PURPOSE: Inguinal hernias are common surgical conditions requiring repair. Mesh reinforcement is widely used to reduce recurrence, but claims data often lack mesh usage and surgical technique information. This study eval...PURPOSE: Inguinal hernias are common surgical conditions requiring repair. Mesh reinforcement is widely used to reduce recurrence, but claims data often lack mesh usage and surgical technique information. This study evaluates the impact of mesh use and procedural and device characteristics on inguinal hernia repair reinterventions using clinical notes from electronic health records (EHR). METHODS: A retrospective cohort study was conducted among adult patients who underwent inguinal hernia repair between October 2015 and September 2023 with 1-year follow-up. Logistic regression was used to estimate the odds of reintervention. RESULTS: There were 1598 patients with 1154 (72.22%) receiving mesh and 444 (27.78%) undergoing no-mesh repairs. 42 patients (2.63%) required reintervention, with 2.34% and 3.38% in the mesh and no mesh group respectively (p = 0.38). Adjusted analyses showed no significant difference in reintervention rates (OR: 0.71, p = 0.32). CONCLUSION: Mesh use in inguinal hernia repair was associated with a lower reintervention rate, though not statistically significant.
INTRODUCTION: Component separation technique (CST) facilitates anterior fascial closure but can increase wound morbidity and alter abdominal wall anatomy. Preoperative Botulinum toxin A (BTA) relaxes the oblique musculat...INTRODUCTION: Component separation technique (CST) facilitates anterior fascial closure but can increase wound morbidity and alter abdominal wall anatomy. Preoperative Botulinum toxin A (BTA) relaxes the oblique musculature, potentially reducing CST. This study evaluated trends in CST utilization following the adoption of BTA. METHODS: A prospectively maintained database was reviewed for patients who underwent open AWR (2016-2024). Primary outcome was proportion of CST use over time; secondary analysis compared early (2016-2017) versus late (2023-2024) cohorts. RESULTS: Among 1484 patients (mean age 58.8 ± 12.3 years; BMI 31.0 ± 5.8 kg/m; defect size 211.5 ± 165.6 cm), fascial closure was achieved in 99.5%. CST decreased from 48.0% to 19.9% (OR: 0.88,95% CI: 0.813,0.946;p < 0.001). BTA increased (2.9% to 11.0%), though annual change was not significant (OR: 0.98,95% CI: 0.898,1.071;p = 0.670). Between early and late cohorts (n = 384 vs. 356), defect size was similar (219.1 ± 160.6 vs. 213.8 ± 181.3 cm;p = 0.367). There was a reduction in wound breakdown (6.5% vs. 0.8%) and recurrence (2.9% vs. 0.6%)(p < 0.05). CONCLUSION: Following the introduction of BTA, utilization of CST decreased and was accompanied by a reduction in wound morbidity.
INTRODUCTION: Despite advances in antiretroviral therapy (ART), surgical outcomes in people with HIV (PWH) remain poorly understood. This study compared postoperative outcomes and healthcare use between PWH and matched p...INTRODUCTION: Despite advances in antiretroviral therapy (ART), surgical outcomes in people with HIV (PWH) remain poorly understood. This study compared postoperative outcomes and healthcare use between PWH and matched people without HIV (non-PWH) undergoing general surgery in British Columbia, Canada. METHODS: Linked HIV-related and health administrative data (Jan 2008-Mar 2020) identified PWH and matched non-PWH. Outcomes included 30-day readmissions, 30-day re-operations, 30-day mortality, one-year mortality, and healthcare utilization. RESULTS: Among 1252 PWH and 5008 non-PWH, HIV status was not associated with odds of 30-day readmissions, re-operations, or deaths. However, PWH had higher odds of mortality within one year post op (OR 1.75, 95% CI: 1.12-2.73), shorter hospital stays (RR 0.64, 95% CI: 0.55-0.73), higher likelihood of lab (RR 2.11, 95% CI: 1.86-2.39), and specialist visits (RR 1.16, 95% CI: 1.01-1.35) compared to non-PWH. CONCLUSION: PWH experienced similar short-term outcomes but higher one-year mortality and distinct care patterns, suggesting factors beyond perioperative care influence outcomes.
