Unexpected perioperative death is one of the most distressing events in surgical practice and may lead to burnout or post-traumatic stress symptoms, with potential implications for surgeon well-being and patient safety. However, its psychological impact remains insufficiently quantified. The STRESSURG study assessed the prevalence and severity of post-traumatic stress symptoms among surgeons after unexpected surgical deaths and explored associated professional, demographic, and institutional factors. An international, cross-sectional online survey endorsed by the IHPBA and ESCP was distributed to surgeons who experienced intraoperative or early postoperative (< = 48 h) patient death. The 42 – item questionnaire included demographics, professional data, and the validated Impact of Event Scale-Revised (IES-R). A total of 354 surgeons participated. Median IES-R score was 22.5 (IQR, 14–35). Clinically relevant distress (≥ 24) was observed in 48.6

Postoperative complications (POC) following hepatic cystic echinococcosis (HCE) surgery remains a challenge. Frailty indices (FIs) as predictors of POC in this context has not been investigated. We aimed to evaluate the predictive value of three frailty assessment tools (mFI-11, FRAIL scale, and PRISMA-7 questionnaire), for POC in patients with HCE undergoing elective surgical treatment. Nested case-control study in a concurrent cohort. Consecutive patients who underwent elective open surgery for HCE between 2012 and 2020 with a minimum follow-up of 4 years were included. Cases were frail patients with mFI-11 ≥ 0.27, PRISMA-7 ≥ 3, or FRAIL ≥ 3. Cases and controls were matched in a 1:1 based on age, sex, cyst diameter, history of HCE surgery, ultrasonographic characteristics, and cyst location. Primary outcome was overall and severe POC. Sample size was based on overall POC of 28

Acute gastric volvulus (AGV), is an uncommon complication of large paraesophageal hernias (PEH), resulting in closed-loop obstruction that may lead to incarceration and strangulation. The aim of this study was to summarize the evidence on clinical characteristics, surgical treatment, postoperative complications (POC), recurrence, and 30-day mortality (30DM), in patients undergoing surgery for AGV secondary to PEH. A systematic review including studies on AGV secondary to PEH was conducted. Searches were performed in WoS, Embase, Medline, Scopus, BIREME-BV and SciELO. Primary outcomes included POC, 30DM and recurrence. Secondary outcomes comprised publication date, study origin and design, number of patients, volvulus type, hospital stay length, treatments; and methodological quality (MQ) of studies assessed using MInCir-T and MInCir-Pr2 scales. Descriptive statistics, weighted averages (WA), least squares logistic regression for comparisons, and meta-analysis of POC prevalence and HM were applied. Of 1049 studies 171 met selection criteria, encompassing 15,178 patients. The WA age of patients was 75.3 ± 13.9 years, with 51.3

To compare postoperative events and oncologic results between minimally invasive gastrectomy (MIG) and open gastrectomy (OG) in gastric cancer surgery. Evidence of the short-term and long-term results of MIG is still limited. A population-based cohort study included all patients undergoing elective gastric cancer resection with curative intent between 2014 and 2021 across 39 centers belonging to the EURECCA Spanish Registry. Postoperative complications, 90-day mortality, and 5-year overall survival (OS) and disease-free survival (DFS) were analyzed in the groups of MIG and OG using propensity score matching (1:1). Subtotal gastrectomy (SG) versus total gastrectomy (TG) was also assessed. A total of 1333 matched-pair patients were included. The use of MIG increased significantly from 2017. The comparison of OG and MIG showed similar results for overall complications (47.4% vs 44.7%), major complications (19.1 vs 18.2%), 90-day mortality (4.4% vs 3.2%), and failure to rescue (23.1% vs 17.3%), but the MIG group showed significantly shorter median length of hospitalization (P < 0.001) in the overall study population (8 vs 10 days) as well as in the subgroups of SG (7 vs 8 days) and TG (10 vs 11 days), and higher ≥ 15 nodes retrieval (84.2% vs 78.8%, P < 0.001). Anastomotic leakage after TG was high (about 17%) and did not differ between surgical approaches. Also, MIG and OG showed similar 5-year OS (62% vs 64.6%) and DFS (58.5% vs 56.5%). The implementation of MIG did not increase complications and showed similar oncologic outcomes as compared with OG.

