Journal of the American College of Surgeons最新文献

{"title":"Invited Commentary.","authors":"Michael E Egger","doi":"10.1097/XCS.0000000000001403","DOIUrl":"10.1097/XCS.0000000000001403","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"37-38"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795780","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 Timing of Definitive Pelvic Fixation in Pelvic Fracture Treated with Preperitoneal Pelvic Packing or Angioembolization.","authors":"Junsik Kwon, Timothy Allison-Aipa, Bishoy Zakhary, Bruno C Coimbra, Matthew Firek, Raul Coimbra","doi":"10.1097/XCS.0000000000001354","DOIUrl":"10.1097/XCS.0000000000001354","url":null,"abstract":"<p><strong>Background: </strong>Preperitoneal pelvic packing (PPP) and angioembolization (AE) are current hemostatic techniques in patients with bleeding pelvic fracture. Concerns exist that PPP may delay definitive internal fixation of pelvic fractures. This study aimed to determine whether PPP results in delayed internal fixation compared with AE.</p><p><strong>Study design: </strong>A retrospective cohort study was conducted using the TQIP database from 2017 to 2021. Adults with isolated pelvic fractures requiring transfusion within 24 hours were included. Patients underwent internal fixation and received either PPP (90) or AE only (253). Inverse probability of treatment weighting was used to adjust for confounding variables. The primary outcome was time from admission to internal fixation; secondary outcomes included in-hospital mortality and hospital resource use.</p><p><strong>Results: </strong>Time to definitive fixation was not significantly different between groups (PPP median 51.4 hours vs AE median 37.5 hours; p = 0.071). In-hospital mortality was higher in the PPP group (4.4% vs 0.6%; p = 0.009). The PPP group had longer ICU and hospital stays, extended mechanical ventilation duration, and higher rates of acute kidney injury and severe sepsis. No significant difference in transfusion volume within 4 hours was observed between the groups.</p><p><strong>Conclusions: </strong>PPP does not significantly delay definitive internal fixation. However, the implementation of PPP for patients with pelvic fractures may be associated with increased complications and hospital resource use compared with AE alone as a hemostatic measure.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"87-95"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391221","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":"Timeliness of Care for Nonelective Cholecystectomy: Comparison of Surgical Practice Models.","authors":"Aricia Shen, Andrew Wang, Nicolas Melo, Rex Chung, Miguel Burch, Tejal Brahmbhatt, Daniel R Margulies, Galinos Barmparas","doi":"10.1097/XCS.0000000000001426","DOIUrl":"10.1097/XCS.0000000000001426","url":null,"abstract":"<p><strong>Background: </strong>Acute care surgery (ACS) practice models with continuous on-site presence provide expedient and comprehensive care and serve as a critical safety net. The program benefits remain contested in comparison to other surgery practice models. We compared the efficiency of care for nonelective cholecystectomies (CCYs) across 4 different surgery practice models within a single hybrid urban hospital system.</p><p><strong>Study design: </strong>Adult patients admitted through the emergency department who underwent CCY for acute biliary disease between January 2018 and December 2023 were categorized into 4 groups: ACS (ACS-main campus [MC]), non-ACS faculty (faculty physicians [FP]-MC), private practice (private practice physicians [PPP]-MC), and community practice (PPP-community hospital [CH]). The primary outcomes were the interval from admission to surgery and hospital length of stay. Secondary outcomes included surgery on a weekend, hospital costs, and readmission within 30 days. Comparison was performed with ANOVA.</p><p><strong>Results: </strong>During the 6-year study period, there were a total of 2,247 CCY: ACS-MC (43.3%), PPP-MC (28.3%), PPP-CH (19.4%), and FP-MC (9.0%). ACS-MC patients had the lowest time interval from admission to surgery (median 25.1 vs 61.1 hours for FP-MC, 33.2 hours for PPP-MC, and 30.3 hours for PPP-CH, p < 0.001). ACS-MC patients had the lowest median hospital length of stay (2 days), and 93.7% of ACS-MC cases were covered by a general surgery resident. PPP-CH had the lowest overall cost.</p><p><strong>Conclusions: </strong>In an era of accelerated consolidation in healthcare markets, the results of this study may provide insight on how large healthcare systems may take advantage of the efficiency of the ACS model to ensure timely and quality care, at the lowest cost.