General Surgery

Surgeon robotic volume strongly linked to better elective outcomes

In 137,879 elective robotic general surgery cases, very high-volume surgeons (≥151 cases/year) had lower odds of conversion to open surgery (AOR 0.45) compared with low-volume surgeons. Very high volume was also associated with fewer complications (AOR 0.87), lower 30-day readmission (AOR 0.79), and less ICU admission (AOR 0.61). Operative time, length of stay, and hospital costs were reduced with increasing surgeon volume (mean ratios 0.77, 0.89, and 0.83, respectively). In 48,045 emergency robotic cases, volume-related benefits were smaller and no clear mortality benefit was observed. 1

Pediatric ERP trial: adherence, not rollout, predicted benefit

The ENRICH‑US stepped‑wedge trial enrolled 597 children (age 10–18) across 18 sites for elective GI surgery and found no LOS reduction by study phase. At the patient level, receiving ≥13 of 21 ERP elements shortened median LOS by 1.14 days and halved complications (AOR 0.48). Implementation fidelity improved over time and correlated with integration into order sets and site culture. This trial supports focusing on adherence to ERP elements rather than assuming system-level implementation guarantees benefit. 2

Documented actionable genomics associate with higher mortality in gallbladder cancer

In a real‑world, matched analysis, patients with documented actionable genomic alterations (AGA) had higher mortality versus undocumented/wild‑type patients (Model 2 mortality 56.2% vs 43.0%). Median overall survival was shorter in the AGA group (750 vs 784 days) though proportional hazards were violated, favoring absolute risk interpretation. KRAS alterations showed worse survival in exploratory analyses; TP53 subgroup was underpowered. Findings underline prognostic relevance of genomic documentation and inequities in testing access. 3