Journal of the American College of Surgeons最新文献

{"title":"Cutting of Intersphincteric Space Procedure in Anal Fistulas Is Fundamentally Similar to Transanal Opening of the Intersphincteric Space Procedure.","authors":"Pankaj Garg, Kaushik Bhattacharya, Vipul D Yagnik, Garg Mahak","doi":"10.1097/XCS.0000000000001739","DOIUrl":"10.1097/XCS.0000000000001739","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1461-1463"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145794216","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: Adhesion Barrier Use May Reduce Incidences of Adhesive Small-Bowel Obstruction Without Compromising the Effectiveness of the Ladd Procedure.","authors":"Peter Mattei","doi":"10.1097/XCS.0000000000001722","DOIUrl":"10.1097/XCS.0000000000001722","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1288-1289"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707155","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":"Importance of Workplace Support for Surgeon Parents: A Mixed-Methods Analysis of Challenges and Their Impact on the Surgical Workforce.","authors":"Ekaterina L Koelliker, Atziri Rubio-Chavez, Manuel Castillo-Angeles, Sarah J Halix, Emma Askew, Nikita Roy, Eugene S Kim, Michael J Sutherland, Susan E Pories, Erika L Rangel","doi":"10.1097/XCS.0000000000001694","DOIUrl":"10.1097/XCS.0000000000001694","url":null,"abstract":"<p><strong>Background: </strong>Balancing surgical careers with family life is linked to risk of pregnancy complications, mistreatment, and attrition. Despite national policy recommendations, institutional support is inconsistent.</p><p><strong>Study design: </strong>A survey was distributed by the American College of Surgeons to 32,890 members. An explanatory mixed-methods design was used, combined multivariate logistic regression with thematic analysis of free-text responses. The primary outcome was lack of workplace support (LOWS), a composite measure reflecting inadequate childbearing-related accommodations or cultural support, including stigma, reputational concerns, financial loss, anxiety about burdening colleagues, or concern that family building might hinder advancement.</p><p><strong>Results: </strong>Of 3,539 participants (10.8% response rate), 1,487 parents (525 men, 962 women) were included in the quantitative analysis and 1,059 in the qualitative analysis. LOWS was associated with female sex (odds ratio [OR] 2.52, 95% CI 1.91 to 3.33, p < 0.001), having children during training (OR 1.68, 95% CI 1.03 to 2.75, p = 0.039) or practice (OR 1.87, 95% CI 1.08 to 3.20, p = 0.024) vs during medical school, third-trimester workweeks more than 60 hours (OR 1.45; 95% CI 1.64 to 1.97, p = 0.019), reducing workload during pregnancy (OR 3.62; 95% CI 2.69 to 4.86, p < 0.001), and having fewer children than desired (OR 2.03, 95% CI 1.60 to 2.58, p < 0.001). Risk factors were similar for male and female surgeon parents, except for third-trimester work hours, which were only significant among women. Four qualitative themes emerged: (1) workplace support mitigates perinatal challenges, (2) workplace support shapes surgeons' reproductive decisions, (3) workplace support is essential to work-family integration, and (4) modern surgical practice must support surgeons' dual caregiving and clinician roles.</p><p><strong>Conclusions: </strong>Although LOWS is more common among female surgeon parents, both sexes face support gaps. Sustainable change requires institutional support policies and cultural shifts enabling usage.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1329-1345"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145505370","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":"Contextualizing Access to Postacute Care Services Among Rural Surgical Populations: In Reply to Mullens and colleagues.","authors":"Sara Myers, Kelly Kenzik","doi":"10.1097/XCS.0000000000001743","DOIUrl":"10.1097/XCS.0000000000001743","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1476-1478"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145819881","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":"Excelsior Surgical Society Presidential Address: The Military Surgeon as a Leader: Adaptive Surgical Leadership to Combat the Peacetime Effect.","authors":"Matthew D Tadlock","doi":"10.1097/XCS.0000000000001894","DOIUrl":"10.1097/XCS.0000000000001894","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1163-1173"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147306983","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":"In-Hospital Mortality Prediction of Patients Requiring Extracorporeal Membrane Oxygenation Using Composite Lactate Metrics and Weight-of-Evidence Modeling.","authors":"Pranav Singh, Julie A Rizzo, Seth Lawson, Marla Gutierrez, Ellynor Herico, Jason M Thomas, Michael J Morris, Steven G Schauer, Michael D April, Michal Sobieszczyk","doi":"10.1097/XCS.0000000000001900","DOIUrl":"10.1097/XCS.0000000000001900","url":null,"abstract":"<p><strong>Background: </strong>Mortality prognostication in adult patients requiring extracorporeal membrane oxygenation (ECMO) is not accurate or established. We hypothesized that composite lactate-based metrics and machine-learning models would improve in-hospital mortality prognostication compared with lactate alone in this population.