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"98-103"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974549","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":"Memory.","authors":"Walter L Biffl","doi":"10.1097/XCS.0000000000001344","DOIUrl":"10.1097/XCS.0000000000001344","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"1-6"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189735","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":"Preoperative Biomarkers and Thromboelastometry According to Caprini Venous Thromboembolism Risk Stratification in Bariatric Patients: Are Clinical Risk Assessments Enough?","authors":"Vanessa N VanDruff, Fakiha Siddiqui, Kristine Kuchta, Julia R Amundson, Christopher J Zimmermann, H Mason Hedberg, John Linn, Woody Denham, Jawed Fareed, Michael B Ujiki","doi":"10.1097/XCS.0000000000001416","DOIUrl":"10.1097/XCS.0000000000001416","url":null,"abstract":"<p><strong>Background: </strong>Obesity is associated with substantial thromboembolic risk; however, no standard laboratory method exists to stratify risk for postoperative thrombotic events. Our aim was to evaluate preoperative prothrombotic biomarkers and thromboelastometry in relationship to clinical venothromboembolism stratification in bariatric patients.</p><p><strong>Study design: </strong>Preoperative blood samples were assessed for rotational thromboelastometry, D-dimer, C-reactive protein (CRP), plasminogen activator inhibitor-1, von Willebrand factor, and P-selectin, and compared with 50 normal control (NC) samples. Patients were stratified into Caprini Risk Score (CRS) groups: moderate (3 to 4), high (5 to 8), and very high (greater than 8) venothromboembolism risk.</p><p><strong>Results: </strong>One hundred bariatric patients were assessed and risk stratified to CRS 3 to 4 (23), CRS 5 to 8 (67), and CRS greater than 8 (10). D-dimer, plasminogen activator inhibitor-1, and CRP were increased compared with NC, all p < 0.001, and P-selectin and von Willebrand factor demonstrated no differences compared with NC. D-dimer demonstrated significant differences between moderate, high, and very high-risk groups (all p < 0.05), and positive correlation with CRS ( r = 0.44, p < 0.001). On thromboelastometry, clot formation time (CFT) was faster than normal in 18% of patients, with maximum clot firmness higher than normal in 54% of patients. No difference was found comparing thromboelastometry between CRS groups. Significant correlations were found between CRP and CFT ( r = -0.44), α-angle ( r = 0.40), and maximum clot firmness ( r = 0.44), all p < 0.05, respectively. D-dimer negatively correlated with CFT ( r = -0.34, p < 0.05), and clotting time ( r = -0.78, p < 0.05) in very high-risk patients.</p><p><strong>Conclusions: </strong>Preoperative D-dimer and CRP are significantly increased in bariatric patients and correlate with prothrombotic features on thromboelastometry. No significant differences were found comparing viscoelastic tests among CRS groups, which suggests patients with marked prothrombotic findings are not being differentiated into higher-risk categories by clinical assessment alone.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"67-76"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032722","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":"Long-Term Cytoreduction Outcomes With or Without Heated Intraperitoneal Chemotherapy For Colorectal Peritoneal Metastases.","authors":"Michael G White, Paula Marincola Smith, Neal Bhutiani, Beth Helmink, Norman Galbraith, Scott Kopetz, Michael Overman, Paul Mansfield, Keith Fournier, Abhineet Uppal","doi":"10.1097/XCS.0000000000001355","DOIUrl":"10.1097/XCS.0000000000001355","url":null,"abstract":"<p><strong>Background: </strong>Patients with peritoneal metastases from colorectal adenocarcinoma (CRC) benefit from cytoreductive surgery (CRS). However, the role of heated intraperitoneal chemotherapy (HIPEC) remains unclear. We studied associations between HIPEC, peritoneal disease-free survival (PDFS), and overall survival (OS) in patients with CRC undergoing CRS.</p><p><strong>Study design: </strong>All patients with CRC undergoing CRS between 2008 and 2023 were retrospectively identified at our center. Patient clinicodemographic factors were determined by chart review. OS and PDFS were evaluated using the Kaplan-Meier method. Associations between clinical factors and survival were determined using Cox proportional hazard models.