Palmerton H, Williams B, Pak G
… +10 more, Zhang B, Prey B, Francis A, Williams J, Pumiglia L, Roedel E, Lallemand M, McClellan J, Ieronimakis N, Bingham J
INTRODUCTION: With trauma, hypothermia is associated with increased bleeding and worse outcomes yet the pace of rewarming is unproven and its influence unclear. We hypothesized that the rate of rewarming influences outco...INTRODUCTION: With trauma, hypothermia is associated with increased bleeding and worse outcomes yet the pace of rewarming is unproven and its influence unclear. We hypothesized that the rate of rewarming influences outcomes and evaluated its impact in a porcine model of trauma. METHODS: Pigs underwent controlled hemorrhage and hypothermia to 32 °C for 1 h, followed by rapid or slow rewarming for 3 h. Hemodynamics and coagulation were compared along with liver gene expression. RESULTS: The mean temperature reached between fast (37.9±0.13 °C) and slow groups (34.5±1.2 °C) was significantly different (p < 0.01). The slow group had a lower heart rate and the mean arterial pressure (MAP) was lower with both slow and fast. No major differences in lactate, pH, coagulation or gene expression were observed. CONCLUSION: Our study supports rapid rewarming for reversing hypothermia post hemorrhage. Further research is needed to evaluate long-term outcomes within clinical settings.
BACKGROUND: Low-grade ductal carcinoma in situ (DCIS) is increasingly detected through breast screening, raising concerns about overtreatment. Active surveillance (AS) has emerged as an alternative to immediate surgery....BACKGROUND: Low-grade ductal carcinoma in situ (DCIS) is increasingly detected through breast screening, raising concerns about overtreatment. Active surveillance (AS) has emerged as an alternative to immediate surgery. We synthesized patient, clinician, and health-system perspectives relevant to AS adoption. METHODS: We conducted a mixed-methods systematic review (MMSR) following PRISMA, integrating quantitative, qualitative, and mixed-methods studies using a convergent integrated synthesis approach (PROSPERO CRD420250656621). PubMed, Embase, and the Cochrane Library were searched from 2000 to 2025. Risk of bias (RoB) was assessed using standardized tools. RESULTS: Fourteen studies were included. Patient preferences varied widely and were influenced by anxiety, terminology, perceived risk, and trust. Clinicians highlighted concerns about progression risk, pathology variability, medicolegal exposure, and limited long-term evidence. Institutional readiness was constrained by gaps in surveillance pathways, risk-stratification tools, and implementation support. Overall RoB was low to moderate. CONCLUSION: Adoption of AS for low-grade DCIS depends not only on clinical evidence but also on psychological, communication, and organizational factors that shape decision-making across patients, clinicians, and health systems.
BACKGROUND: Adolescent substance use is closely linked to traumatic injuries. Screening can identify at-risk youth, while naloxone prescribing can reduce fatal overdose. This study examined drug screening and naloxone pr...BACKGROUND: Adolescent substance use is closely linked to traumatic injuries. Screening can identify at-risk youth, while naloxone prescribing can reduce fatal overdose. This study examined drug screening and naloxone prescribing among injured adolescents. METHODS: This single-center retrospective cohort study included injured adolescents 12-17y treated January 2021-June 2024. Sociodemographics, clinical factors, and substance use screening associated with naloxone prescribing were analyzed. RESULTS: Among 813 injured adolescents, 86 (10.6%) underwent biochemical drug screening and 530 (65.2%) underwent interview-based screening. Among those screened, 53 (61.2%) biochemical and 81 (15.3%) interview screenings were positive. Only 28 (3.4%) received naloxone, including three (5.7%) with positive biochemical and four (4.9%) with positive interview-based screens. Adolescents with interview-based screening (p = 0.006) and hospital stays >24 h (p < 0.001) were more likely to receive naloxone. Most (96.4%) naloxone prescriptions were co-prescribed with opioids and muscle relaxants, instead of substance use screening results. CONCLUSION: Naloxone prescribing for injured adolescents remains infrequent and unrelated to substance use screening results.
OBJECTIVES: This retrospective cohort of patients undergoing surgery from 2019 to 2023 evaluated the association between individual-level social drivers of health (SDoH) and postoperative outcomes (length of stay, 30-day...OBJECTIVES: This retrospective cohort of patients undergoing surgery from 2019 to 2023 evaluated the association between individual-level social drivers of health (SDoH) and postoperative outcomes (length of stay, 30-day mortality, 30-day readmission). METHODS: Patients from a multi-site health system who completed a SDoH questionnaire were categorized as high-risk or not high-risk across five SDoH domains (e.g., financial resources) and were stratified into 3 surgical cohorts (elective outpatient, inpatient and emergency surgery). Regression models, adjusted for potential confounders, assessed the association between SDoH and postoperative outcomes. RESULTS: Among 297,723 patients, 74% completed the SDoH questionnaire. High-risk transportation need was associated with higher unplanned 30-day readmission for all cohorts; for elective surgeries, high-risk transportation was also associated with higher mortality. The other SDoH domains were inconsistently associated with postoperative outcomes. CONCLUSIONS: Individual-level SDoH, particularly transportation needs and financial strain, are linked to adverse postoperative surgical outcomes. Systematic SDoH interventions are crucial to addressing healthcare disparities.
