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.

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

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

Importance Evidence suggests that prophylactic abdominal drainage after gastrectomy for cancer may reduce postoperative morbidity and hospital stay but this evidence comes from small studies with a high risk of bias. Further research is needed to determine whether drains safely meet their primary purpose of identifying and managing postoperative intraperitoneal collections without the need for reoperation

This cross-sectional study uses data from the Veterans Health Administration’s Corporate Data Warehouse to identify individuals whose risk for obesity-related metabolic comorbidity may be misclassified by standard body mass index (BMI) thresholds.

This cohort study examines whether the Medicaid-payer proportion in hospital admissions is associated with in-hospital deaths from necrotizing soft tissue infection.

Importance Vascular injuries require urgent repair to minimize loss of limb and life. Standard revascularization relies on autologous vein or synthetic grafts, but alternative options are needed when adequate vein is not feasible and when clinical conditions preclude safe use of synthetic materials. Objective To evaluate the performance of the acellular tissue engineered vessel (ATEV) in the repair

Importance Patients with painful chronic pancreatitis and a dilated pancreatic duct can be treated by early surgery or an endoscopy-first approach. Objective To compare long-term clinical outcomes of early surgery vs an endoscopy-first approach using follow-up data from the ESCAPE randomized clinical trial. Design, Setting, and Participants Between April 2011 and September 2018, 88 patients with painful

This Viewpoint advocates for greater recognition of the contributions of health care systems to carbon emissions, specifically the use of single-use disposible products, and calls on health care leaders to champion sustainability in their organizations.

This article discusses the use of histotripsy as a noninvasive method for tumor ablation that involves mechanical destruction of tissues without the generation of heat, resulting in accurate and precise treatment without surrounding tissue damage.

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.