Pub Date : 2025-11-12DOI: 10.1016/j.amjsurg.2025.116718
Liam R Kugler, Griffin P Stinson, Victoria E Bindi, Yuriy Stukov, Angela P Mihalic, Janice A Taylor
Background: General surgery residency is a competitive match. USMLE Step1 became pass/fail in 2022. We sought to compare matched general surgery applicants between scored and pass/fail Step1 eras to elucidate possible shifts in residency applications.
Methods: The Texas Seeking Transparency in Application to Residency database was queried from 2017 to 2024. Academic, extracurricular, geographic, and away rotation data were analyzed.
Results: 1861 scored and 302 pass/fail Step1 applicants matched in general surgery. More pass/fail applicants scored ≥250 on Step2 (p = 0.03). Pass/fail applicants had more honored clerkships (p = 0.01). More pass/fail applicants completed away rotations; more away rotations were associated with more interviews (p = 0.003), but not with matching at that program. Pass/fail applicants applied to more programs (p < 0.001); they did not attend more interviews.
Conclusions: Pass/fail applicants demonstrated higher Step2 performance. They applied to more programs, did more away rotations, with similar interview success. This early analysis helps inform applicants into general surgery in the Step1 pass/fail era.
{"title":"Predicting successful general surgery matching in a Step 1 pass/fail era: Analysis of the Texas STAR database.","authors":"Liam R Kugler, Griffin P Stinson, Victoria E Bindi, Yuriy Stukov, Angela P Mihalic, Janice A Taylor","doi":"10.1016/j.amjsurg.2025.116718","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116718","url":null,"abstract":"<p><strong>Background: </strong>General surgery residency is a competitive match. USMLE Step1 became pass/fail in 2022. We sought to compare matched general surgery applicants between scored and pass/fail Step1 eras to elucidate possible shifts in residency applications.</p><p><strong>Methods: </strong>The Texas Seeking Transparency in Application to Residency database was queried from 2017 to 2024. Academic, extracurricular, geographic, and away rotation data were analyzed.</p><p><strong>Results: </strong>1861 scored and 302 pass/fail Step1 applicants matched in general surgery. More pass/fail applicants scored ≥250 on Step2 (p = 0.03). Pass/fail applicants had more honored clerkships (p = 0.01). More pass/fail applicants completed away rotations; more away rotations were associated with more interviews (p = 0.003), but not with matching at that program. Pass/fail applicants applied to more programs (p < 0.001); they did not attend more interviews.</p><p><strong>Conclusions: </strong>Pass/fail applicants demonstrated higher Step2 performance. They applied to more programs, did more away rotations, with similar interview success. This early analysis helps inform applicants into general surgery in the Step1 pass/fail era.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116718"},"PeriodicalIF":2.7,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556175","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 : 2025-11-12DOI: 10.1016/j.amjsurg.2025.116715
Wei-Hsun Lu , Ting-Kai Liao , Ping-Jui Su , Chih-Jung Wang , Ying-Jui Chao , Yan-Shen Shan
Background
New-onset diabetes mellitus (NODM) following distal pancreatectomy (DP) significantly impacts long-term quality of life. This study developed a prediction model for post-DP NODM.
Methods
Retrospective analysis of 159 patients undergoing DP for benign/low-grade malignant lesions (2014–2023). Cox regression identified risk factors incorporated into a scoring system.
Results
Among 130 non-diabetic patients, 26.9 % developed NODM (median 10 months). Five independent predictors: prediabetes (HR 11.02), concomitant splenectomy (HR 2.45), age ≥65 (HR 2.03), BMI ≥25 (HR 1.96), neck/proximal tumor (HR 1.50). The risk scoring system (0–10 points) stratified patients into low-risk (0–2 points), intermediate-risk (3–5 points), and high-risk (6–10 points) categories with significantly different cumulative incidence of NODM at 5 years (4.4 %, 27.9 %, and 87.5 %, respectively). AUC exceeded 0.85 across timepoints.
