Pub Date : 2025-12-01Epub Date: 2025-09-12DOI: 10.1016/j.sopen.2025.09.007
Diego Sanhueza R. MD , Cristián Jarry T. MD, MSc , Julián Varas C. MD, MSc
Objective
To describe LAPPCLINIC, an innovative web-based platform designed to enhance surgical education through remote and asynchronous feedback by video-analysis of residents' own surgical procedures.
Design
We provide a detailed description of the platform workflow, highlighting key features for enhancing surgical education.
Setting
An ongoing multicenter study involving seven surgical residency programs across Chile.
Participants
First-year surgical residents from seven different Chilean programs, with feedback provided by five surgeons, experienced in surgical education, who are beyond their learning curves in laparoscopic cholecystectomy and trained in structured quality-feedback delivery.
Conclusion
LAPPCLINIC implementation has shown strong resident acceptance and significantly higher evaluation of feedback quality compared to traditional OR-based teaching.
{"title":"HOW I DO IT: Breaking boundaries in surgical education by delivering expert feedback to residents anytime and anywhere. The LAPPCLINIC project.","authors":"Diego Sanhueza R. MD , Cristián Jarry T. MD, MSc , Julián Varas C. MD, MSc","doi":"10.1016/j.sopen.2025.09.007","DOIUrl":"10.1016/j.sopen.2025.09.007","url":null,"abstract":"<div><h3>Objective</h3><div>To describe <em>LAPPCLINIC</em>, an innovative web-based platform designed to enhance surgical education through remote and asynchronous feedback by video-analysis of residents' own surgical procedures.</div></div><div><h3>Design</h3><div>We provide a detailed description of the platform workflow, highlighting key features for enhancing surgical education.</div></div><div><h3>Setting</h3><div>An ongoing multicenter study involving seven surgical residency programs across Chile.</div></div><div><h3>Participants</h3><div>First-year surgical residents from seven different Chilean programs, with feedback provided by five surgeons, experienced in surgical education, who are beyond their learning curves in laparoscopic cholecystectomy and trained in structured quality-feedback delivery.</div></div><div><h3>Conclusion</h3><div><em>LAPPCLINIC</em> implementation has shown strong resident acceptance and significantly higher evaluation of feedback quality compared to traditional OR-based teaching.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 7-10"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108032","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 : 2025-12-01Epub Date: 2025-08-16DOI: 10.1016/j.sopen.2025.08.001
Ahmed Al-Mawsheki , Maximilian Bockhorn , Sorin Miftode , Fadl Alfarawan , Asem Al-Salemi , Catharina Fahrenkorg , Nader- El-Sourani
Background
Esophagectomy remains the cornerstone treatment for esophageal cancer but is associated with significant perioperative morbidity and mortality, even in specialized centers. Accurate preoperative risk assessment is crucial to improve patient outcomes, and various predictive models are available for risk stratification. This study aimed to validate and compare the performance of nine established predictive models in forecasting 30-day mortality following esophagectomy in a high-volume esophageal cancer center.
Methods
We retrospectively analyzed of 101 patients who underwent esophagectomy between January 2020 and December 2023 was performed. Clinicopathological characteristics and mortality data were obtained. The predictive accuracy of nine risk models, including the Esophageal-POSSUM (O-POSSUM), Charlson Comorbidity Index (Charlson), Postoperative Estimation of Risk (PER), and Fuchs scores, was assessed using logistic regression, Hosmer-Lemeshow tests for calibration, and the area under the receiver operating characteristic curve (AUC) for discrimination. Mann-Whitney U tests were used to evaluate significant differences between survivors and non-survivors.
Results
The 30-day mortality rate was 8.91 %. The O-POSSUM and Charlson scores demonstrated the highest predictive accuracy with AUCs of 0.832 and 0.806, respectively. The PER and Fuchs models also showed significant associations with mortality but with moderate predictive ability. Models such as the American Society of Anesthesiologists (ASA) and Philadelphia scores demonstrated limited predictive utility. Significant differences in predictive performance were noted across patient subgroups.
