Journal of the American College of Surgeons最新文献

{"title":"Remediation for the Forgotten Few: The American Board of Surgery Alternative Pathway II Experience.","authors":"John A Weigelt, Lewis Flint, Carol Scott-Conner, Gerald Isenberg, Steven Steinberg, Nicole Gifford","doi":"10.1097/XCS.0000000000001260","DOIUrl":"10.1097/XCS.0000000000001260","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"282-286"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829142","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":"Limited or Lasting: Is Preoperative Weight Loss as Part of Prehabilitation Maintained after Open Ventral Hernia Repair?","authors":"Alexis M Holland, William R Lorenz, Sullivan A Ayuso, Michael M Katzen, Souma Kundu, David A Rosas, Brittany S Mead, Gregory T Scarola, Vedra A Augenstein, B Todd Heniford","doi":"10.1097/XCS.0000000000001348","DOIUrl":"10.1097/XCS.0000000000001348","url":null,"abstract":"<p><strong>Background: </strong>Obesity is directly correlated with wound complications and recurrence after open ventral hernia repair. Preoperative weight loss (WL) mitigates these risks, improves overall health, and reduces intra-abdominal volume. For patients successful in losing weight, it is unclear whether this WL is maintained.</p><p><strong>Study design: </strong>A prospective, single-institution hernia database was queried for patients with a BMI 25 kg/m 2 or higher who were requested to lose weight and lost a minimum of 10 lbs preoperatively. Patients' weight was examined at 2 timepoints: postoperative appointment 6 months to 1 year and their most recent documented weight.</p><p><strong>Results: </strong>Of 256 included patients, the average age was 58.2 ± 11.2 years, 30.5% of patients were diabetic, and 67.9% of patients were American Society of Anesthesiologists class III or IV. At initial consultation, the average BMI was 38.2 ± 6.6 kg/m 2 and 34.0 ± 5.8 kg/m 2 at the time of surgery. Average preoperative WL was 26.1 ± 17.1 lbs (10 to 120 lbs) over 10.0 ± 13.6 months.At the first postoperative timepoint, the average BMI was 33.6 ± 5.8 kg/m 2 , and patients lost an additional 1.8 ± 16.2 lbs over 8.4 ± 9.0 months after surgery. At 42.0 ± 36.2 months postoperatively, patients gained an average weight of 2.0 ± 27.1 lbs, for a net WL of 24.0 ± 31.9 lbs from consultation. After surgery, 47.3% of patients continued WL for an additional 18.6 ± 26.4 lbs (total net WL: 44.7 lbs) and decreased BMI by 2.5 ± 3.6 kg/m 2 , 0.8% maintained their same weight, and 22.3% gained back less than half of preoperative WL, totaling 70.3% of patients with long-term optimization.</p><p><strong>Conclusions: </strong>Prehabilitation-induced WL averaged 26 lbs. With 3.5 years of follow-up, patients weighed an average of 24 lbs less than their initial consult weight. Nearly half of patients continued WL postoperatively, and >70% maintained at least half of their WL, demonstrating longevity to preoperative optimization.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"171-179"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189732","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: Reshaping Trauma Care: The Role of Personalized Resuscitation and Surgeon Leadership.","authors":"Paula Ferrada","doi":"10.1097/XCS.0000000000001264","DOIUrl":"10.1097/XCS.0000000000001264","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"169-170"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414555","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":"Can Minimally Invasive Reoperation Become the Standard Approach for Postoperatively Diagnosed T2 Gallbladder Cancer?","authors":"Yuichi Takamatsu, Tomoaki Yoh, Etsuro Hatano","doi":"10.1097/XCS.0000000000001393","DOIUrl":"10.1097/XCS.0000000000001393","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"319"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753262","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":"Diminishing Returns: An Analysis of Surgeon Compensation in the Setting of Ever-Increasing Student Debt.","authors":"Angela D Sickels, Katherine McElroy, Joshua Robinson, Herbert Chen, J Bart Rose","doi":"10.1097/XCS.0000000000001257","DOIUrl":"10.1097/XCS.0000000000001257","url":null,"abstract":"<p><strong>Background: </strong>The knowledge required to manage surgical patients has expanded considerably during the past 40 years. Simultaneously, the cost of medical education has increased substantially. Surgical trainees are at a particular disadvantage due to the time demands of training. We aim to determine whether surgeon compensation over time has adequately accounted for increasing student debt burden.