The American Surgeon[JOURNAL]
Sun
200 papers
Bedside Exploratory Laparotomy: Factors Associated With Mortality and Clinical Implications in Critically - Ill Patients.
Aubrey JM, Ojha A, Morris MJ … +6 more , Liefeld HR, Sharrak-Sitto AM, Burdett LE, Chadwick CL, Chung M, Wright GP
Am Surg · 2026 Apr · PMID 41984048 · Publisher ↗
BACKGROUND: Bedside exploratory laparotomy is a heroic intervention for unstable patients who cannot be transported to the operating room. Given a previously documented high mortality rate, some argue against the procedu...
BACKGROUND: Bedside exploratory laparotomy is a heroic intervention for unstable patients who cannot be transported to the operating room. Given a previously documented high mortality rate, some argue against the procedure on assumption of non-beneficence. This study aims to evaluate procedural mortality rate and identify physiologic factors associated with death after bedside exploration. METHODS: A single-center, retrospective review of consecutive patients who underwent bedside exploratory laparotomy between 2019 and 2024 was conducted. Patients were stratified into cohorts based on a composite outcome of in-hospital or 30-day survival, and an analysis was conducted to identify factors associated with mortality. RESULTS: A total of 51 patients underwent bedside exploratory laparotomy, with a mortality rate of 82.4% (42/51) within 30 days or during index hospitalization. The median postoperative time to death was 18.1 hours. Mortality rates were 73.9% in SICU, 90.0% in MICU, and 88.2% in CTICU. Survivors were younger than non-survivors (46.5 vs. 60.8 years; p = 0.025) and had lower Charlson Comorbidity Index scores (2 vs. 4; p = 0.0011). Preoperative lactate was lower (4.12 vs. 10.16 mmol/L; p = 0.0012) and pH higher (7.30 vs. 7.20; p = 0.042) in survivors. Significant intraoperative findings were more frequent in non-survivors (95% vs. 33%; p < 0.001). CONCLUSION: Bedside exploratory laparotomy is a last-resort intervention with exceedingly high mortality. We observed older patients with significant acidosis or identifiable intraoperative findings have worse prognoses. Preoperative goals-of-care discussions should be prioritized in elderly patients before proceeding with bedside exploration to ensure ethical delivery of surgical care.
Cross-Modality Differences In Pancreatic Cyst Size Measurements May Affect Surgical Decision-Making.
Bresler TE, Lada S, Pandya S … +3 more , Mauch A, Htway Z, Desai K
Am Surg · 2026 Apr · PMID 41984036 · Publisher ↗
IntroductionAccurate preoperative measurement of pancreatic cystic lesions is critical for surgical decision-making, particularly around the 3 cm threshold frequently cited in resection guidelines. However, imaging modal...
IntroductionAccurate preoperative measurement of pancreatic cystic lesions is critical for surgical decision-making, particularly around the 3 cm threshold frequently cited in resection guidelines. However, imaging modalities may provide discrepant size estimates, potentially altering management.MethodsWe retrospectively reviewed patients from a single endoscopist practice (November 2011-November 2024) who underwent EUS-FNA for pancreatic cystic lesions with available MRI and/or CT imaging results. For each modality, the largest recorded dimension was extracted. One-way ANOVA was performed to assess mean size differences, and concordance across the 3 cm surgical threshold was calculated with Cohen's κ.ResultsA total of 190 patients with 246 patient encounters were included. Mean cyst size was 2.93 ± 1.32 cm on MRI (n = 147), 2.95 ± 1.53 cm on EUS (n = 246), and 3.20 ± 1.73 cm on CT (n = 159). The differences were not statistically significant ( = .194). Across modalities, the mean absolute difference in size ranged from 0.7 to 0.9 cm, with outliers exceeding 2 cm. Concordance at the 3 cm cutoff was common; there was good agreement between EUS and MRI (κ = 0.643; < .001) and moderate agreement between EUS and CT (κ = 0.472; < .001).ConclusionSubstantial variability exists in preoperative size assessment of pancreatic cystic lesions, with 7.5-20% of cysts misclassified around the 3 cm cutoff. Given that cyst size is a key determinant of surgical intervention, reliance on a single modality may introduce bias into clinical decision-making. Multimodality assessment reduces discordance and may improve risk stratification.
Enhancing Resident Education in Informed Consent Through Digital Checklists.
Yao J, Moussaed A, Diaz G … +2 more , Romero J, Steen S
Am Surg · 2026 Apr · PMID 41984001 · Publisher ↗
BackgroundIn many teaching hospitals, surgical residents frequently lead consent discussions despite limited procedural experience, which may hinder accurate risk disclosure. We hypothesized that a structured digital ris...
