexander L. Ren MPhil , Jeff Choi MD, MSc , Sherry M. Wren MD
Purpose
Academic surgical department chairs play a critical role in guiding the missions of their departments. One understudied aspect of chairs' influence is their effect on trainee recruitment and diversity. This study explores whether the appointment of female surgical chairs is associated with an increase in the proportion of female and underrepresented-in-medicine applicants and entrants to academic general surgery residency programs.
Method
Academic programs in which a female chair was appointed to replace a male chair were identified. Male-led programs were identified and matched 2:1 to each female-led program based on similar geographic location and time span. Data on applicant and entrant demographics for all included programs was obtained from the Association of American Medical Colleges. A difference-in-difference analysis of applicants and entrants was performed comparing female and underrepresented-in-medicine proportions between the pre-chair appointment and post-appointment years.
Results
No significant changes were found in the proportions of female or underrepresented-in-medicine applicants/entrants following the appointment of a female chair.
Conclusions
Our study found that the appointment of new female chairs is not associated with the gender or racial/ethnic composition of residency applicants/entrants in the immediate post-appointment period. This indicates that increasing diversity among surgical trainees likely relies on the combined efforts of multiple department leaders and faculty members, as well as broader advocacy and outreach efforts in the surgical community.
{"title":"Female department chairs and diversity among general surgery applicants and entering residents","authors":"Alexander L. Ren MPhil , Jeff Choi MD, MSc , Sherry M. Wren MD","doi":"10.1016/j.sopen.2025.10.008","DOIUrl":"10.1016/j.sopen.2025.10.008","url":null,"abstract":"<div><h3>Purpose</h3><div>Academic surgical department chairs play a critical role in guiding the missions of their departments. One understudied aspect of chairs' influence is their effect on trainee recruitment and diversity. This study explores whether the appointment of female surgical chairs is associated with an increase in the proportion of female and underrepresented-in-medicine applicants and entrants to academic general surgery residency programs.</div></div><div><h3>Method</h3><div>Academic programs in which a female chair was appointed to replace a male chair were identified. Male-led programs were identified and matched 2:1 to each female-led program based on similar geographic location and time span. Data on applicant and entrant demographics for all included programs was obtained from the Association of American Medical Colleges. A difference-in-difference analysis of applicants and entrants was performed comparing female and underrepresented-in-medicine proportions between the pre-chair appointment and post-appointment years.</div></div><div><h3>Results</h3><div>No significant changes were found in the proportions of female or underrepresented-in-medicine applicants/entrants following the appointment of a female chair.</div></div><div><h3>Conclusions</h3><div>Our study found that the appointment of new female chairs is not associated with the gender or racial/ethnic composition of residency applicants/entrants in the immediate post-appointment period. This indicates that increasing diversity among surgical trainees likely relies on the combined efforts of multiple department leaders and faculty members, as well as broader advocacy and outreach efforts in the surgical community.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 101-103"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.sopen.2025.11.005
Hanne Pedersen , Alexander Tejera , Christopher Mathieu , Britt-Marie Johansson , Magnus Anderberg , Kristine Hagelsteen
Objective
The aim of this study was to explore experiences and challenges in handling feedback and criticism among early career surgeons.
Design
This study is part of a prospective, exploratory, longitudinal study evaluating surgical residents throughout residency. Semi-structured interviews were conducted with medical doctors applying to a locum or residency position in a surgical specialty. Analysis was performed using a cross-sectional thematic analysis.
Setting
Departments in general surgery, urology, and pediatric surgery at seven hospitals in Sweden.
Participants
Contact information to applicants interviewed for a locum or resident position at the included departments were forwarded to the research group. The research group contacted applicants for inclusion and 50 were included.
Results
Four themes were constructed in relation to the participants' management strategies and experiences: 1) reflection and processing of criticism, 2) emotional response to criticism, 3) cautious feedback culture, and 4) navigating criticism in a hierarchical system.
Conclusion
This study revealed barriers to an effective feedback culture in a pool of applicants for a residency or locum position in surgical disciplines. A culture of reluctance to give feedback was a strong and common denominator. A process of filtering feedback could possibly be a method of survival and thriving in the contemporary workplace. Suggestions and initiatives to change the feedback culture are proposed.
