bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting Long-term Survival and Time-to-recurrence After Esophagectomy in Patients With Esophageal Cancer
Authors: Gujjuri Rohan R. , Clarke Jonathan M. , Elliott Jessie A. , Rahman Saqib A. , Reynolds John V. , Hanna George B. , Markar Sheraz R. ,   ENSURE Study Group
Published: July 2022

Objective:
To develop prediction models to predict long-term survival and time-to-recurrence following surgery for esophageal cancer.

Background:
Long-term survival after esophagectomy remains poor, with recurrence common. Prediction tools can identify high-risk patients and optimize treatment decisions based on their prognostic factors.

Methods:
Patients undergoing curative surgery from the European iNvestigation of SUrveillance After Resection for Esophageal Cancer study were included. Prediction models were developed for overall survival (OS) and disease-free survival (DFS) using Cox proportional hazards (CPH) and random survival forest (RSF). Model performance was evaluated using discrimination [time-dependent area under the curve (tAUC)] and calibration (visual comparison of predicted and observed survival probabilities).

Results:
This study included 4719 patients with an OS of 47.7% and DFS of 40.9% at 5 years. Sixteen variables were included. CPH and RSF demonstrated good discrimination with a tAUC of 78.2% [95% confidence interval (CI): 77.4%–79.1%] and 77.1% (95% CI: 76.1%–78.1%) for OS and a tAUC of 79.4% (95% CI: 78.5%–80.2%) and 78.6% (95% CI: 77.5%–79.5%), respectively for DFS at 5 years. CPH showed good agreement between predicted and observed probabilities in all quintiles. RSF showed good agreement for patients with survival probabilities between 20% and 80%.

Conclusions:
This study demonstrated that a statistical model can accurately predict long-term survival and time-to-recurrence after esophagectomy. Identification of patient groups at risk of recurrence and poor long-term survival can improve patient outcomes by optimizing treatment methods and surveillance strategies. Future work evaluating prediction-based decisions against standard decision-making is required to understand the clinical utility derived from prognostic model use.
Does an Ileoanal Anastomosis Decrease the Rate of Successful Pregnancy Compared With an Ileorectal Anastomosis? A National Study of 1491 Patients
Authors: Challine Alexandre , Voron Thibault , O’Connell Lauren , Chafai Najim , Debove Clotilde , Collard Maxime K. , Parc Yann , Lefèvre Jérémie H. 
Published: July 2022

Objective:
Report the rate of successful pregnancy in a national cohort of women with either an ileal pouch anal (IPAA) or ileorectal (IRA) anastomosis constructed after colectomy for inflammatory bowel disease (IBD) or polyposis.

Background:
Fertility after IPAA is probably impaired. All available data are corroborated by only small sample size studies. It is not known whether construction of IPAA versus IRA influences the odds of subsequently achieving a successful pregnancy, especially with increased utilization of the laparoscopic approach.

Methods:
All women (age: 12–45 y) undergoing IRA or IPAA in France for polyposis or IBD, between 2010–2020, were included. A control population was defined as women aged from 12 to 45 years undergoing laparoscopic appendicectomy during the same period. The odds of successful pregnancy were studied using an adjusted survival analysis.

Results:
A total of 1491 women (IPAA=872, 58%; IRA=619, 42%) were included. A total of 220 deliveries (15%) occurred during the follow-up period of 71 months (39–100). After adjustment, the odds of successful pregnancy was not significantly associated with type of anastomosis (after IPAA: Hazard Ratio [HR]=0.79, 95% confidence interval=0.56–1.11, P=0.17). The laparoscopic approach increased the odds of achieving successful pregnancy (HR=1.79, 95% confidence interval=1.20–2.63, P=0.004). IRA and IPAA significantly impacted fertility when compared with the control population (P<0.001).

Conclusions:
In this large cohort study, total colectomy for polyposis or IBD was associated with reduced fertility compared with the general population. No difference in odds of achieving successful pregnancy was found between IRA and IPAA after adjustment. This analysis suggests laparoscopic surgery may be associated with greater likelihood of pregnancy.
The Timing of Acute and Late Complications Following Mastectomy and Implant-based Reconstruction
Authors: Jimenez Rachel B. , Packowski Kathryn , Horick Nora , Rosado Nikki , Chinta Sachin , Koh Daniel J. , Sobti Nikhil , Specht Michelle C. , Liao Eric C. 
Published: July 2022

Background/Objective:
Implant-based breast reconstruction is a common plastic surgery procedure with well-documented clinical outcomes. Despite this, the natural history and timing of key complication endpoints are not well described. The goal of this study is to determine when patients are most likely to experience specific adverse events after implant-based reconstruction.

