Combined Hepatopancreaticobiliary Volume and Hepatectomy Outcomes in Hepatocellular Carcinoma Patients at Low-Volume Liver Centers
Socioeconomic and geographic barriers to centralization of high-volume care persist. Liver resection outcomes at low-volume liver resection centers that have substantial experience with hepatopancreaticobiliary operation are similar to those at high-volume liver resection centers. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 25, 2021 Category: Surgery Authors: Susanna WL. de Geus, Alison P. Woods, Marianna V. Papageorge, Jian Zheng, Sing Chau Ng, David McAneny, Teviah E. Sachs, Jennifer F. Tseng Tags: New England Surgical Society Article Source Type: research

Guidelines for Patient-Centered Opioid Prescribing and Optimal FDA-Compliant Disposal of Excess Pills after Inpatient Operation: Prospective Clinical Trial
To optimize responsible opioid prescribing after inpatient operation, we implemented a clinical trial with the following objectives: prospectively validate patient-centered opioid prescription guidelines and increase the FDA-compliant disposal rate of leftover opioid pills to higher than currently reported rates of 20% to 30%. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 25, 2021 Category: Surgery Authors: Eleah D. Porter, Sarah Y. Bessen, Ilda B. Molloy, Julia L. Kelly, Niveditta Ramkumar, Joseph D. Phillips, Andrew P. Loehrer, Matthew Z. Wilson, Rian M. Hasson, Srinivas J. Ivatury, Jessica R. Henkin, Richard J. Barth Tags: New England surgical society article Source Type: research

Financial Toxicity in Cancer Care: The Next Metric of Cancer Disparity
Financial toxicity refers to the adverse effects of financial strain on the well-being of a patient faced with a cancer diagnosis and the subsequent cost of care. As cancer care cost escalates and the health-related out-of-pocket expenses grow, patients can incur considerable financial burden. In the current issue, Coroneos and colleagues1 examine the impact of financial toxicity on quality of life outcomes in women undergoing operations for breast cancer. Financial toxicity was measured using the validated Comprehensive Score for Financial Toxicity and was correlated with patient outcomes, including condition-specific qua...
Source: Journal of the American College of Surgeons - February 23, 2021 Category: Surgery Authors: Julie A. Margenthaler Tags: Invited Commentary Source Type: research

Correction
The abstract, “Neglected Surgical Disease Burden Assessment In Zambia: Research Protocol For A Randomized Cross-Sectional Survey,” which appeared in the October supplement of the Journal of the American College of Surgeons, Volume 231, Issue 4, Supplement 2, page e26, was published incorrectly. The correct ab stract is listed below. The authors apologize for this error. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 23, 2021 Category: Surgery Tags: Correction Source Type: research

Infection Risk Stratification in Pancreatic Surgery: Look to the Blood
Some years ago, while on weekend rounds when I was covering our hepato-pancreato-biliary (HPB) service, an enterprising medical student asked why every post-pancreatectomy patient seemed to be on a different perioperative antibiotic regimen. We had likely seen about 10 patients at various postoperative stages with similar recovery trajectories, yet they had been managed very differently with respect to pre-, peri-, and postoperative antibiotic use (not to mention the use of drains … a whole different story!). (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 23, 2021 Category: Surgery Authors: Ryan C. Fields Tags: Invited Commentary Source Type: research

A Step in the Right Direction for Surgeon-Scientists
Leveraging a unique perspective of medical necessity and ability to optimize innovation through iterative clinical translation, surgeon-scientists have made many significant contributions to the advancement of the medical sciences over the past century. Only a few of these advances in medical science include organ transplantation (Starzl), mechanical circulatory support (Jarvik, Frazier), identification of the association of smoking with lung cancer (Ochsner, DeBakey), and translational application of understandings of the biologic process of angiogenesis in treating cancer (Folkman). (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 23, 2021 Category: Surgery Authors: Christopher T. Ryan, Todd K. Rosengart Tags: Invited Commentary Source Type: research

