Mitigating Concerns over Virtual Interviews for Surgical Residencies and Fellowships
In their letter about the commentary “Virtual Interviews for Fellowship and Residency Applications Are Effective Replacements for In-Person Interviews and Should Continue Post-COVID,”1 Haley and colleagues raise several very salient concerns about the impact of virtual interviews for residency and fellowship, especially with regard to equity and the potential for differential impacts on those who are underrepresented in medicine (UIM). That Invited Commentary was based on the article “Initial Experience with a Virtual Platform for Advanced Gastrointestinal Minimally Invasive Surgery Fellowship Interviews....
Source: Journal of the American College of Surgeons - June 23, 2021 Category: Surgery Authors: Andrew S. Wright Tags: Letter Source Type: research

Correction
The article, “Preoperative Frailty Assessment, Operative Severity Score, and Early Postoperative Loss of Independence in Surgical Patients Age 65 Years or Older,” which appeared in the April 2021 issue of the Journal of the American College of Surgeons, Volume 232, Issue 4, pages 387–395, incorrectly named the scoring system discussed. “Operative Severity Score” was used in the title and throughout the article, however the correct name of the scoring system is “Operative Stress Score”. The authors apologize for this error. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 23, 2021 Category: Surgery Tags: Correction Source Type: research

Discussion
DR DAVID BORGSTROM (Morgantown, WV): What virtual set-up was used to provide for nonverbal assessments? Were patients in exam rooms? Were the video links close-ups or distant? Why do you think your student survey response rate was so low? Were student experiences similar across all 3 clinical scenarios? (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 23, 2021 Category: Surgery Tags: Discussion Source Type: research

Discussion
DR DANIEL MARGULIES (West Hollywood, CA): Given that the resources are similar between these levels, especially in terms of specialty care, can the authors comment on what might be the reason for the difference between level I and II trauma centers? Could the higher prevalence of training programs at the level I centers be a factor? (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 23, 2021 Category: Surgery Tags: Discussion Source Type: research

Discussion
DR ERIN MAYNARD (Portland, OR): For many years, the adequacy of transplant fellowship training was measured by the number of cases the fellow performed. Although this is the default of many surgical programs/specialties, we all know that increased numbers do not always reflect competency. The American Society of Transplant Surgeons, along with the Transplant Accreditation and Certification Council, have spent a considerable amount of time over the last few years working on what certification will look like for future transplant fellows. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 23, 2021 Category: Surgery Tags: Western surgical association article Source Type: research

Discussion
DR NABIL WASIF (Phoenix, AZ): Pancreatic cancer is a particularly implacable foe in the war on cancer. One of the few effective weapons in our armamentarium to bring about cure is surgery. For surgeons, the sine qua non of a successful pancreatic resection is achieving negative margins (R0). Either a microscopically positive (R1) or a grossly positive (R2) margin are considered failures of surgical management. This presentation seeks to challenge this dictum in the era of neo-adjuvant chemotherapy. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 23, 2021 Category: Surgery Tags: Western surgical association article Source Type: research

Discussion
DR VICTOR ZAYDFUDIM (Charlottesville, VA): The volume-outcome relationship has been explored extensively in surgical literature. Typically, short-term survival outcomes are compared. The focus of this paper examining potential associations between greater survival and greater incremental cost is of interest. Given numerous published series describing differential short-term outcomes between high- and low-volume centers, potential confounding related to managing severe postoperative complications, especially those that lead to death, might influence cost and survival. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 23, 2021 Category: Surgery Tags: Discussion Source Type: research

Discussion
DR NINH NGUYEN (Orange, CA): The authors found that laparoscopic is the most cost-effective approach to diaphragmatic hernia repair, while the robotic approach affords no clinical benefit in outcomes and is associated with an increased length of stay and cost. The robotic approach for foregut surgery has been extensively examined in the literature, including hiatal hernia, bariatric surgery, and even Heller myotomy. These studies have uniformly found that robotic surgery improves visualization and ergonomics for the surgeon, with clinical outcomes equivalent to those of the laparoscopic approach, but at an increased cost. ...
Source: Journal of the American College of Surgeons - June 23, 2021 Category: Surgery Tags: Discussion Source Type: research

Discussion
DR MELISSA HOGG (Evanston, IL): What was the intent/destination of the 138 patients in this cohort? Were these all surgical candidates? Were they to undergo more neoadjuvant therapy or was the next step resection? In the same line, were the ones who were known to suffer recurrence figured out preop/postop? (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 23, 2021 Category: Surgery Tags: Discussion Source Type: research

