Importance Acute kidney injury (AKI) after cardiac surgery is a common and serious complication. Protein loading appears nephroprotective; thus, continuous hyperoncotic albumin infusion may impact AKI following high-risk cardiac surgery. Objective To evaluate the effect of postoperative 20% albumin infusion compared with usual care on the occurrence of AKI in high-risk cardiac surgery patients. Design

ImportancePrescribing more opioids than patients need following surgery is associated with long-term use, misuse, and diversion. Interventions are needed to increase adherence to procedure-specific guidelines while preserving the ability to manage pain.ObjectiveTo test whether providing clinicians monthly feedback with peer comparisons and patient-reported outcomes would increase adherence to postoperative

ImportanceTracheobronchial replacement remains a surgical and biological challenge despite several decades of experimental and clinical research.ObjectiveTo compile a comprehensive state-of-the-science review examining the current indications, techniques, and outcomes of tracheobronchial replacement in human patients.Evidence ReviewA systematic review of the literature was conducted on July 1, 2024

ImportanceSurgical mortality remains a critical public health issue in resource-limited settings. Hospital ownership type may influence surgical outcomes, yet this relationship is not well understood in East, Central, and Southern Africa, where a diverse mix of public, private, and faith-based hospitals provides care.ObjectiveTo determine whether hospital ownership type (public, private, or faith-based)

ImportanceThe surgeon-anesthesiologist teamwork is a core component of performance in the operating room, which can influence patient outcomes.ObjectiveTo examine the association between surgeon-anesthesiologist dyad familiarity (as dyad volume, the number of procedures done together) with 90-day postoperative major morbidity for high-risk elective surgery.Design, Setting, and ParticipantsThis population-based

ImportanceThe use of robotic-assisted cholecystectomy in acute care surgery is increasing, but its safety and efficacy compared with laparoscopic cholecystectomy remain unclear.ObjectiveTo compare clinical outcomes and bile duct injury rates between robotic-assisted cholecystectomy and laparoscopic cholecystectomy in acute care surgery.Design, Setting, and ParticipantsThis was a retrospective cohort

ImportancePostinduction hemodynamic instability is a frequent complication among patients with severe aortic stenosis (AS). Using cipepofol as the anesthesia agent may reduce the incidence and severity of hemodynamic instability.ObjectiveTo assess whether cipepofol outperforms propofol in maintaining postinduction hemodynamic stability in patients with AS.Design, Setting, and ParticipantsThis single-center

ImportanceApproximately 2 million individuals are incarcerated in the US. Surgical needs increase with age, and an aging prison population means an increasing need for surgical care for incarcerated individuals. Challenges in logistics, privacy, communication, and comorbidities put people in law enforcement custody at risk for suboptimal care and outcomes. Little guidance exists for surgeons seeking

ImportanceAntibiotics are thought to decelerate inflammation progression and reduce complications in acute uncomplicated appendicitis. The evidence of their effectiveness is insufficient, and treatment practices vary widely.ObjectiveTo investigate the effect of preoperatively started antibiotic treatment on the rate of appendiceal perforation.Design, Setting, and ParticipantsThis multicenter, noninferiority

This Viewpoint outlines the problems with the failure rates for nonoperative treatment of uncomplicated appendicitis (NOTA) reported in several major trials and discusses why NOTA may be preferable to appendectomy.

ImportanceUse of modern neoadjuvant chemotherapy (NAC) regimens has markedly increased rates of pathologic complete response (pCR) in breast cancer, raising the question of whether surgical removal of the primary tumor is required for patients with pCR. For surgery to be omitted, one must be able to accurately predict pCR before surgery.ObjectiveTo investigate if adding post-NAC core needle biopsy

ImportanceMetabolic bariatric surgery is the most effective and durable treatment for weight loss and improvement of cardiovascular diseases. With sleeve gastrectomy now surpassing gastric bypass as the most common procedure worldwide, comparing these procedures’ associations with major adverse cardiac events (MACE) is needed.ObjectiveTo compare the risk of MACE among individuals undergoing gastric

This Viewpoint provides communication techniques for surgeons in decision-making discussions with patients who likely will not reach their goals with surgery.

ImportanceCase reports and small retrospective studies have suggested that there is an increased risk of postoperative euglycemic ketoacidosis (eKA) and acute kidney injury (AKI) among patients using sodium-glucose cotransporter 2 inhibitors (SGLT2i) preoperatively. However, there has not been a representative assessment of the risks of these agents among patients undergoing surgery.ObjectiveTo evaluate

ImportanceThere is a dearth of surgical performance measures that accurately predict long-term patient outcomes.ObjectiveTo develop surgical performance measures collected at the time of surgery that accurately predict future outcomes.Design, Setting, and ParticipantsIn this cohort study, surgical video of 157 patients undergoing robotic-assisted radical prostatectomy by 28 surgeons from 4 tertiary

This Viewpoint discusses surgeons with disabilities, their experience in the work environment, and the need to create more informed structure and guidance to include and support trainees and surgeons with disabilities.

