American journal of surgery最新文献

{"title":"Low complication rates mask a high burden of severe morbidity: Analysis of 968 consecutive surgical procedures.","authors":"Pedro Agustin Lovato Gutierrez, Andrés Renet Palma Hernandez, Amilcar Omar Herrera Cevallos","doi":"10.1016/j.amjsurg.2026.117209","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2026.117209","url":null,"abstract":"<p><strong>Background: </strong>Complication incidence alone may inadequately reflect surgical quality in heterogeneous healthcare systems. This study evaluated postoperative outcomes, complication severity, and failure-to-rescue (FTR) within a mixed healthcare system using Clavien-Dindo classification and risk-adjusted analysis.</p><p><strong>Methods: </strong>A retrospective cohort study of 968 consecutive general surgical procedures performed across three institutions between 2015 and 2025 was conducted. Procedures included elective and emergency surgery across multiple surgical specialties. Postoperative complications were classified using Clavien-Dindo criteria. Severe complications were defined as grade III-V events. Multivariable logistic regression analysis was performed to identify independent predictors of severe postoperative complications. Model discrimination, calibration, and internal validation were assessed using AUC-ROC, Hosmer-Lemeshow testing, Brier score, and bootstrap resampling.</p><p><strong>Results: </strong>Overall complication incidence was 2.8%, with severe complications (Clavien-Dindo III-V) accounting for 85.2% of adverse events. Emergency surgery was associated with higher complication rates and greater complication severity. The overall FTR rate was 11.1%. In multivariable analysis, higher ASA classification (OR 3.08, 95% CI 1.70-5.61; p < 0.001), emergency surgery (OR 5.45, 95% CI 1.70-17.48; p = 0.004), operative time (OR 1.11 per 10-min increase, 95% CI 1.04-1.19; p = 0.003), and male sex (OR 7.02, 95% CI 1.57-31.39; p = 0.011) were independently associated with severe postoperative complications. Healthcare setting was not independently associated after adjustment. The model demonstrated good discrimination and calibration (AUC-ROC 0.895; optimism-corrected AUC 0.870).</p><p><strong>Conclusions: </strong>In this mixed healthcare system, low overall complication rates coexisted with a disproportionately high burden of severe postoperative morbidity. Risk-adjusted analysis suggests that patient condition, emergency surgical burden, and operative factors exert greater influence on severe complications than healthcare setting alone. Integrating complication severity and FTR analysis may provide a more meaningful assessment of surgical quality in heterogeneous healthcare environments.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"117209"},"PeriodicalIF":2.3,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148862954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closing the gender gap in support for surgical parenthood.","authors":"Valerie E Polcz, Amalia Cochran, Gilbert R Upchurch","doi":"10.1016/j.amjsurg.2026.117201","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2026.117201","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"117201"},"PeriodicalIF":2.3,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Cloak of Normalcy.","authors":"Ambreen Deol, Kimberly Kopecky","doi":"10.1016/j.amjsurg.2026.117190","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2026.117190","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"117190"},"PeriodicalIF":2.3,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New to research? 5 practical research tips for the aspiring academic surgeon.","authors":"Benjamin L Scott, Robert W Krell, Jenny M Held","doi":"10.1016/j.amjsurg.2026.117206","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2026.117206","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"117206"},"PeriodicalIF":2.3,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148904848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the first cut: Harnessing 4DX and Lean for sustainable OR efficiency in the VHA.","authors":"Lindsey E Goldstein, Bradley M Schmit","doi":"10.1016/j.amjsurg.2026.117188","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2026.117188","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"117188"},"PeriodicalIF":2.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A missed opportunity: Utilization of anorectal visits to increase colorectal cancer screening among younger patients.","authors":"Charlotte Buisson, Matthias Tedros, Ian Paquette, Jonathan Snyder, Earl Thompson, Jenna Whitrock, Carla Justiniano","doi":"10.1016/j.amjsurg.2026.117186","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2026.117186","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer rates are rising among adults younger than 50. Visits for benign anorectal conditions may offer an opportunity to identify patients who are not current with screening. This study evaluated screening completion among patients presenting with anorectal complaints and examined colonoscopy uptake after a screening recommendation.</p><p><strong>Methods: </strong>We conducted a retrospective study of patients seen for benign anorectal diagnoses at two hospitals within a single tertiary health system between January 1 and October 1, 2023. Data included demographics, examination findings, and screening history.</p><p><strong>Results: </strong>Among 776 patients, only 60.5% of adults aged 45-49 had undergone colonoscopy in the prior 10 years. Of the adults aged 45-49 who were not up to date, when a colonoscopy was recommended, 69.0% completed it, compared with 0% who did not receive a recommendation.</p><p><strong>Conclusions: </strong>Benign anorectal visits provide meaningful opportunities to improve colorectal cancer screening in adults aged 45-49.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"117186"},"PeriodicalIF":2.3,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Planning for the \"Unplanned\": Is the QoR-15 too little, too late?","authors":"Benjamin Kirk, Lindsey L Saint","doi":"10.1016/j.amjsurg.2026.117149","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2026.117149","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"117149"},"PeriodicalIF":2.3,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behavioral nudges and the long road to closing the primary hyperparathyroidism screening gap.","authors":"Niranjna Swaminathan, Andrea Gillis","doi":"10.1016/j.amjsurg.2026.117146","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2026.117146","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"117146"},"PeriodicalIF":2.3,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diffusion of innovation in medicine to evaluate impact of new technology.","authors":"Bryant Morocho, N Joseph Espat, Ponnandai Somasundar, Michael Doonan, Steve Kwon","doi":"10.1016/j.amjsurg.2026.117150","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2026.117150","url":null,"abstract":"<p><strong>Purpose: </strong>Diffusion of Innovation (DOI) model, used in finance to evaluate technology adoption, was applied to medicine using robotic surgery adoption as a case study.</p><p><strong>Methods: </strong>National Cancer Database (2010-2021), facility level compound annual growth rate (CAGR) in colorectal surgical volume was calculated. Facilities were grouped by year of robotic adoption into DOI categories. Multivariable linear regression estimated associations between CAGR, DOI groups, initial surgical volume and robotic utilization.</p><p><strong>Results: </strong>There were 714,742 patients. DOI groups demonstrated a bell-shaped association with CAGR (Innovators β = 1.88; Early Majority β = 3.98; Late Majority: 2.57; Laggards: 2.07; all p < 0.01). Patients travelled further to Innovator/Early Adopters (β = 7.42 miles) and Early Majority hospitals (β: 8.25 miles, both p < 0.01).</p><p><strong>Conclusion: </strong>DOI served as a useful model to evaluate the impact of technology adoption at various points of dissemination, demonstrating largest surgical volume growth in institutions who adopt the technology after a period of initial dissemination.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"117150"},"PeriodicalIF":2.3,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148534968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The question of quality in cancer care: How can we make more hospitals 5-star?","authors":"Emily E Witt, Rajshri M Gartland","doi":"10.1016/j.amjsurg.2026.117140","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2026.117140","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"117140"},"PeriodicalIF":2.3,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148496940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}