Pub Date : 2025-09-01DOI: 10.1016/j.sopen.2025.08.004
Gizem Bilgili , Sara Sakowitz , Konmal Ali , Dariush Yalzadeh , Barzin Badiee , Melissa Justo , Mediget Teshome , Edward Nahabet , Peyman Benharash
Background
Frailty has been recognized as an independent risk factor for adverse postoperative outcomes. Coding based frailty instruments such as the Modified Frailty Index (mFI-5) are increasingly incorporated into risk models to provide better prediction of mortality, and complications. However, few have examined the large-scale utility of mFI-5 in the context of mastectomy and breast reconstruction.
Methods
All elective adult (≥ 18 years) hospitalizations in women for mastectomy, with and without immediate breast reconstruction (IBR) were identified in the 2016–2022 National Inpatient Sample. Patients with an mFI-5 score ≥ 2 were considered Frail. Multivariable regression models were constructed to evaluate the association of frailty with major complications, length of stay (LOS) and inpatient costs.
Results
Of an estimated 150,215 patients, 14 % were considered Frail. The proportion of frail patients was increased from 13 % to 16 % during the study period. Relative to others, Frail had a greater mean Elixhauser Index (4.49 ± 1.51 vs 1.89 ± 1.29, P < 0.001), was more commonly of Black race (23.7 vs 11.8 %, P < 0.001) and of the lowest income quartile (29.8 vs 17.1 %, P < 0.001).
Following comprehensive risk adjustment, frailty was associated with increased odds of infectious (AOR 2.36, CI 1.35–4.13), respiratory (AOR 2.05, CI 1.44–2.92), and renal (AOR 5.62, CI 4.16–7.60) complications. Moreover, frailty was associated with greater length of stay, but no difference in hospitalization costs.
Conclusions
Frailty remains associated with greater postoperative complications and length of stay. Status of frailty as ascertained by the mFI-5 may be useful in stratifying patient risk among those receiving mastectomy.
背景：虚弱已被认为是术后不良结果的独立危险因素。基于编码的脆弱性工具，如修正脆弱性指数（mFI-5）越来越多地被纳入风险模型，以更好地预测死亡率和并发症。然而，很少有人研究mFI-5在乳房切除术和乳房重建中的大规模应用。方法在2016-2022年全国住院患者样本中确定所有选择性成年（≥18岁）住院的女性乳房切除术，伴或不伴立即乳房重建（IBR）。mFI-5评分≥2的患者被认为虚弱。我们构建了多变量回归模型来评估虚弱与主要并发症、住院时间（LOS）和住院费用的关系。结果在150,215名患者中，14%被认为虚弱。在研究期间，体弱患者的比例从13%增加到16%。相对于其他人，体弱者的平均Elixhauser指数更高（4.49±1.51 vs 1.89±1.29,P < 0.001），更常见于黑人（23.7 vs 11.8%, P < 0.001）和最低收入四分位数（29.8 vs 17.1%, P < 0.001）。综合风险调整后，虚弱与感染（AOR 2.36, CI 1.35-4.13）、呼吸（AOR 2.05, CI 1.44-2.92）和肾脏（AOR 5.62, CI 4.16-7.60）并发症的发生率增加相关。此外，虚弱与更长的住院时间有关，但住院费用没有差异。结论虚弱仍与术后并发症和住院时间有关。由mFI-5确定的虚弱状态可能有助于对接受乳房切除术的患者进行风险分层。
{"title":"Association of frailty with perioperative outcomes after mastectomy with and without immediate breast reconstruction","authors":"Gizem Bilgili , Sara Sakowitz , Konmal Ali , Dariush Yalzadeh , Barzin Badiee , Melissa Justo , Mediget Teshome , Edward Nahabet , Peyman Benharash","doi":"10.1016/j.sopen.2025.08.004","DOIUrl":"10.1016/j.sopen.2025.08.004","url":null,"abstract":"<div><h3>Background</h3><div>Frailty has been recognized as an independent risk factor for adverse postoperative outcomes. Coding based frailty instruments such as the Modified Frailty Index (mFI-5) are increasingly incorporated into risk models to provide better prediction of mortality, and complications. However, few have examined the large-scale utility of mFI-5 in the context of mastectomy and breast reconstruction.