Conclusions
This simple model enables accurate risk stratification for post-DP NODM, facilitating personalized counseling and tailored surveillance.
{"title":"A simple five-factor risk model for predicting new-onset diabetes after distal pancreatectomy","authors":"Wei-Hsun Lu , Ting-Kai Liao , Ping-Jui Su , Chih-Jung Wang , Ying-Jui Chao , Yan-Shen Shan","doi":"10.1016/j.amjsurg.2025.116715","DOIUrl":"10.1016/j.amjsurg.2025.116715","url":null,"abstract":"<div><h3>Background</h3><div>New-onset diabetes mellitus (NODM) following distal pancreatectomy (DP) significantly impacts long-term quality of life. This study developed a prediction model for post-DP NODM.</div></div><div><h3>Methods</h3><div>Retrospective analysis of 159 patients undergoing DP for benign/low-grade malignant lesions (2014–2023). Cox regression identified risk factors incorporated into a scoring system.</div></div><div><h3>Results</h3><div>Among 130 non-diabetic patients, 26.9 % developed NODM (median 10 months). Five independent predictors: prediabetes (HR 11.02), concomitant splenectomy (HR 2.45), age ≥65 (HR 2.03), BMI ≥25 (HR 1.96), neck/proximal tumor (HR 1.50). The risk scoring system (0–10 points) stratified patients into low-risk (0–2 points), intermediate-risk (3–5 points), and high-risk (6–10 points) categories with significantly different cumulative incidence of NODM at 5 years (4.4 %, 27.9 %, and 87.5 %, respectively). AUC exceeded 0.85 across timepoints.</div></div><div><h3>Conclusions</h3><div>This simple model enables accurate risk stratification for post-DP NODM, facilitating personalized counseling and tailored surveillance.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"251 ","pages":"Article 116715"},"PeriodicalIF":2.7,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556115","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 : 2025-11-11DOI: 10.1016/j.amjsurg.2025.116719
Diego Schaps , Michael Schultz , Regina Woody , Sabran Masoud , Christopher Mantyh
Background
Surgical site infections (SSIs) drive morbidity and costs. In 2022, our SSI rate rose to a National Surgical Quality Improvement Program (NSQIP) rating of “needs improvement.” We implemented a program to improve pre-operative skin preparation compliance.
Methods
One-time hands-on training session for surgical residents and operating room nurses emphasizing chlorhexidine gluconate and isopropyl alcohol (CHG/IPA) compliance. Compliance was directly observed from August 2022 to November 2023 (N = 1032). Institutional SSI incidence was evaluated using NSQIP semiannual reports.
Results
Complete compliance improved from 13.3 % to 39.4 %(p < 0.0001). Adjusted odds of compliance were 3.4-fold higher overall(p < 0.0001), 3.7-fold higher for general surgery(p = 0.0003), and 9.8-fold higher for colorectal surgery(p < 0.0001). Institutional NSQIP SSI ratings improved from “needs improvement” to “as expected,” but reverted to “needs improvement.”
Conclusions
Single hands-on training significantly improved compliance and was associated with improved SSI ratings. However, the effect was not durable, highlighting need for ongoing education and sustained surveillance to achieve lasting improvement.
