ImportanceComponent separation is a reconstructive technique used to facilitate midline closure of large or complex ventral hernias. Despite a contemporary surge in popularity, the incidence and long-term outcomes after component separation remain unknown.ObjectiveTo evaluate the incidence and long-term outcomes of component separation for abdominal wall hernia repair.Design, Setting, and ParticipantsThis

ImportanceActive surveillance (AS) has become an increasingly important option for managing low-risk and select intermediate-risk prostate cancer. Although imaging, particularly multiparametric magnetic resonance imaging (mpMRI), has emerged in the prebiopsy pathway for the diagnosis of prostate cancer, the role of mpMRI in patient selection for AS and the necessity of prostate biopsies during AS remain

ImportanceRadical gastric cancer surgery can cause functional and physiological disorders due to the resection of perigastric vagus nerves. Few studies have used intraoperative neurophysiological monitoring and indocyanine green (ICG) labeling to preserve the perigastric vagus nerve and to evaluate the corresponding effects.ObjectiveTo assess the feasibility and effects of vagus nerve preservation

This comparative effectiveness research uses data from the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) randomized clinical trial to compare benefits with balanced resuscitation for thoracic vs abdominopelvic traumatic hemorrhage.

ImportanceOngoing efforts have encouraged the regionalization of esophageal adenocarcinoma treatment to high-volume centers (HVCs). Yet such centralization has been linked with increased patient travel burden and reduced postoperative continuity of care.ObjectiveTo determine whether traveling to undergo esophagectomy at HVCs is linked with superior overall survival compared with receiving care locally

This Viewpoint provides recommendations for surgeons to stay active amidst demanding professional and personal commitments to help manage stress, avoid burnout, and improve overall quality of life.

Importance International guidelines lack consistency in their recommendations regarding routine imaging in the follow-up after pancreatic resection for pancreatic ductal adenocarcinoma (PDAC). Consequently, follow-up strategies differ between centers worldwide. Objective To compare clinical outcomes, including recurrence-focused treatment and survival, in patients with PDAC recurrence who received

This cross-sectional study analyzes how pain assessment frequency and pain score magnitude and variability differ by age among trauma patients admitted in hospitals.

This Viewpoint discusses the elimination of the percentile score from the American Board of Surgery In-Training Examination (ABSITE) from the program director’s perspective.

ImportancePhysical biomarkers for stratifying patients with lung cancer into subtypes suggestive of outcomes are underexplored.ObjectiveTo investigate the clinical utility of respiratory sarcopenia for optimizing postoperative risk stratification in patients with non–small cell lung cancer (NSCLC).Design, Setting, and ParticipantsThis retrospective cohort study reviewed consecutive patients undergoing

This Viewpoint describes the elimination of the percentile score from the American Board of Surgery In-Training Examination (ABSITE) from the fellowship director’s perspective.

This Viewpoint describes the elimination of the percentile score from the American Board of Surgery In-Training Examination (ABSITE) from the resident’s perspective.

ImportanceDelaying elective noncardiac surgery after a recent acute myocardial infarction is associated with better outcomes, but current American Heart Association recommendations are based on data that are more than 20 years old.ObjectiveTo examine the association between the time since a non–ST-segment elevation myocardial infarction (NSTEMI) and the risk of postoperative major adverse cardiovascular

ImportanceMajor surgery sometimes involves long recovery or even permanent institutionalization. Little is known about long-term trajectories of postoperative recovery, as surgical registries are limited to 30-day outcomes and care can occur across various institutions.ObjectiveTo characterize long-term postoperative recovery trajectories.Design, Setting, and ParticipantsThis retrospective cohort study

ImportanceFemale patients have higher mortality rates after high-risk surgery than male patients. It is unknown whether this mortality gap is due to different rates of postoperative complications or if complications are addressed differently by sex, causing complications to lead to death—so-called failure to rescue.ObjectiveTo evaluate sex differences in failure to rescue across high-risk surgical

This Viewpoint outlines ergononmical best practices in surgery and advocates for adherance to these best practices for surgeons’ longevity and comfort.

ImportanceThere are 2 degree programs for licensed physicians in the US: allopathic medical doctorate (MD) and osteopathic doctorate (DO). However, evidence is limited as to whether outcomes differ between patients treated by MD vs DO surgeons.ObjectiveTo evaluate differences in surgical outcomes and practice patterns by surgeon medical school training (MD vs DO).Design, Setting, and ParticipantsThis

This cohort study examines the association of patient outcomes following resection of stage I to III thymic tumors with whether the procedure was conducted at high-volume centers.