</p><p><strong>Study design: </strong>We conducted a retrospective review of data on surgeon salaries and medical education debt from the Medical Group Management Association and Association of American Medical Colleges (2014 to 2019). Inflation adjustment was performed using the consumer price index calculator from the US Bureau of Labor and Statistics. Outcomes of interest included trends in debt, salaries, and the debt-to-income ratio.</p><p><strong>Results: </strong>The median salary for a general surgeon in 1984 was $111,287, and median medical school debt was $22,000, corresponding to a salary of $274,900 and $54,344 in 2019, respectively, representing a 147% increase. The reported median salary for a general surgeon in 2019 was $350,000 (214.5% increase), and medical school debt was $200,000 (809% increase). The debt-to-income ratio increased from 0.2 in 1984 to 0.57 in 2012 and has remained stable since that time. Direct comparison of loan burden and salary reveals that although medical school debt has increased by 268% in the past 40 years, surgeon salaries have increased as well, but not nearly to the same degree (27.3%).</p><p><strong>Conclusions: </strong>The rate of debt accumulation has outpaced the rate of salary growth for general surgeons to a significant degree.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"262-266"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807072","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":"Mentorship in Academic Surgery: Revisiting the Essence of Faculty Development.","authors":"Eric R Carlson, L D Britt","doi":"10.1097/XCS.0000000000001366","DOIUrl":"10.1097/XCS.0000000000001366","url":null,"abstract":"<p><p>Mentorship is one essential element of faculty development that is traditionally described as a relationship between a senior individual who serves as the mentor for a mentee who is a less experienced individual. Permitting the mentee to select the mentor as a form of informal pairing; providing structured training for mentors and mentees; conducting frequent, in-person sessions; and financially and academically recognizing the mentoring activities will be of mutual benefit to mentors and mentees alike, and beneficial to the organization that the mentors and mentees serve. Mentorship represents a discipline distinct from coaching and sponsorship. Mentoring is an intense, holistic, and long-term professional relationship that transforms the mentor and mentee, as well as the organization in which the interaction occurs. Coaching is a focused, short- or long-term professional interaction that is directed at specific goals and objectives that are established by the coachee. Sponsoring represents active support by the sponsor with significant influence and access to resources and who is advocating for the career advancement of the sponsee. All 3 exercises are of known value to permit academic development and academic advancement in faculty development constructs.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"293-298"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483416","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: Implications for Protein Kinase C-β Inhibition in Coronary Artery Endothelial Cell Ischemia and Reperfusion Injury.","authors":"Abeline R Watkins, Emilio I Alarcon, Erik J Suuronen, Marc Ruel","doi":"10.1097/XCS.0000000000001430","DOIUrl":"10.1097/XCS.0000000000001430","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"135-136"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971009","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":"Indocyanine Green Is Not Necessary If the Elements of Calot's Triangle Are Easy to Identify.","authors":"Adriana Toro, Alessandro Terrasi, Ivan Lo Iacona, Isidoro Di Carlo","doi":"10.1097/XCS.0000000000001429","DOIUrl":"10.1097/XCS.0000000000001429","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"316-317"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013323","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":"Equity Landscape in Healthcare Quality: A Mixed-Methods Study of Efforts Within Surgical Quality Programs.","authors":"Jessica K Liu, Courtney E Collins, Anoosha Moturu, Karen Pollitt, Lillian S Kao, Bonnie S Mason, Avery Nathens, Clifford Y Ko","doi":"10.1097/XCS.0000000000001254","DOIUrl":"10.1097/XCS.0000000000001254","url":null,"abstract":"<p><strong>Background: </strong>Addressing equity in healthcare is necessary to improve population health outcomes. In doing so, a requisite level of foundational resources, organization, and processes is needed. Although increasing attention is being devoted to addressing health inequity, the current landscape supporting these efforts remains unknown. We sought to evaluate the presence of frontline resources, organization, and processes for support of health equity efforts in hospitals participating in American College of Surgeons (ACS) quality programs.