Objective:  To assess the impact of operating room (OR) ventilation quality on surgical site infections (SSI) using a novel ventilation index. Summary Background Data:  Previous studies compared laminar air flow with conventional ventilation, thereby ignoring many parameters that influence air flow properties. Methods:  In this cohort study, we surveyed hospitals participating in the Swiss SSI surveillance

Objective:  While errors can harm patients they remain poorly studied. This study characterized errors in the care of surgical patients and examined the association of errors with morbidity and mortality. Summary Background Data:  Errors have been reported to cause less than 10% or greater than 60% of adverse events. Such discordant results underscore the need for further exploration of the relationship

Objective:  To reach global expert consensus on the definition of TOLS in minimally invasive and open liver resection among renowned international expert liver surgeons using a modified Delphi method. Summary Background Data:  Textbook outcome is a novel composite measure combining the most desirable postoperative outcomes into one single measure and representing the ideal postoperative course. Despite

Objective:  To examine whether body mass index (BMI) changes modify the association between kidney donation and incident hypertension. Summary Background Data:  Obesity increases hypertension risk in both general and living kidney donor (LKD) populations. Donation-attributable risk in the context of obesity, and whether weight change modifies that risk, is unknown. Methods:  Nested case-control study

Objective:  To evaluate the impact of ALND and SLNB on upper limb (UL) morbidity in breast cancer patients. Summary Background:  Axillary de-escalation is motivated by a desire to reduce harm of ALND. Understanding the impact of axillary surgery and disparities in operative procedures on post-operative arm morbidity would better direct resources to the point of need and cement the need for de-escalation

To establish an evidence-based cut-off and predictors for early recurrence in patients with resected locally advanced pancreatic cancer (LAPC).

To evaluate differences in presentation and outcomes of surgery for colorectal cancer.

To determine whether the morphologic features of the main pancreatic duct (MPD) of main-duct-involved-IPMN (i.e., Main duct or mixed main duct/side branch) have implications for risk of malignancy and extent of resection.

Clinical decision support (CDS) systems are increasingly used to facilitate surgical care delivery. Despite formal recommendations to do so, equity evaluations are not routinely performed on CDS systems and underrepresented populations are at risk of harm and further health disparities. We explored surgical literature to determine frequency and rigor of CDS equity assessments and offer recommendations

To establish surgical site infection (SSI) performance benchmarks in pediatric surgery and to develop a prioritization framework for SSI prevention based on procedure-level SSI burden.

Investigate patterns of infant perioperative mortality, describe the infant diagnoses with the highest mortality burden, and evaluate the association between types of postoperative complications and mortality in infants.

Hypothesis:  Poorly cohesive (PC) gastric cancer (GC) exhibits variable clinical behaviour, being extremely aggressive in most cases but more indolent at times. We hypothesized that the integrative genomic and gene expression characterization of a PC GC series could help identifying molecular subtypes with potential clinical implications. Methods:  64 PC GCs were assessed for alterations in 409 genes

Objective:  To evaluate the impact of anastomotic leak (AL) after colon cancer (CC) and rectal cancer (RC) surgery on 5-year relative survival, disease-free survival and disease recurrence. Background:  AL after CC and RC resection is a severe postoperative complication with conflicting evidence whether it deteriorates long-term outcomes. Methods:  Patients with stage I-IV CC and RC who underwent resection

Objective:  To determine the accuracy of preoperative imaging, including contrast-enhanced computed tomography (CE-CT), endoscopic ultrasound (EUS) and 68Gallium-DOTATOC positron emission tomography (68Ga-DOTATOC PET), in identifying nodal metastases (N+) in sporadic nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs). Summary Background Data:  An accurate preoperative identification of N+

Objective:  To assess outcomes of fenestrated-branched endovascular aortic repair (FB-EVAR) of Extent I-III thoracoabdominal aortic aneurysms (TAAAs) without prophylactic cerebrospinal fluid drainage (CSFD). Background:  Prophylactic CSFD has been routinely used during endovascular TAAA repair, but concerns about major drain-related complications gave led to revising this paradigm. Methods:  We reviewed

Objective:  To evaluate the diagnostic accuracy of the app-based diagnostic tool Ada and the impact on patient outcome in the emergency room (ER). Background:  Artificial intelligence (AI)-based diagnostic tools can improve targeted processes in healthcare delivery by integrating patient information with a medical knowledge base and a machine learning system, providing clinicians with differential

