Journal of the American College of Surgeons最新文献

{"title":"Fairness and Equity as Infrastructure: Rethinking Sustainability in Surgical Practice-Erratum.","authors":"Jad M Abdelsattar","doi":"10.1097/XCS.0000000000002139","DOIUrl":"10.1097/XCS.0000000000002139","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1249"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794701","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":"Rethinking Routine Opioid Prescribing after Ambulatory Breast Operation.","authors":"Christopher M Fiorina, Muhammad Luqman, Erin M Bayley","doi":"10.1097/XCS.0000000000002174","DOIUrl":"10.1097/XCS.0000000000002174","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1247-1248"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794679","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":"Afterthoughts and Implementation of Postoperative Opt-in Treatment after Study Completion: In Reply to Fiorina and Colleagues.","authors":"Serena Y Lofftus, James X Wu","doi":"10.1097/XCS.0000000000002175","DOIUrl":"10.1097/XCS.0000000000002175","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1248"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794645","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 Nearby Hospital Closure on Surgical Services: A Retrospective Quasi-Experimental Study.","authors":"Madeline Goosman, Tynan Friend, Adam R Aluisio, Daithi S Heffernan, Brent Emigh, Stephanie Lueckel, Nicole Dagen, Andrew H Stephen","doi":"10.1097/XCS.0000000000002186","DOIUrl":"10.1097/XCS.0000000000002186","url":null,"abstract":"<p><strong>Background: </strong>Hospital closures are increasing because of consolidation, acquisitions, and rising operating costs, yet their effects on surgical workload redistribution within regional health systems remain poorly defined. We evaluated the impact of an urban hospital closure on operative volume, essential surgical procedures, payer mix, and timing of presentation at a neighboring community hospital (NCH) and a state trauma center (TC).</p><p><strong>Study design: </strong>A retrospective review compared surgical activity before (2015 to 2017) and after (2018 to 2024) closure of an urban hospital. Patient demographics, insurance status, operative volume, and presentation timing were analyzed at the NCH and TC. Essential operations were defined as laparoscopic cholecystectomy, laparoscopic appendectomy, and incision and drainage. Analyses were stratified by ZIP codes previously served by the closed hospital.</p><p><strong>Results: </strong>Following hospital closure, total operative volume increased by 2.9% at the NCH and decreased by 3.5% at the TC. Essential operations increased by 20.2% at the NCH but decreased by 11.6% at the TC. Both hospitals experienced increases in holiday or weekend operations (NCH, 15.8%; TC, 10.3%). Patients from ZIP codes previously served by the closed hospital disproportionately contributed to growth in off-hours surgical care and were more likely to be publicly insured. Private insurance coverage did not differ before vs after closure at either hospital.</p><p><strong>Conclusions: </strong>Closure of an urban hospital was associated with redistribution of urgent surgical care toward neighboring hospitals, particularly increases in off-hours essential operations among publicly insured patients. These findings may inform operating room capacity planning, workforce allocation, and resource deployment across surgical systems serving vulnerable populations.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1051-1059"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874600","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 Postoperative Fever and Antibiotic Use with Surgical Site Infection in Children with Complicated Appendicitis: A Retrospective Cohort Study.","authors":"Johanna M Borst, Alexandra Highet, Willemijn LA Schäfer, Ashley C Dodd, Yao Tian, Kiryung Kim, Seth D Goldstein, Jane L Holl, Brendan T Campbell, Shawn J Rangel, Mehul V Raval","doi":"10.1097/XCS.0000000000002047","DOIUrl":"10.1097/XCS.0000000000002047","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infection risk after pediatric complicated appendicitis remains difficult to predict, driving variable discharge antibiotic prescribing. We evaluated whether postoperative day (POD) 3 or 4 fever stratifies surgical site infection risk and whether discharge antibiotics are associated with lower postdischarge infection among afebrile children.</p><p><strong>Study design: </strong>This retrospective multicenter cohort study used American College of Surgeons NSQIP-Pediatric General and Targeted Appendectomy Participant Use Data Files from 2019 to 2023. Children aged 18 years or younger undergoing appendectomy for complicated appendicitis with 1 or more intraoperative finding were included. Primary exposures were POD 3 or 4 fever and discharge antibiotic prescription. Outcomes were any surgical site infection and postdischarge surgical site infection within 30 days. Multivariable models adjusted for intraoperative findings, age, sex, race and ethnicity, operative approach, operative duration, preoperative WBC, and American Society of Anesthesiologists classification.