{"title":"Feedback gap and strategies for handling criticism in early surgical career","authors":"Hanne Pedersen , Alexander Tejera , Christopher Mathieu , Britt-Marie Johansson , Magnus Anderberg , Kristine Hagelsteen","doi":"10.1016/j.sopen.2025.11.005","DOIUrl":"10.1016/j.sopen.2025.11.005","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to explore experiences and challenges in handling feedback and criticism among early career surgeons.</div></div><div><h3>Design</h3><div>This study is part of a prospective, exploratory, longitudinal study evaluating surgical residents throughout residency. Semi-structured interviews were conducted with medical doctors applying to a locum or residency position in a surgical specialty. Analysis was performed using a cross-sectional thematic analysis.</div></div><div><h3>Setting</h3><div>Departments in general surgery, urology, and pediatric surgery at seven hospitals in Sweden.</div></div><div><h3>Participants</h3><div>Contact information to applicants interviewed for a locum or resident position at the included departments were forwarded to the research group. The research group contacted applicants for inclusion and 50 were included.</div></div><div><h3>Results</h3><div>Four themes were constructed in relation to the participants' management strategies and experiences: 1) reflection and processing of criticism, 2) emotional response to criticism, 3) cautious feedback culture, and 4) navigating criticism in a hierarchical system.</div></div><div><h3>Conclusion</h3><div>This study revealed barriers to an effective feedback culture in a pool of applicants for a residency or locum position in surgical disciplines. A culture of reluctance to give feedback was a strong and common denominator. A process of filtering feedback could possibly be a method of survival and thriving in the contemporary workplace. Suggestions and initiatives to change the feedback culture are proposed.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 81-88"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.sopen.2025.11.004
Tirayut Veerasatian , Schawanya K. Rattanapitoon , Nav La , Nathkapach K. Rattanapitoon
{"title":"Rethinking operative approach metrics in hepatic resection: Toward functional and precision outcomes","authors":"Tirayut Veerasatian , Schawanya K. Rattanapitoon , Nav La , Nathkapach K. Rattanapitoon","doi":"10.1016/j.sopen.2025.11.004","DOIUrl":"10.1016/j.sopen.2025.11.004","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Page 80"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-25DOI: 10.1016/j.sopen.2025.11.002
Mohammed Aldakhil , Raghad Ibrahim albarrak MBBS , Jana Abdullah Alomar , Leena Ibrahim Alnasr , Rima Mohammed Alassaf , Nouf khaled Alhumaid
Background
Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) that often leads to the development of complex perianal fistulas, significantly impairing patients' quality of life. Conventional medical and surgical treatments offer limited long-term efficacy, with high recurrence rates and associated complications. Adipose-derived stem cell therapy (ADSCT) has emerged as a promising regenerative therapy due to its anti-inflammatory and tissue-regenerative properties. However, discrepancies in clinical outcomes across studies warrant a systematic evaluation of its efficacy and safety.
Objective
This systematic review aims to critically assess the efficacy, safety, and recurrence rates of ADSCT for complex perianal fistulas in Crohn's disease patients, summarizing data from randomized controlled trials and observational studies.
Methods
This review included 19 studies published between 2009 and 2024 involving Crohn's disease patients treated with either autologous or allogeneic ADSCT. Extracted data included patient demographics, fistula characteristics, treatment protocols, and clinical outcomes such as fistula closure, partial healing, time to healing, recurrence, and adverse events. Study selection followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and is illustrated in a PRISMA flow diagram. Risk of bias was assessed using the Cochrane Risk of Bias Tool for randomized controlled trials and adapted versions of the Newcastle-Ottawa Scale (NOS) and MINORS criteria for observational studies. Studies were categorized as excellent, good, or fair based on their total quality score.
Results
Fistula closure rates ranged from 23.1 % to 91 %, with an overall average of 62.5 %. Partial healing rates varied widely, between 9 % and 93.3 %. Time to healing ranged from 8 to 48 weeks, with an average of 25.3 weeks. Recurrence rates were reported in over half of the studies and reached up to 38.5 %, with a mean recurrence rate of 19.2 %. The majority of adverse events were mild and transient, including local inflammation, discomfort, and minor infections. No serious (Grade 3 or 4) complications were reported. Risk of bias assessment classified one study as excellent, two as good, and two as fair in methodological quality.
Conclusion
Adipose-derived stem cell therapy demonstrates promising efficacy and a favorable safety profile for the treatment of complex perianal fistulas in Crohn's disease. While ADSCT may achieve meaningful clinical response and symptom relief in a substantial proportion of patients, variability in outcomes and study designs highlights the need for standardized protocols and long-term follow-up in future trials.