Methods:
Retrospective consecutive series of patients who received mastectomy and implant-based reconstruction over a 6-year period were included. Complications and unfavorable outcomes including hematoma, seroma, wound infection, skin flap necrosis, capsular contracture, implant rippling, and implant loss were identified. A time-to-event analysis was performed and Cox regression models identified patient and treatment characteristics associated with each outcome.

Results:
Of 1473 patients and 2434 total reconstructed breasts, 785 complications/unfavorable outcomes were identified. The 12-month cumulative incidence of hematoma was 1.4%, seroma: 4.3%, infection: 3.2%, skin flap necrosis: 3.9%, capsular contracture: 5.7%, implant rippling: 7.1%, and implant loss: 3.9%. In the analysis, 332/785 (42.3%) complications occurred within 60 days of surgery; 94% of hematomas, 85% of skin necrosis events, and 75% of seromas occurred during this period. Half of all infections and implant losses also occurred within 60 days. Of the remaining complications, 94% of capsular contractures and 93% of implant rippling occurred >60 days from surgery.

Conclusions:
Complications following mastectomy and implant-based reconstruction exhibit a discrete temporal distribution. These data represent the first comprehensive study of the timing of adverse events following implant-based reconstruction. These findings are immediately useful to guide postoperative care, follow-up, and clinical trial design.
Implementation of a Hepatocellular Carcinoma Screening Program for At-risk Patients Safety-Net Hospital: A Model for National Dissemination
Authors: Lee Rachel M. , Darby Rapheisha , Medin Caroline R. , Haser Grace C. , Mason Meredith C. , Miller Lesley S. , Staley Charles A. , Maithel Shishir K. , Russell Maria C. 
Published: July 2022

Objective:
This study aimed to enhance hepatocellular carcinoma (HCC) screening to achieve earlier diagnosis of patients with hepatitis C (HCV) cirrhosis in our Safety-Net population.

Background:
Adherence to HCC screening guidelines at Safety-Net hospitals is poor. Only 23% of patients with HCC at our health system had a screening exam within 1-year of diagnosis and 46% presented with stage IV disease. HCV-induced cirrhosis remains the most common etiology of HCC (75%) in our patients.

Methods:
In the setting of an established HCV treatment clinic, an HCC screening quality improvement initiative was initiated for patients with stage 3 fibrosis or cirrhosis by transient elastography. The program consisted of semiannual imaging. Navigators scheduled imaging appointments and tracked compliance.

Results:
From April 2018 to April 2021, 318 patients were enrolled (mean age 61 years, 81% Black race, 38% uninsured). Adherence to screening was higher than previously reported: 94%, 75%, and 74% of patients completed their first, second, and third imaging tests. Twenty-two patients (7%) were diagnosed with HCC; 55% stage I and 14% stage IV. All patients were referred and 13 (59%) received treatment. Median time to receipt of treatment was 77 days (range, 32–282). Median overall survival for treated patients was 32 months.

Conclusions:
Implementation of an HCC screening program at a safety-net hospital is feasible and facilitated earlier diagnosis in this study. Patient navigation and tracking completion of imaging tests were key components of the program’s success. Next steps include expanding the program to additional at-risk populations.
Perpetuating Disparity
Authors: Cannon Robert M. , Anderson Douglas J. , MacLennan Paul , Orandi Babak J. , Sheikh Saulat , Kumar Vineeta , Hanaway Michael J. , Locke Jayme E. 
Published: July 2022

Background:
The burden of end-stage kidney disease (ESKD) and kidney transplant rates vary significantly across the United States. This study aims to examine the mismatch between ESKD burden and kidney transplant rates from a perspective of spatial epidemiology.

Methods:
US Renal Data System data from 2015 to 2017 on incident ESKD and kidney transplants per 1000 incident ESKD cases was analyzed. Clustering of ESKD burden and kidney transplant rates at the county level was determined using local Moran’s I and correlated to county health scores. Higher percentile county health scores indicated worse overall community health.