</div></div><div><h3>Methods</h3><div>All elective adult (≥ 18 years) hospitalizations in women for mastectomy, with and without immediate breast reconstruction (IBR) were identified in the 2016–2022 National Inpatient Sample. Patients with an mFI-5 score ≥ 2 were considered Frail. Multivariable regression models were constructed to evaluate the association of frailty with major complications, length of stay (LOS) and inpatient costs.</div></div><div><h3>Results</h3><div>Of an estimated 150,215 patients, 14 % were considered <em>Frail</em>. The proportion of frail patients was increased from 13 % to 16 % during the study period. Relative to others, <em>Frail</em> had a greater mean Elixhauser Index (4.49 ± 1.51 vs 1.89 ± 1.29, <em>P</em> < 0.001), was more commonly of Black race (23.7 vs 11.8 %, P < 0.001) and of the lowest income quartile (29.8 vs 17.1 %, P < 0.001).</div><div>Following comprehensive risk adjustment, frailty was associated with increased odds of infectious (AOR 2.36, CI 1.35–4.13), respiratory (AOR 2.05, CI 1.44–2.92), and renal (AOR 5.62, CI 4.16–7.60) complications. Moreover, frailty was associated with greater length of stay, but no difference in hospitalization costs.</div></div><div><h3>Conclusions</h3><div>Frailty remains associated with greater postoperative complications and length of stay. Status of frailty as ascertained by the mFI-5 may be useful in stratifying patient risk among those receiving mastectomy.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 136-143"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145026353","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}
To evaluate the efficacy and safety of timely staged hepatectomy (SH) following transarterial embolization (TAE) versus emergency hepatectomy (EH) for spontaneous rupture of hepatocellular carcinoma (SR-HCC).
Methods
Between January 2018 and December 2023, 109 patients with SR-HCC were admitted to our center receive SH (34 cases) or EH (75 cases). Performing 1:1 optimal matching propensity score matching (PSM) analysis, resulting in 34 patients in SH group and 34 patients in EH group. We compared perioperative data, peritoneal metastasis rates, recurrence rates, complication rates, and long-term survival outcome between the two matched groups.
Results
After PSM, baseline characteristics were well balanced between the SH and EH groups (standardized mean difference [SMD] < 0.1). Compared with the matched EH group, the SH group had a shorter intraoperative hepatic vascular clamping time, significantly less perioperative blood loss and transfusion volume, and a lower in-hospital mortality rate (P < 0.05). No significant differences were observed between the two groups in postoperative complication rates and peritoneal metastasis rates (P > 0.05). The SH group exhibited a trend toward improved recurrence-free survival (RFS) (Log-rank χ2 = 3.2, P = 0.074), although this did not reach statistical significance. Similarly, overall survival (OS) was comparable between the groups (Log-rank χ2 = 1.78, P = 0.183).
Conclusion
Compared with EH, SH demonstrates superior perioperative safety, characterized by less surgical trauma and lower in-hospital mortality, without increasing postoperative complications and the risk of peritoneal metastasis. Therefore, SH may be considered the preferred treatment for SR-HCC, especially in cases of hemodynamic instability or impaired hepatic functional reserve.
