Journal of the American College of Surgeons最新文献

{"title":"Invited Commentary: From Intervals to Probabilities: Bayesian Inference as the Framework Surgical Quality Benchmarking Requires.","authors":"Marissa C Kuo, Paul C Kuo","doi":"10.1097/XCS.0000000000002032","DOIUrl":"10.1097/XCS.0000000000002032","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"983-984"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874552","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":"Postoperative Outcomes and Recovery Trajectory among Patients with Gastrointestinal Cancer Undergoing Emergency General Surgery.","authors":"Meher Angez, Selamawit Woldesenbet, Charalampos M Charalampous, Shahzaib Zindani, Jun Kawashima, Odysseas P Chatzipanagiotou, Areesh Mevawalla, Muhammad Qasim Chaudry, Timothy M Pawlik","doi":"10.1097/XCS.0000000000002008","DOIUrl":"10.1097/XCS.0000000000002008","url":null,"abstract":"<p><strong>Background: </strong>For older adults with gastrointestinal cancer undergoing emergency general surgery, perioperative metrics do not capture prolonged institutional dependence after operation. We characterized 12-month days elsewhere than home (DEH) recovery trajectories and identified factors associated with protracted recovery (PR) and sustained high DEH (SH-DEH).</p><p><strong>Study design: </strong>We performed a retrospective cohort study using Surveillance, Epidemiology, and End Results-Medicare (2005 to 2019) of beneficiaries aged 66 years and older with gastrointestinal cancer undergoing emergency general surgery. Monthly DEH during the 12 postoperative months was modeled using group-based trajectory modeling. Modified Poisson regression identified preoperative and postoperative factors associated with PR and SH-DEH.</p><p><strong>Results: </strong>Among 15,398 patients, 6,852 were men, 8,546 were women, and 11,917 (77.4%) were White. Four trajectories were identified: routine recovery (42.5%; n = 6,543), chronically dependent (37.1%; n = 5,719), PR (7.2%; n = 1,109), and SH-DEH (13.2%; n = 2,027). SH-DEH was associated with stage IV disease (adjusted relative risk [aRR] 2.39, 95% CI 2.07 to 2.76), frailty (aRR 2.58, 95% CI 2.09 to 3.19), Charlson Comorbidity Index greater than 2 (aRR 1.37, 95% CI 1.24 to 1.53), and intrahepatic cholangiocarcinoma (aRR 3.52, 95% CI 2.58 to 4.82). PR was associated with stage IV disease (aRR 1.92, 95% CI 1.59 to 2.32), a Charlson Comorbidity Index greater than 2 (aRR 1.79, 95% CI 1.55 to 2.08), claims-based frailty risk (aRR 4.50, 95% CI 3.68 to 5.52), and pancreatic cancer (aRR 2.52, 95% CI 2.09 to 3.04; all p < 0.001). Major postoperative complications, prolonged length of stay, and ICU admission increased the likelihood of both PR and SH-DEH. Model discrimination ranged from 0.74 to 0.84.</p><p><strong>Conclusions: </strong>Older adults with gastrointestinal cancer undergoing emergency general surgery demonstrated distinct DEH recovery trajectories. Frailty, advanced disease, comorbidity, and postoperative complications identified patients at risk for prolonged recovery or sustained institutional dependence.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"817-831"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774574","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 Smoking Status on Morbidity and Mortality after Lung Cancer Resection: An Analysis of the Society of Thoracic Surgeons General Thoracic Surgery Database.","authors":"Hannah Kim, Sofia Wagemaker Viana, Christina Pinkston, Catherine G Pratt, Shesh Rai, Christine E Haugen, Ralph C Quillin, Sandra L Starnes, Robert M Van Haren","doi":"10.1097/XCS.0000000000002007","DOIUrl":"10.1097/XCS.0000000000002007","url":null,"abstract":"<p><strong>Background: </strong>Tobacco exposure is the leading cause of lung cancer, with some surgeons and centers requiring smoking cessation before lung resection. The impact of continued smoking on outcomes remains uncertain. We evaluated morbidity and mortality after resection among patients who currently smoke compared with those who formerly smoked.</p><p><strong>Study design: </strong>We analyzed lung cancer resections (2018 to 2023) in the Society of Thoracic Surgeons General Thoracic Surgery Database. Smoking status was defined using Society of Thoracic Surgeons operational definitions as current (within 1 month of operation) or former (abstinence more than 1 month). Patients who never smoked were excluded. Primary outcomes were operative or 30-day mortality and postoperative pulmonary complications. Multivariable regression identified predictors of outcomes. This research was determined to be exempt research with a waiver of informed consent from Advarra IRB (Mod01760092, Version 1.1, Approval date July 17, 2023).