{"title":"Hands-on training for preoperative skin preparation improves compliance with manufacturer instructions for use","authors":"Diego Schaps , Michael Schultz , Regina Woody , Sabran Masoud , Christopher Mantyh","doi":"10.1016/j.amjsurg.2025.116719","DOIUrl":"10.1016/j.amjsurg.2025.116719","url":null,"abstract":"<div><h3>Background</h3><div>Surgical site infections (SSIs) drive morbidity and costs. In 2022, our SSI rate rose to a National Surgical Quality Improvement Program (NSQIP) rating of “needs improvement.” We implemented a program to improve pre-operative skin preparation compliance.</div></div><div><h3>Methods</h3><div>One-time hands-on training session for surgical residents and operating room nurses emphasizing chlorhexidine gluconate and isopropyl alcohol (CHG/IPA) compliance. Compliance was directly observed from August 2022 to November 2023 (N = 1032). Institutional SSI incidence was evaluated using NSQIP semiannual reports.</div></div><div><h3>Results</h3><div>Complete compliance improved from 13.3 % to 39.4 %(p < 0.0001). Adjusted odds of compliance were 3.4-fold higher overall(p < 0.0001), 3.7-fold higher for general surgery(p = 0.0003), and 9.8-fold higher for colorectal surgery(p < 0.0001). Institutional NSQIP SSI ratings improved from “needs improvement” to “as expected,” but reverted to “needs improvement.”</div></div><div><h3>Conclusions</h3><div>Single hands-on training significantly improved compliance and was associated with improved SSI ratings. However, the effect was not durable, highlighting need for ongoing education and sustained surveillance to achieve lasting improvement.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"251 ","pages":"Article 116719"},"PeriodicalIF":2.7,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556144","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 : 2025-11-11DOI: 10.1016/j.amjsurg.2025.116720
Stefanie J Soelling, Megan L Sulciner, Lily V Saadat, Jason B Liu, Chandrajit P Raut, Nancy L Cho
{"title":"Improvements and shortcomings: Female representation in Endocrine Surgery and Surgical Oncology.","authors":"Stefanie J Soelling, Megan L Sulciner, Lily V Saadat, Jason B Liu, Chandrajit P Raut, Nancy L Cho","doi":"10.1016/j.amjsurg.2025.116720","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116720","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116720"},"PeriodicalIF":2.7,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145585782","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 : 2025-11-11DOI: 10.1016/j.amjsurg.2025.116723
Jacquelyn E Fitzgerald, Carlie J Arbaugh, Burkely P Smith, Kimberly E Kopecky
Surgeons face demanding work conditions that often strain romantic relationships, yet institutional support remains limited. This national cross-sectional survey assessed how surgeons and their partners experience relationship strain and perceive institutional support. Participants were recruited through professional surgical networks using snowball sampling. Between June and July 2025, 333 respondents completed a 42-item survey addressing relationship health, work-related stress, communication, and available support. Mean relationship health was high (8.3/10), though 63 % (n = 140) reported work interference, particularly those working >60 h per week (p < 0.001). Major stressors included long hours, unpredictable schedules, and burnout. Relationship health was lower among those who rarely discussed their relationships (p < 0.015). Only 4 % (n = 9) reported access to formal institutional programs, and fewer than half perceived departmental support. Participants emphasized the need for predictable scheduling, partner inclusion, counseling access, and a culture promoting balance. Findings highlight the importance of structural and cultural reforms to sustain surgeon and partner well-being.
