Journal of the American College of Surgeons最新文献

{"title":"Striking Predictive Gold: The Importance of Granularity over Scale.","authors":"Katherine E Goodman, North Bethesda, Charles E Binkley","doi":"10.1097/XCS.0000000000002252","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002252","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169790","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":"Robotic Care Outcomes Project (ROBOCOP): Emergency Cholecystectomy and Bile Duct Injury.","authors":"Jorrdan Nr Bissell, Prajakta H Waghmare, I-Fan Shih, Hannah M Bossie, Kaushik Mukherjee","doi":"10.1097/XCS.0000000000002249","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002249","url":null,"abstract":"<p><strong>Background: </strong>Comparative bile duct injury (BDI) risk between robotic and laparoscopic cholecystectomy remains uncertain in contemporary emergency practice. We compared BDI and perioperative outcomes after robotic (RCHOLE) versus laparoscopic cholecystectomy (LCHOLE).</p><p><strong>Study design: </strong>We conducted a retrospective cohort study of adults undergoing emergency or urgent cholecystectomy from 2019-2024 within the Premier Healthcare Database. Propensity scores incorporating patient, admission, surgeon, and hospital characteristics were used for 1:1 nearest-neighbor matching. Outcomes included index and 30-day BDI, conversion, perioperative complications, reoperation, and readmission. Conditional logistic regression evaluated BDI in matched pairs.</p><p><strong>Results: </strong>Among 522,629 patients, 449,312 underwent LCHOLE and 73,317 RCHOLE; RCHOLE use increased from 4.2% in 2019 to 29.7% in 2024. Propensity score matching (PSM) yielded 73,316 patients per group with standardized mean differences <0.1. RCHOLE was associated with lower BDI during the index hospitalization (0.03% vs 0.05%; OR, 0.55; 95% CI, 0.32-0.94) and through 30 days (0.06% vs 0.11%; OR, 0.56; 95% CI, 0.39-0.81). RCHOLE also had lower conversion (0.7% vs 2.1%; p<0.001), bleeding (2.2% vs 2.6%; p<0.001), abdominal injuries (2.0% vs 2.4%; p<0.001), and 30-day reoperations (1.3% vs 1.5%; p<0.001), but longer operative time (120.7 vs 109.4 minutes; p<0.001). Readmission did not differ (4.5% vs 4.7%; p=0.14).</p><p><strong>Conclusions: </strong>In this contemporary observational cohort, RCHOLE was associated with lower BDI, conversion, and selected perioperative complications than LCHOLE, with longer operative time. Residual confounding remains possible.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166208","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":"The Missing Link: How a Standardized Radiology Report May Increase Access to Resection of Colorectal Liver Metastases.","authors":"Eduardo A Guzmán Huerta","doi":"10.1097/XCS.0000000000002251","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002251","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168027","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":"Patient and Clinician Perspectives on Implementing Remote Surveillance after Lung Cancer Surgery: A Qualitative Analysis.","authors":"Nicole M Mott, Ryan C Jacobs, Raheem D Bell, Samantha L Savitch, Lauren Szczygiel, Nikita Khanna, Shari L Barnett, Margaret Lasonde, Ashley Chang, Kalvin C Lung, David D Odell, Mary E Byrnes","doi":"10.1097/XCS.0000000000002248","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002248","url":null,"abstract":"<p><strong>Background: </strong>Remote surveillance may reduce barriers to lung cancer surveillance after curative-intent surgery, but implementation requires understanding how patients and clinicians value and experience follow-up care. We explored patient and clinician perspectives to inform development and implementation of REmote Telehealth User-Reported caNcer Surveillance (RETURNS).</p><p><strong>Study design: </strong>We conducted a qualitative study using semi-structured interviews with patients who had completed curative-intent lung cancer surgery and clinicians involved in lung cancer surveillance in the United States from August 2024 to December 2025. Transcripts were analyzed using an interpretive description approach.