General Surgery

Delayed anastomotic leak diagnosis after colon resection drives complications and failure-to-rescue

Among 39,175 VA patients undergoing colon resection, 3.1% developed postoperative organ-space SSI, used as a surrogate for anastomotic leak. Of these, 31.1% had delayed organ-space infection, occurring after sepsis rather than before or without prior sepsis. Delayed diagnosis was associated with more discrete complications, higher reoperation probability, and longer hospital stay than early diagnosis. Failure-to-rescue after organ-space infection was markedly higher with delayed versus early diagnosis (7.8% vs 2.2%). These data support structured early leak surveillance and prompt evaluation of new sepsis after colon resection to reduce mortality. 1

Staging laparoscopy reduces futile laparotomy after neoadjuvant therapy for resectable/borderline PDAC

In PREOPANC-2, 322 patients with resectable or borderline pancreatic ductal adenocarcinoma underwent surgery after neoadjuvant treatment. Staging laparoscopy in 240 patients was compared with primary laparotomy without laparoscopy in 82 patients. Occult metastases were detected in 12.1% overall and were the main reason for aborting resection. Non-therapeutic laparotomy rates were substantially lower with staging laparoscopy than without (4.5% vs 17.1%, P=0.002; NNT 8). Tumor size ≥3 cm and baseline CA19-9 >500 U/ml independently predicted occult metastases, enabling more targeted laparoscopy use. Incorporating staging laparoscopy, especially for higher-risk patients, can spare many from unnecessary laparotomy. 2

Claims-based algorithms accurately capture long-term ventral hernia reinterventions and recurrences

This single-center cohort included 1,229 patients undergoing ventral hernia repair from 2011 to 2019 with 4.5-year median follow-up. Investigators compared claims-based algorithms for Non-Recurrence Procedural Intervention and Reoperation for Recurrence against detailed electronic health records. Cumulative incidence estimates for non-recurrence procedural interventions were similar between claims and EHR sources, with modest absolute differences. Reoperation for recurrence rates were nearly identical between claims and EHR data. These validated algorithms can be used to link registries with claims for long-term hernia outcomes, quality improvement, and device surveillance. 3

Liver Immune Frailty Index stratifies early mortality risk after liver transplantation

This prospective study measured pretransplant plasma immune biomarkers in 279 adult deceased-donor liver transplant recipients at two centers. Several cytokines and immune exhaustion markers, including IL-1β and MMPs, were associated with 1-year post-transplant mortality. Multivariable modeling identified fractalkine and MMP3 as independent predictors of early mortality. These two biomarkers formed the Liver Immune Frailty Index, categorizing patients into low, moderate, and high mortality risk groups. Marked differences in 1-year mortality across index strata suggest added prognostic value beyond conventional clinical scores. 4