Journal of the American College of Surgeons最新文献

{"title":"Nipple-Sparing Mastectomy, Informed Consent, and Shared Decision Making.","authors":"Erin M Bayley","doi":"10.1097/XCS.0000000000001364","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001364","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015167","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":"Not Just Another Gallbladder: Why Acute Care Surgery Saves More Than Time.","authors":"Paula Ferrada","doi":"10.1097/XCS.0000000000001427","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001427","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016445","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":"Timeliness of Care for Nonelective Cholecystectomy: A Comparison of Surgical Practice Models.","authors":"Aricia Shen, Andrew Wang, Nicolas Melo, Rex Chung, Miguel Burch, Tejal Brahmbhatt, Daniel R Margulies, Galinos Barmparas","doi":"10.1097/XCS.0000000000001426","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001426","url":null,"abstract":"<p><strong>Background: </strong>Acute Care Surgery (ACS) practice models with continuous on-site presence provide expedient and comprehensive care and serve as a critical safety net. The program benefits remain contested in comparison to other surgery practice models. We compared the efficiency of care for non-elective cholecystectomies (CCY) across four different surgery practice models within a single hybrid urban hospital system.</p><p><strong>Study design: </strong>Adult patients admitted through the emergency department who underwent CCY for acute biliary disease between 01/2018 to 12/2023 were categorized into four groups: ACS (ACS-MC), non-ACS faculty (FP-MC), private practice (PPP-MC), and community practice (PPP-CH). The primary outcomes were the interval from admission to surgery and hospital length of stay. Secondary outcomes included surgery on a weekend, hospital costs, and readmission within 30 days. Comparison was performed with ANOVA.</p><p><strong>Results: </strong>Over the 6-year study period, there were a total of 2,247 CCY; ACS-MC (43.3%), PPP-MC (28.3%), PPP-CH (19.4%), and FP-MC (9.0%). ACS-MC patients had the lowest time interval from admission to surgery (median 25.1 hours vs 61.1 hours for FP-MC, 33.2 hours for PPP-MC, and 30.3 hours for PPP-CH, p<0.001). ACS-MC patients had the lowest median hospital LOS (2 days). 93.7% of ACS-MC cases were covered by a general surgery resident. PPP-CH had the lowest overall cost.</p><p><strong>Conclusion: </strong>In an era of accelerated consolidation in healthcare markets, the results of this study may provide insight on how large healthcare systems may take advantage of the efficiency of the ACS model to ensure timely and quality care, at the lowest cost.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974549","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 Guideline-Concordant Care with Superior Survival Outcomes for Clinical T2N0M0 Esophageal Squamous Cell Carcinoma.","authors":"Ryan C Jacobs, Austin B Chang, Dominic J Vitello, Jonathan E Williams, David D Odell, David J Bentrem","doi":"10.1097/XCS.0000000000001425","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001425","url":null,"abstract":"<p><strong>Background: </strong>For patients with clinical T2N0M0 (cT2N0M0) esophageal squamous cell carcinoma (ESCC), upfront esophagectomy is recommended for low-risk tumors (tumor size <3 cm, low grade histology), and neoadjuvant chemoradiation with esophagectomy or chemoradiation alone is recommended for high-risk tumors (tumor size ≥3 cm, high grade histology). The objectives of this study were to 1) describe the treatment strategies used for patients with cT2N0M0 ESCC and 2) analyze survival outcomes for patients according to treatment strategy and tumor risk category.</p><p><strong>Study design: </strong>We performed a retrospective cohort analysis of patients with cT2N0M0 ESCC in the National Cancer Database from 2006-2020 comparing patients by tumor risk categories. We compared characteristics of patients according to treatment strategy using bivariate analyses. We performed multivariable Cox regressions comparing overall survival outcomes of patients according to treatment strategy and tumor risk category.