Conclusions
The O-POSSUM and Charlson scores were reliable tools for predicting 30-day mortality after esophagectomy. Other models require further validation and refinement. Tailoring risk assessment models in specific clinical settings may enhance their predictive accuracy and contribute to improved patient outcomes.
{"title":"Prediction of mortality after esophagectomy: A comprehensive analysis of various risk scores in a national esophageal center","authors":"Ahmed Al-Mawsheki , Maximilian Bockhorn , Sorin Miftode , Fadl Alfarawan , Asem Al-Salemi , Catharina Fahrenkorg , Nader- El-Sourani","doi":"10.1016/j.sopen.2025.08.001","DOIUrl":"10.1016/j.sopen.2025.08.001","url":null,"abstract":"<div><h3>Background</h3><div>Esophagectomy remains the cornerstone treatment for esophageal cancer but is associated with significant perioperative morbidity and mortality, even in specialized centers. Accurate preoperative risk assessment is crucial to improve patient outcomes, and various predictive models are available for risk stratification. This study aimed to validate and compare the performance of nine established predictive models in forecasting 30-day mortality following esophagectomy in a high-volume esophageal cancer center.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed of 101 patients who underwent esophagectomy between January 2020 and December 2023 was performed. Clinicopathological characteristics and mortality data were obtained. The predictive accuracy of nine risk models, including the Esophageal-POSSUM (O-POSSUM), Charlson Comorbidity Index (Charlson), Postoperative Estimation of Risk (PER), and Fuchs scores, was assessed using logistic regression, Hosmer-Lemeshow tests for calibration, and the area under the receiver operating characteristic curve (AUC) for discrimination. Mann-Whitney <em>U</em> tests were used to evaluate significant differences between survivors and non-survivors.</div></div><div><h3>Results</h3><div>The 30-day mortality rate was 8.91 %. The O-POSSUM and Charlson scores demonstrated the highest predictive accuracy with AUCs of 0.832 and 0.806, respectively. The PER and Fuchs models also showed significant associations with mortality but with moderate predictive ability. Models such as the American Society of Anesthesiologists (ASA) and Philadelphia scores demonstrated limited predictive utility. Significant differences in predictive performance were noted across patient subgroups.</div></div><div><h3>Conclusions</h3><div>The O-POSSUM and Charlson scores were reliable tools for predicting 30-day mortality after esophagectomy. Other models require further validation and refinement. Tailoring risk assessment models in specific clinical settings may enhance their predictive accuracy and contribute to improved patient outcomes.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 19-27"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325320","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 : 2025-12-01Epub Date: 2025-11-03DOI: 10.1016/j.sopen.2025.10.009
Xiaojiao Zhu , Jianwei Han , Chuan Long , Wenjun Cao , Suwei Xu , Yingding Ruan
Background
This study aims to assess the collective influence of inflammatory indicators and surgical interventions on the one-month postoperative recovery outcomes in patients with rib fractures.
Methods
A retrospective analysis involved 70 surgical and 278 non - surgical rib - fracture patients. Primary outcomes were thoracic complication incidence and post - discharge oral analgesic use at one month. Secondary outcomes included hospital stay length and total costs. We collected various data and conducted propensity score matching (1:2 ratio) to control for confounders, followed by multivariate analyses.
Results
After PSM (60 surgical vs. 117 non-surgical patients), surgical reduced hospital stay by 10.4 days (β = −10.36 days, 95 % confidence interval [95 % CI]: −16.03 to −4.70; P < 0.001), but increase in total costs by 30,808.80 CNY (P < 0.001). Pre-existing thoracic complications independently predicted higher one-month postoperative complications (OR[95 % CI] = 4.05 [1.08, 18.15]; P = 0.048), while comorbidities lowered risk (OR[95 %CI] = 0.29 [0.08, 0.89]; P = 0.043). Elevated systemic immune-inflammation index (SII) (Coef [95 % CI] = 528.03 [28.05, 1028.00]; P = 0.039) and neutrophil-to-lymphocyte ratio (NLR) (Coef[95 % CI] = 3.50 [0.62, 6.37]; P = 0.017) were positively correlated with Injury Severity Score (ISS). In surgical patients, a higher lymphocyte-to-monocyte ratio (LMR) independently predicted a lower likelihood of ongoing analgesic use at one month (OR[95 %CI] = 0.70 [0.46, 0.95]; P = 0.046).
