Journal of the American College of Surgeons最新文献

{"title":"Glimpse of Hope for Patients with Oligometastatic Lung Cancer.","authors":"Kavita Parikh, David Zeltsman, Roman Petrov","doi":"10.1097/XCS.0000000000001458","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001458","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208771","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":"Navigating Operating Room Resource Shortages: Cost, Sustainability, and Environmental Stewardship.","authors":"Richard Hsu, Elissa Trieu, Rebecca Schneyer, Kelly Wright","doi":"10.1097/XCS.0000000000001474","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001474","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208836","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":"Meaningful Community Partnership: Recommendations from the Improving Social Determinants to Attenuate Violence (ISAVE) Workgroup of the American College of Surgeons Committee on Trauma.","authors":"Tracey A Dechert, Altovise Love-Craighead, Meera Kotagal, Randi N Smith, Rochelle A Dicker","doi":"10.1097/XCS.0000000000001466","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001466","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199475","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":"Comprehensive Analysis of a Single-Center Inpatient Post-Transplant Physical Therapy Program in High Acuity Patients: Is It Worth the Effort?","authors":"Ramsey Ugarte, Daisuke Noguchi, Cindy Jaeger, Lowa Yu, Minah Ha, Vatche G Agopian, Douglas F Farmer, Samer Ebaid, Fady M Kaldas","doi":"10.1097/XCS.0000000000001473","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001473","url":null,"abstract":"<p><strong>Background: </strong>High acuity post Liver Transplant (LT) patients often have a prolonged hospital course. In response, we developed a novel, intensive inpatient group physical therapy (PT) program and sought to evaluate its impact on outcomes.</p><p><strong>Study design: </strong>All consecutive adult LT recipients at a single center were retrospectively analyzed (August 2013 - July 2021). Comparative and multivariable regression analysis using 131 variables assessed patients who received group physical therapy (PT) at a dedicated area at our hospital (GYM) and patients receiving standard PT (NON-GYM). Subset analysis of GYM and NON-GYM patients assessed outcomes for high acuity patients (MELD of ≥ 35, ICU admission pre-LT, and hospitalization of ≥ 60 d).</p><p><strong>Results: </strong>1183 consecutive adult LTs were performed during the study period. 302 patients were enrolled in the GYM program. NON-GYM patients had higher rates of in hospital mortality (6% vs. 1%, p<0.001). Multivariate analysis of the entire cohort identified NON-GYM as a significant independent risk factor for in hospital mortality (OR 6.543, 95% CI 2.292-18.681, p<0.001) along with preoperative ventilation, coronary artery disease, unplanned reoperation, and reintubation after LT. High acuity GYM patients were less likely to be reintubated (32% vs. 46%, p=0.048), require postoperative tracheostomy (13% vs. 24%, p=0.038), and had lower in hospital mortality (1% vs 15%, p<0.001).</p><p><strong>Conclusion: </strong>This analysis suggests there may be a significant benefit for high acuity LT patients who undergo intensive inpatient group PT in reducing postoperative reintubation, tracheostomy, and in hospital mortality.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199458","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":"Hospital Factors Associated with Fragmentation of Care in Emergency General Surgery: Less Continuity, Higher Mortality.","authors":"Vahe S Panossian, May Abiad, Christine J Atallah, Ikemsinachi C Nzenwa, Tusharindra Lal, Ameera Mazraany, Joshua Ng-Kamstra, John Hwabejire, Haytham Ma Kaafarani, Michael P DeWane","doi":"10.1097/XCS.0000000000001465","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001465","url":null,"abstract":"<p><strong>Background: </strong>Fragmentation of Care (FOC) is defined as re-admission to a non-index hospital and may be associated with worse outcomes among Emergency General Surgery (EGS) patients. This study assesses hospital characteristics associated with patterns of FOC in EGS patients and the effect of interfacility transfer after FOC on mortality.</p><p><strong>Methods: </strong>Using the Nationwide Readmissions Database 2019, we included patients ≥ 18 years old who were admitted to an index hospital with an EGS diagnosis managed operatively, and had an emergency readmission within 90 days. Patients were classified into four patterns of fragmentation: no FOC, FOC, de-fragmented care (readmitted to a non-index hospital, then transferred back), and hyper-fragmented care (readmitted to a non-index hospital, then transferred to another non-index hospital). Patient severity of illness was defined using All Patient Refined Diagnosis Related Groups (APR-DRG) severity of illness categories. Multivariable logistic regression analyses were used to identify hospital characteristics associated with FOC and the effect of FOC on 90-day mortality.</p><p><strong>Results: </strong>Out of 26,100 patients included, 82.5% had no FOC, 16.4% had FOC, 0.3% had de-fragmented care, and 0.9% had hyper-fragmented care. Index hospital characteristics associated with FOC were small size (by number of beds), private investor or government-owned, and low EGS volumes. Controlling for hospital and patient characteristics, FOC (OR 1.22; 95% CI 1.01-1.47; p=0.045) was significantly associated with increased 90-day mortality, driven by those with major or extreme APR-DRG severity of illness (OR 1.36; 95% CI 1.13-1.64; p=0.001).</p><p><strong>Conclusion: </strong>FOC is associated with worse outcomes in EGS patients. This study highlights the impact of FOC and the hospital characteristics associated with FOC, highlighting the need for further investigation into EGS systems of care.