Pub Date : 2025-12-15DOI: 10.1016/j.amjsurg.2025.116785
Dimitrios P Moris, Theodore N Pappas
{"title":"The privilege of mastery: Preserving joy in surgery.","authors":"Dimitrios P Moris, Theodore N Pappas","doi":"10.1016/j.amjsurg.2025.116785","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116785","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116785"},"PeriodicalIF":2.7,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.amjsurg.2025.116774
Martine C Keuning, Bart Lambert, Paul C Jutte, Patrick Nieboer, Agnes D Diemers
Objective: To examine how supervisors and residents perceive real-time instances of good intraoperative supervision and where their perceptions align or differ. By exploring how supervisors guide residents toward operative competence, we aim to align their perceptions to support effective learning.
Methods: Twenty surgical procedures were video recorded in six Dutch teaching hospitals. After each procedure, supervisors and residents independently selected three instances of good supervision. These clips were reviewed in separate video-stimulated interviews. Transcripts were thematically analyzed using a constructivist approach to explore alignment/misalignment in perceptions.
Results: Supervisors emphasized explicitly contributing to residents' learning according to a self-set standard, whereas residents highlighted supervision that fulfilled their learning needs and was communicated professionally. Substantial agreement on the instance of good supervision did not necessarily imply agreement on the underlying rationale. Residents often recognized their supervisor's intentions but did not always interpret the same behaviors similarly. Differences primarily concerned the timing and nature of supervision actions.
Conclusion: Although perspectives differ by role, learner versus teacher, making them explicit can improve alignment and foster more effective, co-regulated learning in the operating room.
{"title":"When supervision works: Analysis of supervisors' and residents' perceptions of 'good supervision' using video-stimulated interviews.","authors":"Martine C Keuning, Bart Lambert, Paul C Jutte, Patrick Nieboer, Agnes D Diemers","doi":"10.1016/j.amjsurg.2025.116774","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116774","url":null,"abstract":"<p><strong>Objective: </strong>To examine how supervisors and residents perceive real-time instances of good intraoperative supervision and where their perceptions align or differ. By exploring how supervisors guide residents toward operative competence, we aim to align their perceptions to support effective learning.</p><p><strong>Methods: </strong>Twenty surgical procedures were video recorded in six Dutch teaching hospitals. After each procedure, supervisors and residents independently selected three instances of good supervision. These clips were reviewed in separate video-stimulated interviews. Transcripts were thematically analyzed using a constructivist approach to explore alignment/misalignment in perceptions.</p><p><strong>Results: </strong>Supervisors emphasized explicitly contributing to residents' learning according to a self-set standard, whereas residents highlighted supervision that fulfilled their learning needs and was communicated professionally. Substantial agreement on the instance of good supervision did not necessarily imply agreement on the underlying rationale. Residents often recognized their supervisor's intentions but did not always interpret the same behaviors similarly. Differences primarily concerned the timing and nature of supervision actions.</p><p><strong>Conclusion: </strong>Although perspectives differ by role, learner versus teacher, making them explicit can improve alignment and foster more effective, co-regulated learning in the operating room.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116774"},"PeriodicalIF":2.7,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.amjsurg.2025.116776
Julie S. Hong , Xiaoyue Ma , William Davis , Phillip Hwang , Shahenda Khedr , Vinh Pham , Roger Patron , Christopher Foglia , Daithi S. Heffernan , Steven Y. Chao
Background
Disparities by race and ethnicity have been reported for incidence, access, and outcomes of colorectal disease. We aimed to describe rates of race and ethnicity reporting in clinical colorectal studies published in high-impact journals.
Methods
All prospective and retrospective clinical studies published in two high-impact colorectal journals and two high-impact surgical journals from 2010 to 2023 were identified using PubMed. Subset analyses of studies published in America were performed.
Results
Of 1220 studies, 1110 met inclusion criteria, and 203 were American. In American studies, rates of reporting White (p = 0.076), Black (p = 0.863), Asian (p = 0.509), or Hispanic patients (p = 0.133) remained unchanged over time. Overall, Black (n = 73, 81.1 %), Asian (n = 33, 36.7 %), and Hispanic patients (n = 33, 36.7 %) were reported less often than White patients (n = 87, 96.7 %) and were more likely to be represented as Other (n = 72, 80.0 %).