</p><p><strong>Results: </strong>Of the included patients, 145/890 (16.3%) with cT2N0M0 ESCC underwent esophagectomy, 176/890 (19.8%) underwent neoadjuvant chemoradiation with esophagectomy, and 418/890 (47.0%) underwent chemoradiation. Among patients with low-risk cT2N0M0 ESCC, 44/222 (19.8%) underwent esophagectomy. Among patients with high-risk cT2N0M0 ESCC, 126/668 (18.9%) underwent neoadjuvant chemoradiation with esophagectomy and 332/668 (49.7%) underwent chemoradiation therapy. Patients with high-risk tumors undergoing chemoradiation had a 53% higher risk of death than patients with high-risk tumors undergoing neoadjuvant chemoradiation with esophagectomy (aHR 1.53 [1.15-2.05]).</p><p><strong>Conclusions: </strong>Approximately half of patients with cT2N0M0 ESCC received guideline-concordant care. Chemoradiation therapy is overutilized in patients with high-risk tumors and upfront esophagectomy is underutilized in patients with low-risk tumors.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026282","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":"Nipple-Sparing Mastectomy and Infection Risk after Immediate Breast Reconstruction.","authors":"Margaret A Olsen, Katelin B Nickel, Julie A Margenthaler, Terence M Myckatyn, David K Warren","doi":"10.1097/XCS.0000000000001424","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001424","url":null,"abstract":"<p><strong>Background: </strong>Wound complications are known to occur after nipple-sparing mastectomy (NSM), especially in procedures involving a periareolar incision. We sought to determine the independent risk of infection and overall wound complications associated with NSM vs. skin-sparing mastectomy (SSM) in a contemporary cohort of women undergoing immediate implant reconstruction.</p><p><strong>Study design: </strong>We identified 352 women ≥ 21 years of age undergoing mastectomy plus immediate implant reconstruction from 09/2021-12/2022 using electronic health records from two hospitals. The relative risk of surgical site infection (SSI) and of serious wound complication (infection or noninfectious wound complication (NIWC; dehiscence or tissue necrosis) requiring surgical treatment in the operating room) within 180 days after surgery associated with NSM vs. SSM was determined using a modified Poisson regression model, controlling for established risk factors for SSI.</p><p><strong>Results: </strong>NSM was performed in 128 women (36.4%), most commonly via an inframammary fold incision (73.4%). Surgical site infection occurred in 49 (13.9%) women within 180 days after surgery, while 70 (19.9%) women developed an SSI and/or noninfectious wound complication. Although the incidence of SSI and the composite SSI/NIWC outcome were similar after NSM vs. SSM (14.8% vs. 13.4% and 21.1% vs. 19.2%, respectively), in multivariable analysis NSM was associated with increased risk of both SSI (RR 2.13, 95% CI 1.26-3.59) and SSI/NIWC (RR 2.19, 95% CI 1.40-3.43).</p><p><strong>Conclusions: </strong>Nipple-sparing mastectomy was associated with increased risk of both SSI and noninfectious wound complications requiring surgical treatment after controlling for other established risk factors, despite uncommon use in this cohort of a periaerolar incision. This information should be communicated to women at the time of pre-surgical counseling to facilitate shared decision making.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974548","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":"Air Bubbles, Saline Solutions, and Vital Colorant: Respect This Order to Properly Identify Biliary Lesions on the Liver Surface.","authors":"Alessandro Terrasi, Luisa Gallo, Ivan Lo Iacona, Isidoro Di Carlo, Adriana Toro","doi":"10.1097/XCS.0000000000001420","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001420","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004931","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":"Variability of Prophylactic Inferior Vena Cava Filter Use in Young Trauma Patients: An Analysis of the Consortium of Leaders in the Study of Traumatic Thromboembolism (CLOTT) Database.","authors":"Andrew J Kerwin, Sarah Lombardo, Elliott R Haut, M Margaret Knudson","doi":"10.1097/XCS.0000000000001417","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001417","url":null,"abstract":"<p><strong>Background: </strong>Data suggest prophylactic inferior vena cava filters (IVCFs) are associated with a slightly reduced PE rate, increased DVT rates, adverse events, increased cost, and no mortality benefit. We hypothesized that there would be few indications for prophylactic IVCFs in trauma patients, and use would be lower than historically reported.