</p><p><strong>Results: </strong>Among 29,414 children, 3,944 (13.4%) developed surgical site infection. Fever occurred in 1,608 (5.5%). Of those with fever, 758 children (47.1%) developed a surgical site infection, compared with 3,186 of 27,806 (11.46%) children without fever (adjusted odds ratio 6.06, 95% CI 5.44 to 6.75). This association persisted across intraoperative finding strata, with no significant interaction. Of 10,799 children discharged on POD 3 or 4 without fever or predischarge surgical site infection, 7,833 (72.5%) received discharge antibiotics. Postdischarge surgical site infection occurred in 453 of 7,833 children (5.78%) with antibiotics vs 164 of 2,966 (5.53%) without antibiotics (adjusted odds ratio 1.03, 95% CI 0.86 to 1.24), unchanged in the overlap-weighted sensitivity analysis.</p><p><strong>Conclusions: </strong>POD 3 or 4 fever was strongly associated with surgical site infection after pediatric complicated appendicitis. Among afebrile children discharged on POD 3 or 4, discharge antibiotics were not associated with lower postdischarge surgical site infection rates, supporting prospective evaluation of fever-guided antibiotic stewardship.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1209-1218"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148042669","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 Fluorescence for Intraoperative Tumor Identification During Resection of Pediatric and Adolescent Intra-Abdominal Malignancy: A Prospective Multi-Institutional Observational Study.","authors":"Sophia Mv Schermerhorn, Stephen J Hartman, Roshni Dasgupta, Todd M Jenkins, Timothy B Lautz, Zachary Kastenberg, Marcus M Malek, Jennifer H Aldrink, Nelson Piché, Erin G Brown, Jonathan P Roach, Daniel S Rhee, Stephanie F Polites, Dave R Lal, Eugene S Kim, Hau D Le, Elisabeth T Tracy, Dafydd A Davies, Chloé Boehmer, Alexander J Bondoc","doi":"10.1097/XCS.0000000000002056","DOIUrl":"10.1097/XCS.0000000000002056","url":null,"abstract":"<p><strong>Background: </strong>Real-time intraoperative discrimination of malignant tissue during pediatric solid-tumor resection is limited, constraining margin optimization; the use of indocyanine green (ICG) fluorescence in this population remains incompletely defined.</p><p><strong>Study design: </strong>Prospective, observational, multi-institutional study (2019 to 2023) of pediatric, adolescent, and young adult patients undergoing resection of intra-abdominal solid malignancies after preoperative ICG administration. The primary endpoint was diagnostic accuracy of ICG fluorescence for tumor-containing specimens; secondary endpoints included association with margin status and surgeon-perceived intraoperative benefit.</p><p><strong>Results: </strong>Forty-three operations in 42 patients yielded 55 specimens, of which 47 (85%) were malignant. Diagnostic performance was highest in hepatic tumors (sensitivity 83%, positive predictive value 83%) and lower in adrenal and heterogeneous tumor types. ICG avidity was not associated with improved negative margin rates (86% vs 75%, p = 0.47). Surgeons reported intraoperative benefit in 67% of cases, most commonly improved visualization. No ICG-related adverse events occurred.</p><p><strong>Conclusions: </strong>ICG fluorescence provides reliable tumor identification in hepatic malignancies but does not correlate with margin-negative resection, indicating limited use for margin guidance. These data support tumor-specific application and further investigation of optimized fluorescence strategies, including dosing, timing, and alternative fluorophores, in pediatric oncologic surgery.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1061-1071"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148150343","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":"Blunt Thoracic Aortic Injury in the Geriatric Population: Results from the Aortic Trauma Foundation.","authors":"Morgan Gaither, Madeline Petrikas, Alexandra MacHugh, Joshua Crapps, Fiorella Yep Mendizabal, Dimitrios Miserlis, Tatiana Cardenas, Carlos Brown, Pedro Teixeira, Joseph DuBose","doi":"10.1097/XCS.0000000000002051","DOIUrl":"10.1097/XCS.0000000000002051","url":null,"abstract":"<p><strong>Background: </strong>The management of blunt thoracic aortic injury (BTAI) is evolving as the trauma population ages, yet the impact of age on treatment patterns and outcomes remains incompletely defined.</p><p><strong>Study design: </strong>A retrospective analysis of the Aortic Trauma Foundation registry (November 2016 to November 2023) identified 823 patients with BTAI, including 118 geriatric patients (65 years and older). Demographics, injury characteristics, management strategies, and outcomes were compared between the geriatric and younger (younger than 65 years) cohorts.</p><p><strong>Results: </strong>Geriatric patients more frequently presented after falls (17.8% vs 6.7%, p < 0.0001) and had a higher proportion of grade IV injuries (18.5% vs 9.2%, p = 0.0021), with no difference in admission systolic blood pressure (116 vs 116, p = 0.960) or Injury Severity Score (31 vs 33, p = 0.150). Management strategies were similar between groups, including nonoperative (37.3% vs 36.9%, p = 0.932), open (4.2% vs 1.9%, p = 0.132), and endovascular repair (58.5% vs 61.1%, p = 0.584). Despite comparable treatment approaches, geriatric patients had higher in-hospital mortality (27.1% vs 10.9%, p < 0.0001) and aortic-related mortality (8.5% vs 3.4%, p = 0.010).</p><p><strong>Conclusions: </strong>Geriatric patients with BTAI sustain more severe injuries and experience significantly higher mortality despite similar management strategies. These findings suggest that current treatment paradigms may not adequately address age-associated risk and highlight the need for age-specific management considerations.