Conclusion
Surgical rib - fracture stabilization shortens hospital stay but raises treatment costs. High SII and NLR, along with thoracic complications, are linked to post - op complications. LMR and HGB levels are associated with analgesic needs, which may aid in tailored pain management.
本研究旨在评估炎症指标和手术干预对肋骨骨折患者术后1个月恢复结果的总体影响。方法回顾性分析70例手术性和278例非手术性肋骨骨折患者的临床资料。主要结局是胸并发症发生率和出院后1个月口服镇痛药的使用情况。次要结局包括住院时间和总费用。我们收集了各种数据，并进行倾向得分匹配（1:2比例）以控制混杂因素，然后进行多变量分析。结果PSM术后（60例手术对117例非手术），手术使住院时间减少10.4天（β = - 10.36天，95%可信区间[95% CI]: - 16.03 ~ - 4.70; P < 0.001），但总费用增加30,808.80元（P < 0.001）。先前存在的胸部并发症独立预测较高的术后1个月并发症（OR[95% CI] = 4.05 [1.08, 18.15]; P = 0.048），而合并症降低风险（OR[95% CI] = 0.29 [0.08, 0.89]; P = 0.043）。全身免疫炎症指数（SII） （Coef[95% CI] = 528.03 [28.05, 1028.00]; P = 0.039）和中性粒细胞/淋巴细胞比值（NLR） （Coef[95% CI] = 3.50 [0.62, 6.37]; P = 0.017）升高与损伤严重程度评分（ISS）呈正相关。在手术患者中，较高的淋巴细胞/单核细胞比率（LMR）独立预测一个月后继续使用止痛药的可能性较低（OR[95% CI] = 0.70 [0.46, 0.95]; P = 0.046）。结论肋骨骨折手术稳定缩短了住院时间，但增加了治疗费用。高SII和NLR以及胸部并发症与术后并发症有关。LMR和HGB水平与镇痛需求有关，这可能有助于定制疼痛管理。
{"title":"Impact of inflammatory biomarkers and surgical interventions on one-month recovery after rib fractures: A propensity-matched cohort study","authors":"Xiaojiao Zhu , Jianwei Han , Chuan Long , Wenjun Cao , Suwei Xu , Yingding Ruan","doi":"10.1016/j.sopen.2025.10.009","DOIUrl":"10.1016/j.sopen.2025.10.009","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to assess the collective influence of inflammatory indicators and surgical interventions on the one-month postoperative recovery outcomes in patients with rib fractures.</div></div><div><h3>Methods</h3><div>A retrospective analysis involved 70 surgical and 278 non - surgical rib - fracture patients. Primary outcomes were thoracic complication incidence and post - discharge oral analgesic use at one month. Secondary outcomes included hospital stay length and total costs. We collected various data and conducted propensity score matching (1:2 ratio) to control for confounders, followed by multivariate analyses.</div></div><div><h3>Results</h3><div>After PSM (60 surgical vs. 117 non-surgical patients), surgical reduced hospital stay by 10.4 days (β = −10.36 days, 95 % confidence interval [95 % CI]: −16.03 to −4.70; <em>P</em> < 0.001), but increase in total costs by 30,808.80 CNY (P < 0.001). Pre-existing thoracic complications independently predicted higher one-month postoperative complications (OR[95 % CI] = 4.05 [1.08, 18.15]; <em>P</em> = 0.048), while comorbidities lowered risk (OR[95 %CI] = 0.29 [0.08, 0.89]; <em>P</em> = 0.043). Elevated systemic immune-inflammation index (SII) (Coef [95 % CI] = 528.03 [28.05, 1028.00]; <em>P</em> = 0.039) and neutrophil-to-lymphocyte ratio (NLR) (Coef[95 % CI] = 3.50 [0.62, 6.37]; <em>P</em> = 0.017) were positively correlated with Injury Severity Score (ISS). In surgical patients, a higher lymphocyte-to-monocyte ratio (LMR) independently predicted a lower likelihood of ongoing analgesic use at one month (OR[95 %CI] = 0.70 [0.46, 0.95]; <em>P</em> = 0.046).</div></div><div><h3>Conclusion</h3><div>Surgical rib - fracture stabilization shortens hospital stay but raises treatment costs. High SII and NLR, along with thoracic complications, are linked to post - op complications. LMR and HGB levels are associated with analgesic needs, which may aid in tailored pain management.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 49-62"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466284","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 : 2025-12-01Epub Date: 2025-10-23DOI: 10.1016/j.sopen.2025.10.006
Troy N. Coaston MSCR , Amulya Vadlakonda MD , Esteban Aguayo MD , Zihan Gao MHSc , Syed Shaheer Ali , Oh Jin Kwon MD , Peyman Benharash MD
Background
Gastrointestinal complications (GIC) are an uncommon but serious sequelae of type B aortic dissection (TBAD), potentially contributing to increased mortality and healthcare resource utilization. Limited studies have characterized these complications among TBAD patients. The present work sought to evaluate the clinical and financial implications of GIC and identifies factors associated with their development.