</p><p><strong>Results: </strong>Among 64 participants (45 patients, 19 clinicians), patient-, clinician-, and system-level considerations for remote surveillance were identified through 6 themes. Patients' \"willingness to fight\" minimized perceived surveillance burdens, while \"desire for peace of mind\" reflected reassurance derived from obtaining and reviewing surveillance imaging in person. \"Fear of abandonment\" captured patients' desire to maintain relationships with their clinical teams. Clinicians identified \"roadblocks ahead,\" including technological, reimbursement, and regulatory barriers; a \"need for trusted systems,\" reflecting concerns about outside imaging quality, interpretation, and accessibility; and \"time for goodbye,\" reflecting surgeons' view that surveillance responsibilities may appropriately transition as their role diminishes during survivorship.</p><p><strong>Conclusions: </strong>Remote lung cancer surveillance implementation must address more than convenience. Strategies should preserve reassurance and continuity while addressing technological access, telehealth barriers, inter-system imaging quality and exchange, and transitions in clinician roles during survivorship.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137274","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":"Mortality Risk Across Early RBC-Equivalent Transfusion Burden in the Whole Blood Era.","authors":"Riddhi Mehta, Bardiya Zangbar, Kartik Prabhakaran, David Samson, Vishmita Kannichamy, Gabriel Froula, Matthew Bronstein, Ilya Shnaydman, Jordan Kirsch","doi":"10.1097/XCS.0000000000002247","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002247","url":null,"abstract":"<p><strong>Background: </strong>Concepts of massive transfusion and transfusion-associated futility were largely established during the component therapy era. Increasing whole blood use may alter the relationship between transfusion burden and mortality. We characterized the continuous association between RBC-equivalent transfusion burden and in-hospital mortality in a contemporary national trauma cohort.</p><p><strong>Study design: </strong>Adult trauma patients receiving ≥1 unit of packed red blood cells within 4 hours of admission were identified in American College of Surgeons TQIP from 2020 to 2023. RBC-equivalent transfusion burden was defined as packed red blood cells plus whole blood units administered within 4 hours. The primary outcome was in-hospital mortality. Multivariable spline-based logistic regression modeled mortality across transfusion burden and identified the maximum mortality slope, 50% predicted mortality, and plateau onset.</p><p><strong>Results: </strong>Among 126,271 patients, 85,832 (68.0%) sustained blunt and 40,439 (32.0%) penetrating injury. Mortality increased nonlinearly with escalating RBC-equivalent transfusion burden. Maximum slope occurred at 21.1 units, the 95th percentile of transfusion burden. Predicted mortality reached 50% at 41.9 units, the 99th percentile, and plateau onset occurred at 55.3 units. Mortality did not approach 100% despite extreme transfusion requirements.</p><p><strong>Conclusions: </strong>In a contemporary national trauma cohort, mortality increased nonlinearly across RBC-equivalent transfusion burden, with distinct high-risk regions near 21, 42, and 55 units. These reference points may contextualize trajectories during active resuscitation while demonstrating that extreme transfusion requirements are not synonymous with universal mortality.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137295","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":"Medical vs Surgical Payment Rate: What Are the Side Effects of Pushing for Total Parity.","authors":"Charles G Callif, Bethany J Slater","doi":"10.1097/XCS.0000000000002246","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002246","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111260","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":"Laparoscopic vs Open Ladd's Procedure: A Multicenter Study of Postoperative Volvulus and Small Bowel Obstruction Rate.","authors":"Stephanie F Brierley, Russell B Hawkins, Ryan Hare, Simone C Hyman, Benjamin A Keller, Aimee G Kim, Claudia Mueller, Lauren N Nicassio, David H Rothstein, Benjamin E Padilla","doi":"10.1097/XCS.0000000000002242","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002242","url":null,"abstract":"<p><strong>Background: </strong>Whether operative approach influences reoperation for postoperative volvulus or small bowel obstruction (SBO) after Ladd's procedure remains uncertain, with limited contemporary multicenter data outside administrative databases. We evaluated whether open vs laparoscopic Ladd's procedure was associated with differences in reoperation for postoperative volvulus and SBO.