BACKGROUND:Main treatment options for pharyngoesophageal diverticulum are the surgical excision or diverticulopexy, always associated with a myotomy, and the endoscopic peroral myotomy. The aim of this study was to describe the outcomes of a consecutive surgical series. METHODS:Observational study of patients who underwent open surgery (2004-2024) and who had a 2-years structured follow-up. Main outcome were symptom resolution and postoperative complications. Baseline characteristics, surgical technique, reinterventions, readmission and recurrence were also analyzed. Descriptive statistics was used, including percentages, mean and standard deviations, and medians with complete ranges. RESULTS:During the study period, 40 patients (73% male) were operated on, with a mean age of 72 ± 11 years. Ninety-five percent presented dysphagia and/or regurgitation, while 2 patients were referred due to a history of pneumonia to bronchoaspiration. The most frequent surgical technique was cricopharyngeal myotomy combined with diverticulectomy. Postoperative morbidity was 15%, with no cases of esophageal fistula. There was no mortality, and the median hospital stay was 3 days. Initial symptom resolution was achieved in 95% of patients. During follow-up (median 7 years [1-20]), 2 recurrences were observed at 18 and 24 months, respectively, both successfully managed endoscopically. CONCLUSIONS:Surgical treatment achieves symptoms resolution in the vast majority of cases, with limited morbidity and recurrence.

The management of patients with acute paraesophageal hernia (APEH) remains to be standardized. This study evaluates the safety and outcomes of a novel staged approach for patients with APEH, which is based on gastric decompression followed by non-operative management and either emergency or semi-elective surgical treatment when deemed necessary. Observational study of a consecutive case series of APEH patients admitted to the hospital between 2007 and 2024, with a minimum follow-up of 3 months. All patients were managed according to the staged approach. Clinical outcomes including postoperative complications, recurrence, and readmission rates were assessed. Fifty-eight patients (70.7

Introducción Las principales alternativas terapéuticas del divertículo faringoesofágico son la cirugía (miotomía con resección o pexia) y el tratamiento endoscópico (septotomía transoral). El objetivo de este estudio es describir los resultados de una serie consecutiva de pacientes tratados quirúrgicamente. Métodos Estudio observacional descriptivo de pacientes intervenidos quirúrgicamente (2004-2024), con un seguimiento protocolizado hasta los 24 meses. Las variables principales fueron la resolución de los síntomas y las complicaciones postoperatorias. Se analizaron además las características clínicas basales, la técnica quirúrgica, las readmisiones, las reintervenciones y las recidivas. Se utilizó estadística descriptiva con cálculo de porcentaje, medias y desviaciones estándar y medianas y rangos completos. Resultados Durante el período del estudio se intervinieron 40 pacientes (73% hombres), con una media de edad de 72±11 años. El 95% consultó por disfagia y/o regurgitación y 2 pacientes fueron referidos por historia de neumonías secundarias a broncoaspiración. La técnica quirúrgica más frecuente fue la miotomía del cricofaríngeo asociada a una diverticulectomía. La morbilidad postoperatoria fue del 15%, sin demostrarse fístula esofágica en ningún caso. No hubo mortalidad postoperatoria y la estancia mediana fue de 3 días. La resolución inicial de los síntomas fue del 95%. Durante el seguimiento (mediana de 7 años [1-20]), se constataron 2 recidivas (a los 18 y 24 meses, respectivamente), ambas tratadas con éxito por vía endoscópica. Conclusiones El tratamiento quirúrgico permite la resolución de los síntomas en la práctica mayoría de casos, con una morbilidad y una recidiva limitadas.

