Annals of Surgery

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OBJECTIVE: To compare costs for 2 days versus 5 days of postoperative antibiotics within the Antibiotics following aPPendectomy In Complex appendicitis (APPIC) trial.Summary Background Data:Recent studies suggest that restrictive antibiotic use leads to a significant reduction in hospital stay without compromising patient safety. Its potential effect on societal costs remains underexplored. METHODS: This was a pragmatic, open-label, multicenter clinical trial powered for non-inferiority...

OBJECTIVE: To quantify the rate of low-yield surgery, defined as no high-grade dysplastic precursor lesions or T1N0M0 pancreatic cancer at pathology, during pancreatic cancer surveillance. SUMMARY BACKGROUND DATA: Global efforts have been made in pancreatic cancer surveillance to anticipate the diagnosis of pancreatic cancer at an early stage and improve survival in high-risk individuals (HRI) with a hereditary predisposition. The negative impact of pancreatic cancer surveillance when surgery is performed for low-grade dysplasia or a non-neoplastic condition is not well-quantified...

OBJECTIVE: To investigate how omitting additional surgery after local excision (LE) affects patient outcomes in high-risk T1 colorectal cancer (CRC). SUMMARY BACKGROUND DATA: It is debatable whether additional surgery should be performed for all patients with high-risk T1 CRC regardless of the tolerability of invasive procedures. METHODS: Patients who had received LE for T1 CRC at the Japanese Society for Cancer of the Colon and Rectum (JSCCR) institutions between 2009 and 2016 were analyzed...

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OBJECTIVE: To measure commercial price variation for cancer surgery within and across hospitals. SUMMARY BACKGROUND DATA: Surgical care for solid organ tumors is costly and negotiated commercial rates have been hidden from public view. The Hospital Price Transparency Rule, enacted in 2021, requires all hospitals list their negotiated rates on their website, thus opening the door for an examination of pricing for cancer surgery. METHODS: This was a cross-sectional study using 2021 negotiated price data disclosed US hospitals for the ten most common cancers treated with surgery...

OBJECTIVE: To evaluate the safety, efficacy, and cost-effectiveness of outpatient appendectomy in patients with uncomplicated acute appendicitis. SUMMARY BACKGROUND DATA: Given that acute appendicitis is the most common cause of acute abdomen, the introduction of outpatient appendectomy protocols could significantly improve the effectiveness and sustainability of healthcare systems. METHODS: A total of 300 patients were enrolled from October 2018 to June 2021 in the PENDI-CSI randomized clinical trial:149 were assigned to the outpatient surgery group (OPS) and 151 to the inpatient surgery group (IPS), followed by one month postoperatively...

BACKGROUND: Neoadjuvant therapy (NT) is increasingly used for patients with localized gastrointestinal (GI) cancers. There is little data assessing patient experience and quality of life (QOL) during NT for GI cancers. OBJECTIVE: To use a customized smartphone application to prospectively measure QOL and the real-time patient experience during NT. METHODS: Patients with GI cancers receiving NT were instructed on using a customized smartphone application through which the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire, a validated measure of health-related (HR) QOL, was administered at baseline, every 30 days, and at completion of NT...

OBJECTIVE: To assess the impact of community-level socioeconomic deprivation on survival outcomes following heart transplantation. BACKGROUND: Despite growing awareness of socioeconomic disparities in the U.S. healthcare system, significant inequities in outcomes remain. While recent literature has increasingly considered the effects of structural socioeconomic deprivation, the impact of community socioeconomic distress on outcomes following heart transplantation has not yet been elucidated...

OBJECTIVE: To assess the correlation between recurrence-free survival (RFS) and overall survival (OS) in the hepato-biliary-pancreatic (HBP) surgical setting in order to validate RFS as a surrogate endpoint. SUMMARY BACKGROUND DATA: Reliable surrogate endpoints for OS are still limited in the field of HBP surgery. METHODS: We analyzed patients who underwent curative resection for HBP disease (986 patients with pancreatic ductal adenocarcinoma [PDAC], 1168 with biliary tract cancer [BTC], 1043 with hepatocellular carcinoma [HCC], and 1071 with colorectal liver metastasis [CRLM]) from September 2002 to June 2022...

