Journal of the American College of Surgeons最新文献

{"title":"Textbook Outcomes for Incisional Hernia: W3 EVEREG Database Analysis.","authors":"Carmen Zaragoza Zaragoza, Álvaro Gomis-Martín, Juan Jesús Rubio-García, Judith Parra Chiclano, Celia Villodre Tudela, José Antonio Pereira, José Manuel Ramia","doi":"10.1097/XCS.0000000000001443","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001443","url":null,"abstract":"<p><strong>Background: </strong>The \"textbook outcome\" (TO) is defined as a composite indicator that signifies the ideal postoperative course following surgical intervention. To date, TO in hernias has not been studied deeply. This study aims to determine TO in W3 incisional hernia repair using data from the Spanish national EVEREG registry and analyze the variables associated with achieving TO.</p><p><strong>Study design: </strong>A retrospective observational study of W3 incisional hernia repair from the EVEREG registry was performed between January 2012 and December 2022. TO for W3 incisional hernia was defined as: hospital stay <8 days, no major postoperative complications (Clavien-Dindo ≥IIIa), and no mortality or readmission within 30 days of surgery. Characteristics between TO group and versus non-TO group were compared using both univariable and multivariable logistic regressions.</p><p><strong>Results: </strong>A total of 2763 patients were included in the study. TO was achieved in 2099 patients (75.97%), a prolonged hospital stay was the main factor related to nonachievement. There were multiple variables statistically associated with textbook outcome achievement. Also, eventration through an umbilical trocar, clean surgery, laparoscopic approach, the use of non-biological mesh, elective surgery or high-risk patients parameters were identified as a statistically significant predictor of textbook outcome achievement.</p><p><strong>Conclusions: </strong>We propose novel TO criteria for W3 incisional hernia repair. In this database, the rate of TO was 76%. TO is a composite measure that can be used to carry out healthcare quality improvement programs and compare results between hospitals.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078641","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":"Effectiveness of Army Military-Civilian Trauma Team Training in Generating Surgical Readiness.","authors":"Alec K Donohue, Ilya V Latyshenko, Andrew J Anklowitz, Rowan Sheldon","doi":"10.1097/XCS.0000000000001445","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001445","url":null,"abstract":"<p><strong>Background: </strong>The Military Health System (MHS) utilizes a readiness program that identifies the knowledge, skills, and abilities (KSAs) necessary for surgeons to provide combat casualty care. Recent studies highlight the importance of surgical experience outside of military hospitals to maintain clinical readiness. The Army Military-Civilian Trauma Team Training (AMCT3) program embeds Army surgeons in civilian trauma centers to provide greater patient acuity and higher case volume. We quantified the current state of this program and the overall readiness generated.</p><p><strong>Study design: </strong>Monthly self-reported clinical care and procedural logs from surgeons assigned to AMCT3 programs in 2022 were collected. Clinical work was assigned CPT codes and processed through the JKSA calculator (Deloitte; London, UK). Training and deployment calendars were used to identify time away from clinical practice.</p><p><strong>Results: </strong>Thirteen surgeons were assigned to AMCT3s in 2022 for a combined 87 clinical months (Avg 6.7 ±3.7). Average monthly workload included 19.3 ±7.9 operative cases, 3.3 ±1.6 chest tubes, 3.4 ±3.2 central venous catheters, 13.1 ±11.7 EFASTs, 28.5 ±12.1 trauma resuscitations, and 39.4 ±36.8 episodes of critical care. Surgeons accumulated 5016.9 ±2315 KSA points per month with 2917.1 ±1877 (58.1%) coming from resuscitations and critical care episodes. Using the MHS threshold of 16,500 KSA points for trauma surgeons, the average surgeon would require 3.3 clinical months to meet the annual readiness threshold.</p><p><strong>Conclusions: </strong>AMCT3 platforms provide significant opportunities for critical care experience and procedures relevant to combat casualty care. The readiness generated through use of this program suggests that it should be fostered and expanded.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078129","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 Outcomes of Microsurgical Breast Reconstruction after Premastectomy and Postmastectomy Radiation Therapy.","authors":"Mark V Schaverien, Puneet Singh, Henry M Kuerer, Catherine L Akay, Mariana Chavez-MacGregor, Carrie K Chu, Mark W Clemens, Wei Qiao, Benjamin D Smith, Karen E Hoffman","doi":"10.1097/XCS.0000000000001444","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001444","url":null,"abstract":"<p><strong>Background: </strong>This study compared complication rates and outcomes between patients who underwent premastectomy radiation therapy (PreMRT) followed by mastectomy with microsurgical immediate breast reconstruction (IMBR) and patients who underwent mastectomy followed by postmastectomy RT (PMRT) then microsurgical delayed breast reconstruction (DBR).</p><p><strong>Study design: </strong>This is a secondary analysis of a randomized controlled trial (NCT02912312) that randomized patients with breast cancer to receive hypofractionated (40.05 Gy/15 fractions) or conventionally fractionated (50 Gy/25 fractions) regional nodal irradiation (RNI) between August 2018 and August 2022. Demographic, treatment, and outcomes data were collected. The primary outcome was the rate of autologous flap loss. Secondary outcomes included rates of other recipient-site complications.</p><p><strong>Results: </strong>144 patients were included: 41 underwent PreMRT with IMBR and 103 underwent PMRT with DBR, including 66 that had tissue expander (TE) placement at the time of mastectomy and 37 who underwent total mastectomy. The median time from mastectomy to DBR was 12.8 months (IQR, 9.7-16.3 months). There were no complete autologous flap losses in either group and rates of other recipient site complications were similar between the groups. Infection at the recipient site occurred in 20% (13/66) of patients in the PMRT group that underwent TE placement, and 9 (14%) required TE explantation because of complications.