Purpose A doctorate degree in surgery is awarded by universities in recognition of high-standard academic research. This study explores the global heterogeneity of PhD programs in surgery and evaluates them using a standardized rating scale. Method A cross-sectional survey was distributed electronically to surgical doctoral programs worldwide. A 25-point rating scale was developed to assess program quality across domains such as dissertation requirements, number and type of publications, journal quartiles, and authorship position. Programs achieving ≥15 points were classified as “excellence-PhD” (e-PhD). Scores were compared across world regions and by university ranking (Shanghai Ranking). Results A total of 949 PhD programs from the 193 United Nations member countries were contacted. Completed questionnaires were returned by 187 departments (response rate 19.7%) from 52 countries. Most departments, 138 out of 187 (73.9%) lacked clear requirements for dissertations based on a single research project, while more explicit criteria existed for thesis by publications: originality 77 out of 187 (41.2%), journal metrics 126 out of 187 (67.9%), and candidate authorship. Program scores showed wide heterogeneity, with higher scores more frequently associated with universities ranked higher in the Shanghai classification. Regional differences were also noted in funding opportunities and evaluation processes. Conclusions Global PhD programs in surgery demonstrate substantial variability in structure and quality, as measured by a newly developed rating scale. While the scale shows promise in identifying high-quality (e-PhD) programs, its practical application may be limited by response bias and differing academic norms. Nonetheless, these findings offer a framework for benchmarking and improving doctoral training in surgical research globally.

OBJECTIVE:To compare postoperative events and oncologic results between minimally invasive gastrectomy (MIG) and open gastrectomy (OG) in gastric cancer surgery. BACKGROUND:Evidence of the short-term and long-term results of MIG is still limited. METHODS:A population-based cohort study included all patients undergoing elective gastric cancer resection with curative intent between 2014 and 2021 across 39 centers belonging to the EURECCA Spanish Registry. Postoperative complications, 90-day mortality, and 5-year overall survival (OS) and disease-free survival (DFS) were analyzed in the groups of MIG and OG using propensity score matching (1:1). Subtotal gastrectomy (SG) versus total gastrectomy (TG) was also assessed. RESULTS:A total of 1333 matched-pair patients were included. The use of MIG increased significantly from 2017. The comparison of OG and MIG showed similar results for overall complications (47.4% vs 44.7%), major complications (19.1 vs 18.2%), 90-day mortality (4.4% vs 3.2%), and failure to rescue (23.1% vs 17.3%), but the MIG group showed significantly shorter median length of hospitalization ( P < 0.001) in the overall study population (8 vs 10 days) as well as in the subgroups of SG (7 vs 8 days) and TG (10 vs 11 days), and higher ≥ 15 nodes retrieval (84.2% vs 78.8%, P < 0.001). Anastomotic leakage after TG was high (about 17%) and did not differ between surgical approaches. Also, MIG and OG showed similar 5-year OS (62% vs 64.6%) and DFS (58.5% vs 56.5%). CONCLUSIONS:The implementation of MIG did not increase complications and showed similar oncologic outcomes as compared with OG.

BACKGROUND:Surgical repair of large type III/IV paraesophageal hernia (PEH) is challenging especially in the presence of acute gastric volvulus (AGV). This study compared postoperative complications (POCs) and 30-day mortality between urgent and elective PEH repair. METHODS:Between 2007 and 2024, a matched case-control study was conducted in a tertiary care hospital in Barcelona, Spain. Patients undergoing PEH repair on an emergency basis or electively were matched (1:1) by age and sex (male/female). Cases were patients with AGV requiring urgent or semielective repair, whereas controls were patients with type III/IV scheduled for elective surgery. POC was the primary outcome variable. RESULTS:A total of 74 patients (37 cases and 37 controls) were analyzed. The mean age was 78.0 years (SD, 8.9). Cases and controls showed similar American Society of Anesthesiologists and modified frailty index scores, but the Charlson comorbidity index score was higher in the urgent group. Cases showed longer duration of surgery than controls (223 [68.4] vs 194 [45.9] minutes; P =.03), postoperative length of hospital stay (13.2 [13.8] vs 4.9 [4.1] days; P =.0008), and need of open or converted procedures (odds ratio [OR], 8.4; P =.008). Urgent surgery was an independent factor for POCs (OR, 7.4; P =.0001). Reoperation rates were unrelated to the type of surgery. Mortality was low (only elective cases), with comparable 90-day readmissions and recurrences between cases and controls. CONCLUSION:In this case-control study, urgent repair of complex PEH showed higher POC than elective surgery but 30-day mortality and readmission rates were similar.