目的评价经动脉栓塞（TAE）后及时分期肝切除术（SH）与急诊肝切除术（EH）治疗自发性肝癌（SR-HCC）的疗效和安全性。方法2018年1月至2023年12月，109例SR-HCC患者接受SH（34例）或EH（75例）治疗。进行1:1最优匹配倾向评分匹配（PSM）分析，SH组34例，EH组34例。我们比较了两组患者的围手术期数据、腹膜转移率、复发率、并发症发生率和长期生存结果。结果经PSM后，SH组和EH组的基线特征平衡良好（标准化平均差[SMD] <； 0.1）。与匹配的EH组相比，SH组术中肝血管夹持时间更短，围术期出血量和输血量明显减少，住院死亡率更低（P < 0.05）。两组术后并发症发生率及腹膜转移率比较差异无统计学意义（P > 0.05）。SH组无复发生存率（RFS）有改善趋势（Log-rank χ2 = 3.2, P = 0.074），但差异无统计学意义。同样，两组间总生存期（OS）具有可比性（Log-rank χ2 = 1.78, P = 0.183）。结论与EH相比，SH具有更强的围手术期安全性，手术创伤小，住院死亡率低，术后并发症和腹膜转移风险无增加。因此，SH可能被认为是SR-HCC的首选治疗方法，特别是在血流动力学不稳定或肝功能储备受损的情况下。
{"title":"Timely staged hepatectomy following transarterial embolization versus emergency hepatectomy for spontaneous hepatocellular carcinoma rupture","authors":"Shuai Liu, Xiangyao Kong, Yuanchuan Gong, Zetao Wu, Luoluo Wang, Yi Ruan, Xinhua Zhou","doi":"10.1016/j.sopen.2025.09.001","DOIUrl":"10.1016/j.sopen.2025.09.001","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the efficacy and safety of timely staged hepatectomy (SH) following transarterial embolization (TAE) versus emergency hepatectomy (EH) for spontaneous rupture of hepatocellular carcinoma (SR-HCC).</div></div><div><h3>Methods</h3><div>Between January 2018 and December 2023, 109 patients with SR-HCC were admitted to our center receive SH (34 cases) or EH (75 cases). Performing 1:1 optimal matching propensity score matching (PSM) analysis, resulting in 34 patients in SH group and 34 patients in EH group. We compared perioperative data, peritoneal metastasis rates, recurrence rates, complication rates, and long-term survival outcome between the two matched groups.</div></div><div><h3>Results</h3><div>After PSM, baseline characteristics were well balanced between the SH and EH groups (standardized mean difference [SMD] < 0.1). Compared with the matched EH group, the SH group had a shorter intraoperative hepatic vascular clamping time, significantly less perioperative blood loss and transfusion volume, and a lower in-hospital mortality rate (<em>P</em> < 0.05). No significant differences were observed between the two groups in postoperative complication rates and peritoneal metastasis rates (<em>P</em> > 0.05). The SH group exhibited a trend toward improved recurrence-free survival (RFS) (Log-rank χ2 = 3.2, <em>P</em> = 0.074), although this did not reach statistical significance. Similarly, overall survival (OS) was comparable between the groups (Log-rank χ2 = 1.78, <em>P</em> = 0.183).</div></div><div><h3>Conclusion</h3><div>Compared with EH, SH demonstrates superior perioperative safety, characterized by less surgical trauma and lower in-hospital mortality, without increasing postoperative complications and the risk of peritoneal metastasis. Therefore, SH may be considered the preferred treatment for SR-HCC, especially in cases of hemodynamic instability or impaired hepatic functional reserve.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 159-165"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048744","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}
Peptic ulcer disease continues to be a major health concern. Surgical intervention is usually reserved for complications, such as pyloric stenosis, leading to gastric outlet obstruction. We compared the outcomes of laparoscopic and open surgery.
Materials and methods
This is a retrospective study comparing Laparoscopic Truncal vagotomy and Gastrojejunostomy with open procedure. We examined the medical records of 151 patients treated for peptic pyloric stenosis at La Rabta Hospital in Tunis, Tunisia, from January 2000 to December 2018. The study focused on benign gastric outlet obstruction due to peptic ulcer disease, with patient progress monitored for over 24 months.