{"title":"Beyond the scalpel: Supporting healthy romantic relationships in surgical life.","authors":"Jacquelyn E Fitzgerald, Carlie J Arbaugh, Burkely P Smith, Kimberly E Kopecky","doi":"10.1016/j.amjsurg.2025.116723","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116723","url":null,"abstract":"<p><p>Surgeons face demanding work conditions that often strain romantic relationships, yet institutional support remains limited. This national cross-sectional survey assessed how surgeons and their partners experience relationship strain and perceive institutional support. Participants were recruited through professional surgical networks using snowball sampling. Between June and July 2025, 333 respondents completed a 42-item survey addressing relationship health, work-related stress, communication, and available support. Mean relationship health was high (8.3/10), though 63 % (n = 140) reported work interference, particularly those working >60 h per week (p < 0.001). Major stressors included long hours, unpredictable schedules, and burnout. Relationship health was lower among those who rarely discussed their relationships (p < 0.015). Only 4 % (n = 9) reported access to formal institutional programs, and fewer than half perceived departmental support. Participants emphasized the need for predictable scheduling, partner inclusion, counseling access, and a culture promoting balance. Findings highlight the importance of structural and cultural reforms to sustain surgeon and partner well-being.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116723"},"PeriodicalIF":2.7,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556152","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 : 2025-11-10DOI: 10.1016/j.amjsurg.2025.116717
Chandler Hinson, Isaiah V Ware, Alizeh Abbas, Amanda Gosman
{"title":"Roses & Thorns of academic surgery: Staying True to a global mission with Dr. Amanda Gosman.","authors":"Chandler Hinson, Isaiah V Ware, Alizeh Abbas, Amanda Gosman","doi":"10.1016/j.amjsurg.2025.116717","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116717","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116717"},"PeriodicalIF":2.7,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556132","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 : 2025-11-08DOI: 10.1016/j.amjsurg.2025.116716
Zi-Chen Yu , Zhe-Jin Shi , Zheng-Kang Fang , Si-Yu Liu , Yang Yu , Kai-Di Wang , Dong-Sheng Huang , Guo-Liang Shen , Cheng-Wu Zhang , Lei Liang
Aims
Early recurrence (ER) is strongly associated with poor long-term survival in patients with hepatocellular carcinoma (HCC). This study aimed to explore a prediction model based on machine learning (ML).
Methods
Six ML algorithms were constructed and compared. The top-performing model was further compared with a conventional logistic regression model. Model interpretability was assessed using SHapley Additive exPlanations (SHAP) values at both global and individual levels.
Results
Among 903 patients included, 351 (38.9 %) experienced ER within two years. As a result, the random forest (RF) model was selected and demonstrated superior discrimination (AUC 0.917) compared with the logistic regression model (AUC 0.853). SHAP analysis identified multiple tumors, microvascular invasion, and tumor size >5 cm as the key contributors to ER. An online calculator based on the RF model is accessible at: https://doctoryu.shinyapps.io/HCCEarlyRecurrencePredictor/.
Conclusion
The RF model offers a clinically interpretable and deployable tool to support individualized postoperative surveillance strategies.
{"title":"Development and validation of machine learning-based model for predicting early recurrence for patients with HBV-associated hepatocellular carcinoma after curative hepatectomy","authors":"Zi-Chen Yu , Zhe-Jin Shi , Zheng-Kang Fang , Si-Yu Liu , Yang Yu , Kai-Di Wang , Dong-Sheng Huang , Guo-Liang Shen , Cheng-Wu Zhang , Lei Liang","doi":"10.1016/j.amjsurg.2025.116716","DOIUrl":"10.1016/j.amjsurg.2025.116716","url":null,"abstract":"<div><h3>Aims</h3><div>Early recurrence (ER) is strongly associated with poor long-term survival in patients with hepatocellular carcinoma (HCC). This study aimed to explore a prediction model based on machine learning (ML).</div></div><div><h3>Methods</h3><div>Six ML algorithms were constructed and compared. The top-performing model was further compared with a conventional logistic regression model. Model interpretability was assessed using SHapley Additive exPlanations (SHAP) values at both global and individual levels.</div></div><div><h3>Results</h3><div>Among 903 patients included, 351 (38.9 %) experienced ER within two years. As a result, the random forest (RF) model was selected and demonstrated superior discrimination (AUC 0.917) compared with the logistic regression model (AUC 0.853). SHAP analysis identified multiple tumors, microvascular invasion, and tumor size >5 cm as the key contributors to ER. An online calculator based on the RF model is accessible at: <span><span>https://doctoryu.shinyapps.io/HCCEarlyRecurrencePredictor/</span><svg><path></path></svg></span>.</div></div><div><h3>Conclusion</h3><div>The RF model offers a clinically interpretable and deployable tool to support individualized postoperative surveillance strategies.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"251 ","pages":"Article 116716"},"PeriodicalIF":2.7,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562481","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 : 2025-11-07DOI: 10.1016/j.amjsurg.2025.116714
Sukanta Ray , Arkadeep Dhali , Sujan Khamrui , Hemabha Saha , Swapnil Sen , Somak Das , Tuhin Subhra Mandal
Objective
The aim of the present study is to externally validate the International Study Group of Pancreatic Surgery (ISGPS) risk classification for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy.