Conclusions
Over 14 years, rates of reporting minority race and ethnicity groups in clinical colorectal surgery research remained low.
{"title":"Minority race and ethnicity are underreported in colorectal surgery research: A 14-year systematic review","authors":"Julie S. Hong , Xiaoyue Ma , William Davis , Phillip Hwang , Shahenda Khedr , Vinh Pham , Roger Patron , Christopher Foglia , Daithi S. Heffernan , Steven Y. Chao","doi":"10.1016/j.amjsurg.2025.116776","DOIUrl":"10.1016/j.amjsurg.2025.116776","url":null,"abstract":"<div><h3>Background</h3><div>Disparities by race and ethnicity have been reported for incidence, access, and outcomes of colorectal disease. We aimed to describe rates of race and ethnicity reporting in clinical colorectal studies published in high-impact journals.</div></div><div><h3>Methods</h3><div>All prospective and retrospective clinical studies published in two high-impact colorectal journals and two high-impact surgical journals from 2010 to 2023 were identified using PubMed. Subset analyses of studies published in America were performed.</div></div><div><h3>Results</h3><div>Of 1220 studies, 1110 met inclusion criteria, and 203 were American. In American studies, rates of reporting White (p = 0.076), Black (p = 0.863), Asian (p = 0.509), or Hispanic patients (p = 0.133) remained unchanged over time. Overall, Black (n = 73, 81.1 %), Asian (n = 33, 36.7 %), and Hispanic patients (n = 33, 36.7 %) were reported less often than White patients (n = 87, 96.7 %) and were more likely to be represented as Other (n = 72, 80.0 %).</div></div><div><h3>Conclusions</h3><div>Over 14 years, rates of reporting minority race and ethnicity groups in clinical colorectal surgery research remained low.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116776"},"PeriodicalIF":2.7,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.amjsurg.2025.116777
Elizabeth R. Benjamin , Demetrios Demetriades , Camilla Cremonini , Anaar Siletz , Subarna Biswas , Jennifer Mooney , Joe DuBose , Nori Bradley , David J. Skaurpa , Lucyna Krzywon , Paula Ferrada , Pak S. Leung , John D. Berne , Jason Young , Thomas M. Scalea
Introduction
In damage control laparotomy (DCL) for trauma, intestinal injuries are often left in discontinuity. This study compared outcomes in patients with intestinal discontinuity versus immediate anastomosis.
Methods
Prospective multicenter, AAST study, included patients requiring DCL with intestinal resection. Patients were categorized into bowel Discontinuity and Continuity groups.
Data collection included clinical characteristics, injury severity, peritoneal contamination, intraoperative blood products, crystalloids and vasopressors, operative time, takeback operative findings, fascia closure and postoperative complications. Outcomes included mortality, bowel ischemia, postoperative complications, fascia closure, and hospital stay.
Results
246 patients from 16 centers. Using propensity score matching, 132 patients in the Discontinuity group were well-matched with 66 in the Continuity group. Discontinuity was associated with significantly higher mortality and septic complications. Fascia closure was more likely to be achieved in the Continuity group at the 2nd takeback operation.
Conclusions
Intestinal discontinuity in DCL is associated with increased mortality and septic complications.
