BACKGROUND: While outpatient thyroidectomy is well-studied in healthy patients, data are limited in patients with previously defined relative contraindications including obstructive sleep apnea, anticoagulant or antiplat...BACKGROUND: While outpatient thyroidectomy is well-studied in healthy patients, data are limited in patients with previously defined relative contraindications including obstructive sleep apnea, anticoagulant or antiplatelet use, substernal goiter, and Graves' disease. This study evaluates safety of outpatient thyroidectomy in high-risk patients compared to low-risk patients at a high-volume endocrine surgery center. STUDY DESIGN: Retrospective cohort. RESULTS: From 2021 to 2025, 513 patients underwent outpatient total thyroidectomy (271 low-risk; 242 high-risk). Complication rates were low and comparable between groups. Hematoma occurred in 1.1% of low-risk versus 0.4% of high-risk patients (p = 0.70). Anticoagulant or antiplatelet therapy (excluding aspirin) was held preoperatively. Transient recurrent laryngeal nerve injury was 4.06% vs 4.56% (p = 0.95); transient hypocalcemia was 15.13% vs 16.6% (p = 0.74). No permanent nerve injuries or permanent hypocalcemia occurred. Adverse 30-day events were also comparable. CONCLUSION: Outpatient thyroidectomy is safe in patients with some relative contraindications. These findings support expanding outpatient eligibility criteria for high-volume centers.
BACKGROUND: Bariatric surgery utilization is low despite high obesity prevalence in the Deep South, and access challenges are poorly understood. This study explores patient perspectives on barriers and facilitators to ba...BACKGROUND: Bariatric surgery utilization is low despite high obesity prevalence in the Deep South, and access challenges are poorly understood. This study explores patient perspectives on barriers and facilitators to bariatric surgery. METHODS: This qualitative study enrolled pre- and post-operative bariatric surgery patients at a tertiary hospital. Using the socioecological model of health, semi-structured interview guides were developed. Interviews were analyzed using inductive thematic analysis. RESULTS: Of 22 participants, the majority were Female (86.4%, n = 19), Black (59.1%, n = 13), lived in urban areas (63.6%, n = 14), and had surgery (72.7%, n = 16). Identified themes included mental health and primary care physician (PCP) role (individual); family and social support (interpersonal); patient education, communication, waiting times, and technology utilization (organizational); support group, transportation, and stigma (community); insurance policy and cost coverage (policy). CONCLUSIONS: Barriers and facilitators to bariatric surgery existed along all socioecological domains. Community outreach and education are needed to improve bariatric surgery access.
BACKGROUND: This survey study sought to characterize the experiences and treatments of sexual and gender minority (SGM) patients with breast cancer. METHODS: The WhySurg survey was modified to focus on SGM patients and d...BACKGROUND: This survey study sought to characterize the experiences and treatments of sexual and gender minority (SGM) patients with breast cancer. METHODS: The WhySurg survey was modified to focus on SGM patients and distributed via social media, support groups, and clinic flyers between 2023 and 2024. SGM individuals, age ≥18, and a history of breast cancer were eligible. Descriptive and reflexive thematic analyses were performed. RESULTS: 50 individuals responded, with 31 (62%) completing it. Most (77%) were cisgender women, 16% nonbinary, and 3% transgender man. Most (58%) were lesbian/gay/homosexual, while 23% were bisexual, 13% pansexual, 13% queer, 3% asexual, 1 heterosexual, and 1 other. 29% experienced discrimination related to their SGM identity during treatment. Three themes emerged: 1) SGM identity influenced surgical choice, 2) respondents were reluctant to share SGM identity, and 3) appropriate surgical expectations are key to optimize gender-affirming patient-centered outcomes. CONCLUSION: SGM data is essential to ensure patient-centered surgical decision-making.