</p><p><strong>Study design: </strong>Using a mixed-methods design of online surveys and semistructured interviews, we evaluated hospitals with ACS quality programs. Descriptive analytics were applied to survey results; interview transcripts were coded using an inductive approach. Data and methods were triangulated to report key findings.</p><p><strong>Results: </strong>Of the 44 programs invited, 36% completed the survey. Five site program leaders were interviewed. All program leaders reported having a strategy at the institution level for supporting equity efforts and having processes in place for reporting instances of discrimination, mistreatment, or harassment. Survey results demonstrated deficient workforce capacity, lack of engagement, and insufficient organization-negatively impacting efforts. The key themes from interviews were (1) implementation occurred primarily and superficially at the institutional level; (2) barriers to implementation included preemptive structure, lack of prioritization, and insufficient disparity data; and (3) opportunities included enhancing leadership and staff buy-in, increasing available resources, developing health equity champions, and defining clear strategies.</p><p><strong>Conclusions: </strong>Efforts aimed at achieving health equity exist but lack the necessary infrastructure, organization, and processes to support effective frontline practices. The findings from this study support consideration of standards development targeting problems and opportunities at both the institutional and program levels for advancing equity in quality improvement efforts.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"220-229"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801225","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":"Implementation and Validation of Decision-Aid Tool to Reduce Unnecessary Testing Before Thoracic Surgery.","authors":"Ayham M Odeh, Raymond Verm, Jenny Kwak, Marshall S Baker, Madison Lozanoski, Irene Helenowski, Wickii Vigneswaran, James Lubawski, Wissam Raad, Richard K Freeman, Zaid M Abdelsattar","doi":"10.1097/XCS.0000000000001363","DOIUrl":"10.1097/XCS.0000000000001363","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to implement and prospectively validate a previously published decision-aid tool to guide ordering of preoperative type and screen (preT&S) tests.</p><p><strong>Study design: </strong>In this interrupted time-series quasi-experimental study, we implemented a decision-aid tool for patients undergoing elective thoracic surgery at a single academic institution. Data were collected 6 months before and prospectively after implementation. The tool, a previously published nomogram, predicts the need for a preT&S using age, BMI, planned operation, approach, and preoperative hemoglobin. We excluded patients who had previous transfusions, neoadjuvant therapy, redo operations, and/or inpatient consults. We validated the tool using multivariable logistic regression, regression discontinuity, c-index, sensitivity, predictive values, and cost savings.</p><p><strong>Results: </strong>One hundred seventy-seven consecutive patients met the inclusion criteria. Eighty-eight were after implementation and 89 patients were before implementation. No differences were observed between the groups in terms of age, sex, BMI, comorbidities, approach, or preoperative hemoglobin (all p > 0.05). Overall transfusion rates were similar (6.8% vs 6.7%; p > 0.99); however, the rate of ordering preT&S was reduced significantly (94.4% vs 60.2%; p < 0.001). At our institution, the decision-aid tool resulted in cost savings of $25,048 over 6 months alone. With a c-index of 0.977, our validation demonstrated 100% sensitivity, 90.3% specificity, and 100% negative predictive value.</p><p><strong>Conclusions: </strong>Implementation and validation of the preT&S nomogram proved feasible, accurate, and resulted in reducing unnecessary testing and costs before elective noncardiac thoracic surgery. Wider implementation has the potential for substantial cost savings.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"241-251"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468253","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}