{"title":"Intestinal discontinuity may be associated with worse outcomes in damage control laparotomy for trauma: An American association for the surgery of trauma prospective multicenter observational study","authors":"Elizabeth R. Benjamin , Demetrios Demetriades , Camilla Cremonini , Anaar Siletz , Subarna Biswas , Jennifer Mooney , Joe DuBose , Nori Bradley , David J. Skaurpa , Lucyna Krzywon , Paula Ferrada , Pak S. Leung , John D. Berne , Jason Young , Thomas M. Scalea","doi":"10.1016/j.amjsurg.2025.116777","DOIUrl":"10.1016/j.amjsurg.2025.116777","url":null,"abstract":"<div><h3>Introduction</h3><div>In damage control laparotomy (DCL) for trauma, intestinal injuries are often left in discontinuity. This study compared outcomes in patients with intestinal discontinuity versus immediate anastomosis.</div></div><div><h3>Methods</h3><div>Prospective multicenter, AAST study, included patients requiring DCL with intestinal resection. Patients were categorized into bowel Discontinuity and Continuity groups.</div><div>Data collection included clinical characteristics, injury severity, peritoneal contamination, intraoperative blood products, crystalloids and vasopressors, operative time, takeback operative findings, fascia closure and postoperative complications. Outcomes included mortality, bowel ischemia, postoperative complications, fascia closure, and hospital stay.</div></div><div><h3>Results</h3><div>246 patients from 16 centers. Using propensity score matching, 132 patients in the Discontinuity group were well-matched with 66 in the Continuity group. Discontinuity was associated with significantly higher mortality and septic complications. Fascia closure was more likely to be achieved in the Continuity group at the 2nd takeback operation.</div></div><div><h3>Conclusions</h3><div>Intestinal discontinuity in DCL is associated with increased mortality and septic complications.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116777"},"PeriodicalIF":2.7,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: We aimed to systematically review applications of artificial intelligence (AI) technologies for ambulatory surgical patients.
Methods: We systematically searched PubMed, Scopus, Web of Science, and EBSCOhost (2015-2025). Studies were included if they used artificial intelligence in ambulatory surgical populations.
Results: Of 26 studies identified, machine learning was used in 25, with a predominantly orthopaedic (65.3 %) focus. Except for two, all were originated in the USA. We found four themes: (1) Preoperative patient selection (n = 10) - Random forest (RF) and eXtreme gradient boost (XGBoost) algorithms predicted appropriateness with an area under curve (AUC) 0.72-0.85, (2) Same-day discharge prediction (n = 8) - Ensemble models demonstrated the highest AUC values (3) Postoperative management and complications (n = 3) - Artificial neural network incorporating intra- and postoperative features predicted opioid refill needs (4) Cost prediction (n = 4) - Ensemble models consistently outperformed single-model approaches.
Conclusions: Our review underscores the promising potential of machine learning applications in ambulatory surgery, particularly with ensemble methods. We observed inconsistencies in the models; data related issues and a lack of external validation.
{"title":"Artificial intelligence and machine learning applications in ambulatory surgery - A systematic review.","authors":"Santosh Patel, Vinaytosh Mishra, Venkatraman Manda","doi":"10.1016/j.amjsurg.2025.116775","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116775","url":null,"abstract":"<p><strong>Background: </strong>We aimed to systematically review applications of artificial intelligence (AI) technologies for ambulatory surgical patients.</p><p><strong>Methods: </strong>We systematically searched PubMed, Scopus, Web of Science, and EBSCOhost (2015-2025). Studies were included if they used artificial intelligence in ambulatory surgical populations.</p><p><strong>Results: </strong>Of 26 studies identified, machine learning was used in 25, with a predominantly orthopaedic (65.3 %) focus. Except for two, all were originated in the USA. We found four themes: (1) Preoperative patient selection (n = 10) - Random forest (RF) and eXtreme gradient boost (XGBoost) algorithms predicted appropriateness with an area under curve (AUC) 0.72-0.85, (2) Same-day discharge prediction (n = 8) - Ensemble models demonstrated the highest AUC values (3) Postoperative management and complications (n = 3) - Artificial neural network incorporating intra- and postoperative features predicted opioid refill needs (4) Cost prediction (n = 4) - Ensemble models consistently outperformed single-model approaches.</p><p><strong>Conclusions: </strong>Our review underscores the promising potential of machine learning applications in ambulatory surgery, particularly with ensemble methods. We observed inconsistencies in the models; data related issues and a lack of external validation.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116775"},"PeriodicalIF":2.7,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145916582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.amjsurg.2025.116778
Annika Bickford Kay , Sean Shughrou , Sarah Majercik , Cempaka Martial , Sarah Ilstrup , Dave Morris
Background
Massive transfusion protocols (MTP) allow for rapid balanced transfusion. In non-traumatic hemorrhage, a hospital-wide MTP Response Team (MTRT) was created. We hypothesized that MTRT utilization would result in improved adherence to MTP.
