Journal of the American College of Surgeons最新文献

{"title":"Trauma Center Level and Mortality in Injured Patients with Shock or Multisystem Trauma.","authors":"Christopher J McLaughlin, Jamie Song, Joseph A Kern, Mark J Seamon, Niels D Martin, Kristen Chreiman, Patrick K Kim, Patrick M Reilly, Elinore J Kaufman","doi":"10.1097/XCS.0000000000002078","DOIUrl":"10.1097/XCS.0000000000002078","url":null,"abstract":"<p><strong>Background: </strong>Level I and Level II trauma centers share similar clinical verification standards, but differences in volume, subspecialty integration, and transfer patterns may affect outcomes for the highest-risk injured patients.</p><p><strong>Study design: </strong>We performed a retrospective cohort study using the Pennsylvania Trauma Outcomes Study database from 1999 to 2023. Patients aged 16 years or older treated at established Level I or Level II trauma centers with an Injury Severity Score (ISS) higher than 9, transfer to a trauma center, or death at a trauma center were included. Patients treated at centers that changed level, Level III and IV centers, burns, age younger than 16 years, ISS less than 9, and transfers out were excluded from comparative outcome analyses. The primary endpoint was in-hospital mortality. Multivariable logistic regression adjusted for age, Glasgow Coma Scale, presenting vital signs, mechanism, Abbreviated Injury Score, ISS, transfer status, and comorbidities.</p><p><strong>Results: </strong>Among 363,470 patients, 247,800 (68.2%) were treated at Level I centers and 115,670 (31.8%) at Level II centers across 11 Level I and 16 Level II facilities. The proportion treated at Level II centers increased from 23.5% in 1999 to 45.2% in 2023. Level I centers treated younger, more severely injured patients and higher proportions transferred in, presenting in shock, or sustaining blunt multisystem or penetrating truncal injury. Overall mortality was 7.7%, with unadjusted mortality of 8.2% at Level I vs 6.9% at Level II centers. After adjustment, mortality did not differ overall. However, Level I centers had lower adjusted mortality among patients with blunt multisystem trauma and those presenting in shock; no adjusted mortality difference was observed for penetrating truncal injury, isolated traumatic brain injury, or ISS strata.</p><p><strong>Conclusions: </strong>In this mature statewide trauma system, Level I and Level II centers had similar adjusted overall mortality, but Level I centers demonstrated a survival advantage for shock and blunt multisystem trauma. These findings support targeted triage and early-transfer strategies for physiologically unstable and complex blunt-injury patients.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1074-1083"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148277800","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":"Dynamic Reassessment of Pulmonary Embolism Risk After Metabolic-Bariatric Surgery.","authors":"Ramsey M Dallal, Marc Neff, Alec C Beekley, Michael Dougherty, John Leighton","doi":"10.1097/XCS.0000000000002052","DOIUrl":"10.1097/XCS.0000000000002052","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary embolism (PE) after metabolic-bariatric surgery (MBS) is rare but catastrophic. Current approaches to extended chemoprophylaxis rely primarily on discharge-based risk assessment, although postdischarge emergency department (ED) encounters and serious complications may identify additional patients at risk.</p><p><strong>Study design: </strong>Using the MBSAQIP 2020 to 2024 dataset, we evaluated 2 MBSAQIP-derived discharge prediction models for postdischarge PE and analyzed whether reassessment after ED encounters and serious complications improved event identification. Secondary analyses evaluated deep venous thrombosis and composite venous thromboembolism (VTE).</p><p><strong>Results: </strong>Among 949,289 patients, 1,050 developed postdischarge PE, including 820 events (78.1%) after postoperative day 7. Discharge-only prediction models identified few subsequent PE events; the revised calculator identified 83 PEs (7.9%). Incorporating postdischarge ED encounters or serious complications identified an additional 193 PEs (18.4%), increasing total identified events to 265 (25.2%). However, 785 PE events (74.8%) occurred without identifiable discharge predictors, ED encounters, or serious complications. Composite VTE demonstrated similar performance, with 603 of 2,770 events (21.8%) identified and 78.2% occurring outside both predictive signals.