Journal of the American College of Surgeons最新文献

{"title":"Beyond the Metric: Defining Quality in Resident Consultations.","authors":"Caroline O Smolkin, Clifford Y Ko","doi":"10.1097/XCS.0000000000002265","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002265","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238705","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":"Palliative Care in Surgery: Updated Research Priorities from the Surgical Palliative Care Research Expert Consensus Conference.","authors":"Bonnie O Wong, Daniel I Hoffman, Kenneth Williams, Claire Morton, Masami Tabata-Kelly, Christina Sheu, Katherine Hill, Ana Berlin, Lauren J Taylor, Kimberly Kopecky, Karleen Giannitrapani, Emily Rivet, Nneka Ufere, Jordan M Cloyd, Amanda J Reich, Zara Cooper, Elizabeth J Lilley","doi":"10.1097/XCS.0000000000002260","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002260","url":null,"abstract":"<p><strong>Background: </strong>Surgical palliative care (SPC) research has advanced since the 2017 research agenda, but persistent gaps in patient selection, intervention delivery, and outcome measurement limit implementation across evolving surgical care settings.</p><p><strong>Study design: </strong>In November 2025, a national consensus conference convened 28 SPC experts and researchers. Through iterative discussion and consensus-building during the meeting and subsequent months, participants updated research priorities across the surgical continuum and health system context. Full methodology and participant attributes were described in Supplemental Materials https://links.lww.com/JACS/A821.</p><p><strong>Results: </strong>The updated agenda identified 11 research gaps across 3 priority areas: patient selection; interventions, care processes, and competencies; and outcome measurement. Priorities were mapped at 2 levels: surgical episodes, encompassing patient-, family-, and provider-level factors, and health systems, encompassing organizational and structural factors affecting SPC delivery. The agenda prioritizes identifying which patients benefit from SPC and when; broadening SPC beyond traditional populations; defining primary SPC competencies and the role of specialty consultation; improving communication of surgical intent, trade-offs, and preference-sensitive decisions; integrating and sustaining SPC across heterogeneous systems and care transitions; transforming clinical cultures; and developing patient-centered, context-specific surgical and systems-level outcomes. Emerging electronic health record, natural language processing, and large language model approaches may support scalable patient identification, intervention delivery, and outcome measurement, while requiring attention to bias and task-dependent performance.</p><p><strong>Conclusions: </strong>SPC research should move beyond narrow proof-of-concept settings toward pragmatic, scalable approaches that define who should receive SPC, what should be delivered, and how success should be measured across diverse surgical environments.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220336","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":"Sex, Age, and Survival in Traumatic Shock: An Ongoing Question, Not Yet an Answer.","authors":"Patricia Martinez Quinones, Nour Hassan","doi":"10.1097/XCS.0000000000002262","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002262","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220398","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":"Nutritional Support: Bridge or Destination?","authors":"Hiley D Cammock, Eric G Sheu","doi":"10.1097/XCS.0000000000002250","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002250","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194802","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":"Beyond Survival: Recovery After Traumatic Injury, Does Time Do the Trick?","authors":"Anna Goldenberg-Sandau","doi":"10.1097/XCS.0000000000002217","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002217","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194818","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":"Evaluation of Vision-Language Models for Surgical Narration and Critical View of Safety Assessment in Laparoscopic Cholecystectomy.","authors":"Rita Glazer, Philip Seger, Brendan Fox, Garrett Skinner, Jiajie Li, Kaity Tung, Andrew Chang, Jeremy Walsh, Matthew Handmacher, Ben Ham, Andrew Nordin, Shinil Shah, Gene Yang, Steven Schwaitzberg, Peter Cw Kim","doi":"10.1097/XCS.0000000000002259","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002259","url":null,"abstract":"<p><strong>Background: </strong>Vision-language models (VLMs) may support surgical documentation through operative video narration, but fluent narration may not capture procedural details or safety-critical anatomy. We compared VLM-generated laparoscopic cholecystectomy narrations with surgeon narration and evaluated Critical View of Safety (CVoS) assessment.</p><p><strong>Study design: </strong>Forty-eight 10-minute segments from 13 Cholec80 videos were evaluated using Gemini 2.5 Flash (Untrained VLM) and Qwen3-VL-CoA (Surgically Trained VLM) under Basic and procedure-specific prompting. VLM and surgeon narrations were compared for structure, semantic similarity, checklist-based procedural content, and CVoS recognition.