Journal of the American College of Surgeons最新文献

{"title":"Invited Commentary.","authors":"Ninh T Nguyen, Shaun Daly, Brian R Smith","doi":"10.1097/XCS.0000000000001406","DOIUrl":"10.1097/XCS.0000000000001406","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"65-66"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795644","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":"Transplant Referral and Long-Term Kidney Allograft Survival for Black Patients: Single-Center Study.","authors":"Alexandra C Bolognese, Madelaine Hack, Christine Kolwitz, Oren Shaked, Christopher Connelly, David Woodland, C Kristian Enestvedt, David Scott, Ali Olyaei, Erin Maynard","doi":"10.1097/XCS.0000000000001395","DOIUrl":"10.1097/XCS.0000000000001395","url":null,"abstract":"<p><strong>Background: </strong>Despite improvements in access to transplantation, there remains disparities in all aspects of transplant among minority patients. We sought to examine referral practices and long-term outcomes of kidney transplantation across racial identities at our center.</p><p><strong>Study design: </strong>We conducted a retrospective review of kidney transplantation recipients from January 2010 to May 2024. Data were obtained from United Network for Organ Sharing and confirmed with the electronic medical record. Patients were categorized as White, Black, Asian, Hispanic, Hawaiian/Pacific Islander, and American Indian/Alaska Native.</p><p><strong>Results: </strong>A total of 1,369 patients met criteria with 67% White, 6.9% Black, 7.9% Asian, 14.1% Hispanic, 2.6% Hawaiian/Pacific Islander, and 1.5% American Indian/Alaska Native. There were no significant between group differences in kidney donor profile index, expected posttransplant survival, recipient or donor age or cytomegalovirus status, cold ischemia time, and time from referral to evaluation or listing. There was a significant difference in waiting time for Black compared with White patients (733.6 vs 595.4 days, p = 0.026). Black patients had higher mean creatinine at 6 months and 1 year compared with all others (1.6 vs 1.3 mg/dL at both time points, p < 0.001). After adjusting for baseline characteristics, Black patients had an increased risk of allograft loss at 15 years compared with White patients (p < 0.001) and were to receive a living donor transplant (10.5% vs 25.3%, p < 0.01) or a preemptive kidney transplantation (10.5% vs 27.0%, p < 0.01).</p><p><strong>Conclusions: </strong>Despite disproportionate representation among patients with chronic kidney disease, compared with age-matched White patients, Black patients at our center are referred for transplant later and have a higher rate of 10-year allograft loss. It is up to us to focus on education and close the gap and improve outcomes for all of our transplant recipients.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"39-47"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753271","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":"Early Results of Radiofrequency Ablation for Treating Molecular Negative Bethesda III Thyroid Nodules.","authors":"Katherine Jackson, Jillian McCabe, Stacey Stern, Ariela Edri, Melanie Goldfarb","doi":"10.1097/XCS.0000000000001388","DOIUrl":"10.1097/XCS.0000000000001388","url":null,"abstract":"<p><strong>Background: </strong>Radiofrequency ablation (RFA) has become an alternative option for management of symptomatic, large, or toxic benign (BII) thyroid nodules, but its role in treatment of thyroid nodules with Bethesda III (BIII) cytology is less described and controversial.</p><p><strong>Study design: </strong>This was a retrospective review of a prospectively maintained database of all thyroid RFA patients at a single institution. Patients were eligible for RFA if they had a symptomatic, large, or toxic thyroid nodule with benign cytology on 2 separate biopsies, including BIII cytology with negative molecular profiling. Volume reduction ratio (VRR) and symptom improvement at 1, 6, 12, and 24 months were compared between BII and BIII nodules.</p><p><strong>Results: </strong>Of 174 thyroid RFA patients, 32 patients had 1 or 2 BIII biopsies. Most patients were female (86.8%) with an average age of 58.6 years and a mean follow-up of 8.2 months (median 6, range 1-31). Both BII and BIII nodules were most frequently solid (BII 52.1%, BIII 78.1%) or predominantly solid (BII 43.7%, BIII 18.8%; p > 0.05). The average maximum nodule diameter was similar between groups (BII 4.1 cm, BIII 4.0 cm, p > 0.05), as well as initial nodule volume (BII 20.2 cc, BIII 15.8 cc, p = NS). At 1-, 6-, 12-, 18-, and 24-month follow-up, there was a mean VRR of 45.3%, 64.8%, 74.8%, 75.5%, and 77.8% for BII nodules vs 46.4%, 69.0%, 81.6%, 72.3%, and 77.0% for BIII nodules (all p > 0.05). All patients with at least 6 months of follow-up had symptom improvement.