Journal of the American College of Surgeons最新文献

{"title":"Invited Commentary: The Buck Stops Here: Where Does the Responsibility Lie for Acute Lower Gastrointestinal Conditions?","authors":"Alex J Bartholomew, Faithful T Ogundiran, Susanna S Hill","doi":"10.1097/XCS.0000000000002031","DOIUrl":"10.1097/XCS.0000000000002031","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"960-962"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868678","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: Emergency Operation in Patients with Cancer: \"When Can I Go Home?\"","authors":"Jamila K Picart, Hari Nathan","doi":"10.1097/XCS.0000000000001976","DOIUrl":"10.1097/XCS.0000000000001976","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"831-833"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774940","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":"Full Bayesian Hierarchical Logistic Regression in American College of Surgeons NSQIP: Advancing Surgical Quality Benchmarking.","authors":"Yaoming Liu, Mark E Cohen, Arielle Grieco, Bruce L Hall, Clifford Y Ko","doi":"10.1097/XCS.0000000000002009","DOIUrl":"10.1097/XCS.0000000000002009","url":null,"abstract":"<p><strong>Background: </strong>American College of Surgeons (ACS) NSQIP benchmarks 30-day postoperative outcomes using hierarchical logistic regression with empirical Bayes smoothing, but this framework can be computationally burdensome at the current program scale and may be less robust in sparse-data settings.</p><p><strong>Study design: </strong>Using 2024 ACS NSQIP data, 14 \"all cases\" outcome models were fit in 963,565 patients from 656 hospitals with matched generalized linear mixed model-empirical Bayes (GLMM-EB) and full Bayesian (FB) hierarchical logistic regression specifications using identical predictors and hospital random intercepts. Comparisons focused on hospital odds ratios, outlier classification, random-intercept variance, and computation time. Secondary analyses examined 4 lower-volume mortality models.</p><p><strong>Results: </strong>FB and GLMM-EB yielded highly concordant hospital estimates across 14 primary models, with a mean correlation of log-odds of 0.9958 and a mean slope of 0.9759. Concordance for outlier detection was high, with mean Jaccard indices of 0.8849 for high outliers and 0.8174 for low outliers. Mean random-intercept variance was slightly higher with FB than GLMM-EB (0.1813 vs 0.1763). Mean processing time was markedly lower with GPU-accelerated FB than GLMM-EB (5.32 vs 121.80 minutes). FB additionally provided posterior probabilities for high- and low-outlier status and supported Bayesian false discovery rate control. Differences between methods increased in the 4 smaller mortality models.</p><p><strong>Conclusions: </strong>In ACS NSQIP benchmarking, modern FB hierarchical logistic regression produced hospital performance estimates similar to GLMM-EB while substantially reducing computation time and extending probabilistic interpretability. These findings support transition to an FB framework for scalable surgical quality benchmarking.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"976-982"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774947","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: Getting There from Here: Standardizing Postoperative Opioid Use in Children.","authors":"Brendan T Campbell","doi":"10.1097/XCS.0000000000002021","DOIUrl":"10.1097/XCS.0000000000002021","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"790-791"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148264849","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: Measuring What Matters in Colorectal Cancer Care: From Rankings to Reliable Quality.","authors":"Sonia L Ramamoorthy","doi":"10.1097/XCS.0000000000002039","DOIUrl":"10.1097/XCS.0000000000002039","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"859-860"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339079","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":"NIH Funding for Artificial Intelligence in Surgical Specialties: Allocation and Alignment with US Disease Burden.","authors":"Rahul Gorijavolu, Andrew Cho, Saurav Boparai, Amanoor S Johal, Vinayak Mathur, Yusuf Ciftci, Ifeoluwa Shoyombo, Elizabeth A King, Leo A Celi, Anne M Stey","doi":"10.1097/XCS.0000000000002065","DOIUrl":"10.1097/XCS.0000000000002065","url":null,"abstract":"<p><strong>Background: </strong>NIH investment in artificial intelligence (AI) within surgical specialties is rapidly expanding, yet whether funding aligns with disease burden or reflects structural disparities remains unclear.</p><p><strong>Study design: </strong>Cross-sectional analysis of NIH Research Portfolio Online Reporting Tools Expenditures and Results (1993 to 2024) identified 1,657 AI grants across 8 surgical specialties. Multivariable regression of 976 grants to 379 investigators (2021 to 2024) evaluated associations between funding and 2021 disability-adjusted life years (DALYs), adjusting for region, investigator sex, and degree. Primary endpoints were total funding and grant number relative to disease burden; secondary analyses assessed regional and investigator variation.