</p><p><strong>Conclusions: </strong>Postdischarge PE after MBS is uncommon but largely unpredictable using current risk-stratification approaches. Discharge-based calculators identified <10% of subsequent PE events. Reassessment after ED encounters or serious complications improved identification of patients at risk but still failed to capture most patients who subsequently developed VTE.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1166-1174"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148150362","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: Paying for What Truly Matters.","authors":"Paula Ferrada","doi":"10.1097/XCS.0000000000002098","DOIUrl":"10.1097/XCS.0000000000002098","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1243-1244"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520370","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: Assessing Risk of Pulmonary Embolism: Can We Do Better?","authors":"Claire B Rosen, Eric G Sheu","doi":"10.1097/XCS.0000000000002096","DOIUrl":"10.1097/XCS.0000000000002096","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1174-1175"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520424","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":"Straight-Stick and Robotic Resection for Solid Organ Cancer: A US Hospital-Based National Analysis.","authors":"Alexander Pohlman, Fadi S Dahdaleh, Amit Merchea, Irene Helenowski, Timothy D Lyon, Ismail Mert, Benzon Dy, Layan Alrahmani, Zaid M Abdelsattar","doi":"10.1097/XCS.0000000000002034","DOIUrl":"10.1097/XCS.0000000000002034","url":null,"abstract":"<p><strong>Background: </strong>The comparative effectiveness of robotic-assisted vs conventional minimally invasive (\"straight stick\") approaches across multiple solid organ malignancies remains incompletely defined, limiting evidence-based operative platform selection.</p><p><strong>Study design: </strong>Patients undergoing minimally invasive primary tumor resection for 17 solid organ cancers were identified in the National Cancer Database (2010 to 2022) and stratified by robotic-assisted vs straight-stick approach. The primary endpoint was conversion to open surgery. Secondary endpoints included short-term outcomes and oncologic and technical metrics. Multivariable logistic and negative binomial regression models were used to estimate adjusted associations.</p><p><strong>Results: </strong>Among 2,258,360 patients, 1,339,482 (59.3%) underwent robotic-assisted resection. Robotic surgery was associated with lower adjusted conversion rates compared with straight-stick approaches (6.1% vs 13.6%, p < 0.001), a finding consistent across all organ sites. Robotic approaches yielded approximately 1 additional lymph node on average after adjustment. Length of stay, 90-day mortality, and negative margin rates were overall similar between groups, with variation by disease site.</p><p><strong>Conclusions: </strong>In this large national cohort, robotic-assisted resection for solid organ malignancies was more frequently used and associated with lower conversion rates and modestly higher lymph node yield compared with straight-stick approaches. These findings support consideration of robotic platforms to reduce conversion risk, although equivalence in other short-term outcomes and potential residual confounding warrant cautious interpretation.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1153-1165"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874561","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: Postoperative Fever as a Predictor of Surgical Site Infection in Pediatric Complicated Appendicitis.","authors":"Anna Hoover, Bethany J Slater","doi":"10.1097/XCS.0000000000002054","DOIUrl":"10.1097/XCS.0000000000002054","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1218-1219"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148150315","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 Arms Race Control Score: A Useful Adjunct, not a Solution.","authors":"Jonathan P Meizoso","doi":"10.1097/XCS.0000000000002088","DOIUrl":"10.1097/XCS.0000000000002088","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1238-1239"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148447726","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":"High Incidence of Anastomotic Stenosis in Pancreatoduodenectomy with Distal Portal Vein Resection: An Ileocolic Vein-Based Anatomical Definition.","authors":"Ryota Ito, Yoshihiro Ono, Sho Kiritani, Kosuke Kobayashi, Hiromichi Ito, Yosuke Inoue, Ryuji Yoshioka, Yoshihiro Mise, Akio Saiura, Yu Takahashi","doi":"10.1097/XCS.0000000000002050","DOIUrl":"10.1097/XCS.0000000000002050","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic stenosis after portal vein resection during pancreaticoduodenectomy for pancreatic cancer can result in portal hypertension-related complications, although the anatomical determinants of stenosis remain poorly defined. We evaluated whether the level of superior mesenteric vein (SMV) transection influences postoperative portal vein stenosis after segmental portal vein resection.