Methods
All hospitalizations entailing a primary diagnosis of TBAD were identified in the 2016–2020 Nationwide Readmissions Database. Patients were stratified into those who developed GIC and those who did not. Outcomes included in-hospital mortality, length of stay (LOS), hospitalization costs, and the need for abdominal surgery. Multivariable logistic and linear regressions were employed to assess associations between patient, facility, and treatment factors with clinical and financial outcomes.
Results
Of 24,927 TBAD hospitalizations, 2.5 % developed GIC, and 24.0 % of these cases required an abdominal procedure. Patients with GIC were younger (median 61 vs. 67 years; p < 0.001), more commonly male (67.4 vs. 56.6 %; p < 0.001), and more likely to have Medicaid insurance (20.9 vs. 12.5 %; p < 0.001). GIC were independently associated with increased odds of in-hospital mortality (adjusted odds ratio 4.54; 95 % CI 3.41–6.04), greater LOS (β 5.80 days; 95 % CI 3.88–7.72), and increased costs (β $41,000; 95 % CI $31000–51,000).
Conclusions
GIC in TBAD patients was associated with substantial clinical and financial burdens. Further study of early identification and targeted interventions is warranted to mitigate these complications and optimize resource utilization in this high-risk population.
背景：胃肠道并发症（GIC）是B型主动脉夹层（TBAD）的一种罕见但严重的后遗症，可能导致死亡率和医疗资源利用率的增加。有限的研究描述了TBAD患者的这些并发症。目前的工作旨在评估GIC的临床和财务影响，并确定与其发展相关的因素。方法在2016-2020年全国再入院数据库中确定所有初步诊断为TBAD的住院病例。患者被分为有GIC的和没有GIC的两组。结果包括住院死亡率、住院时间（LOS）、住院费用和腹部手术的需要。采用多变量逻辑回归和线性回归来评估患者、设施和治疗因素与临床和财务结果之间的关系。结果在24,927例TBAD住院患者中，2.5%发展为GIC，其中24.0%需要腹部手术。GIC患者更年轻（中位年龄61岁vs. 67岁；p < 0.001），更常见的是男性（67.4% vs. 56.6%; p < 0.001），更有可能拥有医疗补助保险（20.9% vs. 12.5%; p < 0.001）。GIC与住院死亡率增加的几率（校正优势比4.54;95% CI 3.41-6.04）、更大的LOS （β 5.80天；95% CI 3.88-7.72）和成本增加（β 41,000美元；95% CI 31,000 - 51,000美元）独立相关。结论TBAD患者的gic与巨大的临床和经济负担相关。有必要进一步研究早期识别和有针对性的干预措施，以减轻这些并发症，并优化这一高危人群的资源利用。
{"title":"Clinical and financial outcomes associated with gastrointestinal complications among patients with type B aortic dissection","authors":"Troy N. Coaston MSCR , Amulya Vadlakonda MD , Esteban Aguayo MD , Zihan Gao MHSc , Syed Shaheer Ali , Oh Jin Kwon MD , Peyman Benharash MD","doi":"10.1016/j.sopen.2025.10.006","DOIUrl":"10.1016/j.sopen.2025.10.006","url":null,"abstract":"<div><h3>Background</h3><div>Gastrointestinal complications (GIC) are an uncommon but serious sequelae of type B aortic dissection (TBAD), potentially contributing to increased mortality and healthcare resource utilization. Limited studies have characterized these complications among TBAD patients. The present work sought to evaluate the clinical and financial implications of GIC and identifies factors associated with their development.</div></div><div><h3>Methods</h3><div>All hospitalizations entailing a primary diagnosis of TBAD were identified in the 2016–2020 Nationwide Readmissions Database. Patients were stratified into those who developed GIC and those who did not. Outcomes included in-hospital mortality, length of stay (LOS), hospitalization costs, and the need for abdominal surgery. Multivariable logistic and linear regressions were employed to assess associations between patient, facility, and treatment factors with clinical and financial outcomes.