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199474","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":"More Is Better: Individual Risk Assessment for Sentinel Lymph Node Biopsy Selection in Melanoma Improved with More Information In reply to Varey 2025-754.","authors":"Michael E Egger, Walter Rf Donica, Kyle R Stephens, Prejesh Philips, Kelly M McMasters","doi":"10.1097/XCS.0000000000001472","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001472","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199476","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":"Predicting Sentinel Node Positivity in Melanoma Patients: Personalized Tools Outperform National Comprehensive Cancer Network and American Joint Committee on Cancer Based Criteria.","authors":"Alexander Hr Varey, Serigne N Lo, Richard A Scolyer, John F Thompson","doi":"10.1097/XCS.0000000000001471","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001471","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199477","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":"Unplanned Readmission Rate Before Interval Appendectomy After Nonoperative Management of Complicated Appendicitis.","authors":"Zane J Hellmann, Shahyan Rehman, Matthew Hornick, Daniel G Solomon","doi":"10.1097/XCS.0000000000001255","DOIUrl":"10.1097/XCS.0000000000001255","url":null,"abstract":"<p><strong>Background: </strong>There remains clinical equipoise regarding the preference for upfront appendectomy or nonoperative management for patients with complicated appendicitis. However, the natural history of the appendix after nonoperative management and pending interval appendectomy in children is not well characterized, and the risk of recurrent appendicitis as a function of time from index admission not known.</p><p><strong>Study design: </strong>The Pediatric Health Information System was queried for all patients younger than 18 years with an ICD-10 diagnosis code for complicated appendicitis admitted between 2018 and 2021. Patients were included for analysis if they received antibiotics on 3 or more consecutive days and did not undergo appendectomy during index admission. Kaplan-Meier analysis was performed to determine rates of unplanned readmission, defined as patients readmitted for appendicitis and receiving antibiotics on 3 or more consecutive days after index admission.</p><p><strong>Results: </strong>A total of 2,826 patients were included in the study for complicated appendicitis. Of those, 2,016 (71.4%) underwent appendectomy, whereas the remaining 810 did not undergo appendectomy. Kaplan-Meier survival analysis demonstrated a 7% decrease unplanned readmission rates for each additional day patients were removed from index admission (hazard ratio [HR] 0.93, 95% CI 0.89 to 0.96). Additionally, unplanned readmission rates in the first 50 days after index admission were twice as high as days 50 to 100 (HR 2.31, 95% CI 1.76 to 3.05).</p><p><strong>Conclusions: </strong>The highest likelihood of recurrent appendicitis or complication after nonoperative management of complicated appendicitis occurs in the first 50 days after index admission. This information will help surgeons during shared decision-making conversations regarding timing of interval appendectomy.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"908-913"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801249","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":"Overcoming Political Upheaval to Deliver Pediatric Surgical Care in Afghanistan: Prospective Analysis of the First 1,000 Procedures.","authors":"Dunya Moghul, Phillip J Hsu, Emma Bryce, Yalda Obaidy, Zane Hellman, Ajmal Sherzad, Dan Poenaru, Maija Cheung","doi":"10.1097/XCS.0000000000001350","DOIUrl":"10.1097/XCS.0000000000001350","url":null,"abstract":"<p><strong>Background: </strong>Pediatric surgical care is limited in Afghanistan. Few details are known about the state of pediatric surgery in Afghanistan. We explore the impact of a newly installed pediatric operating room by a children's charity on the provision of pediatric surgery in Afghanistan.</p><p><strong>Study design: </strong>After the opening of the new Kids Operating Room at Ataturk Hospital in Kabul, Afghanistan, in March 2023, perioperative clinical data were prospectively collected until December 2023. All children (younger than 14 years of age) undergoing surgical procedures were included in a Research Electronic Data Capture database, and descriptive analyses were performed.</p><p><strong>Results: </strong>A total of 1,014 operations were performed during the study period. Seventy-three percent of the patients were from Kabul Province, and 80% were male. Thirty-four percent of the operations were emergencies. Mean age was 6.5 years. Patients who received elective surgery were, on average, younger (age 5.2 years) compared with those who received emergency surgery (age 7.6 years [p < 0.0001]). The most common emergent diagnoses were appendicitis (52%), intussusception (9%), genitourinary pathologies (8.7%), and neurosurgical trauma (6.1%). The most common elective cases were hernias 27%, undescended testes (18%), hypospadias/epispadias (9%), urinary tract stones (8%), hydrocele/spermatocele/varicocele (7%), gastrointestinal pathologies (7%), and neurosurgical disorders (6%). The most frequent procedures were appendectomy (18%), inguinal hernia repair (17%), and orchidopexy (13%). The rates of mortality and infectious complication were both 0.3%.</p><p><strong>Conclusions: </strong>This is the largest study on the provision of pediatric surgical care in Afghanistan, demonstrating the successful implementation of infrastructure for surgical capacity in a low-resource setting with a complex political status. Future efforts to quantify the burden of untreated pediatric surgical disease in this setting should assist advocacy efforts toward resource allocation and public health initiatives.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"876-882"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382495","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.","authors":"Gloria Chen, Joel T Adler","doi":"10.1097/XCS.0000000000001379","DOIUrl":"10.1097/XCS.0000000000001379","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"866-867"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585921","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}