ImportanceSince work-hour restrictions were instituted in 2003, sustainably complying with duty-hour regulations remains a challenge for general surgery residency programs across the nation.ObjectiveTo determine whether industry-based process improvement techniques could be leveraged to increase compliance with work-hour restrictions within a general surgery residency.Design, Setting, and ParticipantsThis

This Viewpoint discusses recent changes in US Centers for Medicare and Medicaid Services policy changes for transfemoral carotid artery stenting in all patients.

This cohort study examines US veterans undergoing endovascular aortic repairs between 2000 and 2023 in the context of the 2018 Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act, which established a community care program to deliver health care to veterans outside Veterans Affairs facilities.

OBJECTIVE To validate the ISGPS complexity grading system for minimally invasive pancreaticoduodenectomy (MIPD). BACKGROUND Although concerns about patient safety persist, MIPD is gaining popularity. The ISGPS recently introduced a difficulty grading system to improve patient selection by aligning procedural complexity with surgeon and center expertise. METHODS Data from MIPD cases reported in the

OBJECTIVE To examine the relationship between moral injury and surgical practice, further explore the concept of protective equity, and understand its role in mitigating the impact of morally injurious events throughout a surgical career. BACKGROUND Moral injury in healthcare settings has evolved from Jonathan Shay's original definition, modified by Brett Litz and others, to encompass the psychological

OBJECTIVE We aimed to study the impact of anorectal malformation (ARM) type and sacral ratio on continence outcomes in children. We secondarily aimed to compare continence outcomes by age group and determine quality of life (QoL) with different bowel regimens. SUMMARY BACKGROUND DATA Children with ARM experience dysfunctional stooling into adulthood. Little is known about how ARM type, sacral ratio

OBJECTIVE This clinical trial investigated the safety and efficacy of single-cycle pembrolizumab in patients with localized deficient mismatch repair (dMMR) colon cancer. BACKGROUND Neoadjuvant immunotherapy has induced remarkable rates of pathological complete response in patients with dMMR colon cancer. However, the optimal length and type of treatment are yet to be determined. METHODS This was an

After skin allotransplantation, intercellular transfer of donor MHC molecules mediated primarily by extracellular vesicles (EVs) released by the allograft is known to contribute to semi-direct and indirect activation of alloreactive T cells involved in graft rejection. At the same time, there is ample evidence showing that initiation of adaptive alloimmunity depends on early innate inflammation caused

OBJECTIVE To investigate the incidence and risk factors of portomesenteric venous thrombosis (PVT) after pancreatic cancer surgery with portomesenteric venous resection (PVR). SUMMARY BACKGROUND DATA Pancreatic cancer surgery with PVR can be complicated by PVT, but the long-term associations, risk factors, and consequences of PVT have not been clearly elucidated. METHODS This study included pancreatic

OBJECTIVE To develop and validate a signature to precisely predict prognosis in pancreatic ductal adenocarcinoma (PDAC) undergoing resection and adjuvant chemotherapy. SUMMARY BACKGROUND DATA PDAC is largely heterogeneous, and responds discrepantly to treatment. METHODS 551 consecutive patients with PDAC from 3 tertiary centers were initially enrolled. Genetic events of the four most commonly mutated

OBJECTIVE To describe the evolution of management strategies for neuroendocrine liver metastases (NE LM) and trends in patient outcomes over the preceding 3 decades. SUMMARY BACKGROUND DATA Liver metastases are common in neuroendocrine neoplasms and impair prognosis. A broad therapeutic armamentarium has evolved over recent decades but there remains uncertainty regarding optimal treatment selection

OBJECTIVE To examine the optimal method of assessing response to neoadjuvant therapy (NAT) in operable pancreatic ductal adenocarcinoma (PDAC) patients. SUMMARY OF BACKGROUND DATA PDAC response to NAT is measured with biochemical, radiographic and pathologic parameters, which can often be discordant with each other. METHODS PDAC patients undergoing resection after NAT at a single institution were retrospectively

It is widely accepted that blood transfusions can cause allosensitisation, but it is often reported that new HLA antibodies are non-specific and transient. This study explores the effect of blood transfusion on allosensitisation in waitlisted transplant patients including the development of transfusion specific antibodies (TSAs), whilst they remain on the waiting list and longitudinally following subsequent

BACKGROUND The effect of Friday the 13th and Full Moons on cardiac transplantation is unknown. We investigated the impact of these superstitious events on recipient and donor qualities, complications, survival, and volume. METHODS All adult transplants from 2013-2023 in the United Network for Organ Sharing database were retrospectively reviewed. Friday the 13th recipients were compared to Adjacent

ImportanceThere is sparse literature on whether routine cholangiography (RC) vs selective cholangiography (SC) during cholecystectomy is associated with improved perioperative outcomes, regardless of whether an intraoperative cholangiogram (IOC) is performed.ObjectiveTo compare perioperative outcomes of cholecystectomy between surgeons who routinely vs selectively perform IOC.Design, Setting, and ParticipantsThis

This case series examines experiences and outcomes associated cardiac reoperations with preexisting internal thoracic artery to left anterior descending artery grafts.

