Journal of the American College of Surgeons最新文献

{"title":"NESS Commentary re Pugacheva JACS-2024-1248.","authors":"Afshin Ehsan, Jaime Hernandez-Montfort","doi":"10.1097/XCS.0000000000001382","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001382","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586007","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":"Comparison of Laparoscopic Cholecystectomy Reimbursement Rate and Medical Malpractice Insurance Premium Cost Across the US 2013-2023.","authors":"Natasha A Sioda, David Etzioni, Kenan Shawwaf, Zhi Ven Fong, Justin T Brady, Kayla L Haydon, Ga-Ram Han, Emily Thompson, Irving Jorge","doi":"10.1097/XCS.0000000000001376","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001376","url":null,"abstract":"<p><strong>Background: </strong>Within the United States (US), there has been an overall increase in cost of malpractice insurance for surgeons and decrease in federal reimbursement for surgical work. This study aims to analyze state-to-state variability to understand differences in costs relative to reimbursement for surgeons and temporal trends.</p><p><strong>Study design: </strong>This study uses publicly available data to conduct a cross-sectional evaluation of surgeon medical malpractice premium rates and surgical reimbursement between 2013 and 2023. Surgeon reimbursement was represented in terms of the unit reimbursement rate for laparoscopic cholecystectomy (LC). The ratio of surgeon reimbursement to malpractice cost was calculated and considered as the number of LCs required in each state to cover the cost of malpractice insurance.</p><p><strong>Results: </strong>Inflation-adjusted reimbursement for LC decreased in all states with a mean decrease of 24%. While there was an overall decrease in inflation-adjusted medical malpractice premium cost, some states experienced an increase of up to 22% (Rhode Island) while other states experienced a decrease in cost of 62% (Oregon). For the year 2023, there was significant variability in the number of LCs needed to afford malpractice insurance premiums across states, ranging from 21 (Minnesota) to 163 (Illinois). Rhode Island experienced the greatest increase in change from 2013-2023 (63%) while Oregon experienced the greatest decrease (50%).</p><p><strong>Conclusion: </strong>This study finds significant variation in Medicare-based surgeon compensation relative to malpractice insurance costs across the US. This discrepancy highlights the challenges faced by surgical practices due to inconsistent insurance cost and decreases in reimbursement rates.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573303","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":"Heart Transplant Equity: Effect of 2018 Allocation Policy Change on Recipient Mortality and Morbidity by Race and Ethnicity.","authors":"Alisa Pugacheva, Selena S Li, S Alireza Rabi, Thais Faggion Vinholo, Eriberto Michel, Ruby Singh, Asishana A Osho","doi":"10.1097/XCS.0000000000001374","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001374","url":null,"abstract":"<p><strong>Background: </strong>In 2018, the US heart allocation policy was changed from 3-tiers to 6-tiers for a more granular assessment of patients' medical urgency. Given previous studies showing significant discrepancies in post-transplant outcomes among Black and Hispanic minority groups, we investigated the effects of the allocation policy change on these groups.</p><p><strong>Methods: </strong>Adult heart transplant patients from 10/18/2014-10/18/2022 were included from the United Network for Organ Sharing (UNOS) database. Multiorgan transplants and retransplants were excluded. 1:1 propensity-matching were performed by race/ethnicity and allocation score era. Primary outcome was overall(4-year) survival assessed using multivariable Cox regression in unmatched cohort; secondary outcomes were in-hospital and 1-year rejection, short-term mortality, and graft failure, assessed using conditional logistic regression in the matched cohort.</p><p><strong>Results: </strong>The total cohort included 19,731 patients; 13,001 White, 4784 Black, and 1946 Hispanic. White, Black, and Hispanic cohorts in matched analysis demonstrated post-allocation change improvements in in-hospital and 1-year rejection (all p<0.05) and comparable short-term mortality and graft failure (all p>0.05). In adjusted analyses, Black recipients had comparable overall mortality to White recipients both pre- (aHR=1.04[0.92,1.18], p=0.514) and post-allocation change (aHR=1.10[0.95,1.27], p=0.194). Post-allocation change, Black recipients had a higher risk of overall mortality (aHR=1.20[1.01,1.42], p=0.033) while Hispanic recipients had lower risk of mortality (aHR=0.72[0.55,0.94], p=0.015) compared to White recipients.</p><p><strong>Conclusions: </strong>This analysis demonstrates improved acute rejection rates post allocation change, by race/ethnicities however, there remain disparities in short and long-term recipient mortality for Black recipients in the post-allocation change era. Future studies will explore the factors impacting long-term survival among these groups.