</p><p><strong>Results: </strong>Attending narrations averaged 490.6 words versus 243.9-252.5 for VLMs. Specific prompting increased cosine similarity for both VLMs (0.507 to 0.593 and 0.543 to 0.584; both adjusted p<0.001), but checklist F1 improved only for the Untrained VLM (0.405 to 0.501; adjusted p=0.006), not the Surgically Trained VLM (0.337 to 0.380; adjusted p=0.233). Among 6 CVoS-positive and 42 CVoS-negative segments, Untrained Specific had sensitivity 0.33 (95% CI 0.10-0.70) and specificity 0.95 (95% CI 0.84-0.99); Surgically Trained Specific had sensitivity 0.83 (95% CI 0.44-0.97) and specificity 0.19 (95% CI 0.10-0.33).</p><p><strong>Conclusions: </strong>Procedure-specific prompting increased similarity to attending narration without consistently improving procedural content. Divergent CVoS errors demonstrate that fluent surgical narration does not establish reliable safety assessment. VLM narration may support surgeon-reviewed documentation, but safety-critical judgments require separate task-specific validation.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182244","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":"Environmental Justice Index and 30-Day Wound Morbidity After Ventral Hernia Repair.","authors":"Ali Alipouriani, William C Bennett, Jenny H Chang, Divya L Deverakonda, Diana C Jimenez, Xinyan Zheng, David M Krpata, Ajita S Prabhu, Lucas R A Beffa, Clayton C Petro, Luciano Tastaldi, Sofya Asfaw, Benjamin T Miller","doi":"10.1097/XCS.0000000000002255","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002255","url":null,"abstract":"<p><strong>Background: </strong>Place-based vulnerability may contribute to wound morbidity after ventral hernia repair (VHR), but the relevance of multidomain Environmental Justice Index (EJI) rankings is uncertain. We evaluated associations between overall and module-specific EJI rankings and 30-day wound outcomes.</p><p><strong>Study design: </strong>This retrospective cohort study included 35,626 patients undergoing clean VHR with hernia width ≤18 cm in the Abdominal Core Health Quality Collaborative. Parastomal hernias and repairs involving anterior component separation were excluded. Overall EJI and social, environmental, health, and climate module rankings were modeled per 0.1-point increase. Multivariable logistic regression with institution-clustered robust standard errors evaluated surgical site infection (SSI), surgical site occurrence (SSO), and SSO requiring procedural intervention (SSOPI), adjusting for patient, hernia, and operative characteristics.</p><p><strong>Results: </strong>SSI, SSO, and SSOPI occurred in 1.9%, 8.1%, and 1.8%, respectively. Overall EJI was associated with SSOPI (OR 1.05, 95% CI 1.01-1.09), but not SSI or SSO. Social vulnerability was associated with SSO (OR 1.06, 95% CI 1.02-1.10) and SSOPI (OR 1.09, 95% CI 1.05-1.14). Health vulnerability was associated with SSI (OR 1.03, 95% CI 1.00-1.07), whereas climate burden was inversely associated with SSI (OR 0.95, 95% CI 0.91-0.99). Highest-versus-lowest EJI stratum absolute risk differences were not statistically significant.</p><p><strong>Conclusions: </strong>Social vulnerability demonstrated the most consistent association with wound morbidity after VHR. EJI may provide complementary contextual information for perioperative assessment, but modest absolute differences do not support its use as a standalone clinical decision tool.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182317","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":"Does Time Truly Heal All? A Prospective Cohort Study of 6- To 12-Month Recovery Transitions After Traumatic Injury.","authors":"Saba Ilkhani, John T Figi, Avery A Thompson, Alexander J Ordoobadi, Manuel Castillo-Angeles, Haytham Kaafarani, Sabrina E Sanchez, Ali Salim, Juan P Herrera-Escobar, Geoffrey A Anderson","doi":"10.1097/XCS.0000000000002257","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002257","url":null,"abstract":"<p><strong>Background: </strong>Recovery after traumatic injury may extend beyond conventional follow-up, but longer-term changes in function, quality of life (QoL), and return to work (RTW) remain incompletely characterized.</p><p><strong>Study design: </strong>English- or Spanish-speaking patients with Injury Severity Score ≥9 from three US Level I trauma centers completed telephone surveys 6 and 12 months after injury. Recovery was characterized as improved, stable, or declined between timepoints. Function was assessed across six Trauma Quality of Life domains; QoL and RTW by self-report; and mental health using GAD-7, PHQ-8, and Breslau PTSD scales. Multivariable logistic regression evaluated predictors of QoL decline. Sensitivity analyses examined traumatic brain injury (TBI), isolated long bone fracture, and general trauma.</p><p><strong>Results: </strong>Among 1,894 patients, 49% of those impaired at 6 months improved, 41% were unchanged, and 11% worsened by 12 months. Patients ≥65 more often improved (20% vs. 16%) and declined (16% vs. 9%) than those <65; surgical patients more often improved (20% vs. 16%). QoL improved in 22%, remained stable in 56%, and declined in 22%. TBI patients had the greatest functional improvement (55%), whereas long bone fracture patients had the greatest QoL improvement (26%). Weak social support (aOR 3.68) and mental health symptoms were associated with QoL decline. RTW reached 61% by 6 months; 74% of non-returners remained so at 12 months.