</p><p><strong>Results: </strong>Of 85,124 patients, 28% (n = 24,093) currently smoked and 72% (n = 61,031) formerly smoked. Patients who currently smoked were younger (65.6 vs 69.6 years; p < 0.001), had fewer comorbidities, and included higher proportions of patients who identify as Black (11.5% vs 7.5%; p < 0.001). Pulmonary complications were more frequent among patients who currently smoke (34.6% vs 30.5%; p < 0.001), but mortality did not differ by smoking status (1.0% vs 1.0%; p = 0.52). Male sex, current smoking, greater pack-years, thoracotomy, and more extensive resection independently predicted pulmonary complications.</p><p><strong>Conclusions: </strong>Patients who currently smoke experienced higher pulmonary morbidity but no increase in mortality. Surgeons should not use smoking status alone when determining whether a patient is a candidate for lung cancer resection. Risk assessment should integrate smoking status in combination with a comprehensive range of preoperative factors to guide shared decision-making and ensure access to lung cancer operations.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"769-779"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774930","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: Building Capacity for Surgical Artificial Intelligence Research.","authors":"Daniel A Hashimoto","doi":"10.1097/XCS.0000000000002077","DOIUrl":"10.1097/XCS.0000000000002077","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"871-873"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148277803","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: A Life of Service: What Herand \"Harry\" Abcarian Teaches Us About Surgical Citizenship.","authors":"Steven D Wexner, Susan Galandiuk","doi":"10.1097/XCS.0000000000002110","DOIUrl":"10.1097/XCS.0000000000002110","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1001-1002"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592380","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":"Surgeon Perspectives on Responsibility for Acute Lower Gastrointestinal Surgical Conditions: A Modified Delphi Study.","authors":"Sara Myers, Anays Murillo, Rebecca K Rudel, Sheina Theodore, Olga Beresneva, Samantha J Rivard, Mari-Lynn Drainoni, Sabrina E Sanchez, S Davids","doi":"10.1097/XCS.0000000000001992","DOIUrl":"10.1097/XCS.0000000000001992","url":null,"abstract":"<p><strong>Background: </strong>Allocation of acute lower gastrointestinal surgical conditions between acute care surgeons and colorectal surgeons remains inconsistent, with no consensus guidelines to inform service assignment in teaching hospitals where both specialties share call.</p><p><strong>Study design: </strong>A 2-round modified Delphi study of expert surgeons was conducted with a predefined 70% consensus threshold. In round 1, participants (n = 16) assigned 20 conditions to acute care surgery, colorectal surgery, or either service. Conditions without consensus were discussed in round 2 (n = 13). Qualitative data were analyzed using directed content analysis.</p><p><strong>Results: </strong>Consensus was achieved for 10 of 20 conditions (50%) after round 1. The remaining conditions required contextual adjudication in round 2, with no uniform specialty assignment. Qualitative analysis identified 3 determinants of service allocation: practice model differences, including capacity for longitudinal care; specialty-specific training, with acute care surgeons emphasizing emergency management and colorectal surgeons emphasizing pelvic, rectal, and minimally invasive expertise; and patient clinical status, wherein hemodynamic instability prioritized surgeon availability over specialty-specific expertise.</p><p><strong>Conclusions: </strong>In the absence of universal agreement, service allocation for acute lower gastrointestinal conditions depends on clinical context, surgeon expertise, and institutional resources. This Delphi-derived framework provides a structured approach to guide triage and care pathways in systems with dual acute care and colorectal surgical coverage.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"952-960"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774760","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":"High-Risk Substance and Polysubstance Use Among Elective Surgery Patients: Prevalence and Risk Factors.","authors":"Xintong Ju, Amelia C Mueller-Williams, Ashley Kocher, Sergio E Pena, Jennifer Waljee, Mark C Bicket, Kelley M Kidwell, Maureen Walton, Anne C Fernandez","doi":"10.1097/XCS.0000000000001991","DOIUrl":"10.1097/XCS.0000000000001991","url":null,"abstract":"<p><strong>Background: </strong>Substance use is a modifiable risk factor that may adversely affect surgical outcomes, yet its prevalence using surgical risk-specific thresholds remains incompletely characterized in preoperative populations.