Journal of the American College of Surgeons最新文献

{"title":"Perceptions of 30-Day Postoperative Function Compared to Quantified Performance: Factors Affecting Perceived Functional Decline in Patients Aged 80 Years and Older.","authors":"Meixi Ma, Xane Peters, Sarah Remer, Lindsey M Zhang, Ronnie A Rosenthal, Thomas Robinson, Clifford Y Ko, Marcia M Russell","doi":"10.1097/XCS.0000000000001496","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001496","url":null,"abstract":"<p><strong>Background: </strong>Older adults value maintenance of function as an outcome of surgery which can be evaluated by subjective perception and objective performance. The aims of this study were to explore whether these perceptions correlate with a decline in function as measured by decreased ability to perform activities of daily living (ADLs) and to identify risk factors associated with worsened 30-day postoperative perceived physical function (PPF) in patients aged 80 and older.</p><p><strong>Study design: </strong>ACS NSQIP Geriatric Surgery Verification Pilot Program data (2015-2017) were used for patients aged 80 and older. Chi-square tests were used to examine concordance between 30-day outcomes of PPF with quantified performance of ADLs. Multivariable logistic regression models identified risks associated with worsened PPF 30-days postoperatively.</p><p><strong>Results: </strong>5,464 patients from 16 hospitals were included. Mean age was 85.7 and 63% were female. At 30-days postoperatively, 33% reported functional decline while 28% had worsened quantified ADL performance (K=0.25). 21% of patients without quantified decline reported worsened PPF. Risk factors for worsened PPF were found for patient (e.g. ASA class IV/V (OR 2.2, 95% CI 1.5 3.2)), procedure (e.g. orthopedic (1.7, 1.2 2.4)), and older adult-specific characteristics (e.g. preoperative fall (1.9, 1.2 2.9)).</p><p><strong>Conclusions: </strong>At 30 days post-surgery, there was discordance between quantified ADL performance and PPF in patients aged 80 and older. While assessing ADLs is a common approach to detect functional decline and loss of independence, directly asking patients about their perceived physical function could serve as an additional important method for identifying functional decline, ensuring that the evaluation remains patient-centered.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663963","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":"Prevalence of Preoperative Palliative Care Needs and Association with Healthcare Use and Cost Among Older Adults Undergoing Major Elective Surgery.","authors":"Jolene Wong Si Min, Yihan Wang, Evan Bollens-Lund, Amanda J Reich, Hiba Dhanani, Claire K Ankuda, Stuart Lipsitz, Tamryn F Gray, Christine S Ritchie, Masami Tabata-Kelly, Zara Cooper","doi":"10.1097/XCS.0000000000001491","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001491","url":null,"abstract":"<p><strong>Background: </strong>Seriously ill older surgical patients with pre-operative palliative care needs, such as those with pain, depression, functional dependence, and care partner needs may benefit from palliative care but their prevalence, characteristics, and outcomes have not been described.</p><p><strong>Study design: </strong>We used data from the Health and Retirement Survey linked to Medicare Claims and included older adults (≥66 years) with and without serious illness who underwent major elective surgery between 2007 to 2019. Exposures included serious illness and pain, depression, functional dependence, and care partner needs before surgery. Outcomes were one-year healthcare utilization and costs (i.e., total hospital days, hospital readmissions, emergency department visits, and Medicare costs).</p><p><strong>Results: </strong>Among 2,499 older adults undergoing major elective surgery, 63% were seriously ill, and 79% reported pain, depression, functional dependence, or care partner needs. Seriously ill older adults with pre-operative palliative care needs experienced higher rates of total hospital days (Incidence Rate Ratio, IRR 2.0, 95% CI 1.5-2.6), hospital readmissions (IRR 2.0, 95% CI 1.6-2.4) and emergency department visits (IRR 1.9, 95% CI 1.6-2.3). Adjusted one-year healthcare costs were significantly higher among seriously ill older adults with these palliative care needs compared to those without serious illness (mean [SE] cost $38,187 [2,291] vs $20,129 [1,742]).