</p><p><strong>Conclusions: </strong>Recovery remains dynamic beyond 6 months after trauma, supporting extended follow-up and individualized rehabilitation. Associations of mental health symptoms and weak social support with QoL decline support incorporating their assessment into post-injury care.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182298","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":"Real-World Use and Outcomes of Post-Discharge Venous Thromboembolism Prophylaxis After Thoracic Cancer Operation.","authors":"Elio R Bitar, Andrew Hawkins, Kaelyn C Cummins, Olivia Sears, Mohamad El Moheb, Emily Rabinovich, Lauren Carroll, Samantha M Ruff, Thomas Shin, Julliard Walker, Allan Tsung","doi":"10.1097/XCS.0000000000002256","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002256","url":null,"abstract":"<p><strong>Background: </strong>Post-discharge venous thromboembolism prophylaxis is conditionally recommended after thoracic cancer operation, but real-world use and associated outcomes across procedures and operative approaches remain poorly characterized.</p><p><strong>Study design: </strong>We conducted a retrospective Epic Cosmos cohort study of adults undergoing lung or esophageal cancer resection from 2016-2025. Post-discharge prophylaxis was defined as prophylactic-dose anticoagulation prescribed within 7 days of discharge. Thirty-day outcomes were compared using 1:3 propensity-score matching stratified by procedure and operative approach.</p><p><strong>Results: </strong>Among 157,619 patients (14,277 esophagectomy; 143,342 lung resection), 11.15% and 1.48%, respectively, received post-discharge prophylaxis. After open esophagectomy, prophylaxis was associated with lower DVT (1.23% vs 2.63%; p=0.039), PE (0.46% vs 1.44%; p=0.047), and mortality (1.70% vs 5.20%; p<0.001), without significantly increased bleeding. Findings were similar after minimally invasive esophagectomy: DVT 0.32% vs 1.46% (p=0.003), PE 0.21% vs 0.89% (p=0.034), and mortality 1.28% vs 3.20% (p=0.003). After open lung resection, prophylaxis was associated with lower PE and mortality but higher bleeding and healthcare use. After minimally invasive lung resection, thromboembolic outcomes did not significantly differ, while bleeding and healthcare use were higher. Enoxaparin accounted for 79.35% of prophylaxis prescriptions; thromboembolic outcomes did not significantly differ between apixaban and enoxaparin.</p><p><strong>Conclusions: </strong>Associations between post-discharge thromboprophylaxis and outcomes differed across thoracic procedures and operative approaches. Favorable associations after esophagectomy contrasted with less consistent lung resection findings, supporting prospective studies to define procedure- and risk-specific prophylaxis strategies.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182236","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":"Nutritional Independence After Bariatric Surgery: Recovery, Reintervention, and Long-Term Survival.","authors":"Mélissa V Wills, Pattharasai Kachornvitaya, Xinlei Zhu, Andrew T Strong, Matthew D Kroh, Valentin Mocanu, Salvador Navarrete, Jerry T Dang","doi":"10.1097/XCS.0000000000002253","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002253","url":null,"abstract":"<p><strong>Background: </strong>Nutritional failure requiring enteral or parenteral support is a serious complication of bariatric surgery, but its long-term course, likelihood of recovery, and relationship with survival are poorly characterized.</p><p><strong>Study design: </strong>We conducted a single-center retrospective cohort study of adults requiring enteral or parenteral nutrition after bariatric surgery from 2004-2023. Nutritional independence was defined as discontinuation of all supplemental nutrition for ≥3 months. Kaplan-Meier and Cox proportional hazards analyses evaluated survival; a 12-month landmark analysis addressed immortal time bias.</p><p><strong>Results: </strong>Among 168 patients (85.1% female; median age 41.2 years; median BMI 47.3 kg/m²), 148 (88.1%) achieved nutritional independence during a median 11.6-year follow-up. Of these, 126 (85.1%) required endoscopic or surgical intervention, most commonly addressing gastrojejunal complications. Median time from nutritional support initiation to independence was 12.1 months. Among 165 patients alive and in follow-up at 12 months, mortality was 20.4% in 93 patients not yet independent versus 6.9% in 72 independent patients (HR 2.56, 95% CI 0.95 to 6.90, p=0.064). Of those not independent at 12 months, 74/93 (79.6%) subsequently achieved independence.</p><p><strong>Conclusions: </strong>Nutritional dependence after bariatric surgery was usually reversible, predominantly through endoscopic or surgical correction rather than nutritional support alone. Delayed nutritional independence was associated with numerically higher mortality, although this did not reach statistical significance. Timely, anatomy-specific intervention should therefore be prioritized to restore nutritional autonomy.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182258","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}