OBJECTIVE: Compare outcomes of patients using versus not using cannabis as a treatment for pain after discharge from surgery. SUMMARY BACKGROUND DATA: Cannabis is increasingly available and is often taken by patients to relieve pain. However, it is unclear whether cannabis use for pain after surgery impacts opioid consumption and postoperative outcomes. METHODS: Using Michigan Surgical Quality Collaborative registry data at 69 hospitals, we analyzed a cohort of patients undergoing sixteen procedure types between January 1, 2021, and October 31, 2021...

OBJECTIVE: To assess if multiplayer virtual reality (VR) training was superior to single player training for acquisition of both technical and non-technical skills in learning complex surgery. SUMMARY BACKGROUND DATA: Superior team-work in the operating room (OR) is associated with improved technical performance and clinical outcomes. VR can successfully train OR staff individually, however VR team training has yet to be investigated. METHOD: Forty participants were randomised to individual or team VR training...

OBJECTIVE: Evaluate the association of annual trauma patient volume on outcomes for emergency medical services (EMS) agencies. SUMMARY BACKGROUND DATA: Regionalization of trauma care saves lives. The underlying concept driving this is a volume-outcome relationship. EMS are the entry point to the trauma system, yet it is unknown if a volume-outcome relationship exists for EMS. METHODS: Retrospective analysis of prospective cohort including eight trauma centers and 20 EMS air medical and metropolitan ground transport agencies...

OBJECTIVE: This study assessed incivility during Mortality and Morbidity (M&M) Conference. BACKGROUND: A psychologically safe environment at M&M Conference enables generative discussions to improve care. Incivility and exclusion demonstrated by "shame and blame" undermine generative discussion. METHODS: We used a convergent mixed-methods design to collect qualitative data through non-participant observations of M&M conference and quantitative data through standardized survey instruments of M&M participants...

OBJECTIVE: Evaluate the association between neighborhood disadvantage and Oncotype DX score, a surrogate for tumor biology, among a national cohort. SUMMARY BACKGROUND DATA: Women living in disadvantaged neighborhoods have shorter breast cancer (BC) survival, even after accounting for individual-level, tumor, and treatment characteristics. This suggests unaccounted social and biological mechanisms by which neighborhood disadvantage may impact BC survival. METHODS: This cross-sectional study included Stage I and II, ER+ /HER2- BC patients with Oncotype DX score data from the National Cancer Database from 2004-2019...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

OBJECTIVE: In this study, we sought to assess how liver allografts preserved using portable normothermic machine perfusion (NMP) compare against those that underwent ischemic cold storage (ICS) in the setting of donation after brain death (DBD) and donation after circulatory death (DCD) liver transplantation. BACKGROUND: Compared to conventional ICS, NMP may offer a more homeostatic preservation, permit physiologic assessment of organ function, and provide opportunities for graft improvement/modification...

OBJECTIVE: To examine the association between race, experience of microaggressions, and implicit bias in surgical training. SUMMARY BACKGROUND DATA: There is persistent underrepresentation of specific racial and ethnic groups in the field of surgery. Prior research has demonstrated significant gender differences among those who experience microaggressions during training. However, little research has been conducted on the association between race and experiences of microaggressions and implicit bias among surgical trainees...

OBJECTIVE: To assess the rate of textbook outcome (TO) and textbook oncological outcome (TOO) in European population based on Gastrodata registry. BACKGROUND: TO is a composite parameter assessing surgical quality and strongly correlates with improved overall survival. Following the standard of treatment for locally advanced gastric cancer (GC), TOO was proposed as a quality and optimal multimodal treatment parameter. METHODS: TO was achieved when all the following criteria were met: no intraoperative complications, radical resection according to the surgeon, pR0 resection, retrieval of at least 15 lymph nodes, no severe postoperative complications, no reintervention, no admission to the intensive care unit, no prolonged length of stay, no postoperative mortality and no hospital readmission...