</p><p><strong>Study design: </strong>We performed a cross-sectional analysis of preoperative screening data from a clinical trial (NCT05783635) at a large Midwestern health system. Between February 2024 and February 2025, 2,688 adults 21 to 75 years of age undergoing elective surgery completed validated self-report assessments of alcohol, nicotine, cannabis, and other drug use. High-risk use was defined as Alcohol Use Disorders Identification Test-Consumption scores ≥5 or weekly or daily use of other substances. Polysubstance use was defined as high-risk use of more than 1 substance. Multivariable logistic regression evaluated associations between patient and surgical factors and high-risk use.</p><p><strong>Results: </strong>Overall, 27.6% (743) of patients reported high-risk substance use and 6.6% (177) reported polysubstance use. Cannabis was the most prevalent high-risk substance (15.0%), followed by alcohol (11.1%), nicotine (8.5%), and other drugs (0.4%). Younger age, male sex, and poorer self-reported health were associated with increased odds of high-risk use. Prevalence varied across surgical services, with the highest rates in neurosurgery (27.1% high risk and 11.4% polysubstance) and lowest in endocrine surgery (15.1% and 3.3%).</p><p><strong>Conclusions: </strong>More than 1 in 4 elective surgical patients report high-risk substance use before surgery. These findings support universal preoperative substance use screening to identify patients at elevated risk for adverse perioperative outcomes and enable targeted risk mitigation.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"875-885"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13317074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited Commentary: Reframing High-Risk Operations as a Time-Limited Trial.","authors":"Matthew B Allen, Elizabeth J Lilley","doi":"10.1097/XCS.0000000000002037","DOIUrl":"10.1097/XCS.0000000000002037","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"949-951"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874545","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: Counting What Counts in Cancer Surgery.","authors":"Vishal R Patel, Arjun Gupta","doi":"10.1097/XCS.0000000000001985","DOIUrl":"10.1097/XCS.0000000000001985","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"898-900"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816690","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":"American College of Surgeons NSQIP Return on Investment Calculator Prototypes.","authors":"Caroline O Smolkin, Mark E Cohen, Arielle Grieco, Clifford Ko, Bruce L Hall","doi":"10.1097/XCS.0000000000002028","DOIUrl":"10.1097/XCS.0000000000002028","url":null,"abstract":"<p><strong>Background: </strong>Hospitals considering participation in quality improvement programs, such as the American College of Surgeons NSQIP, often lack practical estimates of the financial return on investment (ROI). We developed 2 calculators to approximate hospital ROI from complication reduction: reduced length of stay (RLOS) and direct cost avoidance (DCA).</p><p><strong>Study design: </strong>Using the methodology from Healy and colleagues for complication-associated length of stay and that from Merkow and colleagues for complication-attributed direct costs, we constructed RLOS and DCA ROI calculators with risk-adjusted and unadjusted estimates. Relative reductions in postoperative complications associated with NSQIP or similar quality improvement participation were derived from the published literature and verified by the authors. ROI was defined as cost savings minus annual program costs, including NSQIP fees, Surgical Clinical Reviewer salary and benefits, and estimated surgeon effort. A base-case hospital was modeled with 2,000 annual inpatient procedures and 4,500 total annual inpatient and outpatient procedures.</p><p><strong>Results: </strong>All 4 modeled scenarios demonstrated positive ROI. Estimated savings were $1,960,404 (RLOS, risk-adjusted), $1,502,433 (RLOS, unadjusted), $1,636,708 (DCA, risk-adjusted), and $2,306,784 (DCA, unadjusted). After subtracting annual program costs, the estimated ROI was $1,710,404, $1,252,433, $1,386,708, and $2,056,784, respectively. In the RLOS model, the greatest modeled savings were associated with pneumonia, urinary tract infection, and organ-space surgical site infection. In the DCA model, the greatest modeled savings were associated with deep and organ-space surgical site infections, return to the operating room, and ileus.</p><p><strong>Conclusions: </strong>Both calculators suggested positive financial return associated with sustained, active quality improvement participation. RLOS and DCA offer complementary estimates of value and may function as upper-bound scenario tools for hospitals considering or sustaining NSQIP investment.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"901-914"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868658","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}