Annals of Surgery

PURPOSE: Trauma patients are at high risk of venous thromboembolism (VTE). We summarize the comparative efficacy and safety of anti-Xa guided versus fixed dosing for low molecular weight heparin (LMWH) for the prevention of VTE in adult trauma patients. METHODS: We searched Medline and Embase from inception through June 1, 2022. We included randomized controlled trials (RCTs) or observational studies comparing anti-Xa guided versus fixed dosing of LMWH for thromboprophylaxis in adult trauma patients...

OBJECTIVE: This study aimed to compare the short-term outcomes between laparoscopic and open distal pancreatectomy for lesions of the distal pancreas from a real-world database. SUMMARY BACKGROUND DATA: Reports on the benefits of laparoscopic distal pancreatectomy include two randomized controlled trials; however, large-scale, real-world data are scarce. METHODS: We analyzed the data of patients undergoing laparoscopic or open distal pancreatectomy for benign or malignant pancreatic tumors from April 2008 to May 2020 from a Japanese nationwide inpatient database...

OBJECTIVE: We examined long-term health outcomes associated with new persistent opioid use after surgery and hypothesized that patients with new persistent opioid use would have poorer overall health outcomes compared to those who did not develop new persistent opioid use after surgery. SUMMARY BACKGROUND DATA: New persistent opioid use is a common surgical complication. Long-term opioid use increases risk of mortality, fractures, and falls; however, less is known about healthcare utilization among older adults with new persistent opioid use following surgical care...

OBJECTIVE: To evaluate long-term oncologic outcomes of patients with stage IV pancreatic ductal adenocarcinoma (PDAC) and identify survival benchmarks for comparison when considering resection in these patients. SUMMARY BACKGROUND DATA: Highly selected cohorts of patients with liver-oligometastatic pancreas cancer have reported prolonged survival following resection. The long-term impact of surgery in this setting remains undefined due to a lack of appropriate control groups...

OBJECTIVE: This study aimed to evaluate the oncological adequacy of lymphadenectomy (LND) for biliary tumours and surgical outcomes of resections performed using robotic, laparoscopic, and open approaches, and to compare the techniques within a weighted propensity score analysis. SUMMARY BACKGROUND DATA: The need to perform formal LND is considered a limit for the applicability of minimally invasive liver surgery. METHODS: Overall, 25 robotic resections with LND (2021-2022) from a single centre constituted the study group (Rob Group), matched by inverse probability treatment weighting with 97 laparoscopic (Lap Group) and 113 open (Open Group) procedures to address the primary endpoint...

OBJECTIVE: To define the risks associated with the replacement of dual antiplatelets for alternate medication regimens. SUMMARY BACKGROUND DATA: Patients undergoing transcarotid artery revascularization (TCAR) for atherosclerotic disease in the Vascular Quality Initiative database from September 2016-June 2022 were included. In all, 29,802 TCAR procedures were captured between 2016-2022, consisting of 24,651 (82.7%) maintained on dual antiplatelet therapy (DAPT) and 5,151 (17...

OBJECTIVE: To compare textbook outcomes (TO) of open live donor right hepatectomy (RH) versus open right hepatic lobectomy for cancer in a single Western center, and to identify clinical factors associated with failure to achieve a TO. SUMMARY BACKGROUND DATA: TO, a composite quality measure that captures multiple aspects of peri-operative care, has not been thoroughly studied in open RH. We hypothesized that TO rates after RH for live donor transplant could represent the "best-achievable" results of this operation and could serve as the benchmark for RH performed for an oncologic indication...

OBJECTIVE: To evaluate whether redosing antibiotics within an hour of incision is associated with a reduction in incisional surgical site infection (iSSI) in children with appendicitis. SUMMARY OF BACKGROUND DATA: Existing data remain conflicting as to whether children with appendicitis receiving antibiotics at diagnosis benefit from antibiotic redosing prior to incision. METHODS: This was a multicenter retrospective cohort study using data from the Pediatric National Surgical Quality Improvement Program augmented with antibiotic utilization and operative report data obtained though supplemental chart review...

OBJECTIVE: To assess the effect of the Global Budget Revenue (GBR) program on outcomes after surgery. BACKGROUND: There is limited data summarizing the effect of the GBR program on surgical outcomes as compared to traditional fee-for-service systems. METHODS: The Medline, Embase, Scopus, and Web of Science databases were used to conduct a systematic literature search on April 5th, 2022. We identified full-length reports of comparative studies involving patients who underwent surgery in Maryland following implementation of the GBR program...