{"title":"The efficacy of adipose-derived stem cell therapy for complex perianal fistulas in Crohn's disease patients: A systematic review","authors":"Mohammed Aldakhil , Raghad Ibrahim albarrak MBBS , Jana Abdullah Alomar , Leena Ibrahim Alnasr , Rima Mohammed Alassaf , Nouf khaled Alhumaid","doi":"10.1016/j.sopen.2025.11.002","DOIUrl":"10.1016/j.sopen.2025.11.002","url":null,"abstract":"<div><h3>Background</h3><div>Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) that often leads to the development of complex perianal fistulas, significantly impairing patients' quality of life. Conventional medical and surgical treatments offer limited long-term efficacy, with high recurrence rates and associated complications. Adipose-derived stem cell therapy (ADSCT) has emerged as a promising regenerative therapy due to its anti-inflammatory and tissue-regenerative properties. However, discrepancies in clinical outcomes across studies warrant a systematic evaluation of its efficacy and safety.</div></div><div><h3>Objective</h3><div>This systematic review aims to critically assess the efficacy, safety, and recurrence rates of ADSCT for complex perianal fistulas in Crohn's disease patients, summarizing data from randomized controlled trials and observational studies.</div></div><div><h3>Methods</h3><div>This review included 19 studies published between 2009 and 2024 involving Crohn's disease patients treated with either autologous or allogeneic ADSCT. Extracted data included patient demographics, fistula characteristics, treatment protocols, and clinical outcomes such as fistula closure, partial healing, time to healing, recurrence, and adverse events. Study selection followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and is illustrated in a PRISMA flow diagram. Risk of bias was assessed using the Cochrane Risk of Bias Tool for randomized controlled trials and adapted versions of the Newcastle-Ottawa Scale (NOS) and MINORS criteria for observational studies. Studies were categorized as excellent, good, or fair based on their total quality score.</div></div><div><h3>Results</h3><div>Fistula closure rates ranged from 23.1 % to 91 %, with an overall average of 62.5 %. Partial healing rates varied widely, between 9 % and 93.3 %. Time to healing ranged from 8 to 48 weeks, with an average of 25.3 weeks. Recurrence rates were reported in over half of the studies and reached up to 38.5 %, with a mean recurrence rate of 19.2 %. The majority of adverse events were mild and transient, including local inflammation, discomfort, and minor infections. No serious (Grade 3 or 4) complications were reported. Risk of bias assessment classified one study as excellent, two as good, and two as fair in methodological quality.</div></div><div><h3>Conclusion</h3><div>Adipose-derived stem cell therapy demonstrates promising efficacy and a favorable safety profile for the treatment of complex perianal fistulas in Crohn's disease. While ADSCT may achieve meaningful clinical response and symptom relief in a substantial proportion of patients, variability in outcomes and study designs highlights the need for standardized protocols and long-term follow-up in future trials.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"29 ","pages":"Pages 22-28"},"PeriodicalIF":1.7,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-24DOI: 10.1016/j.sopen.2025.11.001
Mikhail Nozdrin MBBS , Maria Irene Bellini PhD , Maria Selyanina BSc , Maria Nozdrina BA , Kavyesh Vivek MBBS , Simona Mihalikova BSc , Vassilios Papalois MD
Aims
Donor AKI is a common reason for discarding deceased donor kidneys due to uncertainty regarding transplant outcomes. Our study investigated the effect of AKI in donor kidneys on post-transplantation outcomes.
Methods
Medline, Embase, Cochrane and Web of Science were searched. Risk of bias assessment was performed. 2984 studies were identified by the search, 34 met the inclusion criteria. A total of 103,529 kidney transplants were analysed, 97,165 (94 %) with and 6364 (6 %) without donor AKI.
Results
There was no significant difference between recipients of grafts from donors with terminal serum creatinine >2.0 mg/dl and < 2.0 mg/dl in 1 year serum creatinine (MD: -0.01, CI: −0.09-0.07, P = 0.84), 1 year patient survival (RR: 0.99, CI: 0.96–1.02, P = 0.52), as well as in 1 year (RR: 1.01, CI: 0.98–1.03, P = 0.61) and 5 year (RR: 0.99, CI: 0.94–1.04, P = 0.63) graft survival. DGF was the only parameter significantly worse in recipients of grafts from donors with terminal serum creatinine >2.0 than to non-AKI recipients (RR: 1.89, CI: 1.64–2.17, P < 0.01). In studies that compared the severity of AKI stage using the AKIN criteria, there was no significant difference in 1 year post-transplantation serum creatinine even between recipients of grafts from the most severe AKI stage (AKIN3) and the non-AKI group (AKIN0) (MD: -0.01, CI:-0.17–0.16, P = 0.92).
