Journal of the American College of Surgeons最新文献

{"title":"Invited Commentary.","authors":"Olajumoke Megafu, Muriel Cleary","doi":"10.1097/XCS.0000000000001387","DOIUrl":"10.1097/XCS.0000000000001387","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"882-883"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663827","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 of Electronic Medical Record Interventions to Maximize Opioid Disposal after Surgery in Routine Clinical Practice.","authors":"Yash Deshmukh, Mateo L Amezcua, Brendan W Barth, Robin R Cotter, Richard J Barth","doi":"10.1097/XCS.0000000000001246","DOIUrl":"10.1097/XCS.0000000000001246","url":null,"abstract":"<p><strong>Background: </strong>Despite guideline-directed opioid prescribing after operation, many patients retain excess opioids. Leftover pills increase the risk for misuse, diversion, and dependency. It is unclear whether interventions applied in routine clinical practice can increase excess opioid disposal rate.</p><p><strong>Study design: </strong>All adult patients at our institution with postoperative opioid prescriptions were identified in general surgery, otolaryngology, plastic surgery, neurosurgery, urology, and transplant surgery. Disposal rates for 453 preintervention patients (operation between March 1, 2023, and June 30, 2023) were compared with 545 intervention patients (operation between October 1, 2023, and January 31, 2024). Pre- and postintervention patients were called 1 to 3 months after operation and asked about excess opioids. Interventions include (1) opioid disposal information sheets provided after operation; (2) opioid disposal reminder delivered via patient portal in electronic medical record (EMR); and (3) best practice alert triggered in EMR at postoperative visit reminded providers to discuss opioid disposal.</p><p><strong>Results: </strong>Opioid disposal outcomes were obtained from 70% (699 of 998) of patients. Fifty-four percent (375 of 699) had excess opioids. The percentage of patients disposing of their excess opioids increased from 30% (39 of 130) preintervention to 83% (204 of 245) postintervention (p < 0.00001). Forty-seven percent (247 of 545) of postintervention patients had discussions with their providers after a best practice alert fired at their postoperative visits. Patients who had a provider discussion were more likely to dispose of excess opioids than those who only received an information sheet and patient portal reminder (92% vs 70%, p < 0.00001).</p><p><strong>Conclusions: </strong>Interventions easily incorporated into the EMR as part of routine clinical practice can markedly increase excess opioid disposal rates after operation. When information on opioid disposal and patient portal reminders are combined with disposal discussions with providers at the postoperative visit, opioid disposal rate of >90% can be achieved.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"898-906"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687351","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":"Lessons from the Renaissance for 21st Century Surgeons.","authors":"Rocco Orlando","doi":"10.1097/XCS.0000000000001236","DOIUrl":"10.1097/XCS.0000000000001236","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"843-848"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502702","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, Seyed Alirez Rabi, Thais Faggion Vinholo, Eriberto Michel, Ruby Singh, Asishana A Osho","doi":"10.1097/XCS.0000000000001374","DOIUrl":"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 posttransplantation outcomes among Black and Hispanic minority groups, we investigated the effects of the allocation policy change on these groups.</p><p><strong>Study design: </strong>Adult heart transplantation patients from October 18, 2014, to October 18, 2022, were included from the United Network for Organ Sharing database. Multiorgan transplants and retransplants were excluded. One to one propensity matching was performed by race and ethnicity and allocation score era. The primary outcome was overall (4-year) survival assessed using multivariable Cox regression in an 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, 4,784 Black, and 1,946 Hispanic. White, Black, and Hispanic cohorts in matched analysis demonstrated postallocation 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- (adjusted hazard ratio [aHR] 1.04 [0.92, 1.18], p = 0.514) and postallocation change (aHR 1.10 [0.95, 1.27], p = 0.194). Postallocation change, Black recipients had a higher risk of overall mortality (aHR 1.20 [1.01, 1.42], p = 0.033), whereas Hispanic recipients had lower risk of mortality (aHR 0.72 [0.55, 0.94], p = 0.015) compared with White recipients.