Journal of the American College of Surgeons最新文献

{"title":"Importance of Perioperative Antibiotic Timing in Elective and Emergency Colorectal Surgery.","authors":"Sarah Peisl, Guido Beldi, Rami Sommerstein, Andreas Widmer, Stephan Harbarth, Beat Schnüriger","doi":"10.1097/XCS.0000000000001686","DOIUrl":"10.1097/XCS.0000000000001686","url":null,"abstract":"<p><strong>Background: </strong>Perioperative antibiotic prophylaxis is crucial in improving outcomes after colorectal surgery. Although guidelines in elective procedures are well established, evidence in emergency settings remains limited. This study evaluated the association between antibiotic timing before incision and 30-day mortality as well as surgical site infections (SSIs) in emergency colorectal surgery.</p><p><strong>Study design: </strong>This nationwide retrospective cohort study analyzed colorectal operations recorded in the Swiss National Infection Surveillance Program. Demographics, antibiotic regimens, and surgical characteristics of consecutive cases were compared between elective and emergency procedures. Independent predictors of 30-day mortality and SSIs were identified using multivariable logistic regression adjusted for patient and surgical factors. Timing of antibiotic administration was modeled using natural cubic splines to assess nonlinear effects.</p><p><strong>Results: </strong>Among 63,945 patients, 16,939 (26.5%) underwent emergency procedures. In the fully adjusted model, antibiotic timing was significantly associated with 30-day mortality (p < 0.001) in both elective and emergency operations. A U-shaped pattern was observed, with the lowest predicted 30-day mortality when antibiotics were administered 48 minutes before incision in elective operations (mean 1.28%, 95% CI 1.15 to 1.40) and 51 minutes before incision in emergency procedures (mean 10.50%, 95% CI 9.71 to 11.20). In contrast, antibiotic timing was not significantly associated with SSIs (p = 0.229).</p><p><strong>Conclusions: </strong>In both elective and emergency colorectal operations, early or late administration of antibiotics relative to the incision was associated with increased 30-day mortality. The lowest risk occurred when antibiotics were administered approximately 50 minutes before incision. These findings support optimizing perioperative antibiotic timing to improve postoperative outcomes in emergency colorectal surgery.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1361-1372"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145482335","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: Cultivating Authenticity in Surgical Training: Reflective Surgical Educational Models, Mentorship, and Professional Identity.","authors":"Sofia Rozani, Pantelis Tsantanis, Vasileios Vougas","doi":"10.1097/XCS.0000000000001699","DOIUrl":"10.1097/XCS.0000000000001699","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1450-1452"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284255","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":"Distinguishing Signal from Perception: What Video-Based Assessment Reveals About Surgical Decision-Making and Technical Performance.","authors":"Divya Kewalramani, Joel Grunhut, Jeffrey Jopling, Mayur Narayan","doi":"10.1097/XCS.0000000000001860","DOIUrl":"10.1097/XCS.0000000000001860","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1478-1480"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146201736","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: The Modern-Day Acute Care Surgeon.","authors":"Peter D Nguyen, Mallory Jebbia, Jeffry Nahmias","doi":"10.1097/XCS.0000000000001859","DOIUrl":"10.1097/XCS.0000000000001859","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1425-1426"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271395","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":"Academies of Medical Educators in Medical Schools: A Supportive Component of Faculty Development Initiatives.","authors":"Eric R Carlson, L D Britt, Ajit K Sachdeva","doi":"10.1097/XCS.0000000000001714","DOIUrl":"10.1097/XCS.0000000000001714","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":"242 5","pages":"1427-1437"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699059","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":"Goals of Care Modeling in the Electronic Health Record: In Reply to Kopecky and Berlin.","authors":"Jeremy A Balch, Gilbert R Upchurch, Tyler J Loftus","doi":"10.1097/XCS.0000000000001884","DOIUrl":"10.1097/XCS.0000000000001884","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1469-1471"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284273","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":"Protecting Healthcare Workers in Conflict Zones: A Universal Human Rights Imperative: In Reply to Ziv and Halaas.","authors":"Tanya L Zakrison, Rishi Rattan, Feroze Y Sidhwa, Anjli Parrin, Marie L Crandall, Thomas K Duncan, Paula Ferrada, Ariel P Santos, Shannon M Foster, Peter Angelos","doi":"10.1097/XCS.0000000000001877","DOIUrl":"10.1097/XCS.0000000000001877","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1465-1468"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284282","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: Polyethylene Glycol-Mediated Axonal Fusion in Peripheral Nerve Repair: Does It Lead to Earlier Return of Nerve Function?","authors":"Carlton Homan, Paul A