BACKGROUND: Community-level sociodemographic factors and hospital quality are associated with access to cancer care and outcomes. METHODS: Using Medicare data (2016-2018), we evaluated the association between social dete...BACKGROUND: Community-level sociodemographic factors and hospital quality are associated with access to cancer care and outcomes. METHODS: Using Medicare data (2016-2018), we evaluated the association between social determinants of health (SDoH) and hospital quality with 30-day mortality and readmission after selected elective cancer surgery. Separate multivariable logistic regression models sequentially adjusted for comorbidities and SDoH factors (Social Vulnerability Index (SVI) and Distressed Communities Index (DCI)) and then Hospital Star Rating. RESULTS: Among 16,869 patients, the "At Risk" DCI group and higher SVI were associated with higher 30-day mortality, and higher SVI was associated with higher odds of 30-day readmission and mortality. Subsequent models demonstrated that higher Hospital Star Rating was associated with lower odds of 30-day mortality and readmission and SDoH factors lost significance after adjusting for Hospital Star Rating. CONCLUSIONS: Hospital quality may have a greater impact on short-term outcomes than SDoH factors.
BACKGROUND: Current guidelines recommend exploratory laparotomy for pediatric patients with abdominal firearm injuries. This study compared clinical outcomes of hemodynamically stable pediatric patients with abdominal fi...BACKGROUND: Current guidelines recommend exploratory laparotomy for pediatric patients with abdominal firearm injuries. This study compared clinical outcomes of hemodynamically stable pediatric patients with abdominal firearm injuries managed with laparoscopy versus laparotomy. METHODS: A retrospective, intention-to-treat study was conducted using the Pediatric Trauma Quality Improvement Program database. Pediatric patients (age <20) with abdominal firearm injuries from 2010 to 2020 were sorted into laparotomy (n = 1806) and laparoscopy (n = 48) groups. RESULTS: Laparoscopy was associated with lower complication rates (4.2% versus 21.1%, odds ratio [OR] 0.16, p = 0.002), fewer ICU stays (62.5% versus 77.4%, OR 0.49, p = 0.02), and fewer transfusions (35.4% versus 57.1%, OR 0.41, p = 0.003). There was no significant difference in infection rate, mortality rate, mean LOS, or mean ICU LOS. CONCLUSIONS: In select trauma patients, laparoscopy was associated with lower rates of complications, transfusions, and ICU stay.
BACKGROUND: Primary anastomosis (PA) is preferred over ostomy creation in most trauma patients with colon injuries. However, concomitant pancreatic injury is considered as a risk factor for anastomotic breakdown. This st...BACKGROUND: Primary anastomosis (PA) is preferred over ostomy creation in most trauma patients with colon injuries. However, concomitant pancreatic injury is considered as a risk factor for anastomotic breakdown. This study investigates outcomes of PA versus ostomy in patients with associated severe pancreatic injuries. METHODS: This ACS TQIP study included patients with severe colon injuries requiring resection and associated severe pancreatic injuries (AIS ≥3). Patients were categorized into anastomosis or ostomy groups. Anastomosis patients were propensity score-matched (1:2) to ostomy patients, controlling for age, gender, ISS, and pancreatic AIS. The primary outcome was surgical site infection (SSI), and secondary outcomes included unplanned return to the operating room (OR), length of stay (LOS), and ICU LOS. RESULTS: Of 269 patients, 60 underwent anastomosis and 209 received an ostomy. Sixty anastomosis patients were matched to 120 ostomy patients. Median ISS, rates of severe head, chest, abdominal, renal, and small bowel injuries, hypotension on admission, transfusion requirements, and comorbidities were similar. SSI rates (10.0% vs 17.5%, p = 0.184) and unplanned return to OR (8.3% vs 14.2%, p = 0.260) did not differ between cohorts. However, the ostomy group had significantly longer median LOS (21 vs 31 days, p = 0.005) and ICU LOS (10 vs 14 days, p = 0.033). CONCLUSION: In patients with severe pancreatic injuries undergoing colon resection, PA was not associated with increased SSIs or unplanned return to the OR compared to ostomy creation. Primary anastomosis was also associated with shorter hospital and ICU stays. These findings support the safety of PA, guided by clinical judgment.