</p><p><strong>Results: </strong>A total of 147 patients were identified with 24.5-month median follow-up. Most patients (111; 75.5%) had a low peritoneal cancer index (PCI; less than 11), whereas 36 patients (24.5%) had high PCI (11 or more). Eighty-three patients (55.8%) had CRS alone. Sixty-four patients underwent CRS with HIPEC (42 [66%] mitomycin C [MMC], 19 [30%] oxaliplatin [OX], 3 [4.7%] cisplatin). The median OS was 59.8 (95% CI 41.7 to 83.0) months. The median PDFS was 13.3 (95% CI 10.4 to 18.5) months. OS was equivalent comparing HIPEC with MMC, HIPEC with OX (hazard ratio [HR] 0.49, 95% CI 0.22 to 1.09, p = 0.08), and CRS alone (HR 0.74, 95% CI 0.41 to 1.32, p = 0.31). Multivariable analysis showed only PCI was associated with OS (HR 1.08, 95% CI 1.03 to 1.14, p = 0.003). Low PCI patients had similar PDFS after CRS-HIPEC (HR 1.07, 95% CI 0.61 to 1.87, p = 0.814) compared with CRS alone. High PCI patients had improved OS comparing CRS-HIPEC with CRS (MMC: HR 0.17, 95% CI 0.04 to 0.76, p = 0.02; OX: HR 0.048, 95% CI 0.006 to 0.37, p = 0.004).</p><p><strong>Conclusions: </strong>HIPEC was not associated with OS or PDFS in patients with PCI 10 or less but was associated with improved OS and PDFS in patients with PCI 11 or more. The use of HIPEC for high PCI may be warranted, although randomized prospective data are needed to confirm this.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"28-37"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12244288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408638","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":"Correction.","authors":"Jonathan Minagogo Hart, Anwar Mohammed Hussien, Samuel Tesfaye, Siyasebew Mamo Nadamo, Mekonnen Feyissa Senbu, Desalegn Fekadu Wadaja, Israel Tadesse Bacha, Hiwot Gebeyehu Tebeje","doi":"10.1097/XCS.0000000000001391","DOIUrl":"10.1097/XCS.0000000000001391","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"106"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674141","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":"Bellal Joseph","doi":"10.1097/XCS.0000000000001404","DOIUrl":"10.1097/XCS.0000000000001404","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"95-97"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795648","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":"M Ashraf Mansour","doi":"10.1097/XCS.0000000000001405","DOIUrl":"10.1097/XCS.0000000000001405","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"26-27"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795650","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":"Outcomes of Retroperitoneal vs Transperitoneal Approach for Open Abdominal Aortic Aneurysm Repair Stratified by Aortic Cross-Clamping Site.","authors":"Mohammed Hamouda, Ahmed Abdelkarim, Mikayla Kricfalusi, Benjamin S Brooke, Mahmoud B Malas","doi":"10.1097/XCS.0000000000001359","DOIUrl":"10.1097/XCS.0000000000001359","url":null,"abstract":"<p><strong>Background: </strong>The approach for open infrarenal abdominal aortic aneurysm (AAA) repair is mainly surgeon driven based on experience and previous training. Although the midline transperitoneal (TP) approach remains the most common, the retroperitoneal (RP) approach is usually used in more complex cases where suprarenal cross-clamping is necessary. As previous literature is conflicting on optimal outcomes between the 2 approaches, we aimed to compare RP vs TP outcomes stratified by aortic clamp level.</p><p><strong>Study design: </strong>The Vascular Quality Initiative database was queried for all patients who underwent open AAA repair from January 2012 to February 2024. Patients were stratified according to aortic cross-clamp site: infrarenal, interrenal, suprarenal, and supraceliac. We used multivariate logistic regression to analyze the outcomes of RP vs TP within each clamp site while adjusting for baseline and clinically relevant variables.</p><p><strong>Results: </strong>A total of 8,842 patients were included. Compared with TP, RP approach was associated with higher odds of postoperative dialysis (adjusted odds ratio [aOR] 1.74, 95% CI 1.07 to 2.83, p = 0.025) with infrarenal cross-clamping. However, at higher clamping sites, RP was associated with lower odds of bowel ischemia (aOR 0.40, 95% CI 0.20 to 0.80, p = 0.009) with interrenal clamping; lower odds of dialysis (aOR 0.66, 95% CI 0.44 to 0.99, p = 0.048), bowel ischemia (aOR 0.52, 95% CI 0.32 to 0.85, p = 0.009), and 30-day mortality (aOR 0.48, 95% CI 0.30 to 0.79, p = 0.004) with suprarenal clamping; and lower odds of in-hospital (aOR 0.35, 95% CI 0.16 to 0.80, p = 0.013) and 30-day mortality (aOR 0.41, 95% CI 0.17 to 0.98, p = 0.046) with supraceliac clamping.</p><p><strong>Conclusions: </strong>In this large multi-institutional study, we identified that differential outcomes of RP vs TP approaches for open AAA are modified by aortic cross-clamping level. RP is associated with lower postoperative complications and better survival compared with TP in cases requiring more proximal cross-clamping sites. However, the TP approach is associated with lower risk of renal complications in cases restricted to infrarenal clamping.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"16-26"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441301","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}