</p><p><strong>Conclusions: </strong>This analysis demonstrates improved acute rejection rates postallocation change, by race and ethnicity; however, there remain disparities in short- and long-term recipient mortality for Black recipients in the postallocation 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":"884-896"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085808/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited Commentary.","authors":"Mohamed Elsheikh, Sarah Billmeier","doi":"10.1097/XCS.0000000000001378","DOIUrl":"10.1097/XCS.0000000000001378","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"874-875"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586037","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":"Opioid Prescribing Disparity in Traumatically Injured Patients.","authors":"Sophia M Smith, Rachel Adams, Emily Ha, Wang Pong Chan, Kendall Jenkins, Cara Michael, Noelle N Saillant, Jeffrey A Franks, Sabrina E Sanchez","doi":"10.1097/XCS.0000000000001353","DOIUrl":"10.1097/XCS.0000000000001353","url":null,"abstract":"<p><strong>Background: </strong>Opioid prescribing is understudied in trauma patients, where disadvantaged communities are overrepresented. In this study, we evaluated disparities in opioid administration after trauma.</p><p><strong>Study design: </strong>We conducted a retrospective cohort study of injured adults at a Level I trauma center, 2018 to 2021. Opioids were quantified in milligram morphine equivalents (MMEs). Primary outcomes were receipt of opioids inpatient and at discharge, MMEs per hospital day, and, for patients prescribed opioids at discharge, MMEs and discharge pain control days. Multivariable logistic regression identified factors associated with overall receipt of opioids after injury, general linear modeling identified factors associated with MMEs received inpatient and at discharge, and negative binomial regression evaluated pain control days prescribed at discharge.</p><p><strong>Results: </strong>Of 3,032 patients, 2,514 (82.92%) required opioids as an inpatient and 1,803 (71.72%) still required opioids the day of discharge. Of these, 1,310 (72.66%) were discharged with opioids. Black (β -24.94, 95% CI -37.25 to -12.62, p < 0.001) and Hispanic (β -21.96, 95% CI -39.21 to -4.71, p = 0.01) patients received lower MMEs while inpatient. Factors associated with lower odds of discharge with opioids included non-English language (odds ratio [OR] 0.56, 95% CI 0.38 to 0.82, p = 0.003), substance use disorder (OR 0.69, 95% CI 0.49 to 0.97, p = 0.03), neuropsychiatric comorbidity (OR 0.58, 95% CI 0.39 to 0.87, p = 0.008), and violent injury (OR 0.61, 95% CI 0.45 to 0.85, p = 0.003). On discharge, Black individuals (β -130.71, 95% CI -251.26 to -10.17, p = 0.03) received lower MMEs and patients with substance use disorder (incidence rate ratio 0.65, 95% CI 0.53 to 0.80, p < 0.001) received fewer pain control days.</p><p><strong>Conclusions: </strong>Trauma patients experienced disparities in opioid prescribing throughout hospitalization. Lower opioid doses were administered to non-White patients, while language, mental health comorbidity, and mechanism influenced discharge opioid prescriptions.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"915-925"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391222","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":"Invited Commentary.","authors":"David McAneny","doi":"10.1097/XCS.0000000000001377","DOIUrl":"10.1097/XCS.0000000000001377","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"906-907"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585915","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":"Use of Preoperative Hypoalbuminemia as Independent Predictor of Post-Conversion and Revisional Bariatric Surgery Outcomes: MBSAQIP Registry Analysis.","authors":"Pourya Medhati, Jerry Dang, Eric G Sheu, Ali Tavakkoli, Abdelrahman Nimeri, Thomas H Shin","doi":"10.1097/XCS.0000000000001346","DOIUrl":"10.1097/XCS.0000000000001346","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic conversions and revisions remain crucial in addressing complications or suboptimal outcomes after primary bariatric procedures. Preoperative malnutrition, proxied by hypoalbuminemia, has traditionally been considered a risk factor for postoperative morbidity. This study investigates the validity of this association in revisional and conversion metabolic and bariatric surgery (MBS).