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1202-1207"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138482","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":"Target Trial Emulation of 6-Month Weight Change after Endoscopic Sleeve Gastroplasty and Sleeve Gastrectomy: A Retrospective Cohort Study.","authors":"Zachary D Leslie, Fateh Bazerbachi, Ahmed Dirweesh, Sruthi Shankar, Jordan Sauve, Eric S Wise, Sayeed Ikramuddin, Daniel B Leslie","doi":"10.1097/XCS.0000000000002072","DOIUrl":"10.1097/XCS.0000000000002072","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic sleeve gastroplasty (ESG) offers a less invasive alternative to sleeve gastrectomy (SG) while preserving gastric anatomy; however, comparative effectiveness data from large real-world cohorts remain limited. Using the 2023 MBSAQIP follow-up file, we compared short-term weight-loss and clinical outcomes after ESG and SG.</p><p><strong>Study design: </strong>ESG and SG cases were identified from the 2023 MBSAQIP follow-up file. Using target trial emulation methodology, patients underwent 1:8 nearest-neighbor matching on age, sex, race, diabetes, hypertension, cardiovascular comorbidity, and highest preoperative BMI. The primary outcome was percent weight change from highest preoperative weight to 6 months. The primary analysis used inverse probability of censoring weighting regression to account for missing 6-month weights. Secondary outcomes included 30-day adverse events and 6-month comorbidity and laboratory outcomes.</p><p><strong>Results: </strong>The matched cohort included 3,753 patients (ESG, 417; SG, 3,336). At 6 months, SG achieved greater weight loss than ESG (-18.51% ± 7.98 vs -12.33% ± 6.96; p < 0.001). In inverse probability of censoring weighting regression, SG remained associated with greater percent weight change (ESG coefficient +7.40; 95% CI, 6.59 to 8.21). Absolute adverse-event rates were low in both groups. SG demonstrated more favorable comorbidity outcomes, whereas ESG was associated with higher 30-day and 6-month readmission (3.8% vs 1.6%) and reoperation (1.0% vs 0.3%) rates.</p><p><strong>Conclusions: </strong>In this target trial emulation of a national bariatric registry, SG was associated with greater 6-month weight loss and more favorable short-term comorbidity outcomes than ESG. Although ESG produced clinically meaningful weight reduction with low absolute adverse-event rates, its higher readmission and reoperation rates should be considered during procedure selection and patient counseling.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1085-1093"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148264833","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":"National Evaluation of the Arms Race Control Score in US Neurosurgery Residents.","authors":"Rushmin Khazanchi, Rishi Jain, Sachin Govind, Noah Drewes, Arun Movva, Hamzah Shaikh, Najib El Tecle, Matthew B Potts","doi":"10.1097/XCS.0000000000002093","DOIUrl":"10.1097/XCS.0000000000002093","url":null,"abstract":"<p><strong>Background: </strong>Research productivity has become a critical factor in the neurosurgery residency match process. The Arms Race Control Score (ARCS) was recently proposed to standardize the evaluation of research output for quality and effort. This study is the first to evaluate ARCS among all current US neurosurgery residents.</p><p><strong>Study design: </strong>We collected bibliometric data for neurosurgery residents completing training between 2025 and 2031 in the US (n = 1,574) and computed ARCS values. We stratified residents by median ARCS and compared demographic, academic, and institutional factors. Temporal trends in ARCS and its subcomponents were analyzed using linear regression. We also correlated ARCS with existing research metrics and used multivariate modeling to assess its predictivity.</p><p><strong>Results: </strong>Residents with above-median ARCS were more likely to hold advanced degrees (23.4% vs 12.0%), graduate from NIH Top 40 schools (44.3% vs 26.4%), and match into Doximity Top 25 residencies (44.4% vs 20.8%; p < 0.0001), but were less likely to be women (24.2% vs 30.0%, p = 0.0107). ARCS increased over time ( R2  = 0.7221, p = 0.0155), alongside publication counts ( R2  = 0.8622, p = 0.0025), and the proportion of minimal-effort publications ( R2  = 0.9598, p = 0.0001). Among existing metrics, ARCS was most strongly correlated with the number of publications (ρ = 0.9295, p < 0.0001). Adding ARCS to a multivariate model did not change predictive performance (area under the curve = 0.77).</p><p><strong>Conclusions: </strong>With the recent rise in minimal-effort publications, ARCS may be a valuable tool in residency evaluation. However, it currently appears to be more influenced by publication quantity rather than quality and may offer minimal incremental use.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1230-1238"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148447636","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: Should Rezūm Water Vapor Thermal Therapy Be Considered for Large and Very Large-Volume Benign Prostatic Hyperplasia?","authors":"Ignacio Gondolesi, Michael A Palese","doi":"10.1097/XCS.0000000000002066","DOIUrl":"10.1097/XCS.0000000000002066","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1039-1040"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339040","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}