Journal of the American College of Surgeons最新文献

{"title":"Glycemic Status and Elective Surgery Risk: Clinically Recognized Hyperglycemia vs Diabetes Diagnosis Alone in a National Cohort.","authors":"Solomon Kim, Beshoy Saad, Gizele Bracamontes, Brenden Tu, Michael S Wong","doi":"10.1097/XCS.0000000000001981","DOIUrl":"10.1097/XCS.0000000000001981","url":null,"abstract":"<p><strong>Background: </strong>Diabetes affects 20% to 25% of surgical patients, but whether elective surgery should be deferred for patients with diabetes absent clinically recognized hyperglycemia remains unclear. We evaluated perioperative risk by glycemic status in adults undergoing elective surgery.</p><p><strong>Study design: </strong>Retrospective cohort study of the National Inpatient Sample, 2016 to 2022. Adults undergoing elective joint arthroplasty, lumbar spine fusion, cholecystectomy, colectomy, cardiac surgery, or hysterectomy were classified as no diabetes, diabetes without hyperglycemia, or diabetes with hyperglycemia using ICD-10 Clinical Modification codes. The primary endpoint was composite major adverse events (mortality, acute kidney injury, sepsis, MI, ischemic stroke, or venous thromboembolism). Survey-weighted multivariable logistic regression adjusted for demographics, payer, procedure type, year, hospital characteristics, and Elixhauser comorbidities.</p><p><strong>Results: </strong>Among 2,104,338 hospitalizations (~10.5 million weighted), 1,641,797 (78.0%) had no diabetes, 398,095 (18.9%) had diabetes without hyperglycemia, and 64,446 (3.1%) had diabetes with hyperglycemia. Adjusted major adverse event probability was 5.31% for no diabetes, 5.85% for diabetes without hyperglycemia, and 9.16% for diabetes with hyperglycemia. Diabetes without hyperglycemia was associated with modestly increased odds of major adverse events (adjusted odds ratio 1.13; 95% CI 1.11 to 1.15; absolute risk difference 0.55%; number needed to harm 183) and ranked 16th of 17 surgical risk factors examined. Diabetes with hyperglycemia was associated with substantially higher risk (adjusted odds ratio 2.00; 95% CI 1.94 to 2.05; absolute risk difference 3.85%; number needed to harm 26).</p><p><strong>Conclusions: </strong>Diabetes without clinically recognized hyperglycemia was a comparatively weak risk factor, whereas clinically recognized hyperglycemia identified a substantially higher perioperative risk. These findings suggest glycemic status may better inform elective surgical risk stratification than diabetes diagnosis alone.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"916-927"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690804","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: Clearing the Smoke on Smoking Cessation.","authors":"Brooks V Udelsman, Anthony W Kim","doi":"10.1097/XCS.0000000000002019","DOIUrl":"10.1097/XCS.0000000000002019","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"779-780"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839600","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: NIH Funding in Surgical Artificial Intelligence: Who, What, Where, Why.","authors":"Jeremy A Balch, Tyler J Loftus","doi":"10.1097/XCS.0000000000002084","DOIUrl":"10.1097/XCS.0000000000002084","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"873-874"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345690","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: Does Surgical Supply Cost Really Matter?","authors":"Christopher P Childers","doi":"10.1097/XCS.0000000000002006","DOIUrl":"10.1097/XCS.0000000000002006","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"937-938"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338861","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":"Reframing Surgical Risk in Frailty: Causal Mediation Analysis of Mortality and Readmission after Pancreatectomy.","authors":"Elio R Bitar, Anthony Kostov, Kellyn E McKee, Olivia Sears, Kaelyn C Cummins, Mohamad El Moheb, Mackenzie M Mayhew, Chengli Shen, Samantha M Ruff, Allan Tsung","doi":"10.1097/XCS.0000000000001994","DOIUrl":"10.1097/XCS.0000000000001994","url":null,"abstract":"<p><strong>Background: </strong>Frailty predicts poor outcomes after pancreatectomy, but whether excess mortality and readmission reflect more postoperative complications, worse rescue after complications, or broader recovery vulnerability remains unclear.</p><p><strong>Study design: </strong>We performed a retrospective study of the American College of Surgeons NSQIP Pancreatectomy database (2014 to 2023) including 71,104 patients undergoing pancreatic resection. Frailty was defined as modified 5-item frailty index score 2 or more. Multivariable logistic regression evaluated associations between frailty and 30-day mortality and readmission. Causal mediation analysis quantified total, direct, and complication-mediated indirect effects. Interaction modeling compared failure-to-rescue and nonprecedented deaths by frailty status.