Pain Management in Trauma: Maximizing Multimodals to Minimize Opioids
The US has been challenged with an opioid crisis, as these medications account for a substantial number of fatal and nonfatal overdoses. Surgeons are on the front lines of this epidemic, balancing the treatment of pain, while confronting the risks of opioids, such as gastrointestinal effects, respiratory distress, delirium, increased hospital length of stay, and potential misuse or diversion.1,2 Recently, progress has been made in this battle, as opioid-related deaths fell in 2018 for the first time in decades. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 23, 2021 Category: Surgery Authors: Brian K. Yorkgitis, Chelsea R. Yap Tags: Invited Commentary Source Type: research

Role of Surgical Innovation in Addressing the GERD Treatment Gap
GERD is a common and costly medical condition that has become increasingly prevalent in Western societies over the past several decades.1 In 2012, GERD accounted for nearly 9 million clinic visits and was the most common diagnosis for outpatients presenting with a gastrointestinal complaint.2 This trend has showed no signs of slowing down. In 2004, GERD treatment in the US cost more than $12 billion, which was more than the cost of abdominal wall hernia and gallstone treatment combined.3 Nearly two-thirds of this cost was attributable to proton-pump inhibitors (PPIs), and this likely underestimates the current cost of ther...
Source: Journal of the American College of Surgeons - February 23, 2021 Category: Surgery Authors: Kyle A. Perry Tags: Invited Commentary Source Type: research

Contents
(Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 23, 2021 Category: Surgery Source Type: research

Editorial Board
(Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 23, 2021 Category: Surgery Source Type: research

Measures to Increase Use of Multiple Arterial Grafts for Isolated Coronary Artery Bypass Grafting
Multiple arterial grafts are infrequently utilized for coronary artery bypass grafting despite well-defined benefits including superior patency and increased survival compared to vein grafts. A focused programmatic and institutional emphasis on the use of multiple arterial grafts for CABG is an effective method to increase their use. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 23, 2021 Category: Surgery Authors: Ana K. Velez, Joseph K. Canner, Eric Etchill, Katherine Giuliano, Diane E. Alejo, Chun Choi, Ahmet Kilic, Stefano Schena, Glenn Joseph Robert Whitman, Jennifer S. Lawton Tags: Original Scientific Article Source Type: research

Does Preoperative Calcium and Calcitriol Decrease Rates of Post-Thyroidectomy Hypocalcemia? A Randomized Clinical Trial
Postoperative hypocalcemia is the most common complication after thyroidectomy. Postoperative supplementation with calcium and calcitriol reduces its occurrence, however, prophylactic preoperative supplementation has not been systematically studied. The primary objective of this study was to determine if pre and postoperative calcium and calcitriol supplementation reduces postoperative hypocalcemia after total thyroidectomy compared to postoperative supplementation alone. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 22, 2021 Category: Surgery Authors: Colleen Donahue, Haddon J. Pantel, Bharat B. Yarlagadda, David Brams Tags: New England Surgical Society Article Source Type: research

Training and Access to Gasless Laparoscopy in Rural Settings
This study was carried out to address the paucity of evidence on the clinical efficacy of gasless laparoscopy in India. The learning curve of the operating surgeons or their training experience was not evaluated in the study. We plan to conduct additional robust studies to evaluate this in the near future. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 19, 2021 Category: Surgery Authors: Anurag Mishra, Lovenish Bains, Jesudian Gnanaraj, Noel Aruparayil Tags: Letter Source Type: research

Gasless Laparoscopy: A Double-Edged Sword in the Developing World
In their recent article entitled “Evaluation of Gasless Laparoscopy as a Tool for Minimal Access Surgery in Low-to-Middle-Income Countries: A Phase II Noninferiority Randomized Controlled Study,” Mishra and colleagues conclude and “advocate for its wider use in low-resource settings to extend the benefits of minimal access su rgery (MAS) over open operation. . ..”1 (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 16, 2021 Category: Surgery Authors: Jeffrey S. Freed, Philip Landrigan Tags: Letter Source Type: research