This article discusses the use of intraoperative autonomic neural blockade as a technique to manage postoperative visceral pain and symptoms of postoperative nausea and vomiting in minimally invasive surgery.

ImportanceMachine learning tools are increasingly deployed for risk prediction and clinical decision support in surgery. Class imbalance adversely impacts predictive performance, especially for low-incidence complications.ObjectiveTo evaluate risk-prediction model performance when trained on risk-specific cohorts.Design, Setting, and ParticipantsThis cross-sectional study performed from February 2024

ImportanceEmployment and personal income loss after traumatic brain injury is a major source of postinjury stress and a barrier to societal reintegration. The magnitude of labor market ramifications following traumatic brain injury remains largely unknown.ObjectivesTo quantify the 3-year postinjury labor market consequences following traumatic brain injury in Canada. To also estimate the incurred national

ImportanceAmong cancer surgeries, patients requiring open radical cystectomy have the highest risk of red blood cell (RBC) transfusion. Prophylactic tranexamic acid (TXA) reduces blood loss during cardiac and orthopedic surgery, and it is possible that similar effects of TXA would be observed during radical cystectomy.ObjectiveTo determine whether TXA, administered before incision and for the duration

This cohort study analyzes the impact of the Organ Procurement and Transplantation Network’s policy changes on mortality and post–liver transplant survival for pediatric patients on the waitlist.

ImportanceHealth care researchers, professionals, payers, and policymakers are increasingly relying on publicly available composite indices of area-level socioeconomic deprivation to address health equity. Implications of index selection, however, are not well understood.ObjectiveTo compare the performance of 2 frequently used deprivation indices using policy-relevant outcomes among Medicare beneficiaries

This study uses life cycle analysis to comprehensively evaluate the environmental impact of a pediatric surgical kit, including water consumption and greenhouse gas emissions.

ImportanceIn patients with clinically node-negative (cN0) breast cancer and 1 or 2 sentinel lymph node (SLN) macrometastases, omitting completion axillary lymph node dissection (CALND) is standard. High nodal burden (≥4 axillary nodal metastases) is an indication for intensified treatment in luminal breast cancer; hence, abstaining from CALND may result in undertreatment.ObjectiveTo develop a prediction

ImportanceIn the Netherlands, organ donation after euthanasia (donation after circulatory death type V [DCD-V]) has been increasingly performed since 2012. However, the outcomes of DCD-V kidney grafts have not been thoroughly investigated. It is critical to assess the outcomes of these kidney grafts to ascertain whether DCD-V is a safe and valuable way to increase the kidney donor pool.ObjectivesTo

Slap fighting is a fast-paced combat sport wherein athletes strike each other in the head with open hands and matches are largely scored by points or knockouts. Power Slap,1 a slap fighting promotion that has offered a platform for this largely underground sport, was first televised in January 2023 and has drawn extensive criticism from both medical and nonmedical personnel.2 Worryingly, the promotional

ImportanceSince 2005, a total of 50 face transplants have been reported from 18 centers in 11 countries. The overall survival of the grafts has not yet been established.ObjectiveTo assess the survival of the face transplant grafts and evaluate factors potentially influencing it.Design, Setting, and ParticipantsData on all the transplants included in this multicenter cohort study were collected at participating

ImportanceNearly 30 million predominantly rural US residents lack timely access to trauma care expertise available at level I or II trauma centers. Telehealth is an established approach to improve access to health care expertise using remote consultation; however, the prevalence of use of telehealth in trauma (teletrauma) across the US is not known.ObjectiveTo examine the prevalence of, trends in,

ImportanceNecrotizing soft tissue infections (NSTIs) are severe life- and limb-threatening infections with high rates of morbidity and mortality. Unfortunately, there has been minimal improvement in outcomes over time.ObservationsNSTIs are characterized by their heterogeneity in microbiology, risk factors, and anatomical involvement. They often present with nonspecific symptoms, leading to a high rate

This Viewpoint presents an updated scientific approach applied to the foundational framework of the Haddon Matrix for injury prevention to reduce firearm injuries and deaths to children and youth.

ImportanceMany health systems use electronic consent (eConsent) for surgery, but few have used surgical consent functionality in the patient portal (PP). Incorporating the PP into the consent process could potentially improve efficiency by letting patients independently review and sign their eConsent before the day of surgery.ObjectiveTo evaluate the association of eConsent delivery via the PP with