</p><p><strong>Study design: </strong>A retrospective cohort analysis was performed on 58,327 MBS revisions and anastomotic conversions from the 2020 to 2022 MBSAQIP registry. Approximately all cases studied were performed laparoscopically (98.8%). A preoperative albumin level of 3.5 g/dL was used as a threshold to identify patients with hypoalbuminemia. We used descriptive statistics, univariate and multivariable logistic regression, and 1:1 nearest-neighbor matching in complete-case analyses to explore the relationship between albumin levels and postoperative outcomes.</p><p><strong>Results: </strong>Although univariate analyses illustrate an association between hypoalbuminemia and postoperative morbidity, multivariable regression and 1:1 matched analysis showed hypoalbuminemia is not an independently significant driver of 30-day overall postoperative complications (including leaks), reoperation, or reintervention. However, 1:1 matched analysis demonstrated significantly increased odds of 30-day postoperative superficial surgical site infection (odd ratio 8.138, p = 0.049) and readmission (odd ratio 1.75, p = 0.045) associated with albumin levels lower than 3.5 g/dL.</p><p><strong>Conclusions: </strong>After adjustment for confounding patient factors, hypoalbuminemia alone did not arise as an independent predictive factor for the 30-day major complications, such as leak, reoperation, or reintervention after revisional and anastomotic conversion MBS, although there may be an increase in surgical site infection and readmission rates.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"868-874"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189743","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":"Shawn J Rangel","doi":"10.1097/XCS.0000000000001380","DOIUrl":"10.1097/XCS.0000000000001380","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"913-914"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585927","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":"Appraisal of Impact of Race-Neutral Estimated Glomerular Filtration Rate Waiting Time Modification on Transplant Wait Time and Outcomes for Black Kidney Candidates: Importance of Transplant Readiness on the Waitlist.","authors":"Amir Ebadinejad, Juan P Cobar, Pamela L Cyr-Long, Wasim Dar, Bishoy Emmanuel, Glyn Morgan, Oscar K Serrano","doi":"10.1097/XCS.0000000000001349","DOIUrl":"10.1097/XCS.0000000000001349","url":null,"abstract":"<p><strong>Background: </strong>In July 2022, the Organ Procurement Transplant Network mandated race-neutral estimated glomerular filtration rate (eGFR) calculations when evaluating kidney transplantation (KT) candidates, replacing historic race-based estimates. This modification also required transplant programs to identify KT candidates on their waitlist who would have benefitted from an earlier waitlist qualification date using race-neutral calculations.</p><p><strong>Study design: </strong>This retrospective study analyzed Black patients listed for KT at our center between 2000 and 2023, recalculating their eGFR using race-neutral formulas. KT recipients with modified wait times (N = 26) were compared with 2 control groups: Black recipients without modifications (N = 21) and non-Black recipients (N = 89). Postoperative outcomes, including complications and readmission rates, were analyzed across groups.</p><p><strong>Results: </strong>Of 126 Black patients evaluated, 60.3% qualified for wait time modifications, with a median gain of 570 days (1.6 years) per patient, totaling 62,057 days (180.7 years). Within 6 months of receiving additional time, 26 patients (34%) were transplanted, mostly from deceased donors (92%) with a median kidney donor profile index of 66%. Black KT recipients with modifications had significantly higher BMI, diabetes, and peripheral vascular disease compared with controls. Readmission rates were higher among Black KT recipients with modifications, although no significant differences in graft loss or mortality were observed.</p><p><strong>Conclusions: </strong>Race-neutral eGFR recalculations substantially improved Black KT candidates' ability to receive a KT, addressing historical disparities in KT. However, higher comorbidities and readmissions among these patients suggest the need for thorough transplant readiness evaluations before waitlist activation.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"859-866"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365005","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}