</p><p><strong>Conclusions: </strong>In our single institution study of RFA for patients with molecular negative BIII thyroid nodules, VRRs for BII and BIII nodules were similar at 12 months. RFA appears safe and effective for BIII nodules devoid of molecular alterations, though longer-term follow-up is needed.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"48-54"},"PeriodicalIF":3.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657575","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":"Bridging the Gap: Enhancing First-Year Education Through the Surgical Ethics and Application for Medical Students Program.","authors":"Austin D Williams, Bhavana Kunisetty, Nicolas Restrepo, Prathik Kalva, Samantha J Lowe, Andrew Childress, Samuel Creden, Todd Rosengart, Savitri Fedson, E Ramsay Camp","doi":"10.1097/XCS.0000000000001488","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001488","url":null,"abstract":"<p><strong>Summary: </strong>Ethical decision-making is fundamental to surgical education, yet formal ethics training remains underrepresented in medical curricula. To address this gap, we developed the Baylor College of Medicine (BCM) Surgical Ethics and Application for Medical Students (SEAMS) program, an elective hybrid course combining 45-minute didactic lectures with interactive role-playing led by faculty experts in ethics, transplant medicine, and surgical oncology. Thirty-two first-year medical students participated in SEAMS and completed pre- and post-program surveys assessing their understanding, confidence, and preferred learning styles related to surgical ethics. While students' perceptions of the importance of surgical ethics discussions remained unchanged, their knowledge and confidence in discussing surgical futility significantly improved (p<0.01). Confidence in initiating and conducting difficult conversations also increased (p<0.01). Following the program, students exhibited a greater preference for lecture-based education on ethics and surgical indications. SEAMS effectively prepared medical students for ethical challenges in clinical practice by integrating structured lectures and role-playing exercises. To enhance efficiency, the authors recommend a flipped classroom model, allowing students to engage with foundational content before in-person sessions. These findings highlight the need for more structured ethics education in surgical training. Moreover, our techniques may aid the communication and ethical decision-making of experienced physicians caring for challenging patients. Future studies should explore the longitudinal impact of such programs on medical students' ethical preparedness.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144506082","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":"Cell Phone Activity and Trauma Patient Volume in New England Through the COVID-19 Pandemic: A Research Consortium of New England Centers for Trauma (ReCONECT) Study.","authors":"Pawan J Mathew, Elena Graetz, Reginald Alouidor, Frederique Pinto, Alia F Aunchman, Haytham M Kaafarani, Jefferson A Proaño-Zamudio, Jane Keating, Stephanie N Lueckel, Manuel A Moutinho, Eric Schneider, Kevin M Schuster","doi":"10.1097/XCS.0000000000001486","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001486","url":null,"abstract":"<p><strong>Background: </strong>We sought to understand whether cellular telephone activity in commercial spaces as a marker for population mobility would be associated with trauma admission volumes, taking advantage of cellular telephone data made available during the COVID-19 pandemic and large swings in population activity.</p><p><strong>Study design: </strong>Trauma registry data from six level I trauma centers (TC) in New England were used to identify the number of daily trauma admissions (TA) from January 20th 2020 to July 31st 2021. The Device Exposure Index (DEX) is a standardized measure of daily cellular telephone interactions with other cellular telephones within a county. Spearman's rank correlation was calculated for the first wave of COVID-19 from March 2020 to May 2020 and for the entire study period. Center-specific Poisson models were created to control for seasonality.</p><p><strong>Results: </strong>During the study period, daily mean TA was 42.8 (SD 10.7) and daily mean DEX was 60.6 (SD 26.8) overlapping device visits to venues per day. The daily DEX index was moderately correlated with TA from March to May of 2020 for five centers serving unique catchment areas, with Spearman's rho ranging from 0.22 to 0.47 (p<0.05). The sixth center where the catchment area overlaps with those of multiple level I centers had much lower correlation r = 0.06 (p=0.59). After controlling for seasonality, DEX vs. TA relationships remained significant among the six centers.</p><p><strong>Conclusion: </strong>County-level daily DEX scores correlated significantly with TC-specific numbers of daily TA at 5 of 6 TC during the first three months of the study period. Additional research is needed; however, use of cellular telephone activity and interactions may be a valuable adjunct for trauma system planning.