Conclusions
Donor AKI is associated with a higher incidence of DGF but has no effect on post-transplant patient and graft survival and, based on this analysis, should not be a sole reason for discarding kidneys.
由于移植结果的不确定性，供体肾AKI是丢弃已故供体肾脏的常见原因。我们的研究调查了供肾AKI对移植后预后的影响。方法检索medline、Embase、Cochrane和Web of Science。进行偏倚风险评估。共纳入2984项研究，34项符合纳入标准。共分析了103,529例肾移植，97,165例（94%）有肾移植，6364例（6%）无肾移植。结果终末血清肌酐为2.0 mg/dl和2.0 mg/dl的供体移植受者1年血清肌酐（MD: -0.01, CI: - 0.09-0.07, P = 0.84）、1年生存率（RR: 0.99, CI: 0.96-1.02, P = 0.52）、1年生存率（RR: 1.01, CI: 0.98-1.03, P = 0.61）和5年生存率（RR: 0.99, CI: 0.94-1.04, P = 0.63）差异均无统计学意义。在终末血清肌酐为2.0的供体移植受者中，DGF是唯一显著低于非aki受者的参数（RR: 1.89, CI: 1.64-2.17, P < 0.01）。在使用AKIN标准比较AKI分期严重程度的研究中，移植后1年的血清肌酐在最严重AKI分期（AKIN3）和非AKI组（AKIN0）之间没有显著差异（MD: -0.01, CI: -0.17-0.16, P = 0.92）。结论：供体AKI与较高的DGF发生率相关，但对移植后患者和移植物的生存没有影响，根据本分析，不应是丢弃肾脏的唯一原因。
{"title":"Impact of deceased donor acute kidney injury (AKI) on renal transplant outcomes","authors":"Mikhail Nozdrin MBBS , Maria Irene Bellini PhD , Maria Selyanina BSc , Maria Nozdrina BA , Kavyesh Vivek MBBS , Simona Mihalikova BSc , Vassilios Papalois MD","doi":"10.1016/j.sopen.2025.11.001","DOIUrl":"10.1016/j.sopen.2025.11.001","url":null,"abstract":"<div><h3>Aims</h3><div>Donor AKI is a common reason for discarding deceased donor kidneys due to uncertainty regarding transplant outcomes. Our study investigated the effect of AKI in donor kidneys on post-transplantation outcomes.</div></div><div><h3>Methods</h3><div>Medline, Embase, Cochrane and Web of Science were searched. Risk of bias assessment was performed. 2984 studies were identified by the search, 34 met the inclusion criteria. A total of 103,529 kidney transplants were analysed, 97,165 (94 %) with and 6364 (6 %) without donor AKI.</div></div><div><h3>Results</h3><div>There was no significant difference between recipients of grafts from donors with terminal serum creatinine >2.0 mg/dl and < 2.0 mg/dl in 1 year serum creatinine (MD: -0.01, CI: −0.09-0.07, <em>P</em> = 0.84), 1 year patient survival (RR: 0.99, CI: 0.96–1.02, <em>P</em> = 0.52), as well as in 1 year (RR: 1.01, CI: 0.98–1.03, <em>P</em> = 0.61) and 5 year (RR: 0.99, CI: 0.94–1.04, <em>P</em> = 0.63) graft survival. DGF was the only parameter significantly worse in recipients of grafts from donors with terminal serum creatinine >2.0 than to non-AKI recipients (RR: 1.89, CI: 1.64–2.17, <em>P</em> < 0.01). In studies that compared the severity of AKI stage using the AKIN criteria, there was no significant difference in 1 year post-transplantation serum creatinine even between recipients of grafts from the most severe AKI stage (AKIN3) and the non-AKI group (AKIN0) (MD: -0.01, CI:-0.17–0.16, <em>P</em> = 0.92).</div></div><div><h3>Conclusions</h3><div>Donor AKI is associated with a higher incidence of DGF but has no effect on post-transplant patient and graft survival and, based on this analysis, should not be a sole reason for discarding kidneys.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"29 ","pages":"Pages 7-21"},"PeriodicalIF":1.7,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-14DOI: 10.1016/j.sopen.2025.11.003
Mustafa Adnan Zaidan , Hussein Ali Tawfeeq , Ali Kamal Ghanim
Background
Ultrasound guided fine needle aspiration cytology (US-FNAC) is the gold standard of evaluation of thyroid nodule. Two main approaches are available - short axis (perpendicular) and long axis (parallel), and each has theoretical clinical advantages. Evidence comparing the diagnostic performance of the two in Middle Eastern populations is limited. Objective: To compare the sensitivity, specificity, and accuracy of US-FNAC of short-axis versus long-axis in thyroid nodules with implications for patient care.