INTRODUCTION: Despite multiple proposed frameworks for surgical mentorship, limited evidence synthesizes how participants experience mentee-mentor matching programs. This study systematically reviews and synthesizes sati...INTRODUCTION: Despite multiple proposed frameworks for surgical mentorship, limited evidence synthesizes how participants experience mentee-mentor matching programs. This study systematically reviews and synthesizes satisfaction among individuals in surgical training or practice participating in such programs METHODS: Following PRISMA guidelines and PROSPERO registration, PubMed, Scopus, and Google Scholar were searched through October 2025. Studies were critically appraised, and certainty of evidence was assessed using GRADE. A single-arm meta-analysis was performed for mentee satisfaction, while secondary outcomes were synthesized qualitatively. RESULTS: Seven studies including 144 mentees and 115 mentors were analyzed, with overall moderate risk of bias. Mentorship models varied (dyad, peer, group, virtual), most commonly pairing early-stage trainees with senior residents or faculty. Shared clinical or research interests were the most frequent matching criterion (83%). The pooled satisfaction proportion was 0.92 (95% CI: 0.80-1.00). Areas for improvement included selection processes, meeting structure, technical issues, and mentor continuity. Certainty of evidence was very low. CONCLUSIONS: Mentee-mentor matching programs appear to be associated with high satisfaction, though evidence certainty is limited, underscoring the need for well-designed controlled studies.
BACKGROUND: This study compares complication rates between patients who had and did not have the Surgical Risk Preoperative Assessment System (SURPAS) used preoperatively. METHODS: This was a multi-center propensity-matc...BACKGROUND: This study compares complication rates between patients who had and did not have the Surgical Risk Preoperative Assessment System (SURPAS) used preoperatively. METHODS: This was a multi-center propensity-matched study, 2017-2024. 1:1 Greedy matching was used to match patients who had and did not have SURPAS used. After matching, rates of 11 postoperative complications were estimated and compared using the Automated Surveillance of Postoperative Infections and Non-Infections (ASPIN) system and compared. RESULTS: Of 457,117 patients, 22,875 (5.00%) had SURPAS. The SURPAS cohort was older, had more ASA class 3-4 patients, fewer with emergent surgery, and more with 2+ comorbidities. After matching, the SURPAS cohort had lower mortality (0.71% vs. 1.02%, p = 0.001), cardiac (0.34% vs. 0.49%, p < 0.001), and renal (0.28% vs. 0.34%, p = 0.013) complications, but more VTEs (1.46% vs. 1.19%, p < 0.001). CONCLUSIONS: SURPAS may identify high-risk patients leading to modifications of care associated with reduced mortality, cardiac, and renal complications.
Pancreatic ductal adenocarcinoma (PDAC) is among the deadliest solid tumors, with five-year survival rates rarely exceeding 10%. Tumor location has been proposed as a prognostic factor, but prior studies have yielded inc...Pancreatic ductal adenocarcinoma (PDAC) is among the deadliest solid tumors, with five-year survival rates rarely exceeding 10%. Tumor location has been proposed as a prognostic factor, but prior studies have yielded inconsistent results due to methodological heterogeneity. Using the TriNetX Global Collaborative Network, we compared outcomes of resected PDAC in the head (pancreaticoduodenectomy) versus the body/tail (distal pancreatectomy). To capture definitive therapy, surgeries performed 30-365 days after diagnosis were included. One-to-one propensity score matching balanced demographics, comorbidities, and tumor stage. After matching, 2306 patients were analyzed. Thirty-day mortality was higher in head tumors (2.3% vs. 0.9%; HR 2.67, p < 0.001), with increased risk of sepsis, while other complications were similar. Long-term mortality remained greater for head tumors (39.8% vs. 31.6%), with shorter median survival (1131 vs. 2020 days). These findings suggest that tumor location is an independent, clinically meaningful prognostic factor after resection and support location-specific strategies.