</p><p><strong>Conclusion: </strong>Seriously ill older adults undergoing major elective surgery had a high prevalence of palliative care needs which were associated with increased healthcare utilization and costs. These findings highlight the imperative to identify and intervene in older surgical patients who may benefit from palliative care.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642803","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":"Value of Surgical Ethics Teaching Throughout the Undergraduate Medical Curriculum.","authors":"Peter Angelos","doi":"10.1097/XCS.0000000000001493","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001493","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637408","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":"Data Extraction and Curation from Radiology Reports for Pancreatic Cyst Surveillance Using Large Language Models.","authors":"Ankur P Choubey, Emanuel Eguia, Alexander Hollingsworth, Subrata Chatterjee, Michael I D'Angelica, William R Jarnagin, Alice C Wei, Mark A Schattner, Richard K G Do, Kevin C Soares","doi":"10.1097/XCS.0000000000001478","DOIUrl":"10.1097/XCS.0000000000001478","url":null,"abstract":"<p><strong>Introduction: </strong>Manual curation of radiographic features in pancreatic cyst registries for data abstraction and longitudinal evaluation is time consuming and limits widespread implementation. We examined the feasibility and accuracy of using large language models (LLMs) to extract clinical variables from radiology reports.</p><p><strong>Methods: </strong>A single center retrospective study included patients under surveillance for pancreatic cysts. Nine radiographic elements used to monitor cyst progression were included: cyst size, main pancreatic duct (MPD) size (continuous variable), number of lesions, MPD dilation ≥5mm (categorical), branch duct dilation, presence of solid component, calcific lesion, pancreatic atrophy, and pancreatitis. LLMs (GPT) on the OpenAI GPT-4 platform were employed to extract elements of interest with a zero-shot learning approach using prompting to facilitate annotation without any training data. A manually annotated institutional cyst database was used as the ground truth (GT) for comparison.</p><p><strong>Results: </strong>Overall, 3198 longitudinal scans from 991 patients were included. GPT successfully extracted the selected radiographic elements with high accuracy. Among categorical variables, accuracy ranged from 97% for solid component to 99% for calcific lesions. In the continuous variables, accuracy varied from 92% for cyst size to 97% for MPD size. However, Cohen's Kappa was higher for cyst size (0.92) compared to MPD size (0.82). Lowest accuracy (81%) was noted in the multi-class variable for number of cysts.</p><p><strong>Conclusion: </strong>LLM can accurately extract and curate data from radiology reports for pancreatic cyst surveillance and can be reliably used to assemble longitudinal databases. Future application of this work may potentiate the development of artificial intelligence-based surveillance models.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12252180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600853","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":"Are We Overcomplicating Ventral Hernia Repair?","authors":"Clayton C Petro, Ajita S Prabhu, Lucas R A Beffa","doi":"10.1097/XCS.0000000000001492","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001492","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584211","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":"Site Reviewer Perspectives on the Implementation of the Commission on Cancer Operative Standards.","authors":"Alison S Baskin, Timothy Kravchenko, Elizabeth C Funk, Amanda B Francescatti, Tina J Hieken, Samantha K Hendren, Judy C Boughey, Ronald J Weigel, Daniel Boffa, Lesly A Dossett","doi":"10.1097/XCS.0000000000001462","DOIUrl":"10.1097/XCS.0000000000001462","url":null,"abstract":"<p><strong>Background: </strong>To reduce technical variation in cancer surgery, the Commission on Cancer (CoC) recently implemented six operative standards as part of its national cancer center accreditation process. CoC sites are evaluated for compliance with these standards through scheduled visits conducted by trained site reviewers. We characterized site reviewers' perspectives on the implementation of the operative standards.</p><p><strong>Study design: </strong>Twenty interviews were conducted with CoC site reviewers using a semi-structured interview guide based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Themes were identified using thematic analysis, mapped to the updated Consolidated Framework for Implementation Research (CFIR).