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542335","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":"Increasing Omission of Race and Ethnicity in a National Surgical Database.","authors":"Kevin G Hu, Jacqueline Ihnat, K Lynn Zhao, SeungJu J Oh, Jeremy A Goss, Neil Parikh, Alexander Kammien, Soraya Fereydooni, Paris D Butler, Michael Alperovich","doi":"10.1097/XCS.0000000000001372","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001372","url":null,"abstract":"<p><strong>Background: </strong>Accurate data collection on race and ethnicity is critical to detecting and characterizing disparities in surgical care. This study explores the prevalence and impact of missing race and ethnicity data in the NSQIP-Pediatric (NSQIP-P) database.</p><p><strong>Study design: </strong>NSQIP-P from 2016-2020 was assessed for patients who were missing data for race (RM), ethnicity (EM), or both (BM). Changes in proportion of RM, EM, and BM patients were assessed with Cochran-Armitage tests. Surgical outcomes were modeled using linear mixed-effects models, treating CPT codes as random effects. Models were bootstrapped with 1000 iterations for each outcome.</p><p><strong>Results: </strong>Of 596,571 patients, 18.0% were RM, 10.9% were EM, and 8.3% were BM. BM patients increased in proportion from 5.7% in 2016 to 12.1% in 2020 (p < 0.0001). Outcomes which differed statistically significantly were worse in RM than non-RM patients. Multivariate analysis found that BM patients had longer hospital lengths-of-stay than non-BM patients (b = 0.5 days, p < 0.001). BM patients also had higher odds of readmission (OR = 1.22 [1.02-1.46]) and any complication (OR = 1.27 [1.03-1.59]).</p><p><strong>Conclusion: </strong>NSQIP-P exhibits a concerning increase in missing race and ethnicity data that has not been previously described in other literature or database documentation. Controlling for surgery type and patient demographics, patients exhibited worse outcomes with respect to hospital lengths-of-stay and rates of both readmission and any complication. Further work is necessary to determine the cause of this missing data and provide guidance for researchers examining surgical disparities utilizing NSQIP-P.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542336","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":"Scudder Oration on Trauma: Major Hepatic Injury, We Can Do Better.","authors":"Andrew B Peitzman, J Wallis Marsh","doi":"10.1097/XCS.0000000000001375","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001375","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542406","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":"Machine Learning Prediction of Financial Toxicity in Patients with Resected Lung Cancer.","authors":"Nathaniel Deboever, Qasem Al-Tashi, Michael Eisenberg, Maliazurina B Saad, Mara B Antonoff, Wayne L Hofstetter, Reza J Mehran, David C Rice, Jack Roth, Stephen G Swisher, Ara A Vaporciyan, Garrett L Walsh, Jia Wu, Ravi Rajaram","doi":"10.1097/XCS.0000000000001373","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001373","url":null,"abstract":"<p><strong>Backgrounds: </strong>Financial toxicity (FT) refers to the financial stress and detrimental impact on quality of life experienced by patients due to treatment costs. In patients with resected lung cancer (LC), we sought to identify those at risk of developing moderate or severe (\"major\") FT using machine learning (ML) techniques based on preoperative characteristics.</p><p><strong>Study design: </strong>Patients who underwent LC resection at a single center between January 2016 and December 2021 were surveyed to ascertain demographic information, financial data, and presence of major FT. Clinicopathologic variables were extracted from a prospective database. Patients were randomly divided into training and test sets. First, we identified the most informative features. Then, 4 ML algorithms (decision tree, random forest [RF], gradient boosting, and extreme gradient boosting) were trained. We ensembled the 4 models' predictions to optimize the model.</p><p><strong>Results: </strong>There were 1477 patients identified, of whom 462 (31.3%) completed the survey. 46 (10.0%) patients experienced major FT. The variables most influential in our models included age, race/ethnicity, smoking status, household income, credit score, marital and employment status, size of residence, BMI, histology, extent of resection, and preoperative forced expiratory volume in 1 second. The ensemble model yielded an accuracy of 0.86, precision of 0.93, and sensitivity of 0.86, leading to an F1 score of 0.88, indicative of a reliable algorithm.</p><p><strong>Conclusion: </strong>ML algorithms can accurately identify patients at risk of experiencing major FT following LC surgery. Preoperatively identifying LC patients vulnerable to financial stress may allow an opportunity for intervention to address downstream cost considerations.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542404","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":"Partnerships to Overcome the Peacetime Effect: Excelsior Surgical Society Panel Session.","authors":"Jeremy W Cannon, Danielle B Holt, Benjamin K Potter, Jennifer M Gurney, Matthew D Tadlock, Gordon Wisbach, Matthew Nealeigh, Jay A Yelon, Patrick V Bailey, Johnathan Woodson, M Margaret Knudson, Eric A Elster","doi":"10.1097/XCS.0000000000001371","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001371","url":null,"abstract":"<p><p>The Military Health System (MHS) in the United States currently faces a crisis: maintaining medical readiness during a time of relative peace in the face of an increasingly hostile and unstable geopolitical environment. Collaboration through partnerships-with civilian academic medical centers, with academic medical societies and scientific journals, and with advocates for improved policy and supporting legislation-represents one important strategy to stave off the peacetime effect that threatens to erode our combat casualty care skills. This panel session held during the 2022 Excelsior Surgical Society Symposium at the American College of Surgeons Clinical Congress explored the way forward for the MHS amidst these historic challenges with important action items and take-home points for civilian and military surgeons alike.