Journal of the American College of Surgeons最新文献

{"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}

{"title":"American Healthcare: Ongoing Threats and Challenges.","authors":"L D Britt","doi":"10.1097/XCS.0000000000001351","DOIUrl":"10.1097/XCS.0000000000001351","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"849-858"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365002","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":"Afshin Ehsan, Jaime Hernandez-Montfort","doi":"10.1097/XCS.0000000000001382","DOIUrl":"10.1097/XCS.0000000000001382","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"896-897"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586007","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 Physiological Stress and Reserve on the Cost of Care: Operative Stress Score and Frailty.","authors":"Timothy L Fitzgerald, Laura Nicolais, Aurora Quaye, Janelle M Richard, Peter Hubbs","doi":"10.1097/XCS.0000000000001467","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001467","url":null,"abstract":"<p><strong>Background: </strong>Physiological stress and reserve negatively impact surgical patients.</p><p><strong>Methods: </strong>Patients undergoing elective surgery were included. Operative stress was defined by operative stress score (OSS) and frailty by RAI.</p><p><strong>Results: </strong>6,182 patients were included. When OSS score of 5, patients were older (67 vs. 65.4), more likely male (70.2 vs 53.9), had longer length of stay (9.7 days vs 3.3 days), and higher mortality (30 days- 3.9 vs. 0.7, 90 days- 6.27 vs. 1.37, and 120 days- 8.24 vs.1.8). Frail patients were older (76 versus 65.4 years), more likely male (68.9 versus 53.9), had higher mortality (30 days- 1.6 versus 0.7, 90 days- 4.4 versus 1.73, and 120 days- 4.7 versus 1.8,), and longer length of stay (4.8 versus 3.3 days). Costs increased with OSS. Net income differed between OSS categories; the highest was OSS of 4 ($9,350 vs. mean $5,213, p < 0.001). Total charges and costs increased with increasing frailty (p < 0.0001). There is a decrease in net income with frailty. Overall, for frail patients, there was a net negative income ($-3,658 vs. $5231, p < 0.0001). Trends were similar with each OSS category (1/2, 3, 4, and 5). Net income was negative for almost all OSS categories in frail (1/2 $-3,658, 3 $-4,440, 4 $971, and 5 $-9,932). Net income was positive for commercially insured but negative for most with Medicare.</p><p><strong>Conclusions: </strong>Increasing OSS was associated with increased costs and profit, and frailty was associated with increased costs and decreased profit. Most with Medicare are cared for at a loss.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187252","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":"Surgery Alone for Resectable Pancreatic Adenocarcinoma: Should We Operate if Multimodal Treatment is Off the Table?","authors":"Roi Anteby, Peter J Fagenholz, Carlos Fernandez-Del Castillo, William G Kastrinakis, Keith D Lillemoe, Motaz Qadan","doi":"10.1097/XCS.0000000000001464","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001464","url":null,"abstract":"<p><strong>Background: </strong>Operative intervention with multimodal therapy, including systemic therapy and/or radiation, is routinely used in the curative-intent treatment of patients with pancreatic ductal adenocarcinoma (PDAC). Occasionally, patients are unable to undergo multimodal therapy. However, contemporary data on the benefit of surgery-alone for patients with resectable PDAC are limited.</p><p><strong>Study design: </strong>The National Cancer Database (NCDB) was queried for patients diagnosed with resectable (clinical stage ≤II) PDAC between 2010-2016. Patients who underwent upfront resection without additional treatment were compared to those who refused surgery, to determine the comparative role of isolated surgical intervention for PDAC. Propensity score matching was used to account for selection bias.</p><p><strong>Results: </strong>A total of 2,391 (6.1%) underwent upfront curative-intent resection without further treatment and 485 (1.2%) refused recommended surgery. Propensity matching resulted in 471 well-balanced pairs. In the surgery group, 30-day and 90-day mortality was 7% (n=33) and 17% (n=81), respectively. Median overall survival (OS) was 14.09 months (95% CI: 12.39, 16.72) compared to 6.34 months (95% CI: 5.72, 6.9) in the no treatment group (log rank test p < 0.001). Estimated 1-year OS rates were 56% (95% CI: 51.7, 60.8) vs. 26% (95% CI: 22.3, 30.6), respectively. For patients who underwent surgery with R0 resection, median OS was 17.87 months (95% CI: 14.7, 21.3) compared to 7.56 months (95% CI: 6.5, 11.5) for non-R0 resection (log rank test p<0.001).</p><p><strong>Conclusions: </strong>This national study of patients with early stage PDAC affirms that surgical resection, in the absence of multimodal therapy, is associated with improved outcomes compared with no resection. However, the association with improved survival is clinically annulled in the absence of a negative-margin resection.