</p><p><strong>Results: </strong>Of 71,104 patients, 15,779 (22.2%) were frail. Frailty was independently associated with 30-day mortality (adjusted odds ratio 1.29, 95% CI 1.13 to 1.46; p < 0.001) and readmission (adjusted odds ratio 1.11, 95% CI 1.06 to 1.16; p < 0.001). For mortality, the total effect of frailty was significant (risk ratio [RR] 1.32, 95% CI 1.23 to 1.40; p < 0.001), the indirect effect through complications was significant (RR 1.25, 95% CI 1.22 to 1.27; p < 0.001), and the direct effect was not (RR 1.07, 95% CI 0.99 to 1.14; p = 0.400); complications mediated 80.72% of the frailty-mortality association. The largest contributors were unplanned reintubation, bleeding requiring transfusion, septic shock, acute kidney injury requiring dialysis, MI, and organ or space surgical site infection. Major complications increased mortality similarly in frail and nonfrail patients, without meaningful frailty-related differences in failure to rescue. For readmission, complications explained only 17% of the frailty association.</p><p><strong>Conclusions: </strong>After pancreatectomy, frailty-associated mortality is largely explained by postoperative complications, whereas frailty-associated readmission is driven predominantly by vulnerability beyond complications. These findings support complication prevention, prehabilitation, and intensified postdischarge follow-up for frail patients.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"963-974"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774845","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: Understanding the Relationship Between Frailty and Mortality After Pancreatic Resection.","authors":"Carrie E Ryan, Mary E Dillhoff","doi":"10.1097/XCS.0000000000002087","DOIUrl":"10.1097/XCS.0000000000002087","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"974-975"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148422088","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":"Oncologic Impact of Margin-to-Size Ratio for Intrahepatic Cholangiocarcinoma.","authors":"Jun Kawashima, Kota Sahara, Miho Akabane, Yutaka Endo, Federico Aucejo, Shishir K Maithel, Bas Groot Koerkamp, Yuki Homma, Itaru Endo, Timothy M Pawlik","doi":"10.1097/XCS.0000000000002062","DOIUrl":"10.1097/XCS.0000000000002062","url":null,"abstract":"<p><strong>Background: </strong>The optimal surgical margin width for intrahepatic cholangiocarcinoma (ICC) remains uncertain. We hypothesized that the oncologic benefit of a wide margin may be modulated by tumor-related factors.</p><p><strong>Study design: </strong>Patients who underwent curative-intent liver resection for solitary ICC were identified from a large, international multi-institutional database. A novel metric, the margin-to-size ratio (MSR), was defined as the ratio of surgical margin width (mm) to tumor size (mm), integrating both parameters into a single variable. Multivariable Cox regression models were used to evaluate the association between MSR and recurrence-free survival (RFS).</p><p><strong>Results: </strong>Among 1,172 patients, the median tumor size was 57.0 mm, the median margin width was 4.0 mm (interquartile range 1.0 to 10.0), and the median MSR was 0.07 (interquartile range 0.02 to 0.20). On multivariable analysis, a higher MSR was independently associated with improved RFS (hazard ratio 0.59, 95% CI 0.36 to 0.96, p = 0.033), whereas neither absolute margin width nor R1 resection status was associated with RFS. Using maximally selected rank statistics, an MSR threshold of 0.142 was identified. Patients with a high MSR (0.142 or more) had superior 3-year RFS compared with individuals with a low MSR (less than 0.142; 55.7% [95% CI 46.0 to 67.6] vs 45.2% [95% CI 38.0 to 53.8]; p = 0.016).</p><p><strong>Conclusions: </strong>MSR was independently associated with RFS after ICC resection, whereas conventional margin metrics, including absolute margin width and R1 resection status, were not associated with RFS. MSR may provide a clinically interpretable framework to contextualize margin adequacy relative to tumor size and inform individualized decision-making.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"804-814"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148157070","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":"Surgeon- and Hospital-Level Contributions to Surgical Supply Cost Variation in an Integrated Health System.","authors":"Ramsey M Dallal, Edmund A Pribitkin, Radi F Zaki, Charles J Yeo","doi":"10.1097/XCS.0000000000002107","DOIUrl":"10.1097/XCS.0000000000002107","url":null,"abstract":"<p><strong>Background: </strong>Direct surgical supply costs are a modifiable component of operating room spending, but it is unclear whether variation reflects reproducible hospital- and surgeon-level practice patterns and whether stewardship opportunity is broadly distributed or concentrated.