Ruzgar NM, Guetter CR, Buchheit JT
… +6 more, Franco C, Correa N, Millar J, Altieri MS, Cannada LK, Association of Women Surgeons (AWS) National Resident and Fellows Committee
OBJECTIVE: Appendiceal cancer (AC) is a rare and understudied gastrointestinal malignancy with a rising incidence. Molecular characterization of this disease is limited. In this work, we analyzed molecular alterations of...OBJECTIVE: Appendiceal cancer (AC) is a rare and understudied gastrointestinal malignancy with a rising incidence. Molecular characterization of this disease is limited. In this work, we analyzed molecular alterations of appendiceal cancer across seven key oncogenic pathways- RTK/RAS, TP53, MAPK, PI3K, TGF-β, WNT and JAK/STAT-stratified by tumor subtype and stage, to identify clinically relevant molecular signatures that could inform precision oncology strategies. METHODS: A cohort of 861 AC cases (402 primary and 459 metastatic) were analyzed from publicly available genomic datasets. Samples were stratified by tumor stage, histology (Group 1-LAMN/Low-Grade Adenocarcinoma; Group 2-Moderate-to High-Grade Adenocarcinoma; Group 3-Goblet Cell Adenocarcinoma; Group 4-Signet Ring Cell Adenocarcinoma), and sex. Mutation frequencies and tumor mutational burden (TMB) were evaluated across the seven pathways. Statistical comparisons were performed using chi-squared tests, and overall survival (OS) was assessed using Kaplan-Meier analysis. RESULTS: In primary AC, alterations in the RTK/RAS pathway (p = 0.006) and MAPK pathway (p = 0.019) were significantly associated with improved overall survival (OS). In metastatic AC, TP53 pathway alterations correlated with poorer OS (p = 0.012). Comparative analyses revealed distinct molecular differences between primary and metastatic tumors: PI3K pathway alterations were more frequent in primary AC than in metastatic cases (18.2% vs. 12.9%, p = 0.03). Similarly, within the TGF-β pathway, SMAD4 mutations were enriched in primary compared to metastatic tumors (6.7% vs. 2.8%, p = 0.01). Histology-based stratification confirmed differential pathway enrichment: PI3K alterations were higher in primary vs. metastatic tumors in Group 2 (22.1% vs. 11.0%, p = 0.008), and TP53 alterations were less frequent in primary vs. metastatic Group 3 cases (15.7% vs. 30.0%, p = 0.037). Genes in the RTK/RAS pathway-including SOS1 (p = 0.04), KIT (p = 0.001), and RAF1 (p = 0.04)-were more commonly mutated in primary tumors. Likewise, the TP53 pathway gene CDKN2A was more frequently altered in primary than in metastatic samples (p = 0.02). Missense mutations were the predominant alteration type across all cohorts. Distinct oncogenic pathway remodeling characterizes appendiceal cancer progression, with primary tumors enriched for PI3K and SMAD4 alterations and metastatic Goblet Cell Adenocarcinoma demonstrating increased TP53 pathway disruption. CONCLUSION: This study offers a comprehensive molecular characterization of AC, comparing distinct oncogenic pathway signatures between primary and metastatic disease. The identification of pathway-specific alterations offers valuable insights into the molecular heterogeneity of AC and highlights opportunities for pathway-targeted therapies. These findings emphasize the importance of integrative molecular profiling to advance precision oncology and improve outcomes for patients with this rare malignancy.
BACKGROUND: Partial mastectomy is generally considered low risk, yet rare thrombotic complications such as stroke, myocardial infarction (MI), and pulmonary embolism (PE) may still occur. This study identified independen...BACKGROUND: Partial mastectomy is generally considered low risk, yet rare thrombotic complications such as stroke, myocardial infarction (MI), and pulmonary embolism (PE) may still occur. This study identified independent predictors of these events within 30 days of surgery. METHODS: A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2018 to 2022. Patients undergoing partial mastectomy (CPT 19301) were analyzed. Univariable screening was followed by outcome-specific multivariable logistic regression. RESULTS: Among 81,318 patients, postoperative stroke occurred in 0.032%, MI in 0.034%, and PE in 0.047%. Increasing age and higher American Society of Anesthesiologists (ASA) classification were associated with both stroke and MI, while diabetes independently increased stroke risk. Pulmonary embolism was associated with longer operative time, higher body mass index, and impaired functional status. CONCLUSION: Although thrombotic complications after partial mastectomy are rare, identifiable patient and operative factors meaningfully influence risk and may guide perioperative risk stratification.