BackgroundIn many teaching hospitals, surgical residents frequently lead consent discussions despite limited procedural experience, which may hinder accurate risk disclosure. We hypothesized that a structured digital risk checklist, created by experienced attending surgeons and embedded within a video-based consent platform, would improve consent quality and serve as an educational tool for residents.MethodsGeneral surgery residents (R1-R5) completed informed consent for common procedures using two formats: traditional written consent followed by a digital checklist-based platform. The checklists included both relevant and irrelevant risk options to encompass risks associated with multiple procedures within a specific surgical field. Residents selected applicable risks for each operation, which were compared to the "gold standard" risk profiles generated by four core faculty attending surgeons that were not shared with residents beforehand. Accuracy, risk counts, and performance by training level were compared between the two consent formats.ResultsConsent practices among 23 surgical residents (R1-R5) across 8 surgical procedures were analyzed. Digital checklists use significantly improved accuracy compared with written consent, with a higher proportion of correctly identified risks (70.4% vs 50.7%, < 0.001). Checklist performance exceeded written performance across all postgraduate year levels and surgical procedures. However, checklist use was associated with increased selection of irrelevant risks, particularly among junior residents compared with seniors (32% vs 15%, < 0.01).ConclusionDigital risk checklists improved the completeness and accuracy of resident-led informed consent but may encourage over-selection of irrelevant risks. With refinement, digital consent aids show promise as effective educational tools in surgical training.
Hem-O-Lock Clip to Replace Stapler for Laparoscopic Appendectomy Provides Value-Based Care.
Guan A, Malkoc A, Wang A … +5 more , Louie N, Han E, Vignaroli K, Gill H, Johna S
Am Surg · 2026 Apr · PMID 41983990 · Publisher ↗
IntroductionLaparoscopic appendectomy (LA) is the first-line treatment for acute appendicitis. We compared Hem-O-Lok clips (HOL) and endoscopic staplers to evaluate cost savings without compromising outcomes within the S...
IntroductionLaparoscopic appendectomy (LA) is the first-line treatment for acute appendicitis. We compared Hem-O-Lok clips (HOL) and endoscopic staplers to evaluate cost savings without compromising outcomes within the San Bernadino service area Kaiser Permanente Health Maintenance Organization.MethodsThis retrospective case-control study included patients ≥6 years who underwent LA (2016-2022) using HOL clips or ES for stump closure. Of 571 patients, 341 used HOL and 230 ES based on surgeon preference. Propensity score matching (1:1) by age, sex, Body Mass Index (BMI), and American Society of Anesthesiologist (ASA) Physical Status Classification yielded 177 pairs. Outcomes included 30-day complications, length of stay, estimated blood loss (EBL), and readmission.ResultsPatients in the HOL group were significantly older, had more comorbidities, had higher BMI values, and classified as ASA II or higher. The diagnosis of acute appendicitis was more frequent in the HOL group (81.3% vs 73.0%) and gangrenous disease more common in ES group (6.1% vs 1.5%). Despite this, there was no increased post-operative complication rates between the two groups. Return to the hospital were similar between the two groups (5.3% vs 7.9%). The cost per ES load is $273 compared to a six pack of HOL clips costing $32.ConclusionHOL clips in LA showed no increase in morbidity, supporting a lower-cost alternative.
The Impact of Hemoglobin Concentration on Prognosis in Patients With Diabetic Foot: A Systematic Review and Meta-Analysis of Risk Factors for Adverse Outcomes and Clinical Management.
Wang D, Wang H, Wu Y … +1 more , Liu J
Am Surg · 2026 Apr · PMID 41983958 · Publisher ↗
BackgroundDiabetic foot (DF) complications, including diabetic foot ulcers (DFUs), lead to significant morbidity, disability, and economic burden. Hemoglobin (Hb) levels may influence the prognosis of DF patients, but th...
BackgroundDiabetic foot (DF) complications, including diabetic foot ulcers (DFUs), lead to significant morbidity, disability, and economic burden. Hemoglobin (Hb) levels may influence the prognosis of DF patients, but their relationship with adverse clinical outcomes remains unclear. This systematic review and meta-analysis aimed to assess the association between hemoglobin concentration and the risk of adverse outcomes in diabetic foot patients, including amputation and mortality.MethodsWe followed PRISMA guidelines to conduct a systematic literature review. A meta-analysis was performed on observational studies assessing the impact of hemoglobin levels on amputation, mortality, and ulcer incidence. A random-effects model was applied, and risk bias was evaluated using the Newcastle-Ottawa Scale.ResultsA total of 22 observational studies involving 10,984 patients were included. Our meta-analysis revealed that lower hemoglobin levels were significantly associated with a higher risk of amputation (OR = 0.97, 95% CI: 0.94-0.99, < .001), and lower hemoglobin concentrations were found in amputation cases compared to non-amputation cases (SMD = -0.14, 95% CI: -0.24 to -0.04, < .01). However, no significant association was found between hemoglobin levels and mortality (OR = 0.99, 95% CI: 0.33-2.89, > .05). Sensitivity and publication bias analyses indicated robust results.ConclusionLower hemoglobin levels were associated with higher odds of amputation in patients with diabetic foot. However, pooled effects were small and heterogeneity was substantial across studies; therefore, hemoglobin likely functions primarily as a marker of overall disease burden and perioperative risk rather than a proven modifiable target. Prospective interventional studies are needed to determine whether correcting anemia improves limb outcomes and survival.