</p><p><strong>Study design: </strong>Retrospective observational study of 298,723 operative encounters from April 1, 2019, to March 31, 2025, across 15 hospitals in a single integrated health system. Hierarchical mixed-effects linear regression modeled log supply cost per case with random intercepts for hospitals and surgeons nested within hospitals, adjusting for CPT3 procedural family, calendar year, COVID-era indicator, and, in a complete-case subset, operative duration. Modeled excess cost benchmarked adjusted supply costs to internally observed top-quartile performance within each CPT3 family.</p><p><strong>Results: </strong>In the baseline model (n = 298,723), hospital-level factors accounted for 35.4% and surgeon-within-hospital factors for 32.7% of total variance (cumulative intraclass correlation coefficient 0.681). After operative time adjustment (n = 150,461), hospital variance was 38.1% and surgeon-within-hospital variance was 26.9% (cumulative intraclass correlation coefficient 0.650). Benchmarking corresponded to a 20% to 25% reduction in mean supply cost per case, with approximately 62% persisting after time adjustment. Fewer than 15% of CPT3 families accounted for more than half of modeled opportunity, and the top 5% of surgeons accounted for 56.1% of modeled excess cost. Higher adjusted supply costs were not consistently associated with 30-day readmission (adjusted odds ratio per 1-SD increase, 1.03; 95% CI 0.97 to 1.09).</p><p><strong>Conclusions: </strong>Surgical supply cost variation was reproducible, concentrated, and only partly explained by operative duration. These findings support targeted supply stewardship focused on high-impact procedure families and surgeons.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"930-937"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604425","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 the Gland: How Parathyroidectomy Enhances Cardiovascular Health in Dialysis-Independent End-Stage Renal Disease Patients.","authors":"Niranjna Swaminathan, Sanya Nathani, Rachael Caretti, Julia Adriana Kasmirski, Raj Roy, Andrea Gillis, Sophie Dream, Brenessa Lindeman, Herbert Chen","doi":"10.1097/XCS.0000000000001965","DOIUrl":"10.1097/XCS.0000000000001965","url":null,"abstract":"<p><strong>Background: </strong>The comparative effect of parathyroidectomy vs cinacalcet on long-term cardiovascular outcomes in dialysis-independent tertiary hyperparathyroidism remains unclear.</p><p><strong>Study design: </strong>A retrospective cohort study was performed using the TriNetX global research network. Adults with tertiary hyperparathyroidism and dialysis-independent end-stage renal disease were identified and stratified by treatment (parathyroidectomy vs cinacalcet). Propensity score matching (1:1) balanced demographics, comorbidities, cardiovascular history, and medication use. Time-to-event analyses were conducted using Cox proportional hazards regression for up to 5 years of follow-up.</p><p><strong>Results: </strong>After matching, 880 patients were included in each cohort (mean age 53 ± 14 years; female patients 49.0% vs 51.3%). Parathyroidectomy was associated with a lower risk of major adverse cardiovascular events compared with cinacalcet (hazard ratio [HR] 0.64, 95% CI 0.52 to 0.78; p < 0.001). MI (12.5% vs 15.4%; HR 0.64, 95% CI 0.52 to 0.78) and heart failure hospitalization (20.0% vs 26.3%; HR 0.62, 95% CI 0.55 to 0.71) were reduced after parathyroidectomy. Coronary revascularization was less frequent (coronary artery bypass graft 0% vs 2.2%, p = 0.001; percutaneous coronary intervention 1.8% vs 2.8%, HR 0.79, 95% CI 0.72 to 0.90). Secondary outcomes demonstrated lower hazards of atrial fibrillation (HR 0.33, 95% CI 0.21 to 0.55), ventricular arrhythmia (HR 0.73, 95% CI 0.70 to 0.85), hypertensive heart disease (HR 0.49, 95% CI 0.41 to 0.59), heart failure (HR 0.64, 95% CI 0.59 to 0.76), and peripheral vascular disease (HR 0.73, 95% CI 0.67 to 0.92). Findings were consistent in sensitivity and competing-risk analyses.</p><p><strong>Conclusions: </strong>Parathyroidectomy was associated with a durable reduction in cardiovascular events compared with cinacalcet in dialysis-independent tertiary hyperparathyroidism. These findings support consideration of surgical management to mitigate long-term cardiovascular risk.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"792-801"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639090","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: Transparency in Surgical Quality Improvement: Demonstrating the Value of American College of Surgeons NSQIP Participation.","authors":"Robert A Meguid, William G Henderson","doi":"10.1097/XCS.0000000000002058","DOIUrl":"10.1097/XCS.0000000000002058","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"914-915"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148150355","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}