Results:
Significant clusters of high-ESKD burden tended to coincide with clusters of low kidney transplant rates, and vice versa. The most common cluster type had high incident ESKD with low transplant rates (377 counties). Counties in these clusters had the lowest overall mean transplant rate (61.1), highest overall mean ESKD incidence (61.3), and highest mean county health scores percentile (80.9%, P<0.001 vs all other cluster types). By comparison, counties in clusters with low ESKD incidence and high transplant rates (n=359) had the highest mean transplant rate (110.6), the lowest mean ESKD incidence (28.9), and the lowest county health scores (20.2%). All comparisons to high-ESKD/low-transplant clusters were significant at P value <0.001.

Conclusion:
There was a significant mismatch between kidney transplant rates and ESKD burden, where areas with the greatest need had the lowest transplant rates. This pattern exacerbates pre-existing disparities, as disadvantaged high-ESKD regions already suffer from worse access to care and overall community health, as evidenced by the highest county health scores in the study.
Effect of Intraoperative Neuromonitoring on the Risks of Recurrent Laryngeal Nerve Injury During Thyroidectomy
Authors: Memeh Kelvin , Vaghaiwalla Tanaz , Keutgen Xavier , Angelos Peter 
Published: July 2022

Objective:
To evaluate the relationship between the use intraoperative neuromonitoring (IONM) during thyroidectomy and the risk of recurrent laryngeal nerve (RLN) injury.

Background:
The role of IONM in reducing RLN injury during thyroidectomy remains controversial. Several studies on this topic apply conventional multivariable regression to adjust for confounding. However, estimates from this method may be biased due to model misspecification, especially with a rare outcome such as RLN injury.

Methods:
We used a pooled dataset created by linking the 2016–2019 National Surgical Quality Improvement Project General Participant User File with the corresponding Targeted-Thyroidectomy file. The primary outcome was RLN injury rates, and the secondary outcomes were operating time and postoperative length of stay. A doubly robust (DR) estimator, in the form of an inverse-probability-weighted regression adjustment model, was used to estimate the effect of the use of IONM on the risk of RLN injury. Sensitivity analyses was performed.

Results:
Twenty-four thousand three hundred seventy patients were evaluated, out of which 15,836 (70%) patients had IONM during thyroidectomy, and RLN injury occurred in 1498 (6.2%) cases. Rates of RLN injury increase with increasing age and BMI and are higher in patients with a cancer diagnosis, previous neck operation, total thyroidectomy, and node dissection. Doubly robust model suggests that the use of IONM was associated with a significant reduction in overall rate of RLN injury [risk ratio 0.77, confidence interval (CI), 0.68-0.87, P<0.001], and postoperative length of stay [−2.5 hours (CI, −4.18 to −0.81 h), P=0.004]. However, IONM use was associated with an increase in operating time [15.41 minutes (CI, 13.29-17.54 minutes), P<0.0001]. Sensitivity analyses revealed that our estimates are largely robust to confounding.

Conclusion:
In a balanced cohort of patients undergoing thyroidectomy from multiple sites and surgeons participating in National Surgical Quality Improvement Project, the use of IONM during thyroidectomy was associated with reduction in RLN injury.
A Statewide Approach to Reducing Re-excision Rates for Women With Breast-conserving Surgery
Authors: Schumacher Jessica R. , Lawson Elise H. , Kong Amanda L. , Weber Joseph J. , May Jeanette , Landercasper Jeffrey , Hanlon Bret , Marka Nicholas , Venkatesh Manasa , Cartmill Randi S. , Pavuluri Quamme Sudha , Nikolay Connor , Greenberg Caprice C. 
Published: July 2022

Objective:
Test the effectiveness of benchmarked performance reports based on existing discharge data paired with a statewide intervention to implement evidence-based strategies on breast re-excision rates.

Background:
Breast-conserving surgery (BCS) is a common breast cancer surgery performed in a range of hospital settings. Studies have demonstrated variations in post-BCS re-excision rates, identifying it as a high-value improvement target.