</p><p><strong>Results: </strong>Site reviewers viewed the operative standards as an effective starting point for improving technical quality and were optimistic the standards would lead to positive change. Compliance was associated with supportive site leadership, effective interdisciplinary communication, and the availability of adequate personnel and institutional resources. In contrast, resistance from surgeons was identified as a key barrier. CoC site reviewers interpret their role as extending beyond assessing compliance, viewing themselves as advocates, educators, and partners to the sites.</p><p><strong>Conclusions: </strong>Overall, CoC site reviewers perceive the operative standards favorably. To enhance implementation of the operative standards, efforts should focus on modifiable institutional and individual level factors, such as leadership support and surgeon engagement. Additionally, the multifaceted role of the site reviewers presents a valuable opportunity to improve compliance by formalizing the supportive relationship between reviewers and sites.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584212","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: Not Just Another Gallbladder: Why Acute Care Surgery Saves More Than Time.","authors":"Paula Ferrada","doi":"10.1097/XCS.0000000000001427","DOIUrl":"10.1097/XCS.0000000000001427","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"104-105"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016445","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":"Feasibility, Outcomes, and Odds of Same-Day Surgery in Laparoscopic Elective Repair of Type IV Hiatal Hernia with Intrathoracic Stomach.","authors":"Nikhil Erabelli, Ethan Bui, Shalin Shah, Clarissa Hoffman, Connor Fritz, Farzaneh Banki","doi":"10.1097/XCS.0000000000001357","DOIUrl":"10.1097/XCS.0000000000001357","url":null,"abstract":"<p><strong>Background: </strong>To assess the feasibility, outcomes, and odds of same-day surgery (SDS) in the laparoscopic elective primary repair of intrathoracic stomach (ITS). To assess the significance of percentage of intraoperative gastric incarceration in planning SDS.</p><p><strong>Study design: </strong>ITS was defined as 100% gastric herniation into the chest on preoperative imaging. The percentage of intraoperative gastric incarceration into the chest was assessed, and patients with partial gastric incarceration were compared with those with 100% incarceration. Planning for SDS started in 2019.</p><p><strong>Results: </strong>From 2012 to 2024, there were 1,057 hiatal hernia repairs and 190 of 1,057 (18%) primary laparoscopic ITS repairs; 8 procedures in which percentage of intraoperative gastric incarceration was not documented were excluded, and 182 procedures were included; 127 of 182 (69.8%) were elective: 58 of 127 (45.7%) had intraoperative partial gastric incarceration and 69 of 127 (54.3%) had 100% incarceration. Since planning for SDS started, there were 56 elective repairs. SDS was planned in 36 of 56 (64.3%) and was performed in 33 of 36 (91.7%). Comparing 33 of 56 (58.9%) procedures performed as SDS to 23 of 56 (41.1%) not performed as SDS showed comparable sex, age, BMI, and American Society of Anesthesiologists class. The operative time was 117 (interquartile range 100 to 144) minutes vs 129 (interquartile range 110 to 167), p = 0.134, emergency department visits were 5 of 33 (15.2%) vs 3 of 23 (13.0%), p = 1.00, and readmissions 4 of 33 (12.1%) vs 1 of 23 (4.3%), p = 0.64. The odds of SDS were comparable for sex, age, BMI, percentage of intraoperative gastric incarceration, and operative time.</p><p><strong>Conclusions: </strong>The percentage of gastric herniation on preoperative imaging does not correlate with the percentage of intraoperative gastric incarceration in about half of patients with ITS. SDS is feasible in the majority of laparoscopic elective ITS repairs and can be performed with good outcomes in patients with intraoperative partial or 100% gastric incarceration.