Methods
A prospective multi-center randomized controlled trial was performed in Pioneer Private Laboratory and Mustafa Hafez Specialized Laboratory, Baghdad, Iraq from March to December 2024. A total of 196 nodules from patients ≥18 years were randomized to undergo short-axis or long-axis US-FNAC. Cytological results by the Bethesda System were correlated with histopathology. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were the primary outcomes.
Results
Of 196 nodules (mean age 47.8 ± 13.5 years; 79.6 % female), patient and nodule characteristics did not differ between groups. Long-axis US-FNAC was 73.9 % sensitive, 100 % specific, 87.0 % accurate, 100 % positive predictive and 79.3 % negative predictive. Short-axis US-FNAC showed sensitivity of 76.7 %, specificity of 100 %, accuracy of 89.2 %, positive predictive value of 100 % and negative predictive value of 83.3 %. There were no differences in accuracy of diagnosis (p = 0.524).
Conclusions
Short-axis and long-axis US-FNAC offer similar diagnostic performance of thyroid nodules in Iraqi patients. Although there were no differences in accuracy between procedures, operator experience, nodule characteristics, and patient factors could be used to choose the technique that best suited the clinical situation, which would allow for flexibility in clinical practice and potential improvements in patient comfort and procedural efficiency.
{"title":"Short-axis versus long-axis ultrasound-guided thyroid nodule biopsy: A randomized controlled trial of diagnostic performance in Iraq","authors":"Mustafa Adnan Zaidan , Hussein Ali Tawfeeq , Ali Kamal Ghanim","doi":"10.1016/j.sopen.2025.11.003","DOIUrl":"10.1016/j.sopen.2025.11.003","url":null,"abstract":"<div><h3>Background</h3><div>Ultrasound guided fine needle aspiration cytology (US-FNAC) is the gold standard of evaluation of thyroid nodule. Two main approaches are available - short axis (perpendicular) and long axis (parallel), and each has theoretical clinical advantages. Evidence comparing the diagnostic performance of the two in Middle Eastern populations is limited. Objective: To compare the sensitivity, specificity, and accuracy of US-FNAC of short-axis versus long-axis in thyroid nodules with implications for patient care.</div></div><div><h3>Methods</h3><div>A prospective multi-center randomized controlled trial was performed in Pioneer Private Laboratory and Mustafa Hafez Specialized Laboratory, Baghdad, Iraq from March to December 2024. A total of 196 nodules from patients ≥18 years were randomized to undergo short-axis or long-axis US-FNAC. Cytological results by the Bethesda System were correlated with histopathology. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were the primary outcomes.</div></div><div><h3>Results</h3><div>Of 196 nodules (mean age 47.8 ± 13.5 years; 79.6 % female), patient and nodule characteristics did not differ between groups. Long-axis US-FNAC was 73.9 % sensitive, 100 % specific, 87.0 % accurate, 100 % positive predictive and 79.3 % negative predictive. Short-axis US-FNAC showed sensitivity of 76.7 %, specificity of 100 %, accuracy of 89.2 %, positive predictive value of 100 % and negative predictive value of 83.3 %. There were no differences in accuracy of diagnosis (<em>p</em> = 0.524).</div></div><div><h3>Conclusions</h3><div>Short-axis and long-axis US-FNAC offer similar diagnostic performance of thyroid nodules in Iraqi patients. Although there were no differences in accuracy between procedures, operator experience, nodule characteristics, and patient factors could be used to choose the technique that best suited the clinical situation, which would allow for flexibility in clinical practice and potential improvements in patient comfort and procedural efficiency.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 73-79"},"PeriodicalIF":1.7,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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