Methods
A validation study was performed in consecutive patients undergoing pancreatoduodenectomy (PD) for all indications from January 2008 to December 2024. Model performance was assessed using the area under the receiver operating characteristic (ROC) curve and calibration plots.
Results
Overall, 591 patients were included in the present study. POPF was observed in 16.2 % of patients. The distribution of patients according to the ISGPS risk categories were: A (32.5 %), B (7.8 %), C (24 %), and D (35.7 %) with corresponding POPF rates of 9.4 %, 15.2 %, 12 %, and 25.6 %. There was no difference in the rate of POPF between risk categories B and C (15.2 % vs 12 %, P = 0.613). ISGPS 3-tier classification showed better distribution of patients in each risk category (A: 32.5 %, B: 31.8 %, C: 35.7 %). Area under the curve (AUC) of ROC for the ISGPS 4-tier and 3-tier classification were 0.633, and 0.636 respectively (p = 0.945). All three models demonstrate suboptimal calibration, with predicted risks substantially underestimating the true incidence of POPF, and predicted probabilities failing to fully differentiate between low- and high-risk individuals.
Conclusion
This external validation study showed moderate model discrimination of ISGPS 4-tier classification. ISGPS 3-tier classification is as predictive as ISGPS 4-tier classification.
目的：本研究的目的是外部验证国际胰腺外科研究小组（ISGPS）对胰十二指肠切除术后胰瘘（POPF）的风险分类。方法：对2008年1月至2024年12月连续接受胰十二指肠切除术（PD）的所有适应症患者进行验证研究。使用受试者工作特征（ROC）曲线下面积和校正图评估模型性能。结果：本研究共纳入591例患者。16.2%的患者出现POPF。按ISGPS风险分类患者分布为：A（32.5%）、B（7.8%）、C（24%）、D(35.7%)，对应的POPF率分别为9.4%、15.2%、12%、25.6%。B类与C类之间的POPF发生率无差异（15.2% vs 12%, P = 0.613）。ISGPS 3层分级在各危险类别患者分布较好（A: 32.5%, B: 31.8%, C: 35.7%）。ISGPS 4层和3层分类的ROC曲线下面积（AUC）分别为0.633和0.636 （p = 0.945）。这三种模型的校准都不理想，预测的风险大大低估了POPF的真实发病率，预测的概率未能完全区分低风险和高风险个体。结论：本外部验证研究显示ISGPS 4层分类的模型判别适度。ISGPS 3层分类与ISGPS 4层分类具有相同的预测性。
{"title":"External validation of ISGPS two-factor, four-tier classification for the prediction of pancreatic fistula after pancreaticoduodenectomy","authors":"Sukanta Ray , Arkadeep Dhali , Sujan Khamrui , Hemabha Saha , Swapnil Sen , Somak Das , Tuhin Subhra Mandal","doi":"10.1016/j.amjsurg.2025.116714","DOIUrl":"10.1016/j.amjsurg.2025.116714","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of the present study is to externally validate the International Study Group of Pancreatic Surgery (ISGPS) risk classification for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy.</div></div><div><h3>Methods</h3><div>A validation study was performed in consecutive patients undergoing pancreatoduodenectomy (PD) for all indications from January 2008 to December 2024. Model performance was assessed using the area under the receiver operating characteristic (ROC) curve and calibration plots.</div></div><div><h3>Results</h3><div>Overall, 591 patients were included in the present study. POPF was observed in 16.2 % of patients. The distribution of patients according to the ISGPS risk categories were: A (32.5 %), B (7.8 %), C (24 %), and D (35.7 %) with corresponding POPF rates of 9.4 %, 15.2 %, 12 %, and 25.6 %. There was no difference in the rate of POPF between risk categories B and C (15.2 % vs 12 %, P = 0.613). ISGPS 3-tier classification showed better distribution of patients in each risk category (A: 32.5 %, B: 31.8 %, C: 35.7 %). Area under the curve (AUC) of ROC for the ISGPS 4-tier and 3-tier classification were 0.633, and 0.636 respectively (p = 0.945). All three models demonstrate suboptimal calibration, with predicted risks substantially underestimating the true incidence of POPF, and predicted probabilities failing to fully differentiate between low- and high-risk individuals.</div></div><div><h3>Conclusion</h3><div>This external validation study showed moderate model discrimination of ISGPS 4-tier classification. ISGPS 3-tier classification is as predictive as ISGPS 4-tier classification.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"251 ","pages":"Article 116714"},"PeriodicalIF":2.7,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556093","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 : 2025-11-07DOI: 10.1016/j.amjsurg.2025.116713
