Surgery

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ResearchSource: JAMAOct 14, 2026

Vasopressin Initiation Threshold Does Not Alter Septic Shock Mortality

The VASSPR cluster crossover trial compared hospital-level strategies initiating vasopressin at a lower vasopressor dose threshold (0.1 mcg/kg/min norepinephrine equivalent) versus a higher threshold (0.4 mcg/kg/min) in 3,959 patients with septic shock across 13 hospitals. The trial reported no significant difference in 28-day mortality between the lower-threshold (31.8%) and higher-threshold (33.0%) strategies, and no difference in kidney replacement therapy-free days through day 28.

Relevant to:SurgeryClinicians managing adult patients with septic shock requiring vasopressor support, including decisions about second-line vasopressor initiation.

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ResearchSource: JAMAOct 14, 2026

Dobutamine Plus Norepinephrine Reduced Postoperative AKI in Septic Shock Trial

A randomized, open-label trial across 39 Chinese tertiary hospitals compared intraoperative dobutamine plus norepinephrine to norepinephrine alone in 584 adults with septic shock undergoing surgical source control. The trial reported lower rates of new-onset or worsening acute kidney injury within 7 postoperative days in the dobutamine group (22.8% vs 34.7%, adjusted risk ratio 0.64), along with lower SOFA scores on postoperative day 1 and higher urine output, though tachycardia occurred more frequently with dobutamine.

Relevant to:SurgeryAdults with septic shock undergoing surgical source control who require intraoperative vasopressor and inotropic support.

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ResearchSource: JAMAOct 14, 2026

Isoflurane Sedation Did Not Reduce Mortality in Respiratory Failure Trial

The SAVE-ICU randomized trial compared an inhaled sedation strategy using isoflurane plus intravenous adjuncts against usual intravenous sedation in 780 mechanically ventilated adults with acute hypoxemic respiratory failure across 14 Canadian ICUs. The trial reported no difference in hospital mortality between groups (42.5% vs 43.8%), with similar ICU-, ventilator-, and hospital-free days, but found the inhaled sedation group received more adjunctive hypoxemia therapies and had fewer delirium- and coma-free days. The authors concluded that inhaled isoflurane sedation did not reduce hospital mortality compared with intravenous sedation.

Relevant to:SurgeryMechanically ventilated adults with acute hypoxemic respiratory failure, including non-COVID and COVID-19 related cases, managed in the intensive care unit.

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ResearchSource: Annals of SurgeryOct 9, 2026

POD2 CRP Below 100 mg/L May Rule Out Anastomotic Leak

A two-cohort multicenter diagnostic accuracy study evaluated whether postoperative day 2 (POD2) C-reactive protein (CRP) below 100 mg/L could exclude anastomotic leakage after elective colon cancer resection with primary anastomosis. The study reported negative predictive values of 98.8% and 99.0% in the test and validation cohorts respectively, and found that a POD3/POD2 CRP ratio below 1 further stratified risk in patients with higher POD2 CRP, allowing a two-step algorithm under which nearly 90% of patients could be discharged by POD2 or 3 with an anastomotic leak risk near 1%.

Relevant to:SurgeryPatients undergoing elective colon cancer resection with primary anastomosis managed within enhanced recovery after surgery (ERAS) pathways.

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ResearchSource: JAMA SurgerySep 30, 2026

Enucleation shows trade-offs versus Whipple for pancreatic head tumors

This multicenter retrospective cohort study with propensity matching compared enucleation to pancreatoduodenectomy in 434 patients with benign or low-grade pancreatic head or uncinate process tumors. The study reported higher clinically relevant postoperative pancreatic fistula rates after enucleation, but fewer major complications, less delayed gastric emptying, shorter hospital stay, higher global health status scores, lower new-onset diabetes, and higher return to work; the complication advantage was greatest for tumors 2.5 cm or smaller. The authors note residual tumor size imbalance after matching and call for prospective confirmation.

Relevant to:SurgeryPatients with benign or low-grade malignant tumors of the pancreatic head or uncinate process being considered for pancreatic resection.

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Surgery

Vasopressin Initiation Threshold Does Not Alter Septic Shock Mortality

Dobutamine Plus Norepinephrine Reduced Postoperative AKI in Septic Shock Trial

Isoflurane Sedation Did Not Reduce Mortality in Respiratory Failure Trial

POD2 CRP Below 100 mg/L May Rule Out Anastomotic Leak

Enucleation shows trade-offs versus Whipple for pancreatic head tumors

Earlier surgery updates

Surgery

Vasopressin Initiation Threshold Does Not Alter Septic Shock Mortality

Dobutamine Plus Norepinephrine Reduced Postoperative AKI in Septic Shock Trial

Isoflurane Sedation Did Not Reduce Mortality in Respiratory Failure Trial

POD2 CRP Below 100 mg/L May Rule Out Anastomotic Leak

Enucleation shows trade-offs versus Whipple for pancreatic head tumors

Earlier surgery updates

Surgery

Recent updates

Earlier surgery updates

Surgery

Recent updates

Earlier surgery updates