</p><p><strong>Study design: </strong>CLOTT is a prospective, observational, cohort, multi-center study conducted at 17 US level 1 trauma centers between 2018 - 2020 including patients aged 18-40 to examine prevention and management of VTE. We conducted a per center analysis of placement rates, timing, and indications for prophylactic IVCFs.</p><p><strong>Results: </strong>74 (0.94%) of 7,880 trauma patients had prophylactic IVCFs inserted. The majority sustained blunt trauma (mean ISS = 30). IVCFs were placed by: interventional radiologists (72.4%), vascular surgeons (17.2%), and trauma surgeons (10.3%). Mean time from injury to placement was 7.2 (SD 7.0) days. Rates of IVCFs/ center varied widely with rate of 2/ 622 patients (0.3%) - 9/ 71 patients (12.7%). Prophylactic IVCF insertion indications were: neurotrauma 24.7%, repeat operations 26.9%, spinal cord injury with paralysis 7.5%, coagulopathy 17.2%, solid organ injury 8.6%, spine fracture 7.5%. Mean time to initiation of VTE prophylaxis was 4.8 days. 62% of patients had VTE prophylaxis initiated before or on the same day as IVCF insertion. All centers had patients who never received pharmacologic VTE prophylaxis (range 2.4% - 30.6%) but this did not correlate with increased prophylactic IVCF insertion.</p><p><strong>Conclusions: </strong>There is variation in the use of prophylactic IVCFs following major trauma. Our data lend support to recent practice management guidelines and should lead to more consistent care of major trauma patients regarding prophylactic IVCFs.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970815","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":"The Continued Quest to Decrease the Risk of Anastomotic Leaks.","authors":"Steven D Wexner","doi":"10.1097/XCS.0000000000001419","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001419","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041351","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":"Improved American College of Surgeons NSQIP Hospital Benchmarking with Risk Adjustment for Many CPT Codes Rather Than Just the Principal Code.","authors":"Mark E Cohen, Yaoming Liu, Bruce L Hall, Clifford Y Ko","doi":"10.1097/XCS.0000000000001418","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001418","url":null,"abstract":"<p><strong>Background: </strong>Because of technical limitations inherent to logistic regression, NSQIP benchmarking has historically risk adjusted for procedure using only one principal CPT code among other predictors. This has the potential to create bias (favorable or unfavorable) for hospitals depending on how many multiple-procedure operations they do. Hospital quality assessments using current statistical methods were compared to those using a new methodology that permits risk adjustment incorporating many recorded CPT codes (capped here at 21).</p><p><strong>Study design: </strong>ACS-NSQIP data from 2023, composed of 994,332 patient cases from 676 hospitals were analyzed. Modeling included a preliminary logistic regression step where 5 years of historical data were used to generate a principal CPT-code-specific linear risk score (logit) for each of 14 outcomes. This score is then used as one of many risk-adjustment variables in follow-on models. For this re-analysis, the first step was replicated with a CatBoost machine learning algorithm that provides a logit risk score based on a set of up to 21 reported CPT codes. Changes in hospital assessments using the two approaches to CPT code-based risk were examined.</p><p><strong>Results: </strong>Benchmarking results for the 14 outcomes were similar, but not identical, across the analytic methods. For 13 out of 14 outcomes studied, the greater the mean number of CPT codes reported for patients in a hospital, the greater their benchmarking advantage when the model considered all codes; hospitals that reported only the principal CPT code had a benchmarking advantage when the model considered only that code.</p><p><strong>Conclusion: </strong>Because of differences between hospitals in the proportion of multiple-procedure operations performed, risk adjustment using many CPT codes provides more defensible benchmarking results.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989065","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":"Missing Race Data in NSQIP Pediatrics In Reply to Cohen and colleagues.","authors":"Kevin G Hu, Michael Alperovich","doi":"10.1097/XCS.0000000000001423","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001423","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026980","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}