Appraising the Quality of Reporting of American College of Surgeons NSQIP Emergency General Surgery Studies
The methodological reporting of emergency general surgery studies using the American College of Surgeons NSQIP database is suboptimal despite journal policies requiring authors to adhere to reporting statements. There is no difference in the quality of reporting between journals with high vs low impact factors. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 14, 2021 Category: Surgery Authors: Mohamad El Moheb, Hadi Sabbagh, Daniel Badin, Tala Mahmoud, Basil Karam, Majed W. El Hechi, Haytham MA. Kaafarani Tags: Original Scientific Article Source Type: research

Infectious Complication in Relation to the Prophylactic Mesh Position: The PRIMA Trial Revisited
A retrospective study based on a previous randomized controlled trial on prophylactic onlay or sublay mesh placement in patients with high risk for incisional hernia. Prophylactic mesh placement was not associated with increased incidence, severity, or need for invasive treatment of infectious complication compared with suture closure. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 14, 2021 Category: Surgery Authors: L. Matthijs van den Dop, D. Sneiders, Gert-Jan Kleinrensink, Hans J. Jeekel, Johan F. Lange, Lucas Timmermans Tags: Original Scientific Article Source Type: research

Outcomes of Carotid Revascularization in Patients with Contralateral Carotid Artery Occlusion
Carotid artery stenosis management in patients with contralateral carotid artery occlusion remains unresolved. Our study shows transcarotid artery revascularization (TCAR) is associated with favorable outcomes compared with transfemoral carotid artery stenting, independent of symptomatic status. Compared with carotid endarterectomy, TCAR was associated with decreased odds of in-hospital stroke only among asymptomatic patients. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 14, 2021 Category: Surgery Authors: Hanaa Dakour-Aridi, Nadin Elsayed, Mahmoud Malas Tags: Original Scientific Article Source Type: research

Incidence and Risk Factors for Long-Term Mesh Explantation Due to Infection in over 100,000 Hernia Surgery Patients
We evaluated the incidence rate, patient factors, surgery risk factors, mesh characteristics, and microorganisms associated with mesh explanation due to infection within 5 years of index operation for a large cohort of abdominal and inguinal hernia surgery patients. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 14, 2021 Category: Surgery Authors: Radwan Dipp Ramos, William J. O ’Brien, Kalpana Gupta, Kamal MF. Itani Tags: New England Surgical Society Article Source Type: research

COVID-19: Opportunity to Re-Imagine Our Response to a National Medical Crisis
The US is facing the most significant health challenge since the 1918-1919 flu pandemic. A response commensurate with this challenge requires engaged leadership and organization across private and public sectors which span federal agencies, public and private healthcare systems, professional organizations and industry. In the trauma and emergency care communities, we have long discussed the tension between competition in healthcare and the need for regional cooperation to respond to large-scale disasters. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 13, 2021 Category: Surgery Authors: Kyle N. Remick, Brendan Carr, Eric Elster Tags: Special Article Source Type: research

NIH Funding for Surgeon-Scientists in the US: What Is the Current Status?
Recent literature suggests that the future of surgeon-scientists in the US has been threatened for the past several decades. However, we documented an overall increase in NIH funding for surgeon-scientists, as well as the number of NIH-funded surgeons, from 2010 to  2020. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 12, 2021 Category: Surgery Authors: Lindsay A. Demblowski, Brad Busse, George Santangelo, Andrew M. Blakely, Patricia L. Turner, David B. Hoyt, Martha A. Zeiger Tags: Original scientific article Source Type: research

Cost Analysis of Pancreaticoduodenectomy at a High-Volume Robotic Hepatopancreaticobiliary Surgery Program
The robotic approach to pancreaticoduodenectomy is thought by many to be associated with increased financial burden for hospitals. We undertook this study to analyze and compare the cost of ‘open’ pancreaticoduodenectomy to that associated with the application of the robotic surgical system to pancreaticoduodenectomy in our hepatobiliary program. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 10, 2021 Category: Surgery Authors: Alexander Rosemurgy, Sharona Ross, Timothy Bourdeau, Kevin Jacob, Ja ’Karri Thomas, Valerie Przetocki, Kenneth Luberice, Iswanto Sucandy Tags: Southern Surgical Association Article Source Type: research