BACKGROUND: Colorectal liver metastases are common, and the degree of liver tumor often determines overall prognosis. Advances in systemic therapy, surgical technique, locoregional therapies, and transplant oncology have...BACKGROUND: Colorectal liver metastases are common, and the degree of liver tumor often determines overall prognosis. Advances in systemic therapy, surgical technique, locoregional therapies, and transplant oncology have expanded the curative-intent treatment options for patients with upfront unresectable colorectal liver metastases (uCRLM). STUDY DESIGN: This narrative review synthesizes the contemporary evidence regarding the management of unresectable or borderline resectable CRLM, with a focus on microsatellite-stable disease. RESULTS: The modern management of uCRLM requires integration of systemic therapy with liver-directed strategies, including ablation, transarterial therapies, hepatic artery infusion chemotherapy, staged hepatectomy techniques, and liver transplantation. Patient selection increasingly emphasizes tumor biology, response to therapy, and adequacy of future liver remnant rather than strict anatomic criteria. Emerging strategies such as combined portal and hepatic vein embolization, multimodal cytoreduction, and transplant-based approaches have further expanded treatment options. CONCLUSIONS: The management of unresectable CRLM has evolved into a dynamic, multidisciplinary field. This review provides a practical, evidence-informed framework to guide treatment sequencing and patient selection, emphasizing the importance of multidisciplinary evaluation and early referral to experienced centers.
INTRODUCTION: Despite the growing number of female surgeons, women's representation in general surgery (GS) leadership remains limited. This study evaluated the academic profile between genders in GS residency leadership...INTRODUCTION: Despite the growing number of female surgeons, women's representation in general surgery (GS) leadership remains limited. This study evaluated the academic profile between genders in GS residency leadership to investigate factors contributing to gender disparity. METHODS: Information on GS residency programs and their leadership was collected in December 2024 using public databases and institutional websites. RESULTS: Within 363 GS residency programs, 1070 leaders were identified: 66.6% men and 33.4% women. Men represented the majority in all leadership positions and academic ranks, except assistant professor. Men had significantly higher median years in practice and scholarly output (p < 0.001), but when adjusted for career length (m-index), there was no significant difference (p = 0.84). CONCLUSION: Gender disparity in GS residency leadership persists, particularly at the department chair level, despite similar academic profiles between genders. This disparity appears driven by academic rank and seniority. Expanding opportunities for academic promotion and a more holistic leadership selection may improve equity.
BACKGROUND: With the increasing use of glucagon-like peptide receptor agonists and declining bariatric surgery referrals for patients with morbid obesity and chronic kidney disease (CKD), it is unclear whether this strat...BACKGROUND: With the increasing use of glucagon-like peptide receptor agonists and declining bariatric surgery referrals for patients with morbid obesity and chronic kidney disease (CKD), it is unclear whether this strategy optimizes long-term survival. STUDY DESIGN: A Markov state transition model simulated the life of 30,000 patients with morbid obesity and stage 5 CKD after three weight loss interventions: diet and exercise (DE), sleeve gastrectomy (SG), and tirzepatide treatment. Base case patients were 45 years old with a pre-intervention body mass index (BMI) of 45 kg/m. SG patients were exposed to a mortality risk in the first three months. Sensitivity analysis was conducted on pre-intervention BMI. RESULTS: Patients who underwent SG or treatment with tirzepatide experienced similar survival for pre-intervention BMIs below 38 kg/m. However, as baseline BMI increased, SG was associated with progressively greater projected survival compared with tirzepatide. At a BMI of 40 kg/m, SG was associated with an additional 0.6 life-years relative to tirzepatide, increasing to 3.2 life-years at a BMI of 50 kg/m. For all BMIs above 37 kg/m, SG and tirzepatide improved survival over DE. CONCLUSION: In this decision-analytic model, greater and more sustained weight loss was the primary driver of improved long-term survival among patients with stage 5 CKD and morbid obesity. While tirzepatide may offer comparable outcomes at lower BMIs, sleeve gastrectomy was associated with significantly increased survival benefit for those with BMIs above 40 kg/m. These findings highlight the importance of individualized, weight loss-focused strategies when counseling patients with advanced CKD.
BACKGROUND: Day-case inguinal hernia repair is increasingly used, but cost structure and distributional cost drivers remain insufficiently characterized. We examined temporal trends, cost composition, and determinants of...BACKGROUND: Day-case inguinal hernia repair is increasingly used, but cost structure and distributional cost drivers remain insufficiently characterized. We examined temporal trends, cost composition, and determinants of total costs. METHODS: We retrospectively studied consecutive adults undergoing open or laparoscopic day-case inguinal hernia repair at Beijing Chao-Yang Hospital, 2018-2024. The primary outcome was total cost per episode (RMB). Annual cost components were described, and multivariable quantile regression estimated associations across q10-q90. RESULTS: Among 12,550 repairs, mean cost fell in 2020, peaked in 2022, and stabilized thereafter. Materials were the largest cost component annually (57.02%-66.29%). Higher costs were associated with other-province origin, bilateral hernia, laparoscopic repair, additional diagnoses, and later calendar year. Lower costs were associated with older age, more prior hospitalizations, uninsured status, and selected sociodemographic factors. Several associations were stronger at higher quantiles. CONCLUSIONS: Costs were materials-dominated and heterogeneous, supporting procurement-focused stewardship and refined payment calibration in ambulatory hernia care.