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497404","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":"Association of Discharge Against Medical Advice with Surgical Outcomes and Healthcare Cost.","authors":"Azza Sarfraz, Mujtaba Khalil, Selamawit Woldesenbet, Abdullah Altaf, Zayed Rashid, Shahzaib Zindani, Jun Kawashima, Timothy M Pawlik","doi":"10.1097/XCS.0000000000001469","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001469","url":null,"abstract":"<p><strong>Background: </strong>Patients who leave the hospital prematurely often remain in a compromised clinical state, which may increase the risk of complications. Discharge against medical advice (DAMA) has been associated with increased morbidity, fragmented care, and higher healthcare costs, but its impact on major surgical populations remains understudied. We sought to evaluate trends, risk factors, and postoperative outcomes among surgical patients who were DAMA.</p><p><strong>Methods: </strong>The Nationwide Readmissions Database (2016-2020) was used to identify adult patients (≥18 years) undergoing major operation. Trends in DAMA incidence over time, risk factors associated with DAMA, as well as impact of DAMA on postoperative outcomes and 30-day healthcare expenditures were assessed using multivariable regression models.</p><p><strong>Results: </strong>Among 1,768,752 surgical patients, 3,951 (0.22%) were DAMA (17.0% in 2016 vs. 25.3% in 2020; p<0.001). Male sex (AOR 1.67, 95% CI 1.54-1.79), younger age (AOR 0.97 per year, 95% CI 0.97-0.97), and substance use disorder (AOR 2.44, 95% CI 2.24-2.65) were associated with DAMA. DAMA patients had longer index hospital stays (9.85 vs. 8.08 days; p<0.001), higher hospitalization costs ($43,379 vs. $39,872; p<0.001), and increased 30-day readmission risk (AOR 1.75, 95% CI 1.62-1.88). DAMA was also linked to fragmented care (AOR 1.98, 95% CI 1.71-2.29), higher DAMA at readmission (17.9% vs. 0.7%), and greater 30-day expenditures ($48,777 vs. $39,872; p<0.001).</p><p><strong>Conclusions: </strong>The rising incidence and costs of DAMA highlight the need for targeted interventions, including risk stratification, and improved discharge planning, to reduce preventable readmissions and optimize resource utilization.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497403","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":"Silent Swell: Evaluating Thrombus Burden in Small Popliteal Artery Aneurysm.","authors":"Salim Lala","doi":"10.1097/XCS.0000000000001484","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001484","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484880","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 the Sequence of Colorectal Cancer Diagnosis Matter for Patients with Multiple Primary Cancers? A Surveillance, Epidemiology, and End Results Database Cohort Study.","authors":"Anjelli Wignakumar, Sameh H Emile, Justin Dourado, Victoria De Trolio, Brett P Weiss, Marylise Boutros, Steven D Wexner","doi":"10.1097/XCS.0000000000001413","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001413","url":null,"abstract":"<p><strong>Background: </strong>We aimed to assess features and outcomes of isolated primary colorectal cancer (CRC) compared to CRC presenting in a sequence of multiple primary cancers.</p><p><strong>Methods: </strong>A retrospective cohort including patients with stage I-IV colorectal adenocarcinoma from the SEER database (2000-2020) was assessed. Patients were classified into three groups: A: CRC as the only malignancy, B: CRC as the first of multiple primary malignancies, C: CRC as the second of multiple primary malignancies. Primary outcomes were overall (OS) and cancer-specific survival (CSS).</p><p><strong>Results: </strong>From our sample of 592,063 patients, 424,920 (71.8%), 70,432 (11.9%), and 96,711 (16.3%) were in Groups A, B, and C, respectively. Group A patients were younger (65.7 vs. 67.3 vs.72.6 years, p<0.001), had elevated pre-treatment CEA (49.7% vs. 43.2% vs. 46.9%, p<0.001), more frequent liver metastases (17.5% vs. 7.4% vs. 12.1%, p<0.001), more frequent lung metastases (6.3% vs. 2.5% vs. 4.2%, p<0.001) and systemic adjuvant treatments (10.4% vs. 8.9% vs. 5.8%, p<0.001). Group A included more T4 tumors (14.5% vs. 10.4% vs. 12.4%, p<0.001) and less surgical treatments than Groups B and C (86.4% vs. 94.8% vs. 88.1%, p<0.001). Group B included more males (57.1% vs. 51.8% vs. 53.1%, p<0.001) and left-sided CRC (37.9% vs. 37.1% vs. 32.2%). Group C entailed more right-sided CRC (38.6% vs. 33.1% vs. 35.3%). Group B had the longest OS and CSS (50.4 and 51.3 months).</p><p><strong>Conclusion: </strong>CRC presenting as the first of multiple primary malignancies less often presented at an advanced stage, more often underwent surgical treatment and was associated with improved OS and CSS than CRC presenting as an isolated primary or second primary malignancy.