Results
A hundred and fifty-one patients treated for peptic ulcer stenosis by gastojejunostomy and truncal vagotomy were included in the study, featuring 52 cases of LTVGJ 99 cases ofOTVGJ. The male-to-female ratio was 5.2, with a mean age of 48 years for both groups. Perioperative outcomes revealed that OTVGJ had a shorter mean operative time (95 min) compared to LTVGJ (115 min), while the median hospital stay was longer for OTVGJ (7.9 days) versus LTVGJ (5.5 days). Both groups exhibited similar rates of delayed gastric emptying and postoperative gastrointestinal symptoms, with no cases of leakage or operative mortality. Diabetes was the only significant risk factor for delayed gastric emptying.
Conclusion
Laparoscopic truncal vagotomy and gastrojejunostomy for gastric outlet obstruction secondary to peptic ulcer disease is a safe and effective modality, offers low morbidity and satisfactory clinical status on long term follow up.
{"title":"Laparoscopy versus open surgery in truncal vagotomy with gastrojejunostomy for peptic pyloric stenosis: a retrospective study of 151 patients","authors":"Souhaib Atri , Mahdi Hammami , Amine Sebai , Ahmed ben Mahmoud , Nadia Rabhi , Dhouha Cherif , Houcine Maghrebi , Amine Makni , Anis Haddad , Montassar Kacem","doi":"10.1016/j.sopen.2025.08.003","DOIUrl":"10.1016/j.sopen.2025.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Peptic ulcer disease continues to be a major health concern. Surgical intervention is usually reserved for complications, such as pyloric stenosis, leading to gastric outlet obstruction. We compared the outcomes of laparoscopic and open surgery.</div></div><div><h3>Materials and methods</h3><div>This is a retrospective study comparing Laparoscopic Truncal vagotomy and Gastrojejunostomy with open procedure. We examined the medical records of 151 patients treated for peptic pyloric stenosis at La Rabta Hospital in Tunis, Tunisia, from January 2000 to December 2018. The study focused on benign gastric outlet obstruction due to peptic ulcer disease, with patient progress monitored for over 24 months.</div></div><div><h3>Results</h3><div>A hundred and fifty-one patients treated for peptic ulcer stenosis by gastojejunostomy and truncal vagotomy were included in the study, featuring 52 cases of LTVGJ 99 cases ofOTVGJ. The male-to-female ratio was 5.2, with a mean age of 48 years for both groups. Perioperative outcomes revealed that OTVGJ had a shorter mean operative time (95 min) compared to LTVGJ (115 min), while the median hospital stay was longer for OTVGJ (7.9 days) versus LTVGJ (5.5 days). Both groups exhibited similar rates of delayed gastric emptying and postoperative gastrointestinal symptoms, with no cases of leakage or operative mortality. Diabetes was the only significant risk factor for delayed gastric emptying.</div></div><div><h3>Conclusion</h3><div>Laparoscopic truncal vagotomy and gastrojejunostomy for gastric outlet obstruction secondary to peptic ulcer disease is a safe and effective modality, offers low morbidity and satisfactory clinical status on long term follow up.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 166-170"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048745","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 : 2025-09-01DOI: 10.1016/j.sopen.2025.06.010
Hinpetch Daungsupawong , Viroj Wiwanitkit
{"title":"Dall-E in hand surgery: Exploring the utility of ChatGPT image generation: Correspondence","authors":"Hinpetch Daungsupawong , Viroj Wiwanitkit","doi":"10.1016/j.sopen.2025.06.010","DOIUrl":"10.1016/j.sopen.2025.06.010","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Page 185"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145094742","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}
Diversity and inclusion are increasingly recognized as critical components of effective surgical practice and team dynamics. Despite growing awareness, structural barriers continue to limit the entry and advancement of individuals from underrepresented groups in surgery. At the annual meeting of the Dutch Surgical Society in 2025, a dedicated symposium on diversity and inclusion was organized to explore the relevance, urgency, and potential impact of these topics in surgery. Drawing from lived experience, research evidence, and a multidisciplinary panel discussion, this event underscored the necessity of shifting from performative diversity toward meaningful inclusion. Key insights from the symposium and actionable strategies to foster sustainable change within surgical education and practice are discussed in this paper. Future directions would include concrete policy development by the Dutch Surgical Society to achieve sustainable change, incorporating these topics in national education programs and development of structured mentorship networks and facilitating a continuous open dialogue.