Methods:
Wisconsin Hospital Association discharge data (2017–2019) were used to compare 60-day re-excision rates following BCS for breast cancer. The analysis estimated the difference in the average change preintervention to postintervention between Surgical Collaborative of Wisconsin (SCW) and nonparticipating hospitals using a logistic mixed-effects model with repeated measures, adjusting for age, payer, and hospital volume, including hospitals as random effects. The intervention included 5 collaborative meetings in 2018 to 2019 where surgeon champions shared guideline updates, best practices/challenges, and facilitated action planning. Confidential benchmarked performance reports were provided.

Results:
In 2017, there were 3692 breast procedures in SCW and 1279 in nonparticipating hospitals; hospital-level re-excision rates ranged from 5% to >50%. There was no statistically significant baseline difference in re-excision rates between SCW and nonparticipating hospitals (16.1% vs. 17.1%, P=0.47). Re-excision significantly decreased for SCW but not for nonparticipating hospitals (odds ratio=0.69, 95% confidence interval=0.52–0.91).

Conclusions:
Benchmarked performance reports and collaborative quality improvement can decrease post-BCS re-excisions, increase quality, and decrease costs. Our study demonstrates the effective use of administrative data as a platform for statewide quality collaboratives. Using existing data requires fewer resources and offers a new paradigm that promotes participation across practice settings.
Emotional Distress and Financial Toxicity in Younger Adult Patients Undergoing Oncologic Surgery
Authors: Tran Thuy B. , Malhotra Gautam , Razavi Marianne , Clark Karen , Loscalzo Matthew , Kruper Laura , Raoof Mustafa , Woo Yanghee , Trisal Vijay , Fong Yuman , Melstrom Laleh 
Published: July 2022

Background:
There has been an alarming increase in the number of young adults (YA) diagnosed with cancer. The emotional, psychosocial, and financial distress experienced by newly diagnosed YA undergoing cancer surgery remains largely unknown.

Methods:
A validated biopsychosocial distress screening tool (SupportScreen) was administered to patients diagnosed with cancer before surgery between 2009 and 2017 in a National Cancer Institute Comprehensive Cancer Center. Patients were stratified into YA less than or equal to 45 years and older adults (OA) above 45 years. Descriptive statistics and logistic regression were used to analyze distress outcomes.

Results:
In total, 4297 patients were identified, with YA comprising 13.3% (n=573) of the cohort. YA reported higher emotional distress, including increased anxiety (33.8% vs 27.4%, P=0.002), greater fear of procedures (26.7% vs 22%, P=0.018), and difficulty managing emotions (26% vs 20.7%, P=0.006). YA struggled more frequently to manage work/school (29.5% vs 19.3%, P<0.001), finding resources (17.8% vs 11.8%, P<0.001), changes in physical appearance (22.2% vs 13.4%, P<0.001), fatigue (36% vs 27.3%, P<0.001), and ability to have children (18.4% vs 3%, P<0.001). Financial toxicity was significantly higher in the YA group (40.5% vs 28%, P<0.001). While income level was strongly protective against emotional distress and financial toxicity in OAs, it was less protective against the risk of financial toxicity in YA. Younger age was an independent predictor of financial toxicity in a model adjusted to income (odds ratio=1.52, P=0.020).

Conclusions:
YA in the prime of their personal and professional years of productivity require special attention when undergoing surgical evaluation for cancer. Resource allocation and counseling interventions should be integrated as part of their routine care to expedite their return to optimal physical and holistic health and mitigate psychosocial distress and financial toxicity.
COVID-19 Vaccination and the Timing of Surgery Following COVID-19 Infection
Authors: Le Sidney T. , Kipnis Patricia , Cohn Bradley , Liu Vincent X. 
Published: July 2022

Objective:
To evaluate whether COVID-19 vaccination status or mode of anesthesia modified the temporal harms associated with surgery following coronavirus disease-2019 (COVID-19) infection.

Background:
Surgery shortly after COVID-19 infection is associated with higher rates of complications, leading to recommendations to delay surgery following COVID-19 infection when possible. However, prior studies were based on populations with low or no prevalence of vaccination.

Methods:
A retrospective cohort study of patients who underwent scheduled surgery in a health system from January 1, 2020 to February 28, 2022 (N=228,913) was performed. Patients were grouped by time of surgery relative to COVID-19 test positivity: 0 to 4 weeks after COVID-19 (“early post-COVID-19”), 4 to 8 weeks after COVID-19 (“mid post-COVID-19”), >8 weeks after COVID-19 (“late post-COVID-19”), surgery at least 30 days before subsequent COVID-19 (“pre-COVID-19”), and surgery with no prior or subsequent test positivity for COVID-19.

