Journal of the American College of Surgeons最新文献

{"title":"Robotic-Assisted vs Laparoscopic Bariatric Surgery and 30-Day Serious Adverse Events: A National MBSAQIP Analysis.","authors":"Ramsey M Dallal, George M Eid, Marc Neff, Daniel F Cottam, Samer G Mattar","doi":"10.1097/XCS.0000000000002049","DOIUrl":"10.1097/XCS.0000000000002049","url":null,"abstract":"<p><strong>Background: </strong>Robotic platforms are widely adopted in bariatric surgery, but whether they improve short-term safety in already standardized, low-morbidity operations remains uncertain.</p><p><strong>Study design: </strong>We performed a retrospective cohort study of 949,507 adults undergoing minimally invasive sleeve gastrectomy, Roux-en-Y gastric bypass, or duodenal switch or single-anastomosis duodenoileal bypass with sleeve gastrectomy at MBSAQIP-accredited US centers from 2020 to 2024. Robotic-assisted laparoscopy (291,483) was compared with conventional laparoscopy (658,024). The primary endpoint was 30-day composite serious adverse events. Anatomy-stratified, conversion-aware multivariable logistic regression with robust SEs and marginal standardization estimated adjusted absolute risk differences.</p><p><strong>Results: </strong>After adjustment for patient demographics, comorbidities, operative year, and conversion status, robotic assistance was associated with higher 30-day serious adverse event risk across procedure types and operative contexts. Adjusted excess risk ranged from 2.4 events per 1,000 primary sleeve gastrectomy cases (95% CI 1.5 to 3.4) to 15.2 events per 1,000 primary duodenal switch or single-anastomosis duodenoileal bypass with sleeve gastrectomy cases (95% CI 5.3 to 25.1). Excess risk was higher in conversion than primary operations for sleeve gastrectomy and Roux-en-Y gastric bypass. Component analysis showed differences distributed across multiple event types, predominantly readmission, reoperation, and reintervention; mortality was rare and similar between platforms. Adjusted excess risk attenuated over time, but the platform-by-year interaction was NS (p = 0.20).</p><p><strong>Conclusions: </strong>In this national MBSAQIP cohort, robotic-assisted bariatric surgery was not associated with improved 30-day patient safety and was associated with small adjusted excess serious adverse event risk. Prospective studies incorporating surgeon- and center-level data are needed before short-term safety benefit is attributed to robotic adoption.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1120-1128"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308658","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: Screening for Delirium: Is More Better?","authors":"Teresa S Jones, Thomas N Robinson","doi":"10.1097/XCS.0000000000002089","DOIUrl":"10.1097/XCS.0000000000002089","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1151-1152"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148422000","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":"Learning Curve or Platform Deficit? Temporal Signal in the MBSAQIP Robotic Bariatric Data.","authors":"Shankar Biswas, Yashasvi Srivastava, Baran Hassan","doi":"10.1097/XCS.0000000000002126","DOIUrl":"10.1097/XCS.0000000000002126","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1245"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701706","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: Vascular Trauma on the Fringes: Blunt Thoracic Aortic Injury Care for the Elderly.","authors":"Erin Greenleaf","doi":"10.1097/XCS.0000000000002057","DOIUrl":"10.1097/XCS.0000000000002057","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1207-1208"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148150337","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":"A Decade In, Still Looking for the Safety Dividend: In Reply to Biswas and Colleagues.","authors":"Ramsey M Dallal","doi":"10.1097/XCS.0000000000002127","DOIUrl":"10.1097/XCS.0000000000002127","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1246-1247"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701554","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":"Efficacy and Safety of Rezūm Water Vapor Thermal Ablation in Large and Small Prostates: A Multicenter Comparative Analysis of 2,725 Patients.","authors":"Mohammed Al-Ogaili, Japnit Dham, Arshia Rangchi, Ahmed Rabie, Maida Bada, Neeraja Tillu, Modassar T Awan, Zachary Dovey, Osama Zaytoun, Maurizio Buscarini","doi":"10.1097/XCS.0000000000002079","DOIUrl":"10.1097/XCS.0000000000002079","url":null,"abstract":"<p><strong>Background: </strong>Rezūm water vapor therapy is well established for benign prostatic hyperplasia in prostates less than 80 cm 3 ; however, evidence in larger glands remains limited despite increasing demand for minimally invasive alternatives to conventional operation. We compared outcomes after Rezūm therapy in patients with large prostate (LP) vs small prostate (SP).