</p><p><strong>Study design: </strong>This multicenter retrospective cohort included patients ≤15 years of age undergoing Ladd's procedure from January 2014 through September 2021 across 10 children's hospitals. Demographic, clinical, perioperative, and postoperative outcomes within 3 years were compared by operative approach. A multivariable logistic model assessed predictors of reoperation for postoperative SBO.</p><p><strong>Results: </strong>Among 697 patients, 495 (71.0%) underwent open and 202 (29.0%) laparoscopic Ladd's procedure; 72 laparoscopic cases (35.6%) were converted to open. Open patients were younger (1.7 months [IQR 0.2, 12.0] vs 9.5 months [IQR 2.0, 60.0], p<0.001) and more frequently had volvulus (31.0% vs 9.2%, p<0.001) and bowel resection (7.2% vs 0.0%, p=0.002). Reoperation for postoperative volvulus was uncommon (2.2%) and did not differ by approach. Reoperation for SBO was more frequent after open Ladd's (6.7% vs 1.5%, p=0.017). Laparoscopic approach was associated with lower adjusted odds of reoperation for SBO (OR 0.216 [95% CI 0.050, 0.934], p=0.040).</p><p><strong>Conclusions: </strong>Reoperation for postoperative volvulus was uncommon and did not differ by operative approach. Laparoscopic Ladd's procedure was associated with lower reoperation for postoperative SBO compared with open operation.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111257","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":"Automating Perioperative Risk Prediction Is Great, But It Is Probably the Easy Part of Prudent Shared Decision-Making.","authors":"Daniel E Hall","doi":"10.1097/XCS.0000000000002244","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002244","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110715","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 and Human Health Impact of Pediatric Appendicitis Management.","authors":"Patricia Cintora, Nathalia Silva de Souza Lima Cano, Gwyneth A Sullivan, Brian C Gulack, Ami N Shah","doi":"10.1097/XCS.0000000000002241","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002241","url":null,"abstract":"<p><strong>Background: </strong>Surgical care is resource intensive, but the environmental consequences of treatment strategies for common pediatric surgical conditions are poorly characterized. We compared environmental emissions and environmentally mediated human health impacts of operative and nonoperative management of pediatric uncomplicated appendicitis.</p><p><strong>Study design: </strong>A process-based life cycle assessment compared laparoscopic appendectomy with nonoperative management using antibiotic therapy. Environmental impacts were modeled using Ecoinvent databases within CarbonGraph EcoScan and quantified with the ReCiPe 2016 method. The functional unit was 1 completed episode of care, including index treatment and downstream events over 1 year. Population-level impacts were modeled across varying rates of nonoperative management uptake.</p><p><strong>Results: </strong>Appendectomy generated 15.20 kg CO₂e and 5.82 × 10⁻⁵ DALYs per episode, compared with 5.98 kg CO₂e and 2.14 × 10⁻⁵ DALYs for nonoperative management including failures. Increasing nonoperative management from 20% to 50% reduced climate change impact by 20.7% and human health damage by 21.7%, corresponding to approximately 66 metric tons of CO₂e annually.</p><p><strong>Conclusions: </strong>For pediatric uncomplicated appendicitis, nonoperative management was associated with lower modeled greenhouse gas emissions and environmentally mediated human health damage than laparoscopic appendectomy. When clinically appropriate, greater use of nonoperative management could reduce the environmental and human health burden of care.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111236","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":"Making Suction Selective in Traumatic Pneumothorax.","authors":"Vladislav Muldiiarov, Zachary M Bauman","doi":"10.1097/XCS.0000000000002243","DOIUrl":"https://doi.org/10.1097/XCS.0000000000002243","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111255","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}