Elective Operation Scheduling during the COVID-19 Pandemic
We were greatly interested to read the article by Prachand and colleagues1 on the scoring system that empowers surgery departments to prioritize medically necessary operations that should not be delayed because of risk associated with COVID-19. COVID-19 is reducing the ability to perform surgical procedures worldwide, giving rise to a multitude of ethical and medical dilemmas. A critical issue is balancing the benefit of surgery against the unknown risk of developing COVID-19 and its associated complications. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 5, 2021 Category: Surgery Authors: Pankaj Kumar, Chiranjeevi H Tags: Letter Source Type: research

Effect of Posterior Tracheopexy on Risk of Recurrence in Children after Recurrent Tracheo-Esophageal Fistula Repair
A recurrent tracheo-esophageal fistula can complicate esophageal atresia (EA) and tracheo-esophageal fistula (TEF) repair in children. Therapeutic approaches and the rate of recurrence vary widely. Most reports are limited by small cohorts and short-term follow-up, and rates of re-recurrence are significant, making it difficult to select the treatment of choice. We aimed to review our experience with the treatment of recurrent TEF utilizing posterior tracheopexy, focusing on operative risks and long-term outcomes. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 5, 2021 Category: Surgery Authors: Ali Kamran, Benjamin Zendejas, Jay Meisner, Sukgi S. Choi, Carlos Munoz-San Julian, Peter Ngo, Michael Manfredi, Jessica L. Yasuda, C Jason Smithers, Thomas E. Hamilton, Russell W. Jennings Tags: Original Scientific Article Source Type: research

Breast-Conserving Therapy vs Mastectomy for Early-Stage Breast Cancer: Should We Re-Evaluate the Current Treatment Paradigm?
We would like to thank Dr Jatoi for his interest in and thoughts regarding our recent publication, “10-year survival after breast-conserving surgery compared with mastectomy in Louisiana women with early-stage breast cancer: a population-based study.”1 We are well aware of the randomized trials he points out, as well as the 1995 meta-analysis of the 10-year survival in 7 randomized trials, wh ich also showed equivalent outcomes between breast-conserving therapy (BCT) and mastectomy for patients with early-stage breast cancer (ESBC). (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 4, 2021 Category: Surgery Authors: John M. Lyons, Quyen D. Chu, Mei-Chin Hsieh, Xiao-Cheng Wu Tags: Letter Source Type: research

15-Year Experience with Multimodality Therapy Including Esophagectomy For Elderly Patients with Locoregional Esophageal Cancer
Optimal curative therapy for locally advanced esophageal (E) and esophagogastric junction (EGJ) cancer may not be offered to elderly patients due to patient and treating physician perception of the high risk of therapy. To understand the risk of multimodality curative therapy including surgical resection in the elderly population, we studied our experience with curative therapy in this patient population and compared the risks and outcomes to those in a younger population (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 4, 2021 Category: Surgery Authors: W Peter Sawyer, Xinyi Luo, Andrew M. Welch, Nathan M. Bolton, Russell Brown, John S. Bolton Tags: Southern Surgical Association Article Source Type: research

Statement from the American College of Surgeons on COVID-19 Vaccination for the Diverse US Population
The American College of Surgeons acknowledges the fact that severity of the COVID-19 pandemic has been disproportionately devastating to communities of color, including minority population subsets such as African Americans, Hispanic/Latinos, and Indigenous/Native Americans123. The explanation for this disparity is multifactorial and involves socioeconomic factors related to viral exposure because of minorities accounting disproportionately for the essential employee workforce; minorities disproportionately utilizing public transportation; and patterns of residential segregation that result in minorities having reduced acce...
Source: Journal of the American College of Surgeons - February 4, 2021 Category: Surgery Authors: Lisa A. Newman, Andre Campbell, American College of Surgeons Board of Regents Anti-Racism Committee Tags: Surgical Perspective Source Type: research