Methods
Adult non-traumatic hemorrhage patients with MTP order at a Level 1 trauma center January 2019–December 2023 were analyzed. MTPs managed without MTRT (NRT group) were compared to MTP with MTRT (MTRT group). Primary outcome was achievement of red blood cell (RBC) to fresh frozen plasma (FFP) ratio 1:1.
Results
110 MTRT vs. 138 NRT analyzed. MTRT was associated with RBC:FFP ratio 1.1:1 vs NRT 1.5:1 (p = 0.004), shorter time to first RBC (10 vs 17 min, p = 0.0008) and less product wastage.
Conclusion
For non-traumatic hemorrhage, MTRT was associated with more balanced RBC:FFP ratios, faster component transfusion, and less wastage. The clinical impact and scalability of this model across healthcare settings should be investigated.
{"title":"A balancing act: Evaluating the impact of a massive transfusion response team on early balanced resuscitation in non-traumatic hemorrhage","authors":"Annika Bickford Kay , Sean Shughrou , Sarah Majercik , Cempaka Martial , Sarah Ilstrup , Dave Morris","doi":"10.1016/j.amjsurg.2025.116778","DOIUrl":"10.1016/j.amjsurg.2025.116778","url":null,"abstract":"<div><h3>Background</h3><div>Massive transfusion protocols (MTP) allow for rapid balanced transfusion. In non-traumatic hemorrhage, a hospital-wide MTP Response Team (MTRT) was created. We hypothesized that MTRT utilization would result in improved adherence to MTP.</div></div><div><h3>Methods</h3><div>Adult non-traumatic hemorrhage patients with MTP order at a Level 1 trauma center January 2019–December 2023 were analyzed. MTPs managed without MTRT (NRT group) were compared to MTP with MTRT (MTRT group). Primary outcome was achievement of red blood cell (RBC) to fresh frozen plasma (FFP) ratio 1:1.</div></div><div><h3>Results</h3><div>110 MTRT vs. 138 NRT analyzed. MTRT was associated with RBC:FFP ratio 1.1:1 vs NRT 1.5:1 (<em>p</em> = 0.004), shorter time to first RBC (10 vs 17 min, p = 0.0008) and less product wastage.</div></div><div><h3>Conclusion</h3><div>For non-traumatic hemorrhage, MTRT was associated with more balanced RBC:FFP ratios, faster component transfusion, and less wastage. The clinical impact and scalability of this model across healthcare settings should be investigated.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116778"},"PeriodicalIF":2.7,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-09DOI: 10.1016/j.amjsurg.2025.116773
Phillip J. Hsu , Katherine Khosrovaneh , Nick Kunnath , Cody L. Mullens , Andrew M. Ibrahim , Samir K. Gadepalli
Background
Neighborhood deprivation begets care delays and complications after children's surgery in single center studies. We aimed to better understand these associations through generalizable data.
Methods
We identified children undergoing six common operations using State Inpatient Databases, defining neighborhood deprivation using Child Opportunity Index. Risk-adjusted length of stay (LOS) and complication rates were compared using multivariable regression.
Results
Among 102,399 children, neighborhood deprivation was associated with race, public insurance, and transfer. On risk-adjusted analysis, children with greater neighborhood deprivation had longer LOS for appendectomy (4.36 vs 4.21 days), skin graft (10.80 vs 8.55 days), and skin excision/debridement (10.45 vs 9.51 days). Risk-adjusted complication rates were not different, and LOS differences persisted in children without complications.
Conclusions
Children from deprived neighborhoods stay longer post-operatively, despite similar complication rates. Factors beyond clinical care are thus associated with utilization, and should inform how payment models and quality metrics account for these non-clinical factors.