Preventable Patient Safety Indicators After Lung Resection: Outcomes and Cost at a Large High-Volume Institution.
Krishna V, Popescu O, Rocco R … +4 more , Moonsamy P, Soukiasian HJ, Brownlee AR, Alban RF
Am Surg · 2026 Apr · PMID 41983952 · Publisher ↗
BackgroundPatient Safety Indicators (PSIs) are quality metrics developed by the Agency for Healthcare Research and Quality (AHRQ) to identify potentially preventable postoperative complications. The rate of PSIs after lu...
BackgroundPatient Safety Indicators (PSIs) are quality metrics developed by the Agency for Healthcare Research and Quality (AHRQ) to identify potentially preventable postoperative complications. The rate of PSIs after lung resection remains poorly defined.MethodsWe retrospectively reviewed our institutional database for all lung resection patients age ≥16 from 2014 to 2024. Patient Safety Indicators evaluated were PSI-9 (hemorrhage/hematoma), PSI-10 (acute kidney injury requiring dialysis), PSI-12 (peri-operative pulmonary embolism [PE] or deep vein thrombosis [DVT]), and PSI-13 (post-operative sepsis). The primary outcome was the incidence of preventable PSIs following lung resection. Secondary outcomes included clinical predictors of PSI, short-term outcomes by PSI status, and PSI-related costs.ResultsAmong 2701 lung resection patients, 35 (1.29%) experienced at least one PSI, totaling 43 PSI events (1.59%). Patient Safety Indicator patients were more often male (65.7% vs 48.3%, = .04), had higher comorbidity burden (Charlson-Deyo 3+: 97.1% vs 73.5%, = .02), and more frequently had prior lung cancer (80.0% vs 52.3%, = .001). Patient Safety Indicator patients had higher 30-day mortality (11.4% vs 1.2%, < .001). Logistic regression identified male sex (aOR 2.20 [1.08-4.46], = .03) and prior lung cancer (aOR 2.95 [1.22-7.12], = .02) as independent predictors of PSI. After review, 37 PSIs were classified as preventable or possibly preventable (1.37%), generating an estimated cost burden of $983,059 and largely driven by PSI-13 sepsis events.ConclusionAlthough PSIs after lung resection are infrequent, focus on preventing post-operative adverse outcomes should remain paramount. Targeted strategies to prevent these preventable complications can help improve outcomes and provide a significant cost-saving opportunity.
Right-Sided Versus Left-Sided Pneumonectomy in Trauma: A Nationwide Analysis.
Nekooei N, Mitchao DP, Bent CI … +7 more , Ashbrook MJ, Anderson K, Ghafil CA, Aiolfi A, Harano T, Inaba K, Matsushima K
Am Surg · 2026 Apr · PMID 41983951 · Publisher ↗
BackgroundPneumonectomy remains a rare trauma procedure due to its high morbidity and mortality. While previous studies suggest that right-sided pneumonectomy is associated with a higher mortality in patients with lung c...
BackgroundPneumonectomy remains a rare trauma procedure due to its high morbidity and mortality. While previous studies suggest that right-sided pneumonectomy is associated with a higher mortality in patients with lung cancer, there are scarce data in trauma. We aimed to compare patient outcomes following right-sided and left-sided pneumonectomy after trauma.MethodsThis is a retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database (2016-2022). Trauma patients (age ≥16 years) who underwent pneumonectomy were included and stratified by the laterality of pneumonectomy. Patient baseline characteristics, injury profile, and clinical outcomes were compared between the right- and left-sided pneumonectomy groups. Multivariable analysis was performed to evaluate the association between the laterality of pneumonectomy and in-hospital mortality.ResultsA total of 301 patients were included. The median age was 30 years, and 85.3% were male. Of those, 137 patients (45.5%) underwent right-sided pneumonectomy. Admission vital signs and Injury Severity Score were comparable between the right- and left-sided groups. Extracorporeal membrane oxygenation (ECMO) was used more frequently in right-sided pneumonectomy patients (8.8% vs 2.4%, = 0.015). In-hospital mortality following right- and left-sided pneumonectomy was 54.0% and 48.2%, respectively ( = 0.313). In the multivariable logistic regression, right-sided pneumonectomy was not associated with increased odds of in-hospital mortality (adjusted odds ratio: 1.137, confidence interval: 0.641-2.015, = 0.662).ConclusionThis study suggests that the laterality of pneumonectomy was not associated with an increased risk of in-hospital mortality. Future research should evaluate the utility of ECMO in trauma patients requiring pneumonectomy.
Mentorship in General Surgery Residency: A Qualitative Study.