Survival after Breast-Conserving Operation Compared with Mastectomy
Chu and colleagues1 report results of a large observational study of women with early stage breast cancer (ESBC), and show that mastectomy (MST) is associated with an increased risk of death from all causes (hazard ratio [HR]: 1.286; 95%CI: 1.197 –1.380) and an increased risk of breast cancer-specific death (HR: 1.298; 95%CI: 1.150–1.465), when compared with breast-conserving operation plus radiation (BCT). The authors conclude, “Our results provide compelling evidence to encourage patients to consider a BCT rather than MST for ESBC, w hen appropriate.” However, the evidence from their observational...
Source: Journal of the American College of Surgeons - February 3, 2021 Category: Surgery Authors: Ismail Jatoi Tags: Letter Source Type: research

Whole Blood Thrombin Generation in Severely Injured Patients Requiring Massive Transfusion
Whole blood was collected from trauma activation patients at a single trauma center. Whole blood thrombin generation (TG) was measured. Whole blood TG was depressed in patients with shock and it effectively predicted massive transfusion, challenging the prevailing bias that all trauma patients present with elevated TG. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 3, 2021 Category: Surgery Authors: Julia R. Coleman, Ernest E. Moore, Jason M. Samuels, Mitchell J. Cohen, Christopher C. Silliman, Arsen Ghasabyan, James Chandler, Saulius Butenas Tags: Original Scientific Article Source Type: research

Make No Assumptions. Give Lots of Tests
I greatly appreciate the honor and opportunity to offer this Presidential Address to my colleagues in the Western Surgical Association. I have so many wonderful people that need to be thanked for helping me get the most out of my life: initially my parents for teaching me about unconditional love, the value of effort, and the importance of repetitions; my brothers Steve and Mike for either pulling or pushing me to competitive success – they were great teammates and opponents in a constant effort to seek excellence in athleticism and academics; my wife, Cathy, the love of my life and the woman who loves me for who I a...
Source: Journal of the American College of Surgeons - February 3, 2021 Category: Surgery Authors: David R. Farley Tags: Western Surgical Association Article Source Type: research

Reverence for the Past Will Often Ensure the Success of the Future: Presidential Address from the Virtual New England Surgical Society Annual Meeting, 2020
As this is our first virtual New England Surgical Society meeting with obvious time constraints, we had to eliminate some of the traditional aspects of the meeting and shorten others. This was done to allow the scientific session presenters, often residents, fellows, and new members the full opportunity to make their presentations in front of the membership and guests. Thus, the presidential address which often is a 45-50-minute oration has been shortened by the Program Committee, and rightfully so, to a 10-15 minute Presidents Message. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - February 2, 2021 Category: Surgery Authors: Walter E. Longo Tags: New England Surgical Society Article Source Type: research

Female Surgeon Scientists
We thank Dr Kibbe for her comments regarding our recent manuscript, “The changing face of academic surgery: Overrepresentation of women among surgeon-scientists with R01 funding.”1 In our study, we compare the percentage of female surgeon-scientists with R01 funding (26%) to the percentage of female academic surgical faculty (19%), as reported in the Association of American Medical Colleges (AAMC) report, “The pipeline and pathways to leadership, 2015-2016.”2 Dr Kibbe brings attention to the more recent AAMC report, “The state of women in academic medicine 2018-2019,” which was published...
Source: Journal of the American College of Surgeons - January 29, 2021 Category: Surgery Authors: Elizabeth D. Krebs, Adishesh K. Narahari, J Hunter Mehaffey, Shayna L. Showalter Tags: Letter Source Type: research

Critical Role of Trauma and Emergency Surgery Physicians in Patient Satisfaction: An Analysis of Consumer Assessment of Healthcare Providers and Systems, Hospital Version Data from 186,779 Patients and 168 Hospitals in a National Healthcare System
Trauma and Emergency Surgery patients are unique with regards to the sudden and unexpected nature of their hospitalization and this may adversely affect patient satisfaction but no large study exists examining this issue. The purpose of this study was to investigate the major factors that affect satisfaction scores in Trauma and Emergency Surgery patients. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - January 29, 2021 Category: Surgery Authors: Mark J. Lieser, Dorraine D. Watts, Tabatha Cooper, John Chipko, Matthew M. Carrick, Gina M. Berg, Nina Y. Wilson, Ransom J. Wyse, Jeneva M. Garland, Samir M. Fakhry Tags: Southern Surgical Association Article Source Type: research