{"title":"Neighborhood deprivation is associated with longer hospital stay for common pediatric surgical procedures independent of complication rates","authors":"Phillip J. Hsu , Katherine Khosrovaneh , Nick Kunnath , Cody L. Mullens , Andrew M. Ibrahim , Samir K. Gadepalli","doi":"10.1016/j.amjsurg.2025.116773","DOIUrl":"10.1016/j.amjsurg.2025.116773","url":null,"abstract":"<div><h3>Background</h3><div>Neighborhood deprivation begets care delays and complications after children's surgery in single center studies. We aimed to better understand these associations through generalizable data.</div></div><div><h3>Methods</h3><div>We identified children undergoing six common operations using State Inpatient Databases, defining neighborhood deprivation using Child Opportunity Index. Risk-adjusted length of stay (LOS) and complication rates were compared using multivariable regression.</div></div><div><h3>Results</h3><div>Among 102,399 children, neighborhood deprivation was associated with race, public insurance, and transfer. On risk-adjusted analysis, children with greater neighborhood deprivation had longer LOS for appendectomy (4.36 vs 4.21 days), skin graft (10.80 vs 8.55 days), and skin excision/debridement (10.45 vs 9.51 days). Risk-adjusted complication rates were not different, and LOS differences persisted in children without complications.</div></div><div><h3>Conclusions</h3><div>Children from deprived neighborhoods stay longer post-operatively, despite similar complication rates. Factors beyond clinical care are thus associated with utilization, and should inform how payment models and quality metrics account for these non-clinical factors.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"253 ","pages":"Article 116773"},"PeriodicalIF":2.7,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-09DOI: 10.1016/j.amjsurg.2025.116772
James L. Rogers , Sebastian Henostroza , Adam Fahey , Carmen C. Solórzano
Background
Clinical trials are crucial in advancing novel therapies for thyroid cancer. Given the increased cost of modern healthcare, cost considerations in clinical trials are important yet remain under-reported.
Methods
A search of ClinicalTrials.gov identified thyroid cancer studies including cost in the trial description or as an outcome. Data collected included trial information, cost outcomes, and cost-effectiveness analyses.
Results
Among 46 thyroid cancer-focused clinical trials, only 28 (60.8 %) mentioned cost in any capacity, of which 21 (75 %) included cost outcomes and 7 (25 %) included cost-effectiveness analyses. Overall, cost was a primary outcome in 1 (2.2 %) trial, secondary outcome in 20 (43.5 %) trials, and exploratory outcome in 7 (15.2 %) trials.
Conclusion
The inclusion of cost analysis in thyroid cancer clinical trials is limited. Given rising cost pressures in modern healthcare systems, the low prevalence of cost endpoints and cost-effectiveness analyses underscores the need for increased awareness and investment in this domain.
{"title":"Cost analysis in thyroid cancer clinical trials: Toward value-based oncology care","authors":"James L. Rogers , Sebastian Henostroza , Adam Fahey , Carmen C. Solórzano","doi":"10.1016/j.amjsurg.2025.116772","DOIUrl":"10.1016/j.amjsurg.2025.116772","url":null,"abstract":"<div><h3>Background</h3><div>Clinical trials are crucial in advancing novel therapies for thyroid cancer. Given the increased cost of modern healthcare, cost considerations in clinical trials are important yet remain under-reported.</div></div><div><h3>Methods</h3><div>A search of <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> identified thyroid cancer studies including cost in the trial description or as an outcome. Data collected included trial information, cost outcomes, and cost-effectiveness analyses.</div></div><div><h3>Results</h3><div>Among 46 thyroid cancer-focused clinical trials, only 28 (60.8 %) mentioned cost in any capacity, of which 21 (75 %) included cost outcomes and 7 (25 %) included cost-effectiveness analyses. Overall, cost was a primary outcome in 1 (2.2 %) trial, secondary outcome in 20 (43.5 %) trials, and exploratory outcome in 7 (15.2 %) trials.</div></div><div><h3>Conclusion</h3><div>The inclusion of cost analysis in thyroid cancer clinical trials is limited. Given rising cost pressures in modern healthcare systems, the low prevalence of cost endpoints and cost-effectiveness analyses underscores the need for increased awareness and investment in this domain.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116772"},"PeriodicalIF":2.7,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-08DOI: 10.1016/j.amjsurg.2025.116766
Yuki Liu , Yu-Hsiang Kao , Naomi C. Hamm , Feibi Zheng , Michael A. Edwards
Background
Research comparing the outcomes of robotic-assisted and laparoscopic duodenal switch (DS) procedures in the US have relied primarily on the same data source and have not considered economic outcomes. Studies using alternative data sources are needed to better understand the health and economic impact of surgery modality for patients receiving DS procedures.