Peng T, Senofsky S, Desai K … +4 more , Wu JX, Tillou A, Wagner JP, Chen F
Am Surg · 2026 Apr · PMID 41983949 · Publisher ↗
BackgroundMentorship is widely recognized as a critical element of surgical residency training and careers. As more general surgery residency programs look to implement program-wide mentorship interventions, best practic...
BackgroundMentorship is widely recognized as a critical element of surgical residency training and careers. As more general surgery residency programs look to implement program-wide mentorship interventions, best practices for fostering effective, enduring mentoring relationships remain poorly described.MethodsCurrent general surgery residents at an academic medical center participated in individual semi-structured interviews exploring perspectives on mentorship. Interviews were transcribed and de-identified prior to thematic coding using Dedoose.ResultsThere were 20 participants (8 interns, 7 mid-level residents, and 5 chief residents; representing 36% of the residency program), with a median age of 30 years and 50% of the cohort identifying as women. Four major themes emerged: (1) mentorship needs evolve throughout training, with an early emphasis on identifying research projects and later shifting toward career development; (2) mentorship needs are often met through multiple mentors including near peers and faculty who fulfill diverse roles; (3) informal relationships are perceived to be more meaningful than formal assignments but require residents to actively seek mentorship; and (4) responsiveness and investment are considered essential qualities of effective mentors.DiscussionGeneral surgery residents may benefit from programs which help facilitate the formation of mentorship teams comprised of both formal and informal relationships to meet the dynamic needs of residency. Near peer mentors may be particularly valuable in the composition of mentorship teams. Future work is needed to identify effective strategies for supporting residents through major transitions and cultivating behaviors that empower trainees to form the informal mentor-mentee relationships that best meet their needs.
Diagnostic Pitfalls and Imaging-Pathologic Correlation in Benign Breast Vascular Lesions Mimicking Malignancy: A Case-Based Systematic Review.
Li G, Gao G, Wang S … +2 more , Qiao G, Cong Y
Am Surg · 2026 Apr · PMID 41983940 · Publisher ↗
ObjectiveThis article systematically reviews the clinical, imaging, and pathological features of benign breast vascular tumors that mimic malignant neoplasms and summarizes key differential diagnosis points to enhance di...
ObjectiveThis article systematically reviews the clinical, imaging, and pathological features of benign breast vascular tumors that mimic malignant neoplasms and summarizes key differential diagnosis points to enhance diagnostic accuracy and avoid misdiagnosis and unnecessary interventions.MethodsAs of December 2025, a literature search was conducted in the PubMed, Web of Science, and Embase databases using keywords "breast hemangioma," "breast lymphangioma," "breast vascular tumor," "benign vascular lesion breast," "angiosarcoma mimic," and "malignant tumor." The inclusion criteria were limited to literature reporting cases of benign vascular tumors confirmed by pathology but initially suspected to be malignant. Ultimately, a total of 10 eligible articles were included for a systematic review.ResultsBenign breast vascular tumors infrequently mimic malignancy: clinically presenting as skin redness, swelling, edema, and pain resembling inflammatory breast carcinoma; demonstrating malignant imaging signs (irregular/spiculated margins, rapid enhancement, washout curve) on mammography, ultrasound, and MRI that elevate BI-RADS classification; and showing atypical cells on cytology prone to misinterpretation. Definitive diagnosis requires multimodal imaging, pathology, and immunohistochemistry.ConclusionBreast vascular tumors are occasionally misdiagnosed as a malignant tumor. It is essential to maintain a high index of suspicion for differential diagnosis during the diagnostic process. For suspected cases, prompt biopsy and rigorous imaging-pathological correlation analysis should be performed. If the biopsy results are inconclusive or show a significant discrepancy with imaging findings, surgical excision should be considered for definitive diagnosis. Most patients have a good prognosis, and all patients remained recurrence-free during follow-up.
Perioperative Diabetic Ketoacidosis in Type 2 Diabetes: Risk and Prevention in the Era of SGLT2 Inhibitors.
Kuo PJ, Yuan-HaoYen, Hsieh CH
Am Surg · 2026 Apr · PMID 41983933 · Publisher ↗
Diabetic ketoacidosis (DKA) typically affects patients with type 1 diabetes but can also occur in type 2 diabetes under severe stress or relative insulin deficiency. The postoperative phase constitutes a high-risk interv...