BACKGROUND: Neighborhood socioeconomic status (nSES) has been associated with health inequities, but its impact on short-term postoperative complications following metabolic and bariatric surgery (MBS) remains unclear. O...BACKGROUND: Neighborhood socioeconomic status (nSES) has been associated with health inequities, but its impact on short-term postoperative complications following metabolic and bariatric surgery (MBS) remains unclear. OBJECTIVE: To evaluate the relationship between nSES, measured by the Distressed Communities Index (DCI), and short-term complications after MBS, and to assess whether race/ethnicity modifies this association. METHODS: A retrospective cohort study was conducted using the Maryland State Inpatient Database (2018-2020) including adults undergoing MBS. Complications were categorized as none versus ≥1. Multivariable logistic regression adjusted for demographic, clinical, socioeconomic, and geographic factors. RESULTS: Only 5.3% of the 10,784 patients experienced at least one complication, most often venous thromboembolism (2.2%) or gastrointestinal leak (0.9%)-while 94.7% had none. Complication rates did not vary across DCI categories, and race/ethnicity did not moderate these associations. CONCLUSIONS: This study found no significant association between neighborhood socioeconomic disadvantages and the occurrence of short-term postoperative complications following MBS.
BACKGROUND: The need for antibiotics in mild-moderate cholecystitis is not known. This systematic review and meta-analysis determines the impact of perioperative antibiotics on postoperative infectious complications in p...BACKGROUND: The need for antibiotics in mild-moderate cholecystitis is not known. This systematic review and meta-analysis determines the impact of perioperative antibiotics on postoperative infectious complications in patients with mild-moderate acute cholecystitis undergoing acute cholecystectomy. METHODS: Electronic searches were performed in EMBASE, Pubmed, and CENTRAL. Random effects meta-analyses were performed. RESULTS: Meta-analysis of infectious complications with 9% (84/889) in intervention group, 12% (106/895) in control group, and no significant effects of antibiotics (8 studies, odds ratio (OR) = 0.78, 95% confidence interval (CI) = [0.58; 1.07], I2 = 0%). Surgical site infections with 5% (28/521) in intervention group, 8% (42/521) in control group, and no significant effects of antibiotics (4 studies, OR = 0.72, CI[0.38; 1.38], I2 = 26%). Length of stay and mortality without significant differences. Trial sequential analysis with futility thresholds reached. CONCLUSION: Antibiotics in mild-moderate acute cholecystitis do not reduce postoperative infections. Current evidence supports omitting antibiotics in the otherwise healthy patients. Further studies of high-risk patients are needed.
BACKGROUND: The rising prevalence of obesity in Mexico has increased the demand for Metabolic & bariatric surgery, a technically complex procedure that requires rigorous surgical training to ensure patient safety. This s...BACKGROUND: The rising prevalence of obesity in Mexico has increased the demand for Metabolic & bariatric surgery, a technically complex procedure that requires rigorous surgical training to ensure patient safety. This study evaluates the safety and efficacy of bariatric procedures performed by surgical fellows acting as primary surgeons under direct supervision, within a structured fellowship program incorporating simulation training and stepwise autonomy at a private teaching hospital. METHODS: A retrospective analysis was conducted on 93 patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2012 and 2023. All procedures were performed by fellows under direct supervision. Outcomes assessed included operative time, complication rates, readmissions, and weight loss, and were compared to a matched cohort operated on by staff surgeons, as well as to benchmark data from NSQIP and MBSAQIP databases. RESULTS: The cohort included 76 females and 17 males, with a mean BMI of 42.6 ± 12.1 kg/m. There were no mortalities, ICU admissions, or conversions to open surgery. Mean operative time was 187.4 min. Major complications occurred in 6.4% (6/93) of patients, with 3.2% requiring reoperation. One-year excess weight loss was 76 ± 18.8%. Compared to the control group and benchmark databases, only operative time was significantly longer. CONCLUSION: Metabolic/bariatric surgery performed by fellows within a structured and supervised training program is safe and effective. Although operative times were longer, patient outcomes were not compromised.
BACKGROUND: Pectoralis nerve blocks (PNB) are increasingly used for post-mastectomy analgesia. We evaluated whether block timing (preoperative vs intraoperative) affected postoperative opioid use. METHODS: A retrospectiv...BACKGROUND: Pectoralis nerve blocks (PNB) are increasingly used for post-mastectomy analgesia. We evaluated whether block timing (preoperative vs intraoperative) affected postoperative opioid use. METHODS: A retrospective review of mastectomy patients receiving preoperative (PPNB) or intraoperative (IPNB) PNB was performed. Multivariable analysis assessed post-anesthesia care unit (PACU) opioid use and morphine milligram equivalents (MME). Subgroup analyses of unilateral (UM) and bilateral mastectomy (BM) were conducted. RESULTS: Among 122 patients, 69 received PPNB and 53 IPNB. No block-related complications occurred. Overall, 36.1% required no postoperative opioids. Block timing was not associated with differences in PACU opioid use or MME on multivariable analysis, including UM and BM subgroups. Preoperative acetaminophen was independently associated with reduced opioid use and lower MME. CONCLUSION: PNBs are safe and effective for multimodal mastectomy analgesia. Block timing did not influence opioid requirements, suggesting timing may be guided by workflow, while multimodal strategies remain critical.