</div></div><div><h3>Results</h3><div>Of 24,927 TBAD hospitalizations, 2.5 % developed GIC, and 24.0 % of these cases required an abdominal procedure. Patients with GIC were younger (median 61 vs. 67 years; <em>p</em> < 0.001), more commonly male (67.4 vs. 56.6 %; p < 0.001), and more likely to have Medicaid insurance (20.9 vs. 12.5 %; p < 0.001). GIC were independently associated with increased odds of in-hospital mortality (adjusted odds ratio 4.54; 95 % CI 3.41–6.04), greater LOS (β 5.80 days; 95 % CI 3.88–7.72), and increased costs (β $41,000; 95 % CI $31000–51,000).</div></div><div><h3>Conclusions</h3><div>GIC in TBAD patients was associated with substantial clinical and financial burdens. Further study of early identification and targeted interventions is warranted to mitigate these complications and optimize resource utilization in this high-risk population.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 43-48"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466282","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 : 2025-12-01Epub Date: 2025-09-08DOI: 10.1016/j.sopen.2025.09.004
Arjun Chaturvedi , Esteban Aguayo , Oh. Jin Kwon , Kevin Tabibian , Barzin Badiee , Saad Mallick , Daniel Tabibian , Peyman Benharash
Background
Despite growing use of minimally invasive surgery (MIS) for hepatocellular carcinoma (HCC), contemporary national data contrasting MIS with open hepatectomy are sparse.
Methods
Adults (≥18 y) undergoing hepatectomy for HCC in the American College of Surgeons National Surgical Quality Improvement Program (2015–2022) were studied. MIS (laparoscopic or robotic) resections were compared with open operations. Entropy balancing harmonized covariates, and multivariable logistic or linear models produced adjusted odds ratios (AOR) for major adverse events (MAE; composite of mortality and serious complications), liver-specific complications, and 30-day readmission.
Results
Among 5832 hepatectomies, 27.0 % were MIS, rising from 18.8 % in 2015 to 36.1 % in 2022 (p < 0.001). After adjustment, MIS was associated with markedly lower odds of MAE (AOR 0.36, 95 % CI 0.29–0.46), postoperative liver failure (AOR 0.34, 0.20–0.58), bile leak (AOR 0.49, 0.28–0.89), need for invasive intervention (AOR 0.29, 0.18–0.47), and 30-day readmission (AOR 0.61, 0.44–0.86). In the subset undergoing major resections, MIS retained protective associations for MAE (AOR 0.26, 0.15–0.46) and readmission (AOR 0.28, 0.11–0.80).
Conclusions
In a large, contemporary U.S. cohort, MIS hepatectomy was independently associated with fewer perioperative complications, liver-specific adverse events, and readmissions compared with open surgery—even for major resections. These findings support continued expansion of minimally invasive hepatectomy and targeted training to extend its benefits to appropriately selected patients with resectable HCC.