BACKGROUND:Postoperative complications (POC) in surgery for hepatic cystic echinococcosis (HCE) still being frequent. Comorbidities as a risk factor has not yet been studied. The aim of this study was to evaluate the predictive value of CCI for POC in surgically treated HCE patients. METHODS:Nested case-control study. Patients undergoing elective surgery for HCE between 2011 and 2019; matched (1:1) by sex, cyst diameter and time follow-up were included. Cases were patients with CCI≥3; and controls, patients with CCI≤2. Primary outcome was POC. Descriptive statistics and bivariate analyses were applied. Logistic regression was used, odds ratios (OR) and their respective 95 % confidence intervals (CI95 %), were calculated. RESULTS:226 patients (113 cases and 113 controls) were analyzed. Significant differences were verified between cases and controls in frequency of evolutionary complications of HCE (OR: 5.5; p = 0.0003); and major rate of ASA I-II in controls (OR: 0.07; p < 0.0001). A great rate of POC (OR: 3.58; p = 0.0002); and Clavien ≥ IIIb POC more frequent in cases were found (OR: 7.00; p = 0.031). Applying logistic regression model, CCI score≥3 was identified as an independent prognostic factor for POC (OR: 6.29 [CI95 %: 2.1-18.8; p < 0.01]). CONCLUSION:In this study, cases showed higher frequency and severity of POC than controls.

Efficacy and effectivity of new interventions are generally established through randomized clinical trials (RCTs). However, among many other methodological challenges, specifying the hypothesis of a RCT remains complex problem for clinical researchers. In this manuscript we discuss the characteristics of three variants of RCTs: superiority RCT (SRCT), non -inferiority RCT (NIRCT), and equivalence RCT (ERCT). These three types of RCT have different assumptions about the effects of an intervention, so setting hypotheses and defining objectives requires knowing some assumptions underlying these RCTs, including elements related to the estimation of the sample size for each one. The aim of this manuscript was to describe methodological differences between SRCT, NIRCT and ERCT.

Background: Radical gastrectomy remains the main treatment for gastric cancer, despite its high mortality. A clinical predictive model of 90-day mortality (90DM) risk after gastric cancer surgery based on the Spanish EURECCA registry database was developed using a matching learning algorithm. We performed an external validation of this model based on data from an international multicenter cohort of patients. Methods: A cohort of patients from the European GASTRODATA database was selected. Demographic, clinical, and treatment variables in the original and validation cohorts were compared. The performance of the model was evaluated using the area under the curve (AUC) for a random forest model. Results: The validation cohort included 2546 patients from 24 European hospitals. The advanced clinical T- and N-category, neoadjuvant therapy, open procedures, total gastrectomy rates, and mean volume of the centers were significantly higher in the validation cohort. The 90DM rate was also higher in the validation cohort (5.6%) vs. the original cohort (3.7%). The AUC in the validation model was 0.716. Conclusion: The externally validated model for predicting the 90DM risk in gastric cancer patients undergoing gastrectomy with curative intent continues to be as useful as the original model in clinical practice.