Mitchell E. McCain , Manh V. Nguyen , William G. Ruley , Nicholas D. Hollman , Stuart D. Hoff , Zhamak Khorgami
Background
This study aimed to determine the predictors of post-operative complications and mortality for patients undergoing colostomy reversal using the National Surgical Quality Improvement Program database.
Methods
We included patients>18 undergoing elective colostomy reversal. A multivariate analysis was performed to find independent predictors of 30-day major complications and death following a colostomy reversal.
Results
Independent predictors of a major complication were age>70 (odds ratio (OR):1.24), having a body mass index≥40 kg/m2(OR:1.42), smoking(OR:1.24), history of severe chronic obstructive pulmonary disease(OR:1.96), having a dependent or partially dependent functional status(OR:1.48), hypertension(OR:1.25), steroid use(OR:1.38), being on dialysis(OR:2.37), and bleeding disorder(OR:1.60). When compared with laparoscopic reversal, the open approach was an independent predictor of both major complications (OR:1.67) and death (OR 3.42).
Conclusions
Age, BMI, smoking, functional status, and some comorbidities can predict higher-risk patients for colostomy reversal. Identifying high-risk patients for elective colostomy reversal may help guide preoperative counseling and risk mitigation strategies.
{"title":"Predictors of mortality and major complications after colostomy reversal: An analysis of national surgical quality improvement program database","authors":"Mitchell E. McCain , Manh V. Nguyen , William G. Ruley , Nicholas D. Hollman , Stuart D. Hoff , Zhamak Khorgami","doi":"10.1016/j.amjsurg.2025.116713","DOIUrl":"10.1016/j.amjsurg.2025.116713","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to determine the predictors of post-operative complications and mortality for patients undergoing colostomy reversal using the National Surgical Quality Improvement Program database.</div></div><div><h3>Methods</h3><div>We included patients>18 undergoing elective colostomy reversal. A multivariate analysis was performed to find independent predictors of 30-day major complications and death following a colostomy reversal.</div></div><div><h3>Results</h3><div>Independent predictors of a major complication were age>70 (odds ratio (OR):1.24), having a body mass index≥40 kg/m<sup>2</sup>(OR:1.42), smoking(OR:1.24), history of severe chronic obstructive pulmonary disease(OR:1.96), having a dependent or partially dependent functional status(OR:1.48), hypertension(OR:1.25), steroid use(OR:1.38), being on dialysis(OR:2.37), and bleeding disorder(OR:1.60). When compared with laparoscopic reversal, the open approach was an independent predictor of both major complications (OR:1.67) and death (OR 3.42).</div></div><div><h3>Conclusions</h3><div>Age, BMI, smoking, functional status, and some comorbidities can predict higher-risk patients for colostomy reversal. Identifying high-risk patients for elective colostomy reversal may help guide preoperative counseling and risk mitigation strategies.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116713"},"PeriodicalIF":2.7,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578459","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}
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