{"title":"Association of operative approach with adverse events following hepatic resections","authors":"Arjun Chaturvedi , Esteban Aguayo , Oh. Jin Kwon , Kevin Tabibian , Barzin Badiee , Saad Mallick , Daniel Tabibian , Peyman Benharash","doi":"10.1016/j.sopen.2025.09.004","DOIUrl":"10.1016/j.sopen.2025.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Despite growing use of minimally invasive surgery (MIS) for hepatocellular carcinoma (HCC), contemporary national data contrasting MIS with open hepatectomy are sparse.</div></div><div><h3>Methods</h3><div>Adults (≥18 y) undergoing hepatectomy for HCC in the American College of Surgeons National Surgical Quality Improvement Program (2015–2022) were studied. MIS (laparoscopic or robotic) resections were compared with open operations. Entropy balancing harmonized covariates, and multivariable logistic or linear models produced adjusted odds ratios (AOR) for major adverse events (MAE; composite of mortality and serious complications), liver-specific complications, and 30-day readmission.</div></div><div><h3>Results</h3><div>Among 5832 hepatectomies, 27.0 % were MIS, rising from 18.8 % in 2015 to 36.1 % in 2022 (<em>p</em> < 0.001). After adjustment, MIS was associated with markedly lower odds of MAE (AOR 0.36, 95 % CI 0.29–0.46), postoperative liver failure (AOR 0.34, 0.20–0.58), bile leak (AOR 0.49, 0.28–0.89), need for invasive intervention (AOR 0.29, 0.18–0.47), and 30-day readmission (AOR 0.61, 0.44–0.86). In the subset undergoing major resections, MIS retained protective associations for MAE (AOR 0.26, 0.15–0.46) and readmission (AOR 0.28, 0.11–0.80).</div></div><div><h3>Conclusions</h3><div>In a large, contemporary U.S. cohort, MIS hepatectomy was independently associated with fewer perioperative complications, liver-specific adverse events, and readmissions compared with open surgery—even for major resections. These findings support continued expansion of minimally invasive hepatectomy and targeted training to extend its benefits to appropriately selected patients with resectable HCC.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 1-6"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050534","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 : 2025-12-01Epub Date: 2025-11-29DOI: 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 : 2025-12-01Epub Date: 2025-10-30DOI: 10.1016/j.sopen.2025.10.007
Victor M. Zaydfudim
{"title":"Health-related quality of life after HPB surgery","authors":"Victor M. Zaydfudim","doi":"10.1016/j.sopen.2025.10.007","DOIUrl":"10.1016/j.sopen.2025.10.007","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 63-64"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466283","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 : 2025-12-01Epub Date: 2025-09-17DOI: 10.1016/j.sopen.2025.09.008
Troy N. Coaston MSCR , Konmal Ali BS , Amulya Vadlakonda MD , Deep J. Mehta , Sara Sakowitz MD, MPH , Dariush Yalzadeh BS , Areti Tillou MD , Peyman Benharash MD , on behalf of the Academic Trauma Research Consortium (ATRIUM)
Background
Malnutrition is an often underrecognized condition among older adults and carries significant relevance among patients hospitalized with traumatic injuries. The present study aimed to evaluate the association of malnutrition with clinical and financial outcomes among older adult patients admitted with external trauma.
Study design
This was a retrospective cohort study of the 2016–2021 National Inpatient Sample including older adults (≥65 years) hospitalized with traumatic injuries. Patients were stratified by nutritional status (Malnourished and Non-Malnourished). Risk-adjusted logistic and linear regression models were constructed to evaluate the association of malnutrition with outcomes including inpatient mortality, clinical complications, and hospitalization costs.
Results
Of 6,587,907 older adults admitted with traumatic injuries, 7.5 % had malnutrition. The prevalence of malnutrition rose from 5.8 % to 8.6 % over the study period (nptrend<0.001). Patients with malnutrition were more commonly of the lowest income quartile (25.5 vs 24.5 %), non-White (19.4 vs 16.9 %), and male (41.3 vs 39.1 %, all p < 0.001). Following risk-adjustment, malnutrition was linked with increased odds of inpatient mortality (Adjusted Odds Ratio [AOR] 1.92, 95 % Confidence Interval [CI] 1.86–1.98) and infectious complications (AOR 2.30, 95 % CI 2.25–2.35) as well as greater inpatient costs (β + $7400, 95 % CI $7100-7600).
