Journal of the American College of Surgeons最新文献

{"title":"How to Win a Game of Darts: Learning Which Enhanced Recovery Program Elements Matter.","authors":"Amanda V Hayman","doi":"10.1097/XCS.0000000000002000","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002000","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774904","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":"Where Should We Put Prehospital Blood?","authors":"John B Holcomb","doi":"10.1097/XCS.0000000000001999","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001999","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774812","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":"Readiness Requires Repetition: Why Daily Trauma Care is the Foundation of Military Surge Capacity.","authors":"Jeffrey D Kerby","doi":"10.1097/XCS.0000000000001997","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001997","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774838","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":"Parathyroidectomy Over Cinacalcet for Tertiary Hyperparathyroidism: Cardiovascular Evidence Tips the Scale.","authors":"Corey A Hounschell, Melanie Goldfarb","doi":"10.1097/XCS.0000000000001996","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001996","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774634","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":"Geriatric Specialty Care Improves Operative Outcomes.","authors":"Thomas N Robinson","doi":"10.1097/XCS.0000000000001998","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001998","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774914","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":"Reframing Surgical Risk in Frailty: Causal Mediation Analysis of Mortality and Readmission after Pancreatectomy.","authors":"Elio R Bitar, Anthony Kostov, Kellyn E McKee, Olivia Sears, Kaelyn C Cummins, Mohamad El Moheb, Mackenzie M Mayhew, Chengli Shen, Samantha M Ruff, Allan Tsung","doi":"10.1097/XCS.0000000000001994","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001994","url":null,"abstract":"<p><strong>Background: </strong>Frailty predicts poor outcomes after pancreatectomy, but whether excess mortality and readmission reflect more postoperative complications, worse rescue after complications, or broader recovery vulnerability remains unclear.</p><p><strong>Study design: </strong>We performed a retrospective study of the ACS-NSQIP Pancreatectomy database (2014-2023) including 71,104 patients undergoing pancreatic resection. Frailty was defined as modified 5-item frailty index score ≥2. Multivariable logistic regression evaluated associations between frailty and 30-day mortality and readmission. Causal mediation analysis quantified total, direct, and complication-mediated indirect effects. Interaction modeling compared failure-to-rescue and non-precedented deaths by frailty status.</p><p><strong>Results: </strong>Of 71,104 patients, 15,779 (22.2%) were frail. Frailty was independently associated with 30-day mortality (aOR 1.29, 95% CI 1.13-1.46; p<0.001) and readmission (aOR 1.11, 95% CI 1.06-1.16; p<0.001). For mortality, the total effect of frailty was significant (RR 1.32, 95% CI 1.23-1.40; p<0.001), the indirect effect through complications was significant (RR 1.25, 95% CI 1.22-1.27; p<0.001), and the direct effect was not (RR 1.07, 95% CI 0.99-1.14; p=0.400); complications mediated 80.72% of the frailty-mortality association. The largest contributors were unplanned reintubation, bleeding requiring transfusion, septic shock, acute kidney injury requiring dialysis, myocardial infarction, and organ/space surgical site infection. Major complications increased mortality similarly in frail and non-frail patients, without meaningful frailty-related differences in failure-to-rescue. For readmission, complications explained only 17% of the frailty association.</p><p><strong>Conclusions: </strong>After pancreatectomy, frailty-associated mortality is largely explained by postoperative complications, whereas frailty-associated readmission is driven predominantly by vulnerability beyond complications. These findings support complication prevention, prehabilitation, and intensified post-discharge follow-up for frail patients.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774845","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":"New Perioperative Do Not Resuscitate Orders: Exploring Risk Factors and Timing.","authors":"Sarah L Remer, Caroline Smolkin, Ronnie Rosenthal, Clifford Y Ko, Marcia M Russell","doi":"10.1097/XCS.0000000000001993","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001993","url":null,"abstract":"<p><strong>Background: </strong>Older adults undergoing surgery are at increased risk for postoperative complications, functional decline, and death, yet factors associated with new perioperative do not resuscitate (DNR) orders and the timing of these orders relative to clinical events remain incompletely defined.</p><p><strong>Study design: </strong>Retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program Geriatric Surgery Pilot Program (2015-2019). Patients aged 65 years and older undergoing surgery at participating hospitals were included. The primary outcome was new perioperative DNR order within 30 days of surgery. Multivariable logistic regression accounting for hospital-level clustering identified predictors of new DNR placement. Timing analyses evaluated DNR placement relative to surgery, mortality, major morbidity, and palliative care consultation (PCC).