Systematic Review and Meta –Analysis of the Association Between Non–Steroidal Anti–Inflammatory Drugs and Operative Bleeding in the Perioperative Period
It is increasingly recognized that non-opioid analgesia is an important analgesia in the perioperative period. Specifically, NSAIDs (nonsteroidal anti-inflammatory drugs) have been touted as an adjunct, or even replacement, for opioids. However, uptake of NSAIDs has been slow due to concern for side effects, including bleeding. We sought to understand the risk of bleeding caused by NSAIDs in the perioperative period. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - January 27, 2021 Category: Surgery Authors: Tasce Bongiovanni, Elizabeth Lancaster, Yeranu í Ledesma, Evans Whitaker, Michael A. Steinman, Isabel Elaine Allen, Andrew Auerbach, Elizabeth Wick Tags: Collective review Source Type: research

Systematic Review and Meta-Analysis of the Association Between Non-Steroidal Anti-Inflammatory Drugs and Operative Bleeding in the Perioperative Period
It is increasingly recognized that non-opioid analgesia important analgesia in the perioperative period. Specifically, NSAIDs (nonsteroidal anti-inflammatory drugs) have been touted as an adjunct or even replacement for opioids. However, uptake of NSAIDs has been slow due to concern for side effects, including bleeding. We sought to understand the risk of bleeding caused by NSAIDs in the perioperative period. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - January 27, 2021 Category: Surgery Authors: Tasce Bongiovanni, Elizabeth Lancaster, Yeranu í Ledesma, Evans Whitaker, Michael A. Steinman, Isabel Elaine Allen, Andrew Auerbach, Elizabeth Wick Tags: Collective Review Source Type: research

High Social Vulnerability and “Textbook Outcomes” after Cancer Operation
The effect of community-level factors on surgical outcomes has not been well examined. We sought to characterize differences in “textbook outcomes” (TO) relative to social vulnerability among Medicare beneficiaries who underwent operations for cancer. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - January 25, 2021 Category: Surgery Authors: J. Madison Hyer, Diamantis I. Tsilimigras, Adrian Diaz, Rayyan S. Mirdad, Rosevine A. Azap, Jordan Cloyd, Mary Dillhoff, Aslam Ejaz, Allan Tsung, Timothy M. Pawlik Tags: Southern surgical association article Source Type: research

Multi-Modal Analgesic Strategy for Trauma: A Pragmatic Randomized Clinical Trial
An effective strategy to manage acute pain and minimize opioid exposure is needed for injured patients. In this trial, we aimed to compare 2 multimodal pain regimens (MMPRs) for minimizing opioid exposure and relieving acute pain in a busy, urban trauma center. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - January 21, 2021 Category: Surgery Authors: John A. Harvin, Rondel Albarado, Van Thi Thanh Truong, Charles Green, Jon E. Tyson, Claudia Pedroza, Charles E. Wade, Lillian S. Kao, MAST Study Group Tags: Original scientific article Source Type: research

Multimodal Analgesic Strategies for Trauma: A Pragmatic Randomized Clinical Trial
An effective strategy to manage acute pain while minimizing opioid exposure is needed for injured patients. In this trial, we aimed to compare two multimodal pain regimens (MMPR) in minimizing opioid exposure and relieving acute pain in a busy, urban trauma center. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - January 21, 2021 Category: Surgery Authors: John A. Harvin, Rondel Albarado, Van Thi Thanh Truong, Charles Green, Jon E. Tyson, Claudia Pedroza, Charles E. Wade, Lillian S. Kao, MAST Study Group Tags: Original Scientific Article Source Type: research

Colorectal Cancer Prevention in Lung Transplant Recipients: The Need for an Enhanced Surveillance Protocol
Lung transplant recipients have a significantly higher risk of precancerous adenoma formation than average risk adults. This increase occurs in the early post-transplant period (within 3 years). An enhanced colorectal cancer surveillance protocol for lung transplant recipients is needed. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - January 20, 2021 Category: Surgery Authors: Jonathan L. Dameworth, Luc Colburn, Devin Corrigan, Rebecca Driessen, Kristina Chapple, Ronald A. Gagliano, Rajat Walia, David Row Tags: Original Scientific Article Source Type: research