Conclusion
Malnutrition among older adults is associated with poorer clinical outcomes and increased financial burden. Rising prevalence and significant disparities underscore the need for increased screening and culturally relevant nutritional interventions to promote quality, equity, and sustainability in trauma care.
背景：营养不良在老年人中是一种常被忽视的疾病，在创伤性损伤住院患者中具有重要的相关性。本研究旨在评估老年外伤患者营养不良与临床和财务结果的关系。这是一项2016-2021年全国住院患者样本的回顾性队列研究，包括因创伤性损伤住院的老年人（≥65岁）。根据营养状况（营养不良和非营养不良）对患者进行分层。构建风险校正logistic和线性回归模型来评估营养不良与住院死亡率、临床并发症和住院费用等结果的关系。结果6587907例老年人外伤住院患者中，营养不良占7.5%。在研究期间，营养不良发生率从5.8%上升到8.6% （nptrend<0.001）。营养不良的患者更常见于最低收入四分位数（25.5%对24.5%）、非白人（19.4%对16.9%）和男性（41.3%对39.1%，均p <； 0.001）。风险调整后，营养不良与住院死亡率增加（调整优势比[AOR] 1.92, 95%可信区间[CI] 1.86-1.98）和感染并发症（AOR 2.30, 95% CI 2.25-2.35）以及住院费用增加（β + $7400, 95% CI $7100-7600）有关。结论老年人营养不良与临床预后差、经济负担增加有关。不断上升的患病率和显著的差异强调需要增加筛查和与文化相关的营养干预措施，以促进创伤护理的质量、公平性和可持续性。
{"title":"The association of malnutrition with clinical and financial outcomes of traumatic injuries in older adults: A national retrospective analysis","authors":"Troy N. Coaston MSCR , Konmal Ali BS , Amulya Vadlakonda MD , Deep J. Mehta , Sara Sakowitz MD, MPH , Dariush Yalzadeh BS , Areti Tillou MD , Peyman Benharash MD , on behalf of the Academic Trauma Research Consortium (ATRIUM)","doi":"10.1016/j.sopen.2025.09.008","DOIUrl":"10.1016/j.sopen.2025.09.008","url":null,"abstract":"<div><h3>Background</h3><div>Malnutrition is an often underrecognized condition among older adults and carries significant relevance among patients hospitalized with traumatic injuries. The present study aimed to evaluate the association of malnutrition with clinical and financial outcomes among older adult patients admitted with external trauma.</div></div><div><h3>Study design</h3><div>This was a retrospective cohort study of the 2016–2021 National Inpatient Sample including older adults (≥65 years) hospitalized with traumatic injuries. Patients were stratified by nutritional status (<em>Malnourished</em> and <em>Non-Malnourished</em>). Risk-adjusted logistic and linear regression models were constructed to evaluate the association of malnutrition with outcomes including inpatient mortality, clinical complications, and hospitalization costs.</div></div><div><h3>Results</h3><div>Of 6,587,907 older adults admitted with traumatic injuries, 7.5 % had malnutrition. The prevalence of malnutrition rose from 5.8 % to 8.6 % over the study period (nptrend<0.001). Patients with malnutrition were more commonly of the lowest income quartile (25.5 vs 24.5 %), non-White (19.4 vs 16.9 %), and male (41.3 vs 39.1 %, all <em>p</em> < 0.001). Following risk-adjustment, malnutrition was linked with increased odds of inpatient mortality (Adjusted Odds Ratio [AOR] 1.92, 95 % Confidence Interval [CI] 1.86–1.98) and infectious complications (AOR 2.30, 95 % CI 2.25–2.35) as well as greater inpatient costs (β + $7400, 95 % CI $7100-7600).</div></div><div><h3>Conclusion</h3><div>Malnutrition among older adults is associated with poorer clinical outcomes and increased financial burden. Rising prevalence and significant disparities underscore the need for increased screening and culturally relevant nutritional interventions to promote quality, equity, and sustainability in trauma care.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 13-18"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108033","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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