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542405","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: Second Surgical Opinion for Pancreas Cancer: Resectability May Be in the Eye of the Beholder.","authors":"Bradley N Reames","doi":"10.1097/XCS.0000000000001217","DOIUrl":"10.1097/XCS.0000000000001217","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"278-280"},"PeriodicalIF":3.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349028","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 Head and Neck Multidisciplinary Clinic on Treatment Package Time During 2 Years of the COVID-19 Pandemic: A Single-Institution Experience.","authors":"Sobia F Khaja, Christopher T Wilke","doi":"10.1097/XCS.0000000000001225","DOIUrl":"10.1097/XCS.0000000000001225","url":null,"abstract":"<p><strong>Background: </strong>Prolongation of treatment package time is strongly associated with inferior oncologic outcomes. We examine the effect of creation of a multidisciplinary head and neck clinic on treatment package times.</p><p><strong>Study design: </strong>This was a retrospective cohort study evaluating treatment package time in patients receiving adjuvant radiation through a multidisciplinary clinic compared with standard clinics at a single academic institution between July 31, 2020, and July 31, 2022.</p><p><strong>Results: </strong>Adjuvant radiotherapy was administered to 23 patients in multidisciplinary clinic, 68 patients in standard clinic and 17 patients in satellite clinics. Patients seen in multidisciplinary clinic began adjuvant radiation sooner (median 35 vs 41 vs 48 days, p = 0.01) with more compact treatment package times (median 78 vs 84 vs 86 days, p = 0.003). Nine patients (13%) in standard clinics and 4 patients (24%) at the satellite clinics had adjuvant treatment package times exceeding 100 days. No patient seen in multidisciplinary clinic had treatment package times exceeding 100 days.</p><p><strong>Conclusions: </strong>Colocalization of radiation oncology and otolaryngology care in multidisciplinary clinic substantially improved time to postoperative radiotherapy and treatment package times. This is likely due to the identification of patients requiring adjuvant radiation earlier in their clinical presentation which in turn allowed for advanced planning and minimization of delays in initiation of adjuvant radiation.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"281-287"},"PeriodicalIF":3.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391467","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":"Prospective Study of Contamination Spread Produced During Open Surgical vs Conventional Percutaneous vs Novel Percutaneous Tracheostomy During COVID-19 Era in a Pig Model.","authors":"Shun Ishii, Julia R Amundson, Andrew S Agos, Arthur Tokarczyk, Reynaldo Torre, Kristine Kuchta, Michael B Ujiki, Steven B Greenberg","doi":"10.1097/XCS.0000000000001231","DOIUrl":"10.1097/XCS.0000000000001231","url":null,"abstract":"<p><strong>Background: </strong>Because of concerns about provider contamination during tracheostomy procedures in a pandemic such as COVID-19, it is essential to objectively evaluate aerosol generation in all tracheostomy approaches, including newly developed tracheostomy procedures. We performed open surgical tracheostomy (OST), conventional percutaneous tracheostomy (CPT), and novel percutaneous tracheostomy (NPT), a modification of CPT designed to reduce contamination spread, in pig models and then compared the degree of contamination with providers using Glo Germ (Glo Germ).</p><p><strong>Study design: </strong>Six Yorkshire pigs were used for data collection. Either OST, CPT, or NPT was performed on the pigs by the same team including a surgeon, anesthesiologist, and respiratory therapist. A mixture of Glo Germ and water was administered via an atomizer into the oral cavity to the tracheal bifurcation before each procedure, and additionally dispersed via an aersolizer in the trachea and lungs through the endotracheal tube before and throughout the procedure. Before and immediately after each procedure, prespecified body parts of the providers were photographed and 2 independent examiners blindly evaluated the photographs to determine degree of Glo Germ contamination using a 3-point Likert scale.</p><p><strong>Results: </strong>Total contamination among provider team average score (minimum 0, maximum 2), was significantly lower for OST than CPT (0.29 ± 0.59 vs 0.63 ± 0.65; p < 0.01) or NPT (0.29 ± 0.59 vs 0.59 ± 0.66; p < 0.01). No significant difference was seen in overall contamination of any provider between CPT and NPT (0.63 ± 0.65 vs 0.59 ± 0.66; p = 0.92).</p><p><strong>Conclusions: </strong>Our results suggest that OST causes significantly less aerosol contamination to providers than either CPT or NPT.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"299-306"},"PeriodicalIF":3.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468526","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}