Journal of the American College of Surgeons最新文献

{"title":"Redefining Resectability in Locally Advanced Pancreatic Cancer: From Anatomy to Judgment.","authors":"Dillon Cheung, Zhi Ven Fong","doi":"10.1097/XCS.0000000000002030","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002030","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839563","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 Predicting ICU and Life Support Intervention Use: Increasing Individual Autonomy and Anticipating Demands Beyond System Capacity.","authors":"Tandis Soltani","doi":"10.1097/XCS.0000000000002029","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002029","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839565","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":"Stick Or Switch: The Diminishing Returns Of Repeated Peripheral Intravenous Access Attempts In Hypotensive Trauma Patients.","authors":"Ryan P Dumas, Bahaa Succar, Michael A Vella, Amelia Maiga, Daniel N Holena","doi":"10.1097/XCS.0000000000002027","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002027","url":null,"abstract":"<p><strong>Background: </strong>Peripheral intravenous (PIV) access is the first-line approach to vascular access in trauma patients. There is no evidence to guide clinicians on when to abandon PIV attempts in favor of alternative access. We sought to characterize PIV success rates, identify factors associated with success, and determine the marginal yield of sequential PIV attempts in hypotensive trauma patients.</p><p><strong>Study design: </strong>We analyzed data from audiovisual recordings of trauma resuscitations from a multicenter prospective study of vascular access in hypotensive (SBP <90mmHg) patients. The primary outcome was PIV attempt success rate. Secondary outcomes included attempt duration and cumulative patient-level success across sequential attempts. Generalized estimating equations with exchangeable correlation structure were used to account for clustering of attempts within patients.</p><p><strong>Results: </strong>A total of 886 PIV attempts occurred in 471 patients across 18 centers. The overall PIV success rate was 67.1%. Male patient sex (adjusted OR 1.92, 95% CI 1.22-3.03, p=0.005) and the presence of a measurable initial systolic blood pressure (adjusted OR 1.84, 95% CI 1.06-3.20, p=0.03) were independently associated with PIV success. The first PIV attempt was successful in 70% of patients, and cumulative success reached 83% by the second attempt. The marginal success rate among patients without prior success dropped from 70% on the first attempt to 54% on the second and 39% on the third.</p><p><strong>Conclusions: </strong>PIV access in hypotensive trauma patients succeeds approximately two-thirds of the time. The marginal yield of sequential PIV attempts declines substantially after two failed attempts. These findings support a practice in which alternate vascular access such as intraosseous access is actively considered after a single failed PIV attempt in patients without a measurable blood pressure.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839548","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":"Clearing the Smoke on Smoking Cessation.","authors":"Brooks V Udelsman, Anthony W Kim","doi":"10.1097/XCS.0000000000002019","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002019","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839600","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":"Facial Trauma, To Transfer or Not to Transfer?","authors":"Abigale Shettig, Peter D Nguyen, Mallory Jebbia, Jeffry Nahmias","doi":"10.1097/XCS.0000000000002024","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002024","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839620","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":"A Thousand More Steps: Using Wearable Data to Optimize Postoperative Recovery.","authors":"Jamila K Picart, Raymond A Jean","doi":"10.1097/XCS.0000000000001845","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001845","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839638","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":"Association of Perioperative Steps and Heart Rate Variability from Wearable Devices with Surgical Outcomes.","authors":"Abdulaziz Elemosho, Odysseas P Chatzipanagiotou, Meher Angez, Timothy M Pawlik","doi":"10.1097/XCS.0000000000001857","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001857","url":null,"abstract":"<p><strong>Background: </strong>Surgical recovery is dependent on physiologic reserve, functional capacity, and wellness status. We sought to delineate the association of perioperative changes in daily steps, heart rate variability (HRV), and self-reported wellness with length of stay, complications and readmissions.</p><p><strong>Study design: </strong>Adults undergoing inpatient surgery with ≥30 preoperative and ≥30 postoperative days of data were identified from the All of Us database. Exposures included postoperative changes in daily steps and heart rate variability (HRV) relative to their preoperative baseline. Wellness, using the \"SPADE\" composite score was examined in a sensitivity analysis. Multivariable regression analyses, adjusted for relevant factors, were used to assess outcomes, including length of stay (LOS), 30-/90-day complications, and readmissions.</p><p><strong>Results: </strong>Among 66,345 patients who underwent a surgical procedure, 1,965 patients (mean age 50.4 years, 69.5% female) were included in the final analytic cohort. Each postoperative +1,000 steps/day relative to preoperative baseline was associated with reduced LOS (incidence rate ratio [IRR]=0.94, 95%CI 0.90-0.99) and lower odds of 30-day (adjusted odds ratio [aOR]=0.83, 95%CI 0.69-1.00) and 90-day (aOR=0.82, 95%CI 0.70-0.96) complications. Incremental increases in steps were also associated with lower odds of 30-day (aOR=0.85, 95% CI 0.76-0.96) and 90-day readmission (aOR=0.84, 95%CI 0.75-0.94). Postoperative HRV changes and self-reported wellness were not associated with any post-operative outcome (p>0.05).</p><p><strong>Conclusions: </strong>Postoperative step count was the most actionable correlate of recovery across endpoints, whereas postoperative HRV change and self-reported wellness conferred limited independent prognostic value. These findings support integrating wearables into ERAS as preoperative HRV-informed triage and postoperative step-guided recovery, while emphasizing less reliance on subjective patient reported measures to inform discharge or clinical decisions.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839579","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":"Right Drug, Right Time, or Right System? Preoperative Antibiotic Timing and Outcomes in Emergency Colorectal Operation.","authors":"Kristen A Ban, David Liska","doi":"10.1097/XCS.0000000000002017","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002017","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839570","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":"Refining Definitions and Reframing Implications of Rural Hospital Bypass for Surgical Patients.","authors":"Cody Lendon Mullens, Justin B Dimick","doi":"10.1097/XCS.0000000000002012","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002012","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839605","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":"\"Fairness\" at Last? Aligning Coding to Reflect Operative Complexity in Surgical Oncology.","authors":"John R Hyngstrom","doi":"10.1097/XCS.0000000000002016","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002016","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839560","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}