{"title":"Exploring diversity and inclusion in surgery: Insights from the 2025 Dutch Surgical Society Symposium","authors":"Begüm Pekbay MD , Hajar Rotbi MSc , Michael El Boghdady MBChB, MD, MCh, MRCS, MHPE, MFSTEd, PFCAPHE, FHEA , Joanna W.A.M. Bosmans MD, PhD , Joris J. Blok MD, PhD, FEBVS","doi":"10.1016/j.sopen.2025.08.002","DOIUrl":"10.1016/j.sopen.2025.08.002","url":null,"abstract":"<div><div>Diversity and inclusion are increasingly recognized as critical components of effective surgical practice and team dynamics. Despite growing awareness, structural barriers continue to limit the entry and advancement of individuals from underrepresented groups in surgery. At the annual meeting of the Dutch Surgical Society in 2025, a dedicated symposium on diversity and inclusion was organized to explore the relevance, urgency, and potential impact of these topics in surgery. Drawing from lived experience, research evidence, and a multidisciplinary panel discussion, this event underscored the necessity of shifting from performative diversity toward meaningful inclusion. Key insights from the symposium and actionable strategies to foster sustainable change within surgical education and practice are discussed in this paper. Future directions would include concrete policy development by the Dutch Surgical Society to achieve sustainable change, incorporating these topics in national education programs and development of structured mentorship networks and facilitating a continuous open dialogue.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 133-135"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144931679","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}
Reconstruction of the digestive tract after extended left colectomy is a common challenge for colorectal surgeons. The main difficulty lies in lowering the colon into the pelvis to achieve a tension-free and well-vascularized anastomosis. We report our 10-year retrospective experience, in which a counterclockwise colonic transposition according to Lillehei and Wangensteen was performed in more than half of the cases. This technique differs from the more widely known Deloyers procedure solely by its axis of rotation. It offers the advantage of being more anatomical, easily reproducible, and functionally equivalent.
{"title":"Counterclockwise colonic transposition after left extended colectomy: an efficient and reproducible alternative to the Deloyers procedure","authors":"Margot Potor , Marie-Céline Schraepen , Julien Lemaire","doi":"10.1016/j.sopen.2025.09.002","DOIUrl":"10.1016/j.sopen.2025.09.002","url":null,"abstract":"<div><div>Reconstruction of the digestive tract after extended left colectomy is a common challenge for colorectal surgeons. The main difficulty lies in lowering the colon into the pelvis to achieve a tension-free and well-vascularized anastomosis. We report our 10-year retrospective experience, in which a counterclockwise colonic transposition according to Lillehei and Wangensteen was performed in more than half of the cases. This technique differs from the more widely known Deloyers procedure solely by its axis of rotation. It offers the advantage of being more anatomical, easily reproducible, and functionally equivalent.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 179-183"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059974","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 : 2025-08-16DOI: 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":"2025-08-16","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 : 2025-08-08DOI: 10.1016/j.sopen.2025.07.003
Miles J. Gibbons , Saad Mallick , Troy Coaston , Nguyen Le , Syed Shaheer Ali , Arjun A. Chaturvedi , Sara Sakowitz , Peyman Benharash
Background
The impact of patient sex and race on clinical in-hospital outcomes and expenditures of falls in older adults remain underexplored. This study examines sex- and race-based disparities of fall-related hospitalizations.
Study design
All hospitalizations for adults (≥65 years) from falls were identified (National Inpatient Sample, 2017–2021). Patients were stratified into sex and racial groups (White and Non-White). Multivariable logistic (dichotomous variables) and linear (continuous variables) regression modeling compared clinical in-hospital outcomes, resource utilization, and hospital costs stratified by sex and race.