</p><p><strong>Conclusion: </strong>PreMRT with microvascular IMBR is associated with a similar complication rate to PMRT with microvascular DBR whilst avoiding complications relating to TE placement and a reduced time to achieve definitive breast reconstruction. A larger randomized clinical trial of PreMRT followed by mastectomy and IMBR is currently underway (NCT05774678).</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021057","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":"Towards a Consensus-Based Stratification of Difficulty in Left Pancreatectomy.","authors":"Alessandro D Mazzotta, Fabio Melandro, Massimo Rossi, Gianluca Mennini","doi":"10.1097/XCS.0000000000001439","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001439","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989133","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":"Assessing the Potential Difficulty of Left Pancreatectomy: International Modified Delphi Consensus.","authors":"Jose M Ramia, Celia Villodre, Mario Serradilla-Martín, Cándido Alcazar, Gerardo Blanco-Fernández, Fernando Rotellar, Luis Sabater, Sanjay Pandanaboyana, Marc Besselink, Pierre-Alain Clavien","doi":"10.1097/XCS.0000000000001438","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001438","url":null,"abstract":"<p><strong>Introduction: </strong>Left pancreatectomy (LP) is the consensus term for the surgical procedure previously known as distal pancreatectomy. Several approaches and techniques are included in the LP definition, with varying difficulty. Several factors may contribute to the difficulty of LP. The aim of study is to identify these factors to facilitate selecting the optimal surgical strategy.</p><p><strong>Methods: </strong>A four-phase Delphi consensus process was undertaken. Participants were asked to indicate their 'agreement/disagreement' on each question on a 5-point Likert scale. For inclusion in the final recommendations, each question reached a ≥ 70% consensus by the end of the two survey rounds. 4) Generation of Delphi recommendations.</p><p><strong>Results: </strong>The survey was sent to 58 expert pancreatic surgeons from 14 countries, with 51 in both rounds. The median age of participants was 53 years (IQR: 47-60) with a median center LP volume in 2023 of 20 (IQR: 13-40). Twelve centers did not perform robotic LP. Eleven questions reached 70% agreement in the first round. The ten difficulty parameters sorted by the percentage of the agreement after two rounds were: previous pancreatic surgery and multi-visceral resection (90.7%); previous acute pancreatitis (88.9%); tumor located in the neck (88.9%); chronic pancreatitis (87.0%); Body Mass Index>30 kg/m2 (83.3%); cirrhosis (79.6%); previous supramesocolic surgery (excluding cholecystectomy) (75.9%): splenic arterial or venous infiltration (74.1%); and splenic vessels preservation (72.2%). Delta measurement between both rounds showed no statistical difference.</p><p><strong>Conclusions: </strong>The present international Delphi study led to an agreement on 10 statements stratifying the difficulty of LP. Validation in prospective series would be useful to confirm the feasibility and utility of this Delphi study.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971233","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":"Tragedy and Healing: The Impact of Two Black Surgeons in the Jim Crow South.","authors":"Savanna Banks, Isaiah V Ware, Anna Dunson, Deja Sibert, Don K Nakayama","doi":"10.1097/XCS.0000000000001437","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001437","url":null,"abstract":"<p><p>In 1956, as racial conflict in the South reached a murderous climax, Thomas H. Brewer, Sr (1894-1956), a prominent Black physician and civic leader in Columbus, Georgia, was shot and killed by a White businessowner. When his assailant was released without charges, many of the town's Black physicians and professionals left town, fearing for their safety and unwilling to live under Jim Crow. In 1964, M. Delmar Edwards (1926-2009), graduating surgery resident at the nearby Tuskegee Veterans Administration Hospital, asked two White surgeons in Columbus-Seaborn Roddenbery, III, and Abraham Conger-to serve as preceptors over his last two years of training, a requirement for board certification. They agreed, and Edwards joined their practice. Edwards filled the void left by Brewer's death. He overcame White-only restrictions to the hospital medical staff, segregated wards, and professional shunning. He eventually served in leadership roles for the hospital, including chair of the department of surgery and vice president of the hospital system. Over the next decades, he encouraged more than 70 Black physicians to settle in Columbus as full members of the city's professional community. Their stories separated by only eight years, Brewer and Edwards embodied an inflection point in the civil rights movement: the transition between murderous injustice and the integration of the Black community into the social and political mainstream of the South brought on by a Supreme Court decision, an Act of Congress, and changes in the hearts of the American people.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008730","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":"Idiopathic Subglottic Stenosis, the Epithelial Mesenchymal Transition, and Adaptive Immunity.","authors":"David E Rosow","doi":"10.1097/XCS.0000000000001433","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001433","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026205","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":"Guideline-Concordant Care in High-Risk Esophageal Squamous Cell Carcinoma: When Less May Not Be More.","authors":"Marisa Sewell, Daniela Molena","doi":"10.1097/XCS.0000000000001432","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001432","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988395","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":"Methodological Considerations for Machine Learning in ACS NSQIP Benchmarking Risk Assessments.","authors":"Rachel L Wolansky, Tyler Zander, Melissa A Kendall, Paul C Kuo","doi":"10.1097/XCS.0000000000001431","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001431","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998577","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":"Implications for Protein Kinase C-Beta Inhibition in Coronary Artery Endothelial Cell Ischemia and Reperfusion Injury.","authors":"Abeline R Watkins, Emilio I Alarcon, Erik J Suuronen, Marc Ruel","doi":"10.1097/XCS.0000000000001430","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001430","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971009","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}