Postoperative Outcomes after Index vs Interval Cholecystectomy for Perforated Cholecystitis
This retrospective study used American College of Surgeons NSQIP data (2006-2018) to analyze patients with perforated cholecystitis and evaluate differences in postoperative outcomes based on timing of cholecystectomy. Patients who underwent index cholecystectomy had significantly longer postoperative hospitalization and higher 30-day postoperative major morbidity and mortality than those who underwent interval cholecystectomy. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - January 19, 2021 Category: Surgery Authors: Laura K. Krecko, Tatiana Hoyos Gomez, John E. Scarborough, Hee Soo Jung Tags: Southern Surgical Association Article Source Type: research

Presidential foreword
To say that 2020 has been an unusual year would be a vast understatement – and this certainly applies to the Southern Surgical Association (SSA). Canceling this year’s annual meeting was an agonizing decision, but not a unique one for the SSA. The 1942 annual meeting is the only other to be cancelled since the first annual meeting of the SSA 132 years ago, most likel y due to events surrounding World War II. Interestingly, there was very little discussion of the decision marking that event in the Transactions of the (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - January 17, 2021 Category: Surgery Authors: William C. Chapman Source Type: research

Tumor Epigenetic Signature and Survival in Resected Gastric Cancer Patients
Precision oncology can identify patient-specific molecular signatures to better inform the prognosis and management of surgical cancer patients. Specifically, microRNAs (miRs) hold promise as prognostic biomarkers because dysregulation of individual miRs is implicated in tumorigenesis, progression, and metastases of various malignancies, including gastric adenocarcinoma (GC). (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - January 16, 2021 Category: Surgery Authors: Yanghee Woo, Carolyn E. Behrendt, Annie Yang, Maria Hahn, Ajay Goel, Haiqing Li, Yate-Ching Yuan, Yuman Fong Tags: Southern Surgical Association Article Source Type: research

I Am Not Comfortable with This: 2020 Scudder Oration on Trauma
I will begin with my thanks to the Committee on Trauma for the honor of this oration. I am fully aware of the historical significance of this lecture and humbled to be included with the list of past honorees. It is anxiety provoking to be given this platform, and as such, I prepared my remarks with the greatest respect and admiration for the American College of Surgeon and its legacy, for all my colleagues in surgery, and in particular, for those of you in our chosen career as trauma surgeons. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - January 15, 2021 Category: Surgery Authors: Gregory J. Jurkovich Source Type: research

Percutaneous Cholecystolithotomy: An Alternative to Cholecystectomy after Cholecystostomy Tube Placement in the Truly High-Risk Surgical Patient
Cholecystectomy, laparoscopic or open, remains the definitive treatment for patients with acute calculous cholecystitis. In the US, cholecystostomy tube drainage is reserved for critically ill patients with severe underlying comorbidities, hemodynamic instability due to severity of the acute inflammatory process, or a combination of both.1 (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - January 13, 2021 Category: Surgery Authors: Taylor S. Riall Tags: Invited Commentary Source Type: research

COVID-19 Pandemic and the Need for Disaster Planning in Surgical Education
The COVID-19 pandemic disrupted nearly every aspect of life in the US and beyond. The findings of the article by Coleman and colleagues1 provide important and timely insights on the impact of the COVID-19 pandemic on clinical experience and the well-being of surgical trainees and young surgeons in practice. The results were similar for residents and young surgeons, showing substantial decreased clinical experience affecting resident education and practicing surgeon compensation, variable access to personal protective equipment (PPE), and the resulting emotional problems and burnout. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - January 13, 2021 Category: Surgery Authors: E. Christopher Ellison, Mohsen M. Shabahang Tags: Invited Commentary Source Type: research