Diabetic ketoacidosis (DKA) typically affects patients with type 1 diabetes but can also occur in type 2 diabetes under severe stress or relative insulin deficiency. The postoperative phase constitutes a high-risk interval for diabetic ketoacidosis in individuals with type 2 diabetes, attributable to surgical stress, altered medication routines, and metabolic changes. The introduction of sodium-glucose cotransporter-2 (SGLT2) inhibitors has added complexity, as these medications can precipitate euglycemic DKA where ketoacidosis occurs without marked hyperglycemia. This review examines postoperative DKA in type 2 diabetes, focusing on pathophysiology, clinical outcomes, prevention strategies, and management approaches. The pathophysiology involves insulin deficiency, counterregulatory hormone excess, and SGLT2 inhibitor effects that promote ketogenesis. Risk factors include emergency surgery, poor glycemic control, insulin-dependent status, and SGLT2 inhibitor use. Prevention strategies include optimizing preoperative glycemic control, discontinuing SGLT2 inhibitors at least 3 days before surgery, maintaining basal insulin during the perioperative period, and monitoring for ketosis. Management requires aggressive fluid resuscitation, insulin therapy, electrolyte management, and addressing any precipitating factors. Early recognition is essential, particularly for euglycemic DKA which may be overlooked due to near-normal blood glucose levels. With proper preventive measures and timely management, most cases of postoperative DKA in type 2 diabetes can be avoided or successfully treated.
Pedicled Gallbladder Serosal Patch for Complex Duodenal Perforation: Technical Description and Clinical Outcome.
Lao WS, Miles WS
Am Surg · 2026 Aug · PMID 41983932 · Publisher ↗
Perforated peptic ulcers are surgical emergencies typically treated by omental patch repair. This report describes the first successful pedicled gallbladder flap for duodenal perforation repair in the setting of inadequa...
Perforated peptic ulcers are surgical emergencies typically treated by omental patch repair. This report describes the first successful pedicled gallbladder flap for duodenal perforation repair in the setting of inadequate patch material. A previously healthy 28-year-old male was taken emergently for surgery after presenting with intra-abdominal sepsis in the setting of rapid, unintentional weight loss. Findings of feculent peritonitis and multiple colonic perforations were managed with a subtotal colectomy and temporary abdominal closure. At re-exploration, a perforated duodenal ulcer was identified. The patient's critical status and absent omentum, insufficient falciform ligament, and friable small bowel precluded traditional repair options. A pedicled gallbladder flap was fashioned instead, with the patient experiencing a successful recovery. He was discharged within a month, tolerating an oral diet and free of surgical drains. The use of a pedicled gallbladder flap to seal a duodenal perforation is a potentially viable approach rooted in existing animal models. Further research is warranted.
Propensity-Score Matched Analysis of Short-term Outcomes of Laparoscopic Compared to Open Surgery in Octogenarian and Nonagenarian Patients With Colon Cancer.
Emile SH, Garoufalia Z, Wignakumar A … +2 more , Perets M, Wexner SD
Am Surg · 2026 Apr · PMID 41964557 · Publisher ↗
BackgroundLaparoscopy has become standard treatment for colorectal cancer. Elderly patients with comorbidities may have additional risks associated with laparoscopic surgery given their frailty and functional status. We...
BackgroundLaparoscopy has become standard treatment for colorectal cancer. Elderly patients with comorbidities may have additional risks associated with laparoscopic surgery given their frailty and functional status. We aimed to investigate the safety and benefits of laparoscopic surgery for colon cancer in patients ≥80 years with significant medical comorbidities.MethodsThe NCDB was searched for patients ≥80 years with stage I-III colon cancer who underwent radical resection from 2010-2019. Patients were classified into two groups: open and laparoscopic colectomy and were propensity-score matched for disease stage, tumor location and size, and treatment facility. Primary outcome was 30- and 90-day mortality; hospital stay, 30-day readmission, resection margin status, and overall survival (OS) were secondary outcomes.ResultsAfter matching, 7314 patients (57.9% females; median age: 84 years) were included; 3657 patients were in each group. Conversion rate from laparoscopic to open colectomy was 13.8%. Laparoscopic colectomy was associated with lower odds of 30-day mortality (OR: 0.61, 95% CI: 0.52, 0.73, < .001), 90-day mortality (OR: 0.64, 95% CI: 0.56, 0.74, < .001), positive resection margins (3.7% vs 5.5%, OR: 0.65, 95% CI: 0.52, 0.82, < .001), shorter hospital stays (median: 6 vs 7 days, < .001), and longer OS (median: 49.8 vs 39.7 months, < .001) than open surgery. Both groups had similar unplanned 30-day readmission rates (6.6% vs 6%, = .082) and number of harvested lymph nodes.ConclusionsLaparoscopic surgery was associated with significant benefits in patients with colon cancer aged ≥80, including less short-term mortality, shorter hospital stays, more R0 resections, and potentially longer survival, compared to laparotomy.
Mirizzi Syndrome: Optimal Timing and Management.
Molina RE, Rosenberg DM, Burrows JE … +5 more , Kim JJ, Petrovich KA, Eade AV, Garcia L, Keeley JA
Am Surg · 2026 Apr · PMID 41964427 · Publisher ↗
IntroductionMirizzi syndrome is uncommon with an incidence of 0.3% to 1.4% of all cholecystectomies and remains challenging given the potential need for biliary reconstruction. Standardized surgical guidelines are lackin...