Discussion
DR KATHERINE MORRIS (Oklahoma City, OK): Can you tell us whether there were any patients who had a negative initial liquid biopsy postoperatively and who later had a positive liquid biopsy? If so, did that relate to new findings of progression on CT scan? Did liquid biopsy ever precede imaging diagnosis of progression of disease? (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 23, 2021 Category: Surgery Tags: Western surgical association article Source Type: research

Discussion
DR DANIEL VARGO (Salt Lake City, UT): The overall results assessing mesh infection and mesh explantation are not completely clear. I might have missed it, but were you able to access every chart for every hernia repair done, or were you only able to access a certain number? In other words, could some patients have sought care outside your system and had an infection or explantation performed at another facility? This "loss rate" would be important to know, especially when you are quoting such a small number of infections. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 23, 2021 Category: Surgery Tags: Discussion Source Type: research

Discussion
DR KRISTA KAUPS (Fresno, CA): This was an examination of the National Inpatient Sample database during a 27-month period of cholecystectomy during pregnancy, with the conclusion that cholecystectomy can best be performed safely in the first and second trimesters of pregnancy, and should not be delayed to the third trimester. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 23, 2021 Category: Surgery Tags: Discussion Source Type: research

Discussion
DR MELANIE GOLDFARB (Santa Monica, CA): When we discuss any cancer treatment, especially in younger patients, we must balance the benefits and risks. Total thyroidectomy, with its increased surgical complications in low-volume surgeons and definitive postoperative hypothyroidism in developing children, might not be necessary for all thyroid cancers. Yet the dogma has always strayed from doing anything less because of the long survivorship after cancer, increased radiosensitivity of pediatric thyroid glands, and the presumed ability to more accurately monitor for recurrence. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 23, 2021 Category: Surgery Tags: Discussion Source Type: research

Discussion
DR AMANDA ARRINGTON (Tucson, AZ): The authors compared outcomes after complex oncologic resections performed at US News and World Report ’s top-ranked hospitals in gastroenterology and gastrointestinal surgery (GGS) compared with nonranked hospitals. The operations included were specifically esophagectomies, gastrectomies, and pancreatectomies. To do this, the Vizient database was used, which includes inpatient data from academic c enters and their affiliated community hospitals. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 23, 2021 Category: Surgery Tags: Discussion Source Type: research

Discussion
DR CHERISSE BERRY (New York, NY): Penetrating and blunt peripheral vascular injuries are often associated with concomitant venous injury, bony injury, nerve injury, and soft-tissue injury. In your methodology, all adult patients with a primary diagnosis of peripheral arterial injuries were included, and patients with severe injuries in nonextremity body regions (Abbreviated Injury Scale score> 2) were excluded. If patients with secondary diagnoses were not excluded, how did you account for patients who sustained concomitant venous injury, bony injury, nerve injury, and soft-tissue injury in the propensity score matching...
Source: Journal of the American College of Surgeons - June 23, 2021 Category: Surgery Tags: Western surgical association article Source Type: research

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

Biomarker Risk Score Algorithm and Preoperative Stratification of Patients with Pancreatic Cystic Lesions
We developed a novel biomarker scoring system and risk Algorithm to provide a more objective and accurate means of determining preoperative pancreatic cyst diagnosis. This type of tool may improve the initial risk stratification of new patients or existing patients who are currently under surveillance. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 21, 2021 Category: Surgery Authors: Michele T. Yip-Schneider, Huangbing Wu, Hannah R. Allison, Jeffrey J. Easler, Stuart Sherman, Mohammad A. Al-Haddad, John M. Dewitt, C Max Schmidt Tags: Original Scientific Article Source Type: research

Unifying the Hepatopancreatobiliary Surgery Fellowship Curriculum via Delphi Consensus
To facilitate the consistent training of hepatopancreatobiliary (HPB) surgeons, members of the Society of Surgical Oncology, American Society of Transplant Surgeons, and Americas Hepato-Pancreato-Biliary Association, along with General Surgery residency program directors, established a pan-American consensus on a HPB fellowship curriculum via the modified Delphi method. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 21, 2021 Category: Surgery Authors: Keon Min Park, Nikdokht Rashidian, Sarah Mohamedaly, Karen J. Brasel, Patricia Conroy, Alexa C. Glencer, Jin He, Michael J. Passeri, Nitin N. Katariya, Adnan Alseidi, TrainHPB research group Tags: Original Scientific Article Source Type: research