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"55-65"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408616","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":"Comparison of Laparoscopic Cholecystectomy Reimbursement Rate and Medical Malpractice Insurance Premium Cost Across the US from 2013 to 2023.","authors":"Natasha A Sioda, David Etzioni, Kenan Shawwaf, Zhi Ven Fong, Justin T Brady, Kayla L Haydon, Ga-Ram Han, Emily Thompson, Irving Jorge","doi":"10.1097/XCS.0000000000001376","DOIUrl":"10.1097/XCS.0000000000001376","url":null,"abstract":"<p><strong>Background: </strong>Within the US, there has been an overall increase in cost of malpractice insurance for surgeons and decrease in federal reimbursement for surgical work. This study aimed to analyze state-to-state variability to understand differences in costs relative to reimbursement for surgeons and temporal trends.</p><p><strong>Study design: </strong>This study uses publicly available data to conduct a cross-sectional evaluation of surgeon medical malpractice premium rates and surgical reimbursement between 2013 and 2023. Surgeon reimbursement was represented in terms of the unit reimbursement rate for laparoscopic cholecystectomy (LC). The ratio of surgeon reimbursement to malpractice cost was calculated and considered as the number of LCs required in each state to cover the cost of malpractice insurance.</p><p><strong>Results: </strong>Inflation-adjusted reimbursement for LC decreased in all states with a mean decrease of 24%. Although there was an overall decrease in inflation-adjusted medical malpractice premium cost, some states experienced an increase of up to 22% (Rhode Island), whereas other states experienced a decrease in cost of 62% (Oregon). For the year 2023, there was significant variability in the number of LCs needed to afford malpractice insurance premiums across states, ranging from 21 (Minnesota) to 163 (Illinois). Rhode Island experienced the greatest increase in change from 2013 to 2023 (63%), whereas Oregon experienced the greatest decrease (50%).</p><p><strong>Conclusions: </strong>This study finds significant variation in Medicare-based surgeon compensation relative to malpractice insurance costs across the US. This discrepancy highlights the challenges faced by surgical practices due to inconsistent insurance cost and decreases in reimbursement rates.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"77-86"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573303","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":"Prehospital Tranexamic Acid and First 24-Hour Blood Product Transfusion in Patients with Isolated Traumatic Brain Injury.","authors":"Zachary C Newman, W Ian McKinley, Rachel K Nordgren, David V Deshpande, Claire E Barbosa, Pierce E Pramuka, Andrew J Benjamin, Martin A Schreiber, Susan E Rowell","doi":"10.1097/XCS.0000000000001401","DOIUrl":"10.1097/XCS.0000000000001401","url":null,"abstract":"<p><strong>Background: </strong>Tranexamic acid (TXA) is an antifibrinolytic drug known to reduce mortality in bleeding trauma patients, yet the evidence of TXAs impact on blood product use within this population is conflicting. In patients with traumatic brain injury (TBI), the impact of TXA on transfusion remains unclear.</p><p><strong>Study design: </strong>This is a secondary analysis of the prehospital TXA for TBI trial that enrolled patients in the prehospital setting with a Glasgow Coma Scale score of 3 to 12 and not in shock (systolic blood pressure < 90 mmHg) before enrollment within 2 hours of injury. Subjects with isolated TBI (iTBI; Abbreviated Injury Scale Head score 3 or greater and Abbreviated Injury Scale 2 or less in any other category) were included. Factors associated with transfusion were characterized using logistic regression.</p><p><strong>Results: </strong>Of 966 patients enrolled in the primary trial, 306 subjects met the definition of iTBI and were included (101 in the 2-g prehospital TXA bolus arm, 97 in the 1-g prehospital TXA bolus or 1-g in-hospital TXA infusion arm, and 108 in the placebo arm). In multivariable regression analysis, receipt of a 1-g TXA bolus or 1-g TXA infusion (odds ratio 0.27, p = 0.03) and receipt of TXA after combining TXA treatment arms (odds ratio 0.32, p = 0.02) were associated with decreased odds of red cell transfusion.</p><p><strong>Conclusions: </strong>In subjects with iTBI, prehospital TXA may be associated with lower odds of red cell transfusion compared with placebo. This effect was likely mediated by treatment group imbalances in the percentage of subjects with a penetrating mechanism of injury, as well as the need for emergent neurosurgical intervention.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"7-15"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780420","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}