Results
An estimated 5,870,482 (survey-weighted) older adults experienced a fall-related hospital admission, with annual incidence rising from 1,108,024 to 1,210,547 (P < 0.001). Unadjusted in-hospital mortality was lower for females compared to males (2.5 vs 4.5 %, P < 0.001). Following risk-adjustment, females had lower odds of in-hospital mortality (AOR: 0.59, 95 %CI: 57–0.60, P < 0.001) and costs (β = −$1344, 95 %CI: −1321 to −1267, P < 0.001).
On crude analysis, in-hospital mortality was higher in Non-White patients (3.4 vs 3.2 %, P < 0.001). Mean LOS was longer for Non-White (6.31 ± 7.69 days) compared to White patients (5.65 ± 5.93 days, P < 0.001). Following risk-adjustment, Non-White patients had higher odds of in-hospital mortality compared to White patients (AOR: 1.16, 95 %CI: 1.08–1.24, P < 0.001) and higher median costs (β = $2304, 95 %CI: 1897.90-2710.16, P < 0.001).
Conclusion
Sex and race are associated with differences in clinical in-hospital outcomes and expenditures in older adult fall hospitalizations, suggesting potential variations in treatment, recovery, and access to care. Further research is needed to better understand these disparities and inform strategies for more equitable care.
患者性别和种族对老年人跌倒的临床住院结果和支出的影响仍未得到充分研究。本研究考察了因跌倒而住院的性别和种族差异。研究设计确定所有因跌倒住院的成人（≥65岁）（2017-2021年全国住院患者样本）。患者被分为性别和种族组（白人和非白人）。多变量logistic（二分类变量）和线性（连续变量）回归模型比较了按性别和种族分层的临床住院结果、资源利用和医院成本。结果估计有5,870,482名（调查加权）老年人因跌倒而住院，年发病率从1,108,024上升到1,210,547 （P < 0.001）。与男性相比，女性未经调整的住院死亡率较低（2.5% vs 4.5%, P < 0.001）。经过风险调整后，女性住院死亡率（AOR: 0.59, 95% CI: 57-0.60, P < 0.001）和费用（β = - 1344美元，95% CI: - 1321至- 1267，P < 0.001）较低。粗略分析，非白人患者的住院死亡率更高（3.4% vs 3.2%, P < 0.001）。非白人患者的平均LOS（6.31±7.69天）比白人患者（5.65±5.93天，P < 0.001）更长。风险调整后，非白人患者的住院死亡率高于白人患者（AOR: 1.16, 95% CI: 1.08-1.24, P < 0.001），中位成本较高（β = 2304美元，95% CI: 1897.90-2710.16, P < 0.001）。结论：性别和种族与老年人跌倒住院的临床住院结果和费用差异有关，提示在治疗、康复和获得护理方面存在潜在差异。需要进一步的研究来更好地了解这些差异，并为更公平的护理策略提供信息。
{"title":"Sex and racial disparities in clinical outcomes and healthcare costs among hospitalized older adult fall patients: A nationwide analysis","authors":"Miles J. Gibbons , Saad Mallick , Troy Coaston , Nguyen Le , Syed Shaheer Ali , Arjun A. Chaturvedi , Sara Sakowitz , Peyman Benharash","doi":"10.1016/j.sopen.2025.07.003","DOIUrl":"10.1016/j.sopen.2025.07.003","url":null,"abstract":"<div><h3>Background</h3><div>The impact of patient sex and race on clinical in-hospital outcomes and expenditures of falls in older adults remain underexplored. This study examines sex- and race-based disparities of fall-related hospitalizations.</div></div><div><h3>Study design</h3><div>All hospitalizations for adults (≥65 years) from falls were identified (National Inpatient Sample, 2017–2021). Patients were stratified into sex and racial groups (White and Non-White). Multivariable logistic (dichotomous variables) and linear (continuous variables) regression modeling compared clinical in-hospital outcomes, resource utilization, and hospital costs stratified by sex and race.</div></div><div><h3>Results</h3><div>An estimated 5,870,482 (survey-weighted) older adults experienced a fall-related hospital admission, with annual incidence rising from 1,108,024 to 1,210,547 (<em>P</em> < 0.001). Unadjusted in-hospital mortality was lower for females compared to males (2.5 vs 4.5 %, P < 0.001). Following risk-adjustment, females had lower odds of in-hospital mortality (AOR: 0.59, 95 %CI: 57–0.60, <em>P</em> < 0.001) and costs (β = −$1344, 95 %CI: −1321 to −1267, <em>P</em> < 0.001).