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187253","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":"Comparative Long-Term Performance of Biologic, Synthetic, and Long-Acting Resorbable Meshes in Ventral Hernia Repair: Population Survival Kinetics Approach.","authors":"Abdulaziz Elemosho, Jeffrey E Janis","doi":"10.1097/XCS.0000000000001412","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001412","url":null,"abstract":"<p><strong>Background: </strong>Long term follow-up outcomes of ventral hernia repairs (VHRs) with meshes are unavailable. Knowledge of these meshes at distant timepoints will be useful in selecting optimal mesh for VHRs. Our study aims to develop a highly accurate model to validate and predict long-term recurrence data of open VHRs and further determine the optimal timing of follow up for different VHRs with different meshes.</p><p><strong>Study design: </strong>Using population survival kinetics, one-phase non-linear regression analysis (NLRA) was used to determine the overall time-to-recurrence for repairs with all three mesh types. Time-to-recurrence was used to validate and predict the year-over-year recurrence data for each specific mesh type.</p><p><strong>Results: </strong>The model found the median overall time-to-recurrence to be longest for long-acting resorbable meshes (166.4 months), followed by synthetic meshes (132.1 months), and shortest for biologic meshes (80 months). At 5 years, about 41% of VHRs with biologic meshes, 27% with synthetic meshes, and 22% with long-acting resorbable meshes are expected to fail due to recurrence; at 10 years, these rates will rise to 65%, 47%, and 39%, respectively. Biologic meshes will have the highest proportion of \"at-risk\" repairs (42%). At 15-years post-repair 98-99% of the remaining unrecurred VHRs in the biologic and synthetic meshes will remain intact beyond that timepoint. Patients who had VHR with biologic and synthetic mesh should be evaluated for recurrence every 6 months for 2 years, then yearly up to 15 years. Patients repaired with long-acting resorbable meshes should be evaluated for recurrence starting at 12-18 months post-repair, then yearly.</p><p><strong>Conclusions: </strong>We demonstrate the first application of population survival kinetics in the surgery literature. Long-acting resorbable meshes have the longest time-to-recurrence and the lowest recurrence rates over 5 and 10 years, suggesting superior long-term performance compared to synthetic and biologic meshes.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174151","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":"Natural History of Popliteal Artery Aneurysm: Evaluating Percent Thrombus and Size Threshold for Operative Management.","authors":"Tiffany R Bellomo, Guillaume Goudot, Srihari K Lella, Brandon Gaston, Natalie Sumetsky, Shiv Patel, Jiwoo Lee, C Y Maximilian Png, Nikolaos Zacharias, Anahita Dua","doi":"10.1097/XCS.0000000000001461","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001461","url":null,"abstract":"<p><strong>Background: </strong>Popliteal artery aneurysms (PAAs), the most common peripheral arterial aneurysms, are associated with high rates of limb amputation and mortality. This study assessed the risk of adverse events associated with PAA anatomic characteristics and establish threshold values to guide surgical decision making.</p><p><strong>Study design: </strong>A retrospective cross-sectional cohort was queried for all patients with a PAA from 2008 to 2022. Anatomic characteristics included largest diameter defined as the maximum diameter measured in either the anterior posterior or transverse dimension and percent thrombus calculated by dividing the thrombus area by the total aneurysm area and multiplying by 100. A composite outcome, termed any adverse event, included critical limb ischemia (CLI), acute limb ischemia (ALI), rupture, thromboembolic event (TE), or amputation.</p><p><strong>Results: </strong>A total of 131 PAAs in 114 participants that underwent initial medical management were followed pre-operatively over a median period of 7.4 months (IQR 3.4, 12.7), had a mean age of 75 (IQR 70, 83) years old at diagnosis, and were majority white (98%; n=124) and male (98%; n=129). Multivariable models including age, race, sex, and aspirin status showed largest diameter (OR 1.01; 95% CI 1.00-1.01; p=0.044) and higher percent thrombus (OR 4.25; 95% CI 1.22-14.82; p=0.023) were associated with increased adverse events. A diameter threshold of 17.7 mm showed low sensitivity (44.4%), high specificity (91.2%), PPV of 94.1%, and NPV of 34.1%. A percent thrombus threshold of 59% yielded a sensitivity of 72.7%, specificity of 54.2%, PPV of 80.6%, and NPV of 43.2%.</p><p><strong>Conclusion: </strong>These results suggest that size thresholds for PAA repair may warrant reconsideration. Percent thrombus burden may serve as additional criteria for identifying high risk PAAs that warrant operative repair.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174152","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":"What Have We Learned from Dr Peitzman and Prometheus? Improving Outcomes After Major Liver Injuries.","authors":"Chad G Ball","doi":"10.1097/XCS.0000000000001381","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001381","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127839","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":"Bridging Faith and Function: A Seamless Solution for Surgical Inclusivity.","authors":"Zaiba Shafik Dawood, Hasan B Alam","doi":"10.1097/XCS.0000000000001460","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001460","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127833","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}