BACKGROUND: Adolescents hospitalized for firearm injuries are at high risk for developing behavioral health conditions, yet sex-based differences in these outcomes remain poorly understood. METHODS: Using the 2016-2022 N...BACKGROUND: Adolescents hospitalized for firearm injuries are at high risk for developing behavioral health conditions, yet sex-based differences in these outcomes remain poorly understood. METHODS: Using the 2016-2022 Nationwide Readmissions Database, we identified adolescents aged 10-18 hospitalized for firearm injuries and evaluated readmissions for new mental health and substance use disorders within the calendar year of injury. Multivariable logistic regression examined associations between sex and behavioral health outcomes. RESULTS: Among 27,428 adolescents, females were more likely than males to be readmitted with new mental health diagnoses (3.0% vs. 2.0%, p < 0.001), particularly depression, anxiety, and post-traumatic stress disorder. Female sex was independently associated with new mental health diagnoses (aOR 1.55, 95% CI 1.25-1.92), but not with new substance use disorders on logistic regression. Females also had longer index hospitalizations, adverse discharges, and higher overall readmission rates. CONCLUSIONS: Female adolescents experience distinct health trajectories after firearm injury. Early behavioral health screening should be systematized to ensure timely recognition and treatment for all firearm-injured youth.
INTRODUCTION: Inguinal hernia repair is becoming increasingly popular as a same-day surgery (admission, operation, and discharge within 24 h) as the proportion of elderly people increases. Relevant studies have not been...INTRODUCTION: Inguinal hernia repair is becoming increasingly popular as a same-day surgery (admission, operation, and discharge within 24 h) as the proportion of elderly people increases. Relevant studies have not been completed; therefore, our objective was to evaluate the safety and feasibility of same-day surgery modalities for inguinal hernia repair in elderly patients aged 70 years and older. METHODS: We conducted a retrospective analysis of patients who underwent inguinal hernia repair at our institution between January 2020 and December 2023. Patients were categorized into three groups: a same-day surgery group aged ≥70 years, an inpatient group aged ≥70 years, and a same-day surgery group aged <70 years. Using 1:1 propensity score matching (PSM), the ≥70 years same-day surgery group was compared separately with the ≥70 years inpatient group and the <70 years same-day surgery group. Postoperative outcomes were compared between these matched cohorts. RESULTS: The study included 230 patients ≥70 years in the same-day surgery group, 645 patients ≥70 years in the inpatient group, and 570 patients <70 years in the same-day surgery group before matching. After PSM, 230 matched pairs were formed for the comparison between the ≥70 years same-day surgery and inpatient groups. No significant differences were found in intraoperative blood loss, operative time, or postoperative complications (including fever, vomiting, urinary retention, VTE, seroma, wound healing, pain scores at discharge, and recurrence rates) (P > 0.05). However, relative to same-day surgery, inpatient management was associated with significantly higher total costs (¥15,006.84 ± 3045.87 vs. ¥12,990.42 ± 3399.61; P < 0.001) and a longer postoperative stay (40.35 ± 19.43 vs. 12.57 ± 3.74 h; P < 0.001). Another PSM created 156 matched pairs for the comparison between the ≥70 years and <70 years same-day surgery groups. Similarly, no significant differences were observed in all intraoperative and postoperative outcomes, including costs and complications (P > 0.05). CONCLUSION: This propensity score-matched retrospective study demonstrates that day-surgery inguinal hernia repair is a safe and feasible option for carefully selected patients aged 70 years and older. This approach is suitable for those who are adequately assessed for anesthetic risk and have underlying medical conditions that do not require complex multidisciplinary care. The outcomes and cost-efficiency are comparable to both inpatient management in the elderly and same-day surgery in younger patients.