</p><p><strong>Results: </strong>Among 47,564 cases from 27 sites, 1,108 (2.3%) had a new perioperative DNR order. Independent predictors included ASA IV/V (OR 2.6, 95% CI 1.9-3.6), disseminated cancer (OR 3.3, 95% CI 2.5-4.3), emergent surgery (OR 3.5, 95% CI 1.8-6.7), malnutrition (OR 2.3, 95% CI 1.6-3.1), and postoperative delirium (OR 2.3, 95% CI 1.8-2.9). PCC was associated with new DNR placement in cases with non-missing PCC data (OR 10.8, 95% CI 6.9-17.0). New DNR orders were placed a mean 3.8 (±7.0) days after surgery; 32.5% occurred within 24 hours of surgery. Among patients who died, DNR orders were placed a mean 5.2 (±6.6) days before death, with 43.3% occurring within 24 hours of death. Among 239 cases with both PCC and DNR dates, 46.4% occurred on the same day.</p><p><strong>Conclusions: </strong>New perioperative DNR orders in older adults cluster early after surgery and near death. These patterns, together with low overall specialty PCC use, identify potential opportunities for earlier structured multidisciplinary goals-of-care discussions in high-risk surgical patients.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774569","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, Jennifer S Davids","doi":"10.1097/XCS.0000000000001992","DOIUrl":"https://doi.org/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 two-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 three 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":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-22","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":"Toolkit to Promote Collaboration Between Surgeons and Anesthesiologists: Addressing Common Barriers to Perioperative Teamwork.","authors":"Helen S Wei, Fei Wu, Robert E Berry, Sylvia B Merrell, Judith A Clair, Fred G Davis, Sara N Goldhaber-Fiebert, Haytham M Kaafarani, Hamza Khan, Rebecca D Minehart, David Benavides Zora, May Cm Pian-Smith, Jeffrey B Cooper","doi":"10.1097/XCS.0000000000001988","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001988","url":null,"abstract":"<p><strong>Background: </strong>Collaboration between surgeons and anesthesiologists is central to perioperative safety, yet interpersonal and systems barriers within this dyad remain poorly characterized. This qualitative study aimed to identify sources of conflict and practical strategies used by clinicians to improve collaboration during peri-operative care.</p><p><strong>Study design: </strong>A qualitative phenomenological study was conducted using semi-structured virtual interviews with practicing surgeons and anesthesiologists in the United States. Participants were recruited via respondent-driven snowball sampling to achieve geographic and practice diversity. Forty physicians (20 surgeons and 20 anesthesiologists) from 24 states, ages 31-81 years, were interviewed between February 2022 and June 2024. Transcripts were coded by multidisciplinary investigator teams using qualitative analysis software, with consensus coding and thematic analysis to identify patterns describing barriers to collaboration and strategies promoting effective teamwork.</p><p><strong>Results: </strong>Seven themes describing conflicts and barriers to collaboration were identified: Systems and Professional Identity, Communication, Relationships, Personality Traits, Behaviors, Trainees, and Medical Management. Five themes describing strategies to enhance collaboration emerged: Communication across the pre-, intra-, and post-operative phases; Relationship Building; Team-Building Attitudes; Team-Building Actions; and Rebuilding Trust. Interviewees described practical tactics to strengthen collaboration, including fostering familiarity (eg, introductions and first-name communication), communicating thoroughly (eg, early case discussions, explaining clinical reasoning, announcing intra-operative status changes), and adopting a shared mentality emphasizing openness, respect for expertise, and assuming positive intent. These insights informed development of a clinician-level \"toolkit\" summarizing actionable behaviors to support effective peri-operative teamwork.</p><p><strong>Conclusions: </strong>Surgeons and anesthesiologists identified multiple interpersonal and systems factors that hinder collaboration but also described practical behaviors that can strengthen working relationships. Deliberate communication, relationship building, and shared team attitudes represent actionable strategies that may improve peri-operative teamwork and support safe, effective patient care.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729068","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":"Climbing the Hill of Causation: Reproducibility, External Validation, and Strength of Evidence in Different Databases.","authors":"Mujtaba Khalil, Timothy M Pawlik","doi":"10.1097/XCS.0000000000001990","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001990","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728993","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}