</div><div>On crude analysis, in-hospital mortality was higher in Non-White patients (3.4 vs 3.2 %, <em>P</em> < 0.001). Mean LOS was longer for Non-White (6.31 ± 7.69 days) compared to White patients (5.65 ± 5.93 days, P < 0.001). Following risk-adjustment, Non-White patients had higher odds of in-hospital mortality compared to White patients (AOR: 1.16, 95 %CI: 1.08–1.24, <em>P</em> < 0.001) and higher median costs (β = $2304, 95 %CI: 1897.90-2710.16, P < 0.001).</div></div><div><h3>Conclusion</h3><div>Sex and race are associated with differences in clinical in-hospital outcomes and expenditures in older adult fall hospitalizations, suggesting potential variations in treatment, recovery, and access to care. Further research is needed to better understand these disparities and inform strategies for more equitable care.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 120-125"},"PeriodicalIF":1.7,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908473","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 : 2025-08-05eCollection Date: 2025-09-01DOI: 10.1016/j.sopen.2025.07.009
Deshka S Foster, Michael I D'Angelica
Colorectal cancer with synchronous metastatic disease to the liver represents a particular challenge in multidisciplinary cancer care. Optimal management involves a combination of surgical resection, systemic, regional and/or targeted therapies; however, the order of and timing of specific therapies requires a nuanced understanding of the disease biology including tumor genomics. In the following article, we conducted a narrative review of the literature to critically examine existing data on the impact of tumor genomics in synchronous colorectal liver metastasis management. We provide a qualitative synthesis of the available literature and identify areas of particular interest for investigation moving forward.
{"title":"Consideration of tumor genomics in the management of synchronous colorectal liver metastases.","authors":"Deshka S Foster, Michael I D'Angelica","doi":"10.1016/j.sopen.2025.07.009","DOIUrl":"10.1016/j.sopen.2025.07.009","url":null,"abstract":"<p><p>Colorectal cancer with synchronous metastatic disease to the liver represents a particular challenge in multidisciplinary cancer care. Optimal management involves a combination of surgical resection, systemic, regional and/or targeted therapies; however, the order of and timing of specific therapies requires a nuanced understanding of the disease biology including tumor genomics. In the following article, we conducted a narrative review of the literature to critically examine existing data on the impact of tumor genomics in synchronous colorectal liver metastasis management. We provide a qualitative synthesis of the available literature and identify areas of particular interest for investigation moving forward.</p>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"106-109"},"PeriodicalIF":1.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-05eCollection Date: 2025-09-01DOI: 10.1016/j.sopen.2025.07.006
Henrik Nienhüser, Nicolas Jorek, Ali Majlesara, Frank Pianka, Arianeb Mehrabi, Christoph W Michalski
{"title":"Robotic Ivor-Lewis esophagectomy - How-we-do-it.","authors":"Henrik Nienhüser, Nicolas Jorek, Ali Majlesara, Frank Pianka, Arianeb Mehrabi, Christoph W Michalski","doi":"10.1016/j.sopen.2025.07.006","DOIUrl":"10.1016/j.sopen.2025.07.006","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"104-105"},"PeriodicalIF":1.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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