ImportanceOriginally developed for use in contaminated fields, there is growing evidence against the use of biologic and biosynthetic mesh in ventral hernia repair. However, its prevalence and patterns of use in current practice are largely unknown.ObjectivesTo describe the prevalence of biologic and biosynthetic mesh use in ventral hernia repair and to identify factors associated with its use.Design

OBJECTIVES The efficacy of enhanced recovery after surgery (ERAS) to improve the prognosis of patients who undergo laparoscopic distal gastrectomy (LDG) for gastric cancer is uncertain. This randomized study compared oncological outcomes in LDG after ERAS or conventional care. BACKGROUND At present, randomized controlled trials have confirmed that ERAS can improve the short-term clinical outcomes of

OBJECTIVE The present study aimed to assess the efficacy of this approach and establish the criteria that identify LAPC patients who may achieve survival benefits from RRCIA. SUMMARY BACKGROUND DATA Surgical resection for locally advanced pancreatic cancer (LAPC) remains challenging and associated with high morbidity and mortality, especially for surgery with major arterial reconstruction. We previously

OBJECTIVE To characterize the association between type of fellowship training and patient outcomes following hepatopancreatic (HP) surgery across different surgeon career stages using a national representative cohort of Medicare beneficiaries. BACKGROUND The current state of training in HPB surgery in North America is defined through three main pathways: the Complex General Surgical Oncology (CGSO)

OBJECTIVE To identify the risk factors, manifestations, and clinical implications of chyle leak (CL) after pancreatic surgery, and to reappraise the International Study Group for Pancreatic Surgery (ISGPS) definition and classification of CL. SUMMARY BACKGROUND DATA The risk factors, clinical scenarios, and management of CL after pancreatic surgery remain controversial. METHODS Data from patients who

OBJECTIVE To compare early patency and outcomes of single outflow (SOT) and double outflow (DOT) reconstruction in right lobe living donor liver transplantation (RtLDLT) in a multicenter open-labelled randomized controlled trial. SUMMARY BACKGROUND DATA Optimum graft venous outflow is a key factor in determining outcomes of RtLDLT. There is no data directly comparing SOT and DOT technique of graft

OBJECTIVE To delineate how identity-based bias exposure evolves with rank and/or context among healthcare workers, and assess their attitudes toward existing DEI education. BACKGROUND Although Diversity, Equity and Inclusion (DEI) training is widely mandated for healthcare workers, few studies examine how clinicians' needs evolve across a career, how context impact recipients' ability to respond, or

BACKGROUND A pediatric national heart review board (NHRB) and exception guidance document to standardize decision-making were implemented in 2021 to reduce variability and ensure equity in status exceptions for pediatric candidates. We evaluated the hypothesis that these changes decreased center variability and racial disparities within the granted exceptions. METHODS Guidance document and pediatric

BACKGROUND Liquid biopsy offers a potential alternative to decrease or eliminate endomyocardial biopsy (EMB) for diagnosing allograft rejection. piRNAs are novel and promising disease biomarkers for their intrinsic characteristics such as stability in body fluids; however, their role in allograft rejection remains unexplored. METHODS A training set based on small RNA sequencing technology was performed

BACKGROUND This analysis compared effects of the activin signaling inhibitor, sotatercept, across pulmonary arterial hypertension (PAH) subgroups stratified by baseline cardiac index (CI). METHODS Pooled data from PULSAR (N=106; NCT03496207) and STELLAR (N=323; NCT04576988) were analyzed using two different CI thresholds, < and ≥ 2.0 L/min/m2 or 2.5 L/min/m2. Median differences in change from baseline

Importance Postoperative pancreatic fistulas (POPF) are the biggest contributor to surgical morbidity and mortality after pancreatoduodenectomy. The impact of POPF could be influenced by the surgical approach. Objective To assess the clinical impact of POPF in patients undergoing minimally invasive pancreatoduodenectomy (MIPD) and open pancreatoduodenectomy (OPD). Design, Setting, and Participants

This Viewpoint details the potential impacts that the 2024 Alabama Supreme Court decision defining cryopreserved embryos as “children” and restricting in vitro fertilization could have on patients with cancer and surgeons.

ImportanceNeoadjuvant therapy (NT) is an increasingly used treatment strategy for patients with localized pancreatic ductal adenocarcinoma (PDAC). Little research has been conducted on cancer care delivery during NT, and the standards for optimal delivery of NT have not been defined.ObjectiveTo develop consensus best practices for delivering NT to patients with localized PDAC.Design, Setting, and ParticipantsThis

The COVID-19 pandemic has underscored the importance of vaccines, especially for immunocompromised populations like solid organ transplant (SOT) recipients, who often have weaker immune responses. The purpose of this study was to compare deep learning architectures for predicting SARS-CoV-2 vaccine responses 12 months post-vaccination in this high-risk group. Utilizing data from 303 SOT recipients

BACKGROUND Device-related infection (DRI) remains a cause of morbidity and mortality following durable left ventricular assist device (dLVAD) implantation. We evaluated outcomes following pump exchange (PE) for DRI following dLVAD implantation. METHODS Forty-nine patients underwent PE between 1/2007 and 12/2022 for major DRI. Outcomes included survival, incidence of subsequent DRI, and proportion of

Patients 65 years of age or older represent the fastest-growing demographic group added to the U.S. heart transplant (HT) list. While post-HT outcomes appear acceptable, immortal time bias is introduced if adverse outcomes that occur while waiting for HT are not considered. Recent durable left ventricular assist device (dLVAD) technological innovations have engendered the question of whether this patient