</p><p><strong>Results: </strong>NIH AI funding was not associated with disease burden after adjustment (funding: incidence rate ratio [IRR] 1.00, 95% CI 0.99 to 1.01, p > 0.9; grant number: IRR 0.93, 95% CI 0.87 to 0.99, p = 0.033). Funding per DALY varied widely across disease categories without proportional allocation to higher-burden conditions. Regional disparities were evident: compared with the Midwest, the South received more grants (IRR 1.46, 95% CI 1.10 to 1.94) but lower per-grant funding (IRR 0.79, 95% CI 0.65 to 0.94). Female investigators received fewer grants than male investigators (IRR 0.69, 95% CI 0.57 to 0.84), although per-award funding was similar.</p><p><strong>Conclusions: </strong>NIH funding for AI research in surgical specialties is not aligned with disease burden and instead reflects regional and investigator-level variation. These findings identify structural disparities in funding allocation and establish a benchmark for policy efforts to better align AI research investment with population health needs.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"861-871"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148264880","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":"New Perioperative DNR Orders: Exploring Risk Factors and Timing.","authors":"Sarah L Remer, Caroline Smolkin, Ronnie Rosenthal, Clifford Y Ko, Marcia M Russell","doi":"10.1097/XCS.0000000000001993","DOIUrl":"10.1097/XCS.0000000000001993","url":null,"abstract":"<p><strong>Background: </strong>Older adults undergoing surgery are at increased risk for postoperative complications, functional decline, and death, yet factors associated with new perioperative DNR orders, and the timing of these orders relative to clinical events remain incompletely defined.</p><p><strong>Study design: </strong>Retrospective cohort study using the American College of Surgeons NSQIP Geriatric Surgery Pilot Program (2015 to 2019). Patients aged 65 years and older undergoing surgery at participating hospitals were included. The primary outcome was a new perioperative DNR order within 30 days of surgery. Multivariable logistic regression accounting for hospital-level clustering identified predictors of new DNR placement. Timing analyses evaluated DNR placement relative to surgery, mortality, major morbidity, and palliative care consultation (PCC).</p><p><strong>Results: </strong>Among 47,564 cases from 27 sites, 1,108 (2.3%) had a new perioperative DNR order. Independent predictors included American Society of Anesthesiologists class IV and V (odds ratio [OR] 2.6, 95% CI 1.9 to 3.6), disseminated cancer (OR 3.3, 95% CI 2.5 to 4.3), emergent surgery (OR 3.5, 95% CI 1.8 to 6.7), malnutrition (OR 2.3, 95% CI 1.6 to 3.1), and postoperative delirium (OR 2.3, 95% CI 1.8 to 2.9). PCC was associated with new DNR placement in cases with nonmissing PCC data (OR 10.8, 95% CI 6.9 to 17.0). New DNR orders were placed a mean 3.8 (±7.0) days after surgery; 32.5% occurred within 24 hours of surgery. Among patients who died, DNR orders were placed a mean 5.2 (±6.6) days before death, with 43.3% occurring within 24 hours of death. Among 239 cases with both PCC and DNR dates, 46.4% occurred on the same day.</p><p><strong>Conclusions: </strong>New perioperative DNR orders in older adults cluster early after surgery and near death. These patterns, together with low overall specialty PCC use, identify potential opportunities for earlier, structured multidisciplinary goals-of-care discussions in high-risk surgical patients.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"939-949"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774569","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: From Intervals to Probabilities: Bayesian Inference as the Framework Surgical Quality Benchmarking Requires.","authors":"Marissa C Kuo, Paul C Kuo","doi":"10.1097/XCS.0000000000002032","DOIUrl":"10.1097/XCS.0000000000002032","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"983-984"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874552","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":"Postoperative Outcomes and Recovery Trajectory among Patients with Gastrointestinal Cancer Undergoing Emergency General Surgery.","authors":"Meher Angez, Selamawit Woldesenbet, Charalampos M Charalampous, Shahzaib Zindani, Jun Kawashima, Odysseas P Chatzipanagiotou, Areesh Mevawalla, Muhammad Qasim Chaudry, Timothy M Pawlik","doi":"10.1097/XCS.0000000000002008","DOIUrl":"10.1097/XCS.0000000000002008","url":null,"abstract":"<p><strong>Background: </strong>For older adults with gastrointestinal cancer undergoing emergency general surgery, perioperative metrics do not capture prolonged institutional dependence after operation. We characterized 12-month days elsewhere than home (DEH) recovery trajectories and identified factors associated with protracted recovery (PR) and sustained high DEH (SH-DEH).