Journal of the American College of Surgeons最新文献

{"title":"The Innovation Value Model: Aligning Physician Innovation with Value-Based Care.","authors":"Grayson Mast, Matthew A Carnell, L D Britt, Alexa Shaw","doi":"10.1097/XCS.0000000000002036","DOIUrl":"10.1097/XCS.0000000000002036","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1240-1243"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited Commentary: Going the Extra Mile: Picking the Right Trauma Center Destination for Critically Injured Patients in a Mature StateWide Trauma System.","authors":"Joshua B Brown","doi":"10.1097/XCS.0000000000002080","DOIUrl":"10.1097/XCS.0000000000002080","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1083-1084"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited Commentary: What Does It Mean for Surgeons to Be Flourishing?","authors":"Peter Angelos","doi":"10.1097/XCS.0000000000002081","DOIUrl":"10.1097/XCS.0000000000002081","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1139-1140"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the Quebec Provincial Enhanced Recovery After Surgery Program on Postoperative Outcomes for Patients Undergoing Colorectal Operation.","authors":"Lily Puterman-Salzman, Eugenie Samson, Debbie Watson, Pepa Kaneva, Liza Abraham, Anna Wang, Liane S Feldman, Lawrence Lee","doi":"10.1097/XCS.0000000000002064","DOIUrl":"10.1097/XCS.0000000000002064","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery after surgery (ERAS) pathways improve perioperative outcomes, yet large-scale implementation remains inconsistent. In 2022, Quebec launched a province-wide ERAS implementation program across all hospitals performing colorectal surgery with coordinated implementation and centralized data collection.</p><p><strong>Study design: </strong>Patients undergoing elective colectomy were included from preimplementation (September to November 2022) and postimplementation (August 2024-January 2025) cohorts. Adherence to 18 ERAS process measures, hospital characteristics, and 30-day postoperative outcomes were collected. Primary outcomes were length of stay (LOS) and 30-day complications. Program effectiveness was evaluated using a continuous-treatment difference-in-differences analysis.</p><p><strong>Results: </strong>Among 3,292 patients (1,405 preimplementation; 1,887 postimplementation), adherence improved across all perioperative phases after implementation. Median LOS decreased from 4 to 3 days (p < 0.001), whereas overall complication rates remained stable. At the hospital level, adherence improved in 49.2% of hospitals, was unchanged in 45.0%, and decreased in 6.6%. In adjusted analyses, each 10% increase in adherence was independently associated with an additional 0.11-day reduction in LOS (95% CI, 0.07 to 0.15) and a 5.5% reduction in complications (95% CI, 0.5 to 10.6) after implementation.</p><p><strong>Conclusions: </strong>Province-wide ERAS implementation was associated with higher adherence and shorter postoperative LOS without increased complications. Variation in adherence improvement across hospitals was associated with differences in outcomes, underscoring the importance of sustained ERAS adherence to maximize the benefits of large-scale quality improvement initiatives.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1189-1199"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited Commentary: When a Hospital Closes, the Patients Do Not Disappear: When Healthcare Systems Shut Down, Resources Are Still Needed.","authors":"Anna Goldenberg-Sandau","doi":"10.1097/XCS.0000000000002085","DOIUrl":"10.1097/XCS.0000000000002085","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1059-1060"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited Commentary: Tailor-Made Solution to Trimming Venous Thromboembolism Risk.","authors":"Andea T Obi, Peter K Henke, Nicholas H Osborne","doi":"10.1097/XCS.0000000000002083","DOIUrl":"10.1097/XCS.0000000000002083","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1049-1050"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited Commentary: Interpreting Short-Term Safety in Robotic Bariatric Surgery: The Importance of What Drives the Outcome.","authors":"Vijay Subramanian","doi":"10.1097/XCS.0000000000002067","DOIUrl":"10.1097/XCS.0000000000002067","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1128-1129"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting Extended Thromboprophylaxis after Surgery Through Multidimensional Dynamic Pulmonary Embolism Risk Assessment: Development and Temporal Validation in 4.8 Million Operations.","authors":"Ramsey M Dallal, Jeffrey Riggio, Michael Li, Luis H Eraso, Benjamin Moran, Geno J Merli","doi":"10.1097/XCS.0000000000002074","DOIUrl":"10.1097/XCS.0000000000002074","url":null,"abstract":"<p><strong>Background: </strong>Extended thromboprophylaxis reduces postoperative venous thromboembolism but is inconsistently used because pulmonary embolism (PE) risk varies across operations and may change after discharge. We developed and temporally validated a 2-stage calculator to estimate PE risk at discharge and update risk after unplanned readmission or reoperation.</p><p><strong>Study design: </strong>American College of Surgeons-NSQIP adult operations from 2020 to 2023 were used for development (n = 3,864,605), with operations in 2024 reserved for temporal validation (n = 956,434). The primary outcome was 30-day postoperative PE. Penalized logistic regression modeled discharge risk using patient, surgical, and early postoperative variables; dynamic reassessment added timing of first unplanned readmission and reoperation. A prespecified 0.5% predicted-risk threshold was evaluated.</p><p><strong>Results: </strong>Among 4,856,597 operations, 17,045 patients developed PE (0.35%). In temporal validation, the discharge model demonstrated area under the curve 0.811 (95% CI 0.801 to 0.818), calibration slope 1.024, and intercept 0.036. Dynamic reassessment improved discrimination to area under the curve 0.892 (95% CI 0.887 to 0.897), with calibration slope 0.991 and intercept 0.030. Among 57,840 patients with an unplanned-return event, reassessment moved 24,320 patients above the 0.5% treatment-consideration threshold, despite being below that threshold at discharge. This newly flagged group had 711 observed PEs, a 2.92% PE rate, and 1 PE within 30 days for every 34.2 newly flagged patients under usual care. Sensitivity analyses indicated that unplanned return, rather than exact postoperative day, was the durable risk signal.</p><p><strong>Conclusions: </strong>Across adult surgery, dynamic PE reassessment after unplanned readmission or reoperation identifies an actionable high-risk postoperative state not captured at discharge. This surgeon-facing calculator can make extended-prophylaxis reconsideration reproducible when prevention remains possible.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1041-1049"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148277792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited Commentary: Endoscopy to Operation: Defining the Role of Sleeve-Based Therapy.","authors":"John Morton","doi":"10.1097/XCS.0000000000002104","DOIUrl":"10.1097/XCS.0000000000002104","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1093-1094"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited Commentary: Beyond Resilience: Restructuring Surgical Training Culture for Parenting Residents.","authors":"Thomas J Miner","doi":"10.1097/XCS.0000000000002055","DOIUrl":"10.1097/XCS.0000000000002055","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1107-1108"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148150306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}