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317209","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":"Evaluating Initial Site Visit Pass Rate Across American College of Surgeons Accreditation Programs.","authors":"Brett A Johnson, Geoffrey G Hobika, Erica McNamara, Clifford Y Ko","doi":"10.1097/XCS.0000000000001441","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001441","url":null,"abstract":"<p><strong>Background: </strong>The American College of Surgeons (ACS) accreditation programs establish evidence-based, consensus-driven standards to improve surgical quality. While the criteria are publicly available for self-assessment, limited data exist on initial pass rates and the effectiveness of remediation after a failed site visit. This study evaluates outcomes of initial ACS accreditation visits to determine whether accreditation primarily validates hospitals already meeting standards or serves as a driver for systemic quality improvement.</p><p><strong>Study design: </strong>This retrospective cohort study utilized the ACS Quality Database to identify hospitals undergoing first-time comprehensive accreditation visits from 2017-2023 across seven ACS Quality Programs. The primary outcome was the initial accreditation pass rate; secondary outcomes included re-evaluation, domain-level, and standard-level pass rates. Multivariable logistic regression identified factors associated with first-attempt success. Subgroup analysis evaluated the effect of prior system-level accreditation experience in multi-hospital systems.</p><p><strong>Results: </strong>Of 833 initial site visits, 61% of hospitals achieved accreditation on their first attempt. Pass rates varied substantially by program, ranging from 31% to 86%. Among hospitals that failed initially, 94% of hospitals that pursued re-evaluation achieved accreditation. The most common areas of deficiency involved the quality domains \"Personnel and Services Resources\" and \"Patient Care: Expectations and Protocols.\" In a subgroup analysis, hospitals in systems with prior accreditation experience had higher first-attempt pass rates (OR: 1.69; 95% CI: 1.09-2.65; P=0.021).</p><p><strong>Conclusion: </strong>Findings demonstrate that many hospitals pursuing accreditation initially face challenges in meeting core patient safety and quality standards. However, through remediation, most ultimately achieve accreditation, underscoring accreditation's role as a driver for systemic improvement.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266533","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":"Academic Surgeon Financial Compensation in the US: Trends from 2017 to 2023.","authors":"Paula S Flores-Pérez, Dheeman Futela, Albert L Rancu, David Febre, Michael Alperovich, Ajay Malhotra","doi":"10.1097/XCS.0000000000001481","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001481","url":null,"abstract":"<p><strong>Background: </strong>Academic surgeons play a dual role in healthcare by providing patient care and spearheading research and trainees' education, but non-surgical responsibilities are frequently uncompensated and undervalued. For faculty underrepresented in medicine, these issues may be compounded by additional expected mentorship and advocacy roles. Comprehensive analyses of academic surgeon compensation trends remain scarce; this study evaluated recent trends in academic surgeon compensation stratified by rank, sex, race/ethnicity, and subspecialty.</p><p><strong>Study design: </strong>Total annual compensation from 2017-2023 for full-time surgery department faculty was collected from the American Association of Medical Colleges Faculty Salary Survey and analyzed according to rank, sex, and race/ethnicity identifiers and across 11 surgical subspecialties. Average salaries, wage gaps, and changes across time were assessed.</p><p><strong>Results: </strong>The Faculty Salary Survey data for 2023 included 12,443 faculty in academic surgery departments. The average salary for surgery faculty weighed by rank had a 2.9% compounded growth rate from 2017-2023, with division chiefs having the greatest compound growth rate and associate professors having the lowest. After adjusting for rank, women consistently earned less than men. In 2023, Black/African American faculty earned less than White faculty, and Asian women faculty members experienced the largest wage gap compared to White men faculty.</p><p><strong>Conclusions: </strong>This study summarizes trends in academic surgeon compensation. It highlights the need for further research that identifies the root causes of disparities and informs interventions that address them, promoting the recruitment and retention of a skilled, diverse academic surgeon workforce.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258229","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}