Ghareeb","doi":"10.1097/XCS.0000000000001696","DOIUrl":"10.1097/XCS.0000000000001696","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1257-1258"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284219","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":"2025 Update to Committee on Surgical Combat Casualty Care Research Gap Analysis: Top 10 Research and Development Priorities for Battlefield Surgical Care.","authors":"James D Wallace, Laura S Kraemer, Matthew J Martin, Martin A Schreiber, John B Holcomb, Jan-Michael Van Gent, Christian S McEvoy, Dylan M Griffiths, Caryn A Stern, Matthew D Tadlock, Jennifer M Gurney","doi":"10.1097/XCS.0000000000001875","DOIUrl":"10.1097/XCS.0000000000001875","url":null,"abstract":"<p><strong>Background: </strong>In 2019, the Joint Trauma System Committee on Surgical Combat Casualty Care identified the \"top 10\" research and development priorities for forward operation. Since then, readiness planning has shifted toward large-scale combat operations (LSCO), which are expected to produce higher casualty volumes coupled with significant resource constraints.</p><p><strong>Study design: </strong>Additional questions addressing anticipated LSCO threats were included with previous research questions from the 2019 web-based survey, which was distributed to the Committee on Surgical Combat Casualty Care membership, who ranked topics on a Likert scale from 1 (low) to 10 (high priority). An analysis of demographics, descriptive and univariate statistics, and interrater correlation was performed.</p><p><strong>Results: </strong>Of 73 surveys, 94.5% of respondents were military. Interrater agreement was high (interrater correlation coefficient 0.91, 95% CI 0.88 to 0.93). Top 5 focus areas included personnel number, mix, and capabilities (7.36); resuscitation and initial hemorrhage management (7.07); Chemical, Biological, Radiation, Nuclear, and Explosives (CBRNE) events and patients (6.87); pain/sedation/anxiety management (6.81); and burn injuries (6.67). CBRNE had the largest positive mean score change (+0.41). Top research priorities included creating dried or shelf-stable blood products/bioartificial blood substitutes (9.12) and optimizing blood product transfusion and storage (8.99). The greatest decrease in priority from 2019 was on REBOA.</p><p><strong>Conclusions: </strong>The 2025 survey identified a broader set of priorities spanning 5 focus areas. Underscoring unresolved threats, 4 topics from 2019 persisted. Six new topics highlighted emerging needs. Priorities shifted away from REBOA toward blood product optimization and shelf-stable or bioartificial substitutes-critical for resource-constrained environments-as well as treatment for burns and CBRNE in LSCO.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1178-1187"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271406","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":"Cutting of the Intersphincteric Space for High Anal Fistula: Functional Preservation and a Predictive Model for Postoperative Anal Incontinence.","authors":"Jiawei Qin, Yanyan Tan, Xueping Zheng, Xu Yang, Yanlan Wu, Kunlan Wu, Gongjian Dai, Yan Ding, Dachao Xu","doi":"10.1097/XCS.0000000000001697","DOIUrl":"10.1097/XCS.0000000000001697","url":null,"abstract":"<p><strong>Background: </strong>Management of high anal fistula (HAF) remains challenging due to risks of recurrence and anal incontinence. This study was undertaken to assess the effectiveness of the cutting of the intersphincteric space (COIS) in HAF and to develop a predictive model for postoperative functional decline.</p><p><strong>Study design: </strong>A prospective single-center cohort study of 146 consecutive patients with HAF who underwent COIS at the Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from January 2021 to July 2024, with an 18-month follow-up was conducted. COIS is a sphincter-preserving technique targeting intersphincteric space dissection to maintain anal sphincter integrity. The primary outcome was the change in anal functional status, measured by the Wexner incontinence score, at 3 months postoperatively. Secondary outcomes included recurrence rate and identification of independent predictors of functional decline via multivariate logistic regression.</p><p><strong>Results: </strong>Significant anal functional decline occurred in 11.6% (17 of 146) of patients, with a recurrence rate of 4.8%. Sex, age, and neutrophil ratio were independent predictors of functional decline (area under the curve 0.739, 95% CI 0.645 to 0.833). A nomogram incorporating these biomarkers demonstrated excellent calibration and clinical use. Single-center design may limit generalizability; external validation in multicenter cohorts is warranted.</p><p><strong>Conclusions: </strong>COIS represents a functionally optimized approach for HAF, balancing radical cure and sphincter integrity. The predictive model integrating systemic biomarkers advances personalized risk assessment, guiding surgical decision-making for patients prioritizing continence. These findings underscore the importance of metabolic and inflammatory profiling in prognostication, shifting the paradigm from anatomy-driven to function-preserving strategies.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1391-1404"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326553","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}