La eficacia de una nueva intervención se establece generalmente a través de ensayos clínicos (EC) con asignación aleatoria (AA). Sin embargo, entre otros tantos desafíos metodológicos, el especificar la hipótesis de un EC con AA, sigue siendo un problema complejo de resolver para los investigadores clínicos. En este manuscrito discutimos las características de tres variantes de los EC con AA: EC de superioridad (ECS), EC de no-inferioridad (ECNI), y EC de equivalencia (ECE). Estos tres tipos de EC tienen supuestos diferentes sobre los efectos de una intervención, por lo que plantear hipótesis y definir objetivos requiere conocer algunos supuestos subyacentes a estos EC, incluso hasta elementos relacionados con la estimación del tamaño de muestra para cada cual. El objetivo de este manuscrito fue describir las diferencias metodológicas entre ECS, ECNI y ECE.

BACKGROUND:There has been significant debate about the advantages and disadvantages of using administrative databases or clinical registry in healthcare improvement programs. The aim of this study was to review the implementation and outcomes of an accountability policy through a registry maintained by professionals of the surgical department.MATERIALS AND METHODS:All patients admitted to the department between 2003 and 2022 were prospectively included. All adverse events (AEs) occurring during the admission, convalescent care in facilities, or at home for a minimum period of 30 days after discharge were recorded.RESULTS:Out of 60,125 records, 24,846 AEs were documented in 16,802 cases (27.9%). There was a progressive increase in the number of AEs recorded per admission (1.17 in 2003 vs. 1.93 in 2022) with a 26% decrease in entries with AEs (from 35.0% in 2003 to 25.8% in 2022), a 57.5% decrease in reoperations (from 8.0% to 3.4%, respectively), and an 80% decrease in mortality (from 1.8% to 1.0%, respectively). It is noteworthy that a significant reduction in severe AEs was observed between 2011 and 2022 (56% vs. 15.6%).CONCLUSION:A prospective registry of AEs created and maintained by health professionals, along with transparent presentation and discussion of the results, leads to sustained improvement in outcomes in a surgical department of a university hospital.

AntecedentesSe ha debatido mucho sobre las ventajas e inconvenientes del uso de bases administrativas o de registros clínicos en los programas de mejora de la atención médica. El objetivo de este estudio ha sido revisar la implementación y los resultados de una política de evaluación continua, mediante un registro mantenido por profesionales de un Servicio de Cirugía.Material y métodosSe incluyeron, de forma prospectiva, todos los pacientes ingresados en el servicio entre los años 2003 y 2022. Se anotaron todos los efectos adversos (EA) acaecidos durante el ingreso, la estancia en centros de convalecencia o en su domicilio durante un periodo mínimo de 30 días tras el alta.ResultadosDe 60.125 registros, en 16.802 (27,9%) se registraron 24.846 EA. Hubo un aumento progresivo del número de EA registrados por ingreso (1,17 en 2003 vs. 1,93 en 2022) con una disminución de 26% de los registros con EA (35% en 2003 hasta 25,8% en 2022), de 57,5% en las reoperaciones (de 8 a 3,4%, respectivamente), y de 80% en la mortalidad (de 1,8 a 1%, respectivamente). Es de remarcar la reducción significativa de los EA graves, observada entre los años 2011 y el 2022 (56 vs. 15,6%).ConclusiónUn registro prospectivo de EA creado y mantenido por profesionales del servicio, junto con la presentación y discusión abierta y trasparente de los resultados, produce una mejora sostenida de los resultados en un servicio quirúrgico de un hospital universitario.

Cross-sectional studies (CSS) began European countries in the 1940s in. The CSSs correspond to observational-type investigations that allow studying the prevalence of disease, determining the association between variables and the development of an effect of interest, discovering the properties of a diagnostic test, and censusing populations, describing the characteristics of a population at a given time and place. This implies that follow-up periods are not required, and that they are neither prospective nor retrospective. These characteristics allow them to be cheaper and easier to perform in relation to longitudinal studies. On the other hand, being descriptive in nature, they serve as input and preliminary evidence for studies of greater methodological complexity, such as cohort studies. However, they have limitations and biases that must be considered by researchers. The aim of this manuscript was to generate a study document to review essential characteristics, strengths and weaknesses; discuss methodological issues of ECT in health sciences; and provide some examples obtained from the literature, for a better understanding of the design.