IntroductionMirizzi syndrome is uncommon with an incidence of 0.3% to 1.4% of all cholecystectomies and remains challenging given the potential need for biliary reconstruction. Standardized surgical guidelines are lacking, which continues to hinder the establishment of optimal operative strategies tailored to disease severity.ObjectiveEvaluate postoperative outcomes based on timing of diagnosis (preoperative vs intraoperative), timing of cholecystectomy (index vs delayed), and surgical subspecialty performing the operation.MethodsA multi-center retrospective review was conducted of all cholecystectomies performed between 2014 and 2023 across 3 Los Angeles County hospitals. Patients with Mirizzi syndrome were identified and stratified according to the Csendes classification. Primary outcomes included bile duct injury, bile leak, biloma, abscess, need for postoperative drainage or reoperation, and readmission. Comparisons were performed using Fisher's exact test.ResultsAmong 14 486 cholecystectomies performed during the study period, 65 patients (0.45%) met inclusion criteria. Complications were significantly lower in patients with preoperative diagnosis compared with intraoperative diagnosis, 25% vs 57% ( = 0.05). Most patients underwent index-admission cholecystectomy, 52/65 (80%). In advanced disease (types II-Va), complication rates did not differ between index and delayed surgery, 55% vs 38% ( = 0.67). Overall complication rates were similar between acute care surgery and hepatopancreatobiliary surgery, 24% vs 40% ( = 0.28). For type I disease, outcomes were comparable between services.ConclusionsPreoperative diagnosis of Mirizzi syndrome is associated with improved postoperative outcomes. Type I disease can be safely managed by either acute care or hepatopancreatobiliary surgeons, while delayed surgery in advanced cases appears safe to facilitate specialized care.
What Does the Career of a Woman Surgical Chair Look Like? Academic and Professional Profiles of Women in Surgical Leadership.
Aldrete AS, Cranmer M, Vincent GT … +1 more , Guo Y
Am Surg · 2026 Apr · PMID 41964391 · Publisher ↗
BackgroundHistorically, women in surgery have faced systemic barriers to becoming physicians, including cultural expectations that discourage leadership roles. This study provides a descriptive analysis of the educationa...
BackgroundHistorically, women in surgery have faced systemic barriers to becoming physicians, including cultural expectations that discourage leadership roles. This study provides a descriptive analysis of the educational, professional, and academic profiles of women serving as surgical chairs in the United States, with the goal of offering insight to support current and future surgical trainees.MethodsSupplementary data, including educational history, professional achievements, and publication metrics, were collected from public resources such as institutional websites, LinkedIn, and Doximity.ResultsOn average, women surgical chairs reached their positions 18.5 years after completing residency. Most (96%, 22/23) pursued fellowship training across 13 specialties, with surgical oncology being the most common (26.1%, 6/23). Nearly half (47%, 11/23) earned an additional advanced degree, including MS, MBA, or MPH qualifications. Before their appointment as Chair of the Department of Surgery, these women spent an average of 8.1 years at their institution. Their academic contributions were notable, with a mean of 208 publications, 11,428 citations, an H-index of 56.7, and an i-10 index of 151.6.DiscussionDespite ongoing strides toward gender equity in surgery, significant barriers to leadership for women remain. This study aims to illuminate the pathways taken by current women leaders, providing a framework to inspire and guide future generations of women surgeons toward leadership roles.
Reusable Scrub Cap Attitudes and Hospital Policy Change With Operating Room Sustainability Education.
Nguyen D, Kempf A, Hutchinson J … +5 more , Nashed H, Solomon N, Schul M, Ji L, Lum S
Am Surg · 2026 Apr · PMID 41964213 · Publisher ↗
While reusable surgical scrub caps are associated with lower carbon emissions compared to single-use scrub caps, many hospital systems prohibit reusable scrub caps in the OR. Between 11/5/24 and 3/26/25, an evaluation of...
While reusable surgical scrub caps are associated with lower carbon emissions compared to single-use scrub caps, many hospital systems prohibit reusable scrub caps in the OR. Between 11/5/24 and 3/26/25, an evaluation of scrub cap usage was performed while OR sustainability lectures were delivered to perioperative staff and surgical specialty departments. Pre- and post-lecture Likert surveys assessed OR sustainability knowledge, motivation to improve, and scrub cap preference. Overall, 255 pre- and 230 post-lecture surveys were analyzed. Of pre-lecture respondents, 57.4% felt knowledgeable, 90.8% felt motivated to improve OR sustainability, and 40.2% preferred single-use scrub caps. Pre-lecture odds ratios showed younger respondents (vs older, OR 2.27, 95% CI 1.28-4.04, = 0.006) and surgeons (OR 3.77, 95% CI 2.01-7.06, < 0.0001) felt less knowledgeable and other perioperative staff felt more knowledgeable (OR 0.47, 95% CI 0.27-0.82, = 0.007) than nursing staff. Surgeons felt less motivated than nursing staff (OR 2.60, 95% CI 1.33-5.09, = 0.006), and younger respondents were less likely to prefer single-use scrub caps (vs older, OR 2.06 95% CI 1.16-3.64, = 0.01). Post-lecture, 87.9% felt knowledgeable, 94.4% felt motivated to improve OR sustainability, and 42.5% preferred single-use scrub caps. No differences were noted among comparison groups post-lecture. At the end of the study period, official hospital policy was revised to allow use of reusable scrub caps. Comparing the 6 months before and after the policy change, 31,200 fewer disposable scrub caps were purchased at a cost savings of $976.22.