From Surgeon-Scientist, to Mentor, to Department Chair: 10 Years after Receiving the Jacobson Promising Investigator Award
It was an incredible honor to be the 6th recipient of the Jacobson Promising Investigator Award of the American College of Surgeons. This brief report summarizes my journey in the 10 years since receiving this award, from a surgeon-scientist, to a scientific mentor, and, ultimately, to a department chair responsible for building the careers of other surgeon-scientists. Awards are given to individuals but reflect the work of large supporting teams, including mentors, collaborators, and mentees. In this narrative, I will point out the many colleagues who have contributed to my own career development. (Source: Journal of the ...
Source: Journal of the American College of Surgeons - June 20, 2021 Category: Surgery Authors: Justin B. Dimick Tags: Special Article Source Type: research

Update to the Association of periOperative Registered Nurses Guidelines for Religious Head Coverings
In response to the recent article by Abdelwahab and colleagues1 in the Journal of the American College of Surgeons, the Association of periOperative Registered Nurses (AORN) appreciates this guidance and would like to clarify for your readers the newest update to the AORN Guideline for Surgical Attire. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 16, 2021 Category: Surgery Authors: Lisa Spruce Tags: Letter Source Type: research

Upgrading Your Surgical Skills Through Preceptorship
The major evolution of general surgery and its subspecialties has involved the introduction of new knowledge, patient management approaches, operations, and technology. The “safe introduction” of the latter two has been much debated and studied since the introduction of laparoscopic cholecystectomy in the United States in 1989.1-3 (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 11, 2021 Category: Surgery Authors: David V. Feliciano, Conor P. Delaney, Philip Schauer, Danny M. Takanishi, Lori Arviso Alford, Walter Medlin, Ajit K. Sachdeva Tags: Education Source Type: research

Probability of Postoperative Complication after Liver Resection: Stratification of Patient Factors, Operative Complexity, and Use of Enhanced Recovery after Surgery
The current study aimed to assess the performance of the 3-level complexity classification that stratified liver resection procedures into 3 complexity grades (grade I, low; grade II, intermediate; and grade III, high complexity) and to evaluate whether the Enhanced Recovery after Surgery (ERAS) protocol improves postoperative outcomes for each complexity grade. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 7, 2021 Category: Surgery Authors: Kosuke Kobayashi, Yoshikuni Kawaguchi, Michael Schneider, Giulia Piazza, Ismail Labgaa, Ga ëtan-Romain Joliat, Emmanuel Melloul, Emilie Uldry, Nicolas Demartines, Nermin Halkic Tags: Original scientific article Source Type: research

Relationship between Financial Toxicity and Surgical Treatment for Early-Stage Breast Cancer: A Propensity Score-Matched Comparison of Breast-Conserving Therapy and Mastectomy
Financial toxicity in early breast cancer is comparable in patients undergoing mastectomy and breast-conserving therapy. Decisions regarding treatment approach should be based on patient- and disease-specific criteria. Low credit score and annual income, no supplemental insurance, and employment status changes are associated with worse financial toxicity, regardless of treatment modality. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 7, 2021 Category: Surgery Authors: Stefanos Boukovalas, Jun Liu, Malke Asaad, Mark V. Schaverien, Catherine Akay, Patrick B. Garvey, Rosa F. Hwang, Anaeze C. Offodile Tags: Original Scientific Article Source Type: research

Helping the Surgeon Recover: Peer-to-Peer Coaching after Bile Duct Injury
An individualized surgical coaching program for safe cholecystectomy targeted at surgeons who had injured a bile duct creates a unique opportunity for professional development and may help promote safe laparoscopic cholecystectomy. Coaching can help surgeons regain confidence and maintain well-being after a bile duct injury. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 7, 2021 Category: Surgery Authors: Alice Zhu, Shirley Deng, Brittany Greene, Melanie Tsang, Vanessa N. Palter, Shiva Jayaraman Tags: Original Scientific Article Source Type: research

Probability of Postoperative Complication After Liver Resection: Stratification of Patient Factor, Operative Complexity, and Use of Enhanced Recovery After Surgery
The use of enhanced recovery after surgery protocol may decrease the probability of postoperative complication for each operative complexity of liver resection (the 3-level complexity classification). Our regression model for predicting postoperative complication showed a good discrimination for predicting patients with a high probability of postoperative complication. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 7, 2021 Category: Surgery Authors: Kosuke Kobayashi, Yoshikuni Kawaguchi, Michael Schneider, Giulia Piazza, Ismail Labgaa, Joliat Ga ëtan-Romain, Emmanuel Melloul, Emilie Uldry, Nicolas Demartines, Nermin Halkic Tags: Original Scientific Article Source Type: research