Objective:  We herein advocate for more extensive utilization of ex vivo resection techniques for otherwise unresectable liver tumors by presenting the largest collective American experience. Summary Background Data:  Advanced in situ resection and vascular reconstruction techniques have made R0 resection possible for otherwise unresectable liver tumors. Ex vivo liver resection may further expand the

The pathogenesis of lung hypoplasia in congenital diaphragmatic hernia (CDH), a common birth defect, is poorly understood. The diaphragmatic defect can be repaired surgically, but the abnormal lung development contributes to a high mortality in these patients. To understand the underlying pathobiology, we compared the proteomic profiles of fetal rat lungs at the alveolar stage (E21) that were either

Objective:  To describe national trends in surgical technique and rates of reoperation for recurrence for patients undergoing ventral hernia repair (VHR) in the United States. Summary Background Data:  Surgical options for VHR, including minimally invasive approaches, mesh implantation, and myofascial release, have expanded considerably over the past two decades. Their dissemination and impact on population-level

Objective:  Exemplify an explainable machine learning framework to bring database to the bedside; develop and validate a point-of-care frailty assessment tool to prognosticate outcomes after injury. Summary Background Data:  A geriatric trauma frailty index that captures only baseline conditions, is readily-implementable, and validated nationwide remains underexplored. We hypothesized Trauma fRailty

Objective:  To examine variation in “failure to rescue” (FTR) as a driver of differences in mortality between centres and over time for patients undergoing colorectal cancer surgery. Background:  Wide variation exists in postoperative mortality following colorectal cancer surgery. FTR has been identified as an important determinant of variation in postoperative outcomes. We hypothesized that differences

Objective:  This multicenter study aimed to assess (1) the effect of an improvement collaborative on enhanced recovery after surgery (ERAS) protocol adherence after elective colectomy and (2) the association between adherence and patient outcomes. Summary Background Data:  ERAS pathways provide a framework to standardize care processes and improve postoperative outcomes in patients after colon surgery

Objective:  To propose a new decision algorithm combining biomarkers measured in a tumor biopsy with clinical variables, to predict recurrence after liver transplantation (LT). Summary Background Data:  Liver cancer is one of the most frequent causes of cancer-related mortality. LT is the best treatment for hepatocellular carcinoma (HCC) patients but the scarcity of organs makes patient selection a

Objective:  To test the hypothesis that in surgical patients ≥70 years, preoperative cognitive impairment is independently associated with postoperative delirium. Background:  Postoperative delirium is common among elderly surgical patients and is associated with longer hospitalization and significant morbidity. Some evidence suggest that baseline cognitive impairment is an important risk factor. Routine

Objective:  This study aimed to assess the relationship between surgeons’ leadership style and team behavior in the hybrid operating room through video coding. Secondly, possible fluctuations in leadership styles and team behavior during operative phases were studied. Summary/Background-Data:  Leadership is recognized as a key component to successful team functioning in high-risk industries. The ‘full

Total mesorectal excision (TME) for rectal cancer (RC) often results in significant bowel symptoms, commonly known as Low Anterior Resection Syndrome (LARS). Although pelvic floor muscle training (PFMT) is recommended in non-cancer populations for treating bowel symptoms, this has been scarcely investigated in RC-patients. The objective was to investigate PFMT-effectiveness on LARS in patients after

To explore potential sex differences in outcomes and regenerative parameters post major hepatectomies.

Living donor liver transplantation (LDLT) using small grafts, especially left-lobe grafts (LLG), continues to be a challenge due to small-for-size syndrome (SFSS). We herein demonstrate that with surgical modifications, outcomes with small grafts can be improved.

To compare the (sentinel) lymph node detection rate of ICG-fluorescent imaging versus standard-of-care 99mTc-nanocoilloid for sentinel lymph node (SLN)-mapping.

To define benchmark values for liver transplantation (LT) in patients with perihilar cholangiocarcinoma (PHC) enabling unbiased comparisons.

To define benchmark cutoffs for redo liver transplantation (redo-LT).

We aimed to investigate the postoperative trend in blood pressure-related outcomes (blood pressure and antihypertensive drug use) during the year following adrenalectomy for primary aldosteronism (PA) to determine the optimal timing for outcome assessment and to determine the necessary follow-up length.

To identify a prognostic significant gene signature for predicting colorectal cancer (CRC) recurrence.

This study investigated the patterns, predictors and survival of recurrent disease following esophageal cancer surgery.