OBJECTIVE: To assess the oncological benefit of adjuvant chemotherapy (AC) in node positive (ypN+) rectal cancer following neoadjuvant chemoradiotherapy (NACRT) and radical surgery. SUMMARY BACKGROUND DATA: The evidence for adjuvant chemotherapy (AC) following total mesorectal excision (TME) for locally advanced rectal cancer (LARC) is conflicting and the net survival benefit is debated. METHODS: An international multicenter comparative cohort study was performed comparing oncological outcomes in tertiary rectal cancer centers from the Netherlands and France...

OBJECTIVE: To assess associations between co-occurring preoperative smoking and risky alcohol use on the likelihood of adverse surgical outcomes. SUMMARY BACKGROUND DATA: Risky alcohol use and smoking are known surgical risk factors with a high co-occurrence and additive adverse effects on multiple organ systems that impact surgical health, yet no research has evaluated the impact of co-occurrence on surgical outcomes. METHODS: This investigation analyzed 200,816 patients from the Michigan Surgical Quality Collaborative database between 7/1/2012 to 12/31/2018...

OBJECTIVE: To determine the association between risk adjusted hospital perioperative mortality rates, postoperative complications, and failure to rescue (FTR) after inpatient pediatric surgery. BACKGROUND: FTR has been identified as a possible explanatory factor for hospital variation in perioperative mortality in adults. However, the extent to which this may be the case for hospitals that perform pediatric surgery is unclear. METHODS: The Pediatric Health Information System® database (2012-2020) was used to identify patients who underwent one of 57 high-risk operations associated with significant perioperative mortality (n=203,242)...

OBJECTIVE: Health Professional Shortage Areas (HPSA) were created by the Health Resources and Services Administration to identify communities with a shortage of clinical providers. For medical conditions, these designations are associated with worse outcomes. However, far less is known about patients undergoing high complexity surgical procedures, such as coronary artery bypass grafting (CABG). SUMMARY BACKGROUND DATA: To compare post-operative surgical outcomes of high complexity surgery in beneficiaries living in HPSA versus non-HPSA designated areas...

OBJECTIVE: To develop and validate the Veterans Administration (VA) Lung Cancer Mortality (VALCAN-M) score, a risk prediction model for 90-day mortality following surgical treatment of clinical stage I non-small cell lung cancer (NSCLC). BACKGROUND: While surgery remains the preferred treatment for functionally fit patients with early-stage NSCLC, less invasive, non-surgical treatments have emerged for high-risk patients. Accurate risk prediction models for post-operative mortality may aid surgeons and other providers in optimizing patient-centered treatment plans...

OBJECTIVE: To develop a machine learning model that automatically quantifies the spread of blood in the surgical field using intraoperative videos of laparoscopic colorectal surgery and evaluate whether the index measured with the developed model can be used to assess tissue handling skill. SUMMARY BACKGROUND DATA: Although skill evaluation is crucial in laparoscopic surgery, existing evaluation systems suffer from evaluator subjectivity and are labor-intensive...

OBJECTIVE: This survey study aims to determine the prevalence of pregnancy complications and infertility in female physicians in comparison to the general population. Risk factors, workplace environment, and education are also examined. SUMMARY BACKGROUND DATA: Physicians undertake long training and have stressful work environments during optimal childbearing years. While growing literature indicates increased rates of pregnancy complications and infertility in female surgeons, the prevalence in female physicians of all specialties is unknown...

OBJECTIVE: The objective of this study is to systematically synthesize the existing literature on the experiences of motherhood in female surgeons both during surgical training and as staff physicians, to identify knowledge gaps, and provide recommendations for institutional changes to better support pregnant female surgeons. BACKGROUND: There are disproportionately fewer medical students pursuing surgical specialties as surgery is often seen as incompatible with childbearing and pregnancy...

OBJECTIVE: To verify an intraoperative adverse event (iAE) classification (ClassIntra grade) to evaluate quality control and predict the prognostic performance of laparoscopic radical surgery for gastric cancer. SUMMARY OF BACKGROUND DATA: Surgical quality control is a key factor in the evaluation of surgical treatment for tumors. And, there is no recognized iAE classification for gastric cancer. METHODS: We performed a retrospective post-hoc analysis of previously collected data from the FUGES-001 study (NCT02327481) and a subset of the CLASS-01 study (NCT01609309)...

OBJECTIVE: To present technical details and short-term experiences of Liver transplantation as a two-stage procedure using small for size grafts in a multicenter cohort study. SUMMARY BACKGROUND DATA: Two-stage liver transplantation using small for size grafts should be a feasible procedure with lower morbidity and mortality rates. Retrospective cohort study between 2015 and 2022 with multicenter experience. Twenty-three RAPID procedures for non-cirrhotic indications were performed in six European centers (twenty with grafts from living donors and three after deceased donation)...

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