</p><p><strong>Study design: </strong>We conducted a retrospective study of adult patients supported with ECMO at a Level I trauma center from 2022 to 2024 (N = 104). Composite metrics were generated by multiplying lactate by acid-base markers and comparing performance to lactate after Benjamini-Hochberg correction to control the false discovery rate. For machine-learning models, 3 multilayer perceptron architectures were developed using laboratory markers from a patient's hospital admission. Feature attribution through local interpretable model-agnostic explanations guided the development of a weight-of-evidence (WoE) model using only initial laboratory values.</p><p><strong>Results: </strong>The composite metric of average arterial lactate × average arterial bicarbonate was the most significantly elevated marker in nonsurvivors and more significant than lactate alone (false discovery rate-adjusted p = 4.49 × 10 -4 vs 2.14 × 10 -3 ). The 100 × 50 multilayer perceptron architecture achieved 85% accuracy (95% CI 80 to 89%), 87% precision (95% CI 82% to 92%), F1 score of 0.81 (95% CI 0.74 to 0.86), and area under the curve of 0.879 (95% CI 0.84 to 0.92). Local interpretable model-agnostic explanations identified kidney replacement therapy, surrogate respiratory quotient, lactate gradient, and arterial bicarbonate as metrics incorporated in the WoE model achieving 80% accuracy (95% CI 76% to 84%), 70% precision (95% CI 63% to 77%), F1 score of 0.72 (95% CI 0.66 to 0.78), and area under the curve of 0.886 (95% CI 0.853 to 0.920).</p><p><strong>Conclusions: </strong>Composite lactate metrics and the WoE model improved in-hospital mortality prediction in patients requiring ECMO. Prospective studies and external validation are warranted to confirm these findings.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1189-1200"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147343400","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: Robotic Cholecystectomy: Who Benefits?","authors":"J Scott Roth","doi":"10.1097/XCS.0000000000001716","DOIUrl":"10.1097/XCS.0000000000001716","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":"242 5","pages":"1381-1382"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699028","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":"Peroral Pyloromyotomy Should Precede Gastric Electrical Stimulation for Refractory Gastroparesis: Why Comparative Studies Matter: In Reply to Nellis and Sujka.","authors":"Seung Hyeon Shim, Kevin M El-Hayek","doi":"10.1097/XCS.0000000000001899","DOIUrl":"10.1097/XCS.0000000000001899","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":"242 5","pages":"1481-1482"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699049","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 Access and Discharge Practices for Rural Surgical Patients.","authors":"Cody Lendon Mullens, Pasithorn Amy Suwanabol, Janice C Probst","doi":"10.1097/XCS.0000000000001742","DOIUrl":"10.1097/XCS.0000000000001742","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1475-1476"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145819828","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":"Employment Disruption and Insurance Instability Among Patients with Gastrointestinal Cancer Diagnosis.","authors":"Azza Sarfraz, Odysseas P Chatzipanagiotou, Zayed Rashid, Areesh Mevawalla, Abdullah Altaf, Ishika Agarwal, Mujtaba Khalil, Shahzaib Zindani, Meher Angez, Timothy M Pawlik","doi":"10.1097/XCS.0000000000001684","DOIUrl":"10.1097/XCS.0000000000001684","url":null,"abstract":"<p><strong>Background: </strong>Employment and insurance disruptions are common among working-age individuals diagnosed with gastrointestinal (GI) cancers, yet underlying mechanisms and consequences associated with insurance instability remain poorly defined. We sought to characterize the incidence and identify predictors of postdiagnosis insurance instability among patients with GI cancer and assess the mediating role of employment disruption.</p><p><strong>Study design: </strong>The IBM MarketScan Commercial Claims database (2013 to 2020) was used to identify adults with newly diagnosed GI cancer who were employed and continuously insured for 12 months before diagnosis. Insurance instability was defined as any change in healthcare coverage within 12 months postdiagnosis. Generalized structural equation modeling estimated direct and indirect effects mediated by early (1 to 4 months), mid (5 to 8 months), and late (9 to 12 months) employment disruption.</p><p><strong>Results: </strong>Within 12 months after GI cancer diagnosis, 1,163 patients (9.8%) experienced a change in insurance type vs 3,547 controls (8.8%; adjusted hazard ratio [HR] 1.18, 95% CI 1.10 to 1.26). Insurance instability was associated with delayed surgery (adjusted rate ratio 1.15, 95% CI 1.04 to 1.26), earlier chemotherapy (adjusted rate ratio 0.91, 95% CI 0.85 to 0.98), higher out-of-pocket costs ($3,675 vs $3,206, p ≤ 0.001), and total spending ($128,514 vs $116,939, p = 0.016). Insurance instability risk was highest among individuals with HMO (HR 2.60, 95% CI 2.32 to 2.91), exclusive provider organization (HR 1.82, 95% CI 1.52 to 2.17), and comprehensive plans (HR 2.66, 95% CI 2.13 to 3.32) vs preferred provider organizations (p < 0.001). Employment disruption mediated 97.2% (95% CI 93.8% to 100%) of the total effect of insurance instability, with 19.9%, 43.4%, and 34.0% attributed to early-phase, mid-phase, and late-phase employment disruptions, respectively.</p><p><strong>Conclusions: </strong>Insurance instability after GI cancer diagnosis was largely mediated by mid- and late-phase employment disruption, highlighting the need for policies that protect employment and guarantee insurance continuity during cancer care.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1318-1328"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459016","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}