Results:
Among patients who were not fully vaccinated at the time of COVID-19 infection, the adjusted rate of perioperative complications for the early post-COVID-19 group was significantly higher than for the pre-COVID-19 group (relative risk: 1.55; P=0.05). No significantly higher risk was identified between these groups for patients who were fully vaccinated (0.66; P=1.00), or for patients who were not fully vaccinated and underwent surgery without general anesthesia (0.52; P=0.83).

Conclusions:
Surgery shortly following COVID-19 infection was not associated with higher risks among fully vaccinated patients or among patients who underwent surgery without general anesthesia. Further research will be valuable to understand additional factors that modify perioperative risks associated with prior COVID-19 infection.
Association Between Size of Dominant Candidate Lesion on Four-Dimensional CT and Four-Gland Hyperplasia among Patients with Primary Hyperparathyroidism
Authors: Broekhuis Jordan M , Chaves Natalia , Chen Hao Wei , Cloonan Daniel J , Sacks Barry A , James Benjamin C 
Published: July 2022

BACKGROUND:
Four-dimensional (4D) CT localization allows minimally invasive parathyroidectomy as treatment for primary hyperparathyroidism (PHPT), but false positive localization is frequent. We sought to characterize the ability of 4D CT to predict four-gland hyperplasia (HP) based on the size of candidate lesions.

STUDY DESIGN:
We retrospectively analyzed patients with PHPT who underwent 4D CT imaging and parathyroidectomy between 2014 and 2020 from a prospectively collected institutional database. The cohort was stratified into two groups, HP vs single adenoma (SA) and double adenoma (DA), based on operative findings and pathology. Logistic regression models assessed the association between the greatest diameter of the dominant candidate lesion on 4D CT and the outcomes of four-gland hyperplasia vs SA and DA.

RESULTS:
Among a cohort of 240 patients, 41 were found to have HP, and 199 had adenomas (SA = 155, DA = 44). Patients with HP were less likely to have a preoperative calcium level greater than 1 mg/dL above the upper limit of normal compared with patients with adenomas (63% vs 81%, p = 0.02) and more likely to report symptoms (61% vs 43%, p = 0.04). After adjusting for BMI, we found an estimated 13% reduction in odds of HP for every 1-mm increase in the greatest diameter of dominant candidate lesions identified on 4D CT scan (odds ratio 0.87, 95% CI 0.78 to 0.96, p = 0.009).

CONCLUSIONS:
A smaller size of the dominant lesion on 4D CT scan is associated with an increased risk of HP in PHPT. Use of 4D CT imaging localization may provide evidence for differentiating HP from adenomas.
Artificial Intelligence and Surgery: Ethical Dilemmas and Open Issues
Authors: Cobianchi Lorenzo , Verde Juan Manuel , Loftus Tyler J , Piccolo Daniele , Dal Mas Francesca , Mascagni Pietro , Garcia Vazquez Alain , Ansaloni Luca , Marseglia Giuseppe Roberto , Massaro Maurizio , Gallix Benoit , Padoy Nicolas , Peter Angelos , Kaafarani Haytham M 
Published: July 2022

BACKGROUND:
Artificial intelligence (AI) applications aiming to support surgical decision-making processes are generating novel threats to ethical surgical care. To understand and address these threats, we summarize the main ethical issues that may arise from applying AI to surgery, starting from the Ethics Guidelines for Trustworthy Artificial Intelligence framework recently promoted by the European Commission.

STUDY DESIGN:
A modified Delphi process has been employed to achieve expert consensus.

RESULTS:
The main ethical issues that arise from applying AI to surgery, described in detail here, relate to human agency, accountability for errors, technical robustness, privacy and data governance, transparency, diversity, non-discrimination, and fairness. It may be possible to address many of these ethical issues by expanding the breadth of surgical AI research to focus on implementation science. The potential for AI to disrupt surgical practice suggests that formal digital health education is becoming increasingly important for surgeons and surgical trainees.

CONCLUSIONS:
A multidisciplinary focus on implementation science and digital health education is desirable to balance opportunities offered by emerging AI technologies and respect for the ethical principles of a patient-centric philosophy.