BACKGROUND: The clinical relevance of residual micrometastatic nodal disease (ypN1mi) detected in the sentinel lymph node (SLN) or following targeted axillary dissection (TAD) after neoadjuvant systemic therapy (NST) rem...BACKGROUND: The clinical relevance of residual micrometastatic nodal disease (ypN1mi) detected in the sentinel lymph node (SLN) or following targeted axillary dissection (TAD) after neoadjuvant systemic therapy (NST) remains uncertain, particularly regarding the need for completion axillary lymph node dissection (cALND). METHODS: This narrative review summarizes evidence from registry-based and international cohort studies evaluating axillary recurrence and oncological outcomes in patients with ypN1mi managed with or without cALND after NST. RESULTS: Analyses from the SEER registry and the OPBC-07/microNAC cohort demonstrate a low incidence of axillary recurrence and no significant differences in oncological outcomes between SLNB alone and cALND. In subgroup analyses of triple-negative breast cancer, microNAC reported lower axillary recurrence rates with cALND; however, no difference in invasive recurrence was observed between groups. CONCLUSIONS: Routine cALND appears unnecessary in most patients with ypN1mi after NST. Future studies should evaluate whether regional nodal irradiation can also be safely omitted.
OBJECTIVE: We investigated the viability of offering a telemedicine pathway to patients seeking metabolic bariatric surgery (MBS). METHODS: Patients were randomized to receive hybrid telemedicine (HTM, n = 21) or face-to...OBJECTIVE: We investigated the viability of offering a telemedicine pathway to patients seeking metabolic bariatric surgery (MBS). METHODS: Patients were randomized to receive hybrid telemedicine (HTM, n = 21) or face-to-face (F2F, n = 22) care. Patient characteristics, program visit completion, patient satisfaction with visits, time to surgery, and insurance payor collection ratio were compared between groups. RESULTS: The HTM group had a higher proportion of initial medical visits completed than the F2F group (100.0% vs 72.7%). Groups did not significantly differ in patient satisfaction with visits, time to surgery, or insurance payor collection ratio. In the HTM group, 42.9% of patients underwent MBS, whereas 27.3% underwent MBS in the F2F group. Overall, 30.2% of patients elected to initiate obesity management medications, and 34.8% discontinued the program. CONCLUSION: MBS programs may improve treatment access by offering an HTM pathway. Larger investigations are needed to confirm the effect of telemedicine on MBS program access.
INTRODUCTION: We sought to identify prognostically meaningful thresholds for tumor size and lymph node (LN) metastasis as a first step toward developing a dedicated staging system for oncocytic thyroid carcinoma (OTC). M...INTRODUCTION: We sought to identify prognostically meaningful thresholds for tumor size and lymph node (LN) metastasis as a first step toward developing a dedicated staging system for oncocytic thyroid carcinoma (OTC). METHODS: Using SEER (2004-2022), tumor size and LN thresholds for OTC were analyzed using restricted cubic splines; Cox models estimated association with overall (OS) and disease-specific survival (DSS). RESULTS: Among 4114 patients, median tumor size was 34 mm, and 1410 (34.3%) had ≥1 LN examined. Tumor size showed a linear relationship with OS and DSS (no prognostic threshold). LN positivity showed thresholds of 2.42 positive LNs for OS and 2.14 for DSS; thus, ≥3 positive LNs was considered a prognostic threshold. Patients with ≥3 vs < 3 positive LNs had lower adjusted DSS (HR 3.32; p < 0.001) and OS (HR 2.65; p < 0.001). CONCLUSION: For OTC, ≥3 positive LNs constituted a prognostic threshold, while tumor size conferred continuous risk.
BACKGROUND: First-generation college and medical students (FGS) have a laborious path to medical school graduation. Without guidance, many FGS face an increased "distance traveled" to become surgeons. METHODS: During the...BACKGROUND: First-generation college and medical students (FGS) have a laborious path to medical school graduation. Without guidance, many FGS face an increased "distance traveled" to become surgeons. METHODS: During the 2021-2023 academic years, surgical subspecialty events were offered to pre-clinical students. Students were surveyed about first-generation status and their confidence in pursuing a surgical career. RESULTS: Across twenty-two surgical events, 235 students participated, of which 57% (134) identified as FGS with only 3% (4) having previous surgical exposure and 10% (13) reporting initial interest in surgery. Of non-FGS 42% (42) had previous exposure and 66% (66) reported interest in surgery. Following the event, 79% (37) FGS reported confidence in pursuing surgery. CONCLUSIONS: These surgical subspecialty events offered many FGS a first exposure to surgery while increasing their confidence to pursue a surgical career. By building strong support networks, medical schools can support FGS as they contribute to the diversity of the surgical field.