Objective
To compare perioperative outcomes and cost between robotic-assisted and laparoscopic DS procedures.
Setting
Data from the Premier Healthcare Database (PHD), a multi-center, hospital-based database.
Methods
A retrospective cohort study from January 1, 2017, to December 31, 2023, including primary robotic-assisted or laparoscopic elective DS procedures. Propensity score matched analysis was performed. Perioperative and 30-day complications and cost were compared.
Results
The study cohort included 4221 DS patients, 36 % robotic and 64 % laparoscopic. Patients receiving an R-DS had a higher BMI and Charlson Comorbidity Index (CCI). After matching, 1073 patients per cohort were analyzed. R-DS procedures had a longer median operative time (230 min vs. 186 min, p < .001) and less gastrointestinal (GI) bleeding (0.2 % vs. 0.9 %, p = .0021). All other adverse outcomes were comparable. For the matched cohort, there was a significant decrease in 30-day cost (p < .001) and complication rates (p < .001) for R-DS, but not L-DS. Median 30-day perioperative costs were similar for R-DS and L-DS in 2023 ($17,156 and $16,476 for R-DS and L-DS, respectively).
Conclusion
R-DS and L-DS have comparable outcomes and costs. Overall complications and costs associated with DS procedures are decreasing. R-DS procedures have longer operation time and lower risk of GI bleeding.
{"title":"Robotic assisted versus laparoscopic duodenal switch procedures: A nationwide propensity score matched analysis","authors":"Yuki Liu , Yu-Hsiang Kao , Naomi C. Hamm , Feibi Zheng , Michael A. Edwards","doi":"10.1016/j.amjsurg.2025.116766","DOIUrl":"10.1016/j.amjsurg.2025.116766","url":null,"abstract":"<div><h3>Background</h3><div>Research comparing the outcomes of robotic-assisted and laparoscopic duodenal switch (DS) procedures in the US have relied primarily on the same data source and have not considered economic outcomes. Studies using alternative data sources are needed to better understand the health and economic impact of surgery modality for patients receiving DS procedures.</div></div><div><h3>Objective</h3><div>To compare perioperative outcomes and cost between robotic-assisted and laparoscopic DS procedures.</div></div><div><h3>Setting</h3><div>Data from the Premier Healthcare Database (PHD), a multi-center, hospital-based database.</div></div><div><h3>Methods</h3><div>A retrospective cohort study from January 1, 2017, to December 31, 2023, including primary robotic-assisted or laparoscopic elective DS procedures. Propensity score matched analysis was performed. Perioperative and 30-day complications and cost were compared.</div></div><div><h3>Results</h3><div>The study cohort included 4221 DS patients, 36 % robotic and 64 % laparoscopic. Patients receiving an R-DS had a higher BMI and Charlson Comorbidity Index (CCI). After matching, 1073 patients per cohort were analyzed. R-DS procedures had a longer median operative time (230 min vs. 186 min, p < .001) and less gastrointestinal (GI) bleeding (0.2 % vs. 0.9 %, p = .0021). All other adverse outcomes were comparable. For the matched cohort, there was a significant decrease in 30-day cost (p < .001) and complication rates (p < .001) for R-DS, but not L-DS. Median 30-day perioperative costs were similar for R-DS and L-DS in 2023 ($17,156 and $16,476 for R-DS and L-DS, respectively).</div></div><div><h3>Conclusion</h3><div>R-DS and L-DS have comparable outcomes and costs. Overall complications and costs associated with DS procedures are decreasing. R-DS procedures have longer operation time and lower risk of GI bleeding.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"253 ","pages":"Article 116766"},"PeriodicalIF":2.7,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145838745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-08DOI: 10.1016/j.amjsurg.2025.116770
Lyen C Huang, Kevin D Helling
{"title":"The people left behind.","authors":"Lyen C Huang, Kevin D Helling","doi":"10.1016/j.amjsurg.2025.116770","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116770","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116770"},"PeriodicalIF":2.7,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}