</p><p><strong>Study design: </strong>Patients who underwent pancreaticoduodenectomy with segmental portal vein resection for borderline resectable or locally advanced pancreatic cancer at 2 centers were retrospectively analyzed. Proximal transection was defined as SMV transection proximal to the ileocolic vein confluence, whereas distal transection was defined as transection at or distal to the ileocolic vein confluence. The primary outcome was nontumorous anastomotic stenosis.</p><p><strong>Results: </strong>Among 276 patients, 232 underwent proximal transection and 44 underwent distal transection. Nontumorous anastomotic stenosis occurred more frequently after distal than proximal transection (40.9% vs 1.7%, p < 0.01). Symptomatic stenosis associated with refractory ascites, varices, or gastrointestinal bleeding was also more common in the distal group (15.9% vs 1.2%, p < 0.01). On multivariable analysis, distal SMV transection independently predicted anastomotic stenosis, whereas portal vein resection length was not associated with stenosis risk.</p><p><strong>Conclusions: </strong>SMV transection at or distal to the ileocolic vein confluence was strongly associated with postoperative anastomotic stenosis and clinically significant portal hypertension-related complications after pancreaticoduodenectomy with portal vein resection. These findings suggest that peripheral SMV reconstruction represents a distinct technical risk factor independent of resection length.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1176-1186"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138463","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":"Short-Term Outcomes of Laparoscopic Hiatal Hernia Repair with Consecutive Transoral Incisionless Fundoplication: A Prospective Multicenter Cohort Study.","authors":"Jennifer M Kolb, Marcia Irene Canto, Brett Parker, Michael Murray, Olaya I Brewer Gutierrez, Reem Z Sharaiha, Barham K Abu-Dayyeh, Peter Janu, Kenneth J Chang, Ninh T Nguyen","doi":"10.1097/XCS.0000000000002059","DOIUrl":"10.1097/XCS.0000000000002059","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic hiatal hernia repair with consecutive transoral incisionless fundoplication (cTIF) offers a combined endoscopic surgical therapy for GERD, but data integrating symptom response with objective physiologic outcomes remain limited.</p><p><strong>Study design: </strong>Prospective multicenter registry of patients with BMI less than 35 kg/m 2 , hiatal hernia less than 5 cm, confirmed GERD, and no earlier antireflux intervention undergoing cTIF across 8 sites. The primary endpoint was clinical success, defined as >50% reduction in GERD-Health-Related Quality-of-Life score within 12 months. Secondary endpoints included normalization of the Reflux Symptom Index, normalization of esophageal acid exposure by pH testing, discontinuation or rare use of proton pump inhibitor (PPI), patient satisfaction, and adverse events.</p><p><strong>Results: </strong>Among 188 patients (mean hiatal hernia size 3 cm), clinical success was achieved in 90% of patients. Improvement in GERD-Health-Related Quality-of-Life score occurred in 90% of patients, and Reflux Symptom Index normalized in 84% of patients. Daily PPI use was discontinued in 84% of patients. Objective testing demonstrated normalization of esophageal acid exposure in 84% of patients and the DeMeester score in 85% of patients. Patient satisfaction increased from 6% preoperatively to 75% postoperatively. The median length of stay was 23 hours (interquartile range 16 to 25). Three serious adverse events occurred (1.6%).</p><p><strong>Conclusions: </strong>cTIF achieves high rates of symptom improvement, PPI discontinuation, and normalization of esophageal acid exposure with low morbidity, supporting its role as an effective strategy for selected patients with GERD.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1220-1229"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148150357","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: When Seconds Matter: Rethinking Persistence in Peripheral Intravenous Access Attempt for Trauma Patients in Hemorrhagic Shock.","authors":"Shea P Gallagher, Thaddeus J Puzio","doi":"10.1097/XCS.0000000000002041","DOIUrl":"10.1097/XCS.0000000000002041","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1117-1119"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964055","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}