ImportanceEvidence suggests that physician gender and patient-physician gender concordance have the potential to improve patient outcomes, especially for female patients. However, whether long-term outcomes differ by surgeon gender and patient-surgeon gender concordance has not been studied in the US.ObjectiveTo compare long-term postoperative outcomes by surgeon gender and patient-surgeon gender concordance

ImportanceMajor emergency abdominal surgery is associated with high morbidity and mortality. Understanding trends in outcomes over time can reveal critical practice-changing improvements, identify gaps in postoperative care, and establish a large-scale benchmark for future research.ObjectiveTo investigate trends in morbidity and mortality after major emergency abdominal surgery in Denmark.Design, Setting

ImportanceAcute cholecystitis in older patients with multimorbidity is associated with a high risk of morbidity and mortality. Debate exists as to whether operative or nonoperative treatment is the most appropriate approach.ObjectivesTo compare the effectiveness of operative and nonoperative treatment in older adults with multimorbidity who are hospitalized emergently with acute cholecystitis.Design

This Surgical Innovation describes the use of video review of intraoperative trauma care and the potential to improve the quality of trauma care and create opportunities for coaching.

ImportanceEmpiric extended-spectrum antibiotics are routinely prescribed for over a million patients hospitalized annually with abdominal infection despite low likelihoods of infection with multidrug-resistant organisms (MDROs).ObjectiveTo evaluate whether computerized provider order entry (CPOE) prompts providing patient- and pathogen-specific MDRO infection risk estimates can reduce empiric extended-spectrum

ImportanceAbout 100 million urinary catheters are used globally each year. Urinary catheters are effective to establish bladder drainage, but they are associated with risks, including infection and encrustation. To mitigate the associated risks, an understanding of urinary catheter indications, placement and removal techniques, and maintenance is necessary.ObservationsThis review describes catheter

ImportanceLaparoscopic elective sigmoid resection is a treatment option for patients with recurring, persistent painful, or complicated diverticulitis, but outcomes of surgery compared with conservative treatment are unclear in long-term follow-up.ObjectiveTo compare quality-of-life (QOL), complication, and recurrence outcomes of surgery vs conservative treatment in patients with recurring, persistent

ImportanceLong-term follow-up studies of operative and nonoperative treatment of adult symptomatic lumbar scoliosis (ASLS) are needed to assess benefits and durability.ObjectiveTo assess the durability of treatment outcomes for operative vs nonoperative treatment of ASLS.Design, Setting, and ParticipantsThe Adult Symptomatic Lumbar Scoliosis 1 (ASLS-1) study was a multicenter, prospective study with

ImportanceThere are no large prospective cohort studies validating the previously reported high appendiceal tumor rate in patients with periappendicular abscess.ObjectiveTo confirm the appendiceal neoplasm rate associated with periappendicular abscess.Design, Setting, and ParticipantsThe Peri-Appendicitis Acuta Tumor prospective multicenter cohort study was conducted at 12 hospitals in Finland. All

ImportanceObesity and steatotic liver disease are associated with excess morbidity and mortality from cardiovascular, pulmonary, metabolic, and hepatic causes. Bariatric surgery has demonstrated long-term benefits in terms of weight loss and mortality rates, but barriers to its utilization persist.ObjectiveTo evaluate the impact of bariatric surgery on outcomes and cost-effectiveness among patients

ImportanceHumeral shaft fractures are routinely managed nonoperatively, but this approach is potentially associated with higher nonunion rates and inferior functional outcomes when compared with operative fixation.ObjectiveTo assess whether there is any difference in outcome between surgery and functional bracing for adults with an isolated, closed humeral shaft fracture.Design, Setting, and ParticipantsThis

ImportanceAntibiotic allergy labels (AALs) impact patient health and perioperative outcomes. Antibiotic allergy delabeling could improve antibiotic prescribing and infection-related outcomes perioperatively.ObjectiveTo assess the feasibility and safety of antibiotic allergy assessment and delabeling in anesthesiologist-led preoperative assessment clinics and expand delabeling efforts outside of specialist

This cohort study examines correlations between underrepresented-in-medicine and female faculty representation, retention, and promotion and general surgery resident attrition at a national level.

ImportanceHepatobiliary cancers are heterogeneous and molecularly complex. Recent advances in next-generation sequencing (NGS) have enhanced the understanding of their molecular landscape and enabled deployment of biomarker-based gene- and immune-targeted therapies. This review examines the role of molecular testing and targeted therapies in these malignant neoplasms.ObservationsPatients with hepatobiliary

ImportanceThe association of neoadjuvant chemoimmunotherapy (NCIT) vs chemoradiotherapy (NCRT) with tumor downstaging and survival in locally advanced esophageal squamous cell carcinoma (ESCC) remains unclear because of limited evidence.ObjectiveTo compare the associations of NCIT and NCRT with tumor regression and long-term survival in patients with locally advanced ESCC.Design, Setting, and ParticipantsIn