</p><p><strong>Study design: </strong>We performed a retrospective cohort study using Surveillance, Epidemiology, and End Results-Medicare (2005 to 2019) of beneficiaries aged 66 years and older with gastrointestinal cancer undergoing emergency general surgery. Monthly DEH during the 12 postoperative months was modeled using group-based trajectory modeling. Modified Poisson regression identified preoperative and postoperative factors associated with PR and SH-DEH.</p><p><strong>Results: </strong>Among 15,398 patients, 6,852 were men, 8,546 were women, and 11,917 (77.4%) were White. Four trajectories were identified: routine recovery (42.5%; n = 6,543), chronically dependent (37.1%; n = 5,719), PR (7.2%; n = 1,109), and SH-DEH (13.2%; n = 2,027). SH-DEH was associated with stage IV disease (adjusted relative risk [aRR] 2.39, 95% CI 2.07 to 2.76), frailty (aRR 2.58, 95% CI 2.09 to 3.19), Charlson Comorbidity Index greater than 2 (aRR 1.37, 95% CI 1.24 to 1.53), and intrahepatic cholangiocarcinoma (aRR 3.52, 95% CI 2.58 to 4.82). PR was associated with stage IV disease (aRR 1.92, 95% CI 1.59 to 2.32), a Charlson Comorbidity Index greater than 2 (aRR 1.79, 95% CI 1.55 to 2.08), claims-based frailty risk (aRR 4.50, 95% CI 3.68 to 5.52), and pancreatic cancer (aRR 2.52, 95% CI 2.09 to 3.04; all p < 0.001). Major postoperative complications, prolonged length of stay, and ICU admission increased the likelihood of both PR and SH-DEH. Model discrimination ranged from 0.74 to 0.84.</p><p><strong>Conclusions: </strong>Older adults with gastrointestinal cancer undergoing emergency general surgery demonstrated distinct DEH recovery trajectories. Frailty, advanced disease, comorbidity, and postoperative complications identified patients at risk for prolonged recovery or sustained institutional dependence.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"817-831"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774574","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":"Impact of Smoking Status on Morbidity and Mortality after Lung Cancer Resection: An Analysis of the Society of Thoracic Surgeons General Thoracic Surgery Database.","authors":"Hannah Kim, Sofia Wagemaker Viana, Christina Pinkston, Catherine G Pratt, Shesh Rai, Christine E Haugen, Ralph C Quillin, Sandra L Starnes, Robert M Van Haren","doi":"10.1097/XCS.0000000000002007","DOIUrl":"10.1097/XCS.0000000000002007","url":null,"abstract":"<p><strong>Background: </strong>Tobacco exposure is the leading cause of lung cancer, with some surgeons and centers requiring smoking cessation before lung resection. The impact of continued smoking on outcomes remains uncertain. We evaluated morbidity and mortality after resection among patients who currently smoke compared with those who formerly smoked.</p><p><strong>Study design: </strong>We analyzed lung cancer resections (2018 to 2023) in the Society of Thoracic Surgeons General Thoracic Surgery Database. Smoking status was defined using Society of Thoracic Surgeons operational definitions as current (within 1 month of operation) or former (abstinence more than 1 month). Patients who never smoked were excluded. Primary outcomes were operative or 30-day mortality and postoperative pulmonary complications. Multivariable regression identified predictors of outcomes. This research was determined to be exempt research with a waiver of informed consent from Advarra IRB (Mod01760092, Version 1.1, Approval date July 17, 2023).</p><p><strong>Results: </strong>Of 85,124 patients, 28% (n = 24,093) currently smoked and 72% (n = 61,031) formerly smoked. Patients who currently smoked were younger (65.6 vs 69.6 years; p < 0.001), had fewer comorbidities, and included higher proportions of patients who identify as Black (11.5% vs 7.5%; p < 0.001). Pulmonary complications were more frequent among patients who currently smoke (34.6% vs 30.5%; p < 0.001), but mortality did not differ by smoking status (1.0% vs 1.0%; p = 0.52). Male sex, current smoking, greater pack-years, thoracotomy, and more extensive resection independently predicted pulmonary complications.</p><p><strong>Conclusions: </strong>Patients who currently smoke experienced higher pulmonary morbidity but no increase in mortality. Surgeons should not use smoking status alone when determining whether a patient is a candidate for lung cancer resection. Risk assessment should integrate smoking status in combination with a comprehensive range of preoperative factors to guide shared decision-making and ensure access to lung cancer operations.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"769-779"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774930","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}