</p><p><strong>Study design: </strong>In this multicenter retrospective study, 2,725 patients undergoing Rezūm therapy across 5 centers were stratified by prostate volume: LP (greater than or equal to 80 cm 3 ; n = 993) and SP (less than 80 cm 3 ; n = 1,732). Primary outcomes were 6-month changes in International Prostate Symptom Score (IPSS), IPSS quality of life, peak urinary flow rate, and post-void residual. Secondary outcomes included Sexual Health Inventory for Men scores, complications, and retreatment rates.</p><p><strong>Results: </strong>At 6 months, LP and SP cohorts achieved comparable improvements in IPSS (41.4% vs 41.9%; p = 0.958), quality of life (50.0% vs 50.0%; p = 0.394), and peak urinary flow rate (122.2% vs 118.2%; p = 0.62). LP patients experienced greater reduction in post-void residual (68.8% vs 24.0%; p < 0.001). Sexual Health Inventory for Men scores remained stable in both groups despite a significant between-group difference. Complication rates were similar (5.0% vs 4.9%; p = 0.559). Over a median follow-up of 41 months, LP patients had lower surgical retreatment rates than SP patients (3.6% vs 7.2%; p < 0.001).</p><p><strong>Conclusions: </strong>In this large multicenter cohort, Rezūm therapy provided comparable symptomatic and flow-rate improvements in prostates greater than or equal to 80 cm 3 and less than 80 cm 3 , with greater improvement in bladder emptying and lower long-term surgical retreatment rates among larger glands. These findings support the safety, effectiveness, and durability of Rezūm therapy in appropriately selected patients with prostates greater than or equal to 80 cm 3 .</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1031-1039"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338982","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":"Stick or Switch: Diminishing Returns of Repeated Peripheral IV Access Attempts in Hypotensive Trauma Patients.","authors":"Ryan P Dumas, Bahaa Succar, Michael A Vella, Amelia Maiga, Daniel N Holena","doi":"10.1097/XCS.0000000000002027","DOIUrl":"10.1097/XCS.0000000000002027","url":null,"abstract":"<p><strong>Background: </strong>Peripheral IV (PIV) access is the first-line approach to vascular access in trauma patients. There is no evidence to guide clinicians on when to abandon PIV attempts in favor of alternative access. We sought to characterize PIV success rates, identify factors associated with success, and determine the marginal yield of sequential PIV attempts in hypotensive trauma patients.</p><p><strong>Study design: </strong>We analyzed data from audiovisual recordings of trauma resuscitations from a multicenter, prospective study of vascular access in hypotensive (SBP <90 mmHg) patients. The primary outcome was the PIV attempt success rate. Secondary outcomes included attempt duration and cumulative patient-level success across sequential attempts. Generalized estimating equations with exchangeable correlation structure were used to account for clustering of attempts within patients.</p><p><strong>Results: </strong>A total of 886 PIV attempts occurred in 471 patients across 18 centers. The overall PIV success rate was 67.1%. Male patient sex (adjusted odds ratio 1.92, 95% CI 1.22 to 3.03, p = 0.005) and the presence of a measurable initial systolic blood pressure (adjusted odds ratio 1.84, 95% CI 1.06 to 3.20, p = 0.03) were independently associated with PIV success. The first PIV attempt was successful in 70% of patients, and cumulative success reached 83% by the second attempt. The marginal success rate among patients without earlier success dropped from 70% on the first attempt to 54% on the second and 39% on the third attempt.</p><p><strong>Conclusions: </strong>PIV access in hypotensive trauma patients succeeds approximately two-thirds of the time. The marginal yield of sequential PIV attempts declines substantially after 2 failed attempts. These findings support the practice in which alternate vascular access, such as intraosseous access, is actively considered after a single failed PIV attempt in patients without a measurable blood pressure.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1109-1117"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839548","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":"Flexibility Stigma and the Double Bind of Family Formation in Medical and Surgical Residency.","authors":"Meg C Lovejoy, Ekaterina L Koelliker, Emma A Askew, Jana Zeineddine, Maria Yialamas, Jonathan B Greer, Stephanie L Nitzschke, Keith D Lillemoe, Erika L Rangel","doi":"10.1097/XCS.0000000000002046","DOIUrl":"10.1097/XCS.0000000000002046","url":null,"abstract":"<p><strong>Background: </strong>Persistent burnout, attrition, and mistreatment among pregnant and parenting medical trainees suggest structural deficiencies in training environments. Flexibility stigma-bias against individuals using work-life accommodations within cultures defined by constant availability-may limit the effectiveness of existing policies.