Underrepresentation in Surgical Societies: A Specialty-Focused Analysis of ACS and SUS Membership.
Bajaj A, Nenchev K, Sriram N … +7 more , Vodapally S, Patel R, Rodriguez GC, Rai P, George E, Reisner KR, Gosain AK
Am Surg · 2026 Apr · PMID 41958035 · Publisher ↗
BackgroundAnalyzing the representation of specialties within professional surgical societies provides insight into differences in specialty composition across professional organizations. This study compares membership by...
BackgroundAnalyzing the representation of specialties within professional surgical societies provides insight into differences in specialty composition across professional organizations. This study compares membership by surgical specialty in the American College of Surgeons (ACS) and Society of University Surgeons (SUS) to national counts.Study DesignACS data was sourced from 2024 ACS Fellowship Statistics while SUS member data was sourced from their public member directory. Proportions of specialties within ACS and SUS were compared to national representation (active board certificates). Analyses were performed across ACS-recognized surgical subspecialties to evaluate differences in representation between ACS, SUS, and national distributions.ResultsThis study analyzed 59,148 ACS Fellows, 1574 SUS members, and 201,820 active board-certified surgeons, revealing significant differences in the representation of surgical specialties across these categories ( < 0.001). In contrast to general surgery and specialties that require a formal general surgery training, many surgical subspecialties were represented at proportions lower than their national board certification distributions in the ACS and SUS.ConclusionThis study revealed significant differences in surgical subspecialty representation within larger professional surgical societies. Targeted efforts improving engagement across surgical fields is imperative to promote representation and facilitate collaborative efforts.
Photodynamic Therapy as an Adjunct During Stent-Bridged Neoadjuvant Management of Obstructive Colon Cancer: A Case-Based Narrative Review.
Liu B, Ma Z, Wang Z … +3 more , He L, Han Q, Chen H
Am Surg · 2026 Apr · PMID 41958031 · Publisher ↗
Malignant left-sided large-bowel obstruction remains a high-risk presentation that often requires urgent decompression. Self-expanding metal stents (SEMS) can convert an emergency to an elective operation and may create...
Malignant left-sided large-bowel obstruction remains a high-risk presentation that often requires urgent decompression. Self-expanding metal stents (SEMS) can convert an emergency to an elective operation and may create a window for staging, multidisciplinary planning, and (in selected patients) neoadjuvant systemic therapy. Photodynamic therapy (PDT) is a light-activated, locally delivered ablative modality that has been used historically for palliation or local control of colorectal and pelvic recurrences, but its role in contemporary management of obstructing colon cancer remains investigational. We present an anchoring case of obstructive rectosigmoid adenocarcinoma managed with endoscopic SEMS placement, interval endoluminal PDT, followed by systemic neoadjuvant therapy and curative resection with a pathologic complete response. Using this case as a framework, we review established management pathways for obstructing left-sided colon cancer (emergency surgery, diversion, and SEMS as a bridge to surgery), summarize evidence and guideline positions on SEMS and neoadjuvant therapy for resectable colon cancer, and synthesize the limited clinical literature describing PDT in colorectal malignancy. We emphasize that, given the multimodal sequence and existing evidence base, PDT should be viewed as a potential adjunct to-rather than a replacement for-SEMS, systemic therapy, or standard oncologic surgery. This case illustrates technical feasibility and conceptual integration, but does not establish efficacy; prospective study is needed to define patient selection, timing, and safety.
Surgeon-Specific Computer to Improve Operating Room Flow: A Controlled Clinical Trial.
Zhao K, Park J, Tran J … +3 more , Akopian G, Kaufman H, Truong A
Am Surg · 2026 Apr · PMID 41958026 · Publisher ↗
BackgroundDelays in postoperative documentation can disrupt operating room (OR) efficiency and continuity of care. Surgeons frequently leave the OR to access computers, creating workflow interruptions.ObjectiveTo evaluat...