Metabolic dysfunction-associated fatty liver disease (MAFLD) reflects the multifactorial pathogenesis of fatty liver disease in metabolically sick patients. The effects of metabolic surgery on MAFLD have not been investigated. This study assesses the impact of Roux-en-Y gastric bypass (RYGB) on MAFLD in a prototypical cohort outside the guidelines for obesity surgery.

To derive and validate a polygenic risk score (PRS) to predict the occurrence and severity of diverticulitis and to understand the potential for incorporation of a PRS in current decision-making.

To evaluate whether circulating miRNAs predict response to neoadjuvant chemotherapy (NAC) and inform decision-making in breast cancer patients.

To evaluate whether postoperative serum hyperamylasemia (POH), with drain fluid amylase (DFA) and C-reactive protein (CRP), improves the Fistula Risk Score (FRS) accuracy in assessing the risk of a postoperative pancreatic fistula (POPF).

The FLOT protocol and the CROSS tri-modality regimen represent current standards in the management of locally advanced esophageal adenocarcinoma (EAC). In the absence of published RCT data, this propensity-matched comparison evaluated tolerance, toxicity, impact on sarcopenia and pulmonary physiology, operative complications, and oncologic metrics.

This study aims at constructing a staging system incorporating tumor regression grade and ypN-category (TRG-N) in patients with neoadjuvant therapy before esophagectomy. It is hypothesized that this would prognosticate better than the current AJCC post neoadjuvant therapy (ypTNM) stage groups.

The aim of the study was to evaluate the impact of the use of a reinforced stapler (RS) during distal pancreatectomy on postoperative outcomes.

To describe outcome after pancreatic surgery in the first six years of a mandatory nationwide audit.

The aim of this study was to explore the incidence, risk factors, clinical course and treatment of perforation and fistula of the gastrointestinal tract in a large unselected cohort of patients with necrotizing pancreatitis.

The Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) conducted a retrospective study on the disease course and clinical management of ganglioneuromas.

Randomized controlled trials (RCTs) yield the highest level of evidence but are notoriously difficult to perform in surgery. Surgical RCTs may be hampered by slow accrual, the surgical learning curve, and lack of financial support. Alternative RCT designs such as stepped-wedge RCTs (SW-RCTs), registry-based RCTs (RB-RCTs), and trials-within-cohorts (TwiCs) may overcome several of these difficulties

The MELFO (MELanoma FOllow-up) study is an international phase III RCT comparing an experimental low-intensity schedule against current national guidelines.

To determine the prevalence of metastases to the cervical and recurrent laryngeal cervicothoracic (CT) nodes as well as survival and recurrence patterns after esophagectomy with three-field lymph node dissection (TFD) in patients with predominately adenocarcinoma (AC) of the esophagus.

To develop and validate a risk prediction model of 90-day mortality (90DM) using machine learning in a large multicenter cohort of patients undergoing gastric cancer resection with curative intent.

Robotic distal pancreatectomy (DP) is an emerging attractive approach, but its role compared to laparoscopic or open surgery remains unclear. Benchmark values are novel and objective tools for such comparisons. The aim of this study was to identify benchmark cutoffs for many outcome parameters for DP with or without splenectomy beyond the learning curve.

We sought to identify causal factors that explain the selective benefit of pre-hospital administration of thawed plasma (TP) in traumatic brain injury (TBI) patients using mediation analysis of a multi-omic database.

Surgeon preferences such as instrument and suture selection and idiosyncratic approaches to individual procedure steps have been largely viewed as minor differences in the surgical workflow. We hypothesized that idiosyncratic approaches could be quantified and shown to have measurable effects on procedural outcomes.

This study investigates whether liver grafts donated after circulatory death (DCD) that are declined by the entire Euro-transplant region can be salvaged with abdominal normothermic regional perfusion (aNRP).

To explore the prospects of academic e-learning by evaluating our long-standing internet-based surgical learning program and to assess the impact of training on the presentation skills of our residents. The eventual goal is to search whether such models could be further developed by the ESA.

To evaluate the effect of intraoperative blood salvage and autotransfusion (IBSA) use on red blood cell (RBC) transfusion and postoperative outcomes in liver surgery.

To compare overall (OS) and recurrence-free survival (RFS) in esophageal adenocarcinoma patients with a complete pathological response (pCR) following neoadjuvant chemotherapy (nCT) or neoadjuvant chemoradiotherapy (nCRT).