</p><p><strong>Study design: </strong>Six-month ethnographic study across 2 internal medicine and 2 general surgery residency programs at 2 academic teaching hospitals. Data were collected through site observations, focus groups, and semi-structured interviews examining program culture, work-life challenges, and accommodation use. Participants included 28 residents who were pregnant or parents of an infant aged 1 year or younger, 23 residents without infants, and 13 program leaders.</p><p><strong>Results: </strong>Flexibility stigma was pervasive across sites, where use of accommodations-particularly for parenting-was perceived as signaling reduced commitment to ideal resident norms of self-sacrifice and constant availability. Anticipated reputational harm led many trainees to forgo accommodations despite consequences for pregnancy health, parenting, relationships, and self-care. Trainees described \"double binds\" between professional expectations and essential personal goals, including becoming a parent, meeting perceived parenting standards, maintaining healthy pregnancies, sustaining relationships, and preserving basic well-being. Program-level factors, including staffing models, scheduling practices, policy communication, community culture, and leadership behavior, variably intensified or mitigated these pressures.</p><p><strong>Conclusions: </strong>Flexibility stigma functions as a structural barrier that limits accommodation uptake and exacerbates competing demands on pregnant and parenting residents. Addressing both cultural norms and program design is necessary to improve trainee well-being, support family formation, and advance equity in surgical and medical training.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1095-1107"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981968","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 Variation in Postoperative Delirium Screening and Outcomes in Older Adult Surgical Patients: A National Analysis of Geriatric and Non-Geriatric Surgery Verification Hospitals.","authors":"Sarah L Remer, Caroline Smolkin, Ronnie Rosenthal, Clifford Y Ko, Marcia M Russell","doi":"10.1097/XCS.0000000000002043","DOIUrl":"10.1097/XCS.0000000000002043","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium in older surgical patients drives morbidity, mortality, and resource usage, yet real-world implementation and impact of standardized screening within older adult-focused surgical programs remain undefined.</p><p><strong>Study design: </strong>Retrospective cohort study of American College of Surgeons NSQIP (from January to December 2024), including inpatients aged 75 years and older. Primary endpoints were postoperative delirium screening and screen positivity. Outcomes were compared between American College of Surgeons Geriatric Surgery Verification (GSV) and non-GSV hospitals, with stratification by hospital-level screening frequency. Secondary endpoints included length of stay (LOS), prolonged LOS (top quartile), and 30-day readmissions.</p><p><strong>Results: </strong>Among 97,886 patients (mean age 81.7 ± 5.3 years), 53.0% underwent delirium screening. Screening was higher at GSV hospitals (94.3% vs 52.5%). Overall delirium screen positivity was 12.5% and did not differ between GSV and non-GSV hospitals (11.3% vs 12.5%, p = 0.25), with similar delirium risk per 100 patient-days. Among screened patients, GSV hospitals demonstrated shorter LOS and fewer prolonged LOS. Among patients with positive delirium screens, LOS, prolonged LOS, and 30-day readmissions were similar across hospital types.</p><p><strong>Conclusions: </strong>GSV hospitals achieve substantially higher delirium screening rates without increased detection, suggesting observed variation reflects screening practices rather than true incidence. Shorter LOS among screened patients at GSV hospitals indicates that structured geriatric perioperative care processes may improve efficiency and outcomes, independent of delirium, whereas outcomes converge once delirium develops.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1141-1151"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148211645","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: Enhanced Recovery After Surgery Protocols and Dose-Response Relationship Between Adherence and Outcomes for Colorectal Procedures.","authors":"Elen Safarian, Fergal Fleming","doi":"10.1097/XCS.0000000000002102","DOIUrl":"10.1097/XCS.0000000000002102","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1200-1201"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584608","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}