BackgroundDelays in postoperative documentation can disrupt operating room (OR) efficiency and continuity of care. Surgeons frequently leave the OR to access computers, creating workflow interruptions.ObjectiveTo evaluate whether adding an additional surgeon-dedicated workstation within the OR improves postoperative documentation and order completion times. Secondary outcomes included adverse events and resident and attending feedback.MethodsA prospective controlled clinical trial was conducted from July 1-31, 2025, comparing ORs equipped with additional surgeon workstations to control ORs with standard computer complement. Consecutive elective and urgent general surgery cases with resident involvement were included. Median time from procedure end to postoperative note (PN) and postoperative order (PO) completion were compared. Multivariable linear regression identified independent predictors of documentation efficiency. Surveys were distributed anonymously to all residents and attendings assessing workstation usage.ResultsA total of 182 cases were analyzed, 101 (56%) with the experimental additional workstation. Median PN (7 vs 10 minutes, = 0.02) and PO (9 vs 14 minutes, < 0.001) completion times were shorter favoring the surgeon-dedicated workstation. On multivariable regression, the workstation independently reduced PN and PO completion times by 4.9 minutes (95% CI 1.4-8.5, = 0.006) and 9.1 minutes (95% CI 2.7-15.5, = 0.005), representing 54% and 83% relative improvement, respectively. No adverse postoperative events occurred. Resident surveys indicated 100% agreement that the workstation improved workflow and patient care.ConclusionImplementation of surgeon-dedicated OR workstations significantly reduced postoperative documentation times and improved OR workflow without adverse events. This strategy may represent a cost-effective, scalable intervention to enhance surgical efficiency.
Web Scraping Techniques for Surgical Research: A Technical Tutorial With a Worked Example in Publication Data Mining.
Kuo AC, Wolansky RL, Hiraldo L … +2 more , Sujka J, Kuo PC
Am Surg · 2026 Apr · PMID 41958024 · Publisher ↗
BackgroundWeb scraping-the automated extraction of data from websites-has become an essential technique for researchers seeking to collect large-scale data that would be impractical to gather manually. Surgeon-scientists...
BackgroundWeb scraping-the automated extraction of data from websites-has become an essential technique for researchers seeking to collect large-scale data that would be impractical to gather manually. Surgeon-scientists increasingly encounter publicly available web data relevant to outcomes research, health services analysis, workforce studies, and policy work, yet technical guidance on implementing web scrapers remains limited in the surgical literature.MethodsThis tutorial provides a clinician-oriented technical guide to web scraping for surgical research. We present key concepts including static vs dynamic websites, CSS selectors, browser automation, rate limiting, and ethical considerations. A complete worked example demonstrates the full pipeline by scraping a surgical research group's publication page (https://www.onetomapanalytics.com) to build a structured bibliometric database.ResultsThe worked example successfully extracts structured publication data-including titles, author lists, abstracts, keywords, and PubMed links-from a JavaScript-rendered website, producing an analysis-ready data set. We demonstrate how this pipeline generalizes to other surgical research applications including hospital price transparency data, residency program characteristics, and quality metrics.ConclusionsWeb scraping is a powerful tool for surgeon-scientists when implemented with technical rigor and ethical responsibility. By anchoring the tutorial to a concrete surgical use case and providing a reusable code template, we equip surgical researchers with the foundational knowledge to design, implement, and adapt web scrapers for their own data collection projects.
Immune-Inflammatory Markers Associated With Occult Appendiceal Neoplasms in Patients With Acute Appendicitis.
Trifunović N, Mitrović N, Trifunović J … +2 more , Nikolić M, Filipović S
Am Surg · 2026 Apr · PMID 41958010 · Publisher ↗
BackgroundAcute appendicitis ranges from mild inflammation to perforation. A clinically important subset of cases harbors an occult appendiceal neoplasm that is often indistinguishable from routine appendicitis preoperat...
BackgroundAcute appendicitis ranges from mild inflammation to perforation. A clinically important subset of cases harbors an occult appendiceal neoplasm that is often indistinguishable from routine appendicitis preoperatively. Blood-derived inflammatory indices have been proposed as predictors of disease severity and malignancy. We evaluated the diagnostic value of platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and CRP/SII for predicting complicated appendicitis and identifying neoplasms.MethodsWe conducted a 5-year retrospective study of 837 appendectomies at a tertiary surgical center. Preoperative clinical, laboratory, imaging, and histopathologic findings were analyzed. Appendicitis severity was classified according to WSES criteria. Diagnostic performance was assessed using logistic regression and receiver-operating characteristic (ROC) analysis.ResultsAppendiceal neoplasms were found in 1.1% of patients and were uniformly unsuspected intraoperatively. Neoplastic patients were significantly older ( < 0.001) and had higher PLR and SII ( < 0.001 and = 0.005). PLR (AUC 0.868) and SII (AUC 0.770) showed the strongest discrimination between benign and malignant pathology. CRP/SII showed the best performance for complicated appendicitis (AUC 0.703). Age, PLR, and CRP/SII were independent predictors of neoplasm, while SII, PLR, and CRP/SII were independently associated with complicated disease.DiscussionAppendiceal neoplasms may present as clinically uncomplicated appendicitis. Simple inflammatory indices-particularly PLR and SII-were associated with both disease severity and hidden malignancy. These inexpensive and widely available markers may support early surgical decision-making in older or high-risk patients. Prospective validation is needed to define optimal thresholds and refine their role in preoperative triage.
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