COVID-19 and Firearm Injury: A Uniquely American Problem
The COVID-19 pandemic has impacted the healthcare sector in many ways. One of the unfortunate outcomes that appears to be associated with the pandemic, or perhaps with our response to the pandemic, is a substantial rise in firearm-related injury. This end point is unique to the US compared with Western European countries. Although many countries and cities quickly reported a considerable and sustained decrease in trauma volume,1-3 only the US reported a net decrease in blunt mechanism of injury trauma volume and a concomitant, substantial increase in firearm-related injuries in many large cities. (Source: Journal of the Am...
Source: Journal of the American College of Surgeons - January 13, 2021 Category: Surgery Authors: Babak Sarani Tags: Invited Commentary Source Type: research

If Enhanced Recovery Is So Good for Our Patients, Should We Be Applying It to Every Case?
In this study of the feasibility of enhanced recovery in emergency colorectal operations, Fischer and colleagues3 propose that there is meaningful benefit to expanding ERPs to the nonelective setting. With increasing ERP expansion to select populations, such as geriatric patients4 and other surgical disciplines,5 it seems reasonable to expand ERP to emergency colorectal patients, where we expect higher variability in patient presentation, disease severity, and outcomes and there should be an important opportunity for optimization. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - January 13, 2021 Category: Surgery Authors: Christina N. Weed, Vlad V. Simianu Tags: Invited Commentary Source Type: research

Prehabilitation: The Devil Is in the Details
In their recent article, Lyons and colleagues1 performed a systematic review of prospective randomized controlled trials of prehabilitation in non-bariatric abdominal and pelvic procedures to determine whether prehabilitation provides a meaningful benefit in terms of postoperative outcomes. Specifically, the outcomes examined included overall postoperative complication, physical function using the 6 minute walk test, Clavien-Dindo grading, surgical site infection, and length of stay. After an exhaustive literature review with a focus on exercise as the requisite intervention before operation, 14 articles remained for revie...
Source: Journal of the American College of Surgeons - January 13, 2021 Category: Surgery Authors: Ajita Prabhu Tags: Invited Commentary Source Type: research

Character Matters
In an era characterized by the relative neglect of reflective disciplines, and one in which shorthanded, if not underhanded, punditry and sound-bite communication dominate our societal discourse, the review offered by Young and colleagues1 in this issue of the Journal of American College of Surgeons is refreshing and appreciated. The authors raise the question of whether the characteristics required for success as a surgeon have changed during the past century, as viewed through the lens of the qualities espoused in American College of Surgeons (ACS) presidential addresses since these commenced in 1913. (Source: Journal of...
Source: Journal of the American College of Surgeons - January 13, 2021 Category: Surgery Authors: John D. Mellinger Tags: Invited Commentary Source Type: research

The Invisible Hand Guiding Trauma Center Designation: It Is Time for a Different Paradigm
It is well established that organized systems of trauma care improve mortality and reduce complications after injury. The distribution of trauma centers within a system, including the number, level, and location of these centers, is an essential determinant of efficient function. The necessity for thoughtful designation of trauma centers, based on the needs of the population served, has been a recognized fundamental of trauma system design since their beginnings in the 1970s. Yet, almost 50 years later, there is still no consensus about the process for such a needs analysis or metrics on which it should be based. (Source: ...
Source: Journal of the American College of Surgeons - January 13, 2021 Category: Surgery Authors: Robert J. Winchell Tags: Invited Commentary Source Type: research

Association of Medicaid Expansion with Diagnosis and Management of Colon Cancer
In March 2010, Medicaid expansion under the Affordable Care Act (ACA) was signed into law and has subsequently provided insurance to 10 million Americans living with incomes at or below 138% of the federal poverty threshold. Although initially intended to be nationally implemented, a Supreme Court ruling ultimately allowed individual states to decide whether to participate in Medicaid expansion. As of early November 2020, 38 states and the District of Columbia had affirmed their participation.1 After expansion of Medicaid in these states, the literature has firmly established the law ’s positive effect on healthcare ...
Source: Journal of the American College of Surgeons - January 13, 2021 Category: Surgery Authors: Thomas M. Diehl, Daniel E. Abbott Tags: Invited Commentary Source Type: research