Surgeon Volume and Risk of Reoperation after Laparoscopic Primary Ventral Hernia Repair: A Nationwide Register-Based Study
This nationwide registry-based study found a significantly higher risk of reoperation after laparoscopic primary ventral hernia repair performed by low- and medium-volume surgeons compared with high-volume surgeons. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 7, 2021 Category: Surgery Authors: Camilla Christophersen, Siv Fonnes, Jason Joe Baker, Kristoffer Andresen, Jacob Rosenberg Tags: Original Scientific Article Source Type: research

Genomic Sequencing and Insight into Clinical Heterogeneity and Prognostic Pathway Genes in Patients with Metastatic Colorectal Cancer
Understanding of signaling pathways has not been fully incorporated into prognostication and therapeutic options. We evaluated the hypothesis that information about cancer-related signaling pathways can improves prognostic stratification and explains some of the clinical heterogeneity in patients with metastatic colorectal cancer. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 7, 2021 Category: Surgery Authors: Yoshikuni Kawaguchi, Scott Kopetz, Lawrence Kwong, Lianchun Xiao, Jeffrey S. Morris, Hop S. Tran Cao, Ching-Wei D. Tzeng, Yun Shin Chun, Jeffrey E. Lee, Jean-Nicolas Vauthey Tags: Original Scientific Article Source Type: research

Evaluation of Postoperative Complication with Medically Necessary, Time-Sensitive Scoring System During Acute COVID-19 Pandemic: A Prospective Observational Study
Medically Necessary Time-Sensitive (MeNTS) score was proposed to objectively prioritize elective surgery during COVID-19. Whether higher MeNTS score is associated with worse outcomes was not examined. Despite higher MeNTS score in patients with moderate and severe postoperative complication, it had low prediction capability for these complications. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 7, 2021 Category: Surgery Authors: M üşerref Beril Dinçer, Meltem Merve Güler, Ali Fuat Kaan Gök, Mehmet İlhan, Mukadder Orhan-Sungur, Tülay Özkan-Seyhan, Ahmet Kemalettin Koltka Tags: Original Scientific Article Source Type: research

Informed Consent and Informed Decision-Making in High-Risk Surgery: A Quantitative Analysis
Informed decision-making is different from informed consent, and both should be used to provide a collaborative process between patients and surgeons before high-risk surgical procedures. Surgeons frequently use informed consent but employ informed decision-making less often. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - June 4, 2021 Category: Surgery Authors: Kristin L. Long, Angela M. Ingraham, Elizabeth M. Wendt, Megan C. Saucke, Courtney Balentine, Jason Orne, Susan C. Pitt Tags: Original Scientific Article Source Type: research

Gauze: Origin of the Word
We use gauze in all fields of medicine. Yet, what is the origin of this daily used word? Gauze, is a loosely woven cloth used for dressings and swabs. It is a light, open-weave fabric made of cotton when used for surgical dressings and of silk and other fibers when used for dress trimming [1-2]. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 31, 2021 Category: Surgery Authors: Ariel Roguin Tags: History Source Type: research

Education, Ethics, and History: The Peer Review Process in the US
Despite the near-universal acceptance of the benefits of a sound peer review process (PRP), the topic of peer review remains a source of controversy among surgeons. The current PRP is plagued by heterogeneity across different hospital and institutional systems. These inconsistencies, combined with a perceived lack of fairness inherent to the PRP in some institutions, led to concerns among practicing surgeons. In this review of the relevant literature on the PRP, we attempted to provide some context and insight into the history of the PRP, its role, its shortcomings, its potential abuses, and some key requirements for its s...
Source: Journal of the American College of Surgeons - May 29, 2021 Category: Surgery Authors: Bryan K. Richmond, David Welsh Tags: Ethics Source Type: research

Education, Ethics and History: The Peer Review Process in the US
Despite the near-universal acceptance of the benefits of a sound peer-review process (PRP), the topic of peer review remains a source of controversy among surgeons. The current PRP is plagued by heterogeneity across different hospital and institutional systems. These inconsistencies, combined with a perceived lack of fairness inherent to the PRP in some institutions lead to concerns among practicing surgeons. In the following review of the relevant literature on the PRP, we attempt to provide some context and insight into the history of the PRP, its role, its shortcomings, its potential abuses, and some key requirements fo...
Source: Journal of the American College of Surgeons - May 29, 2021 Category: Surgery Authors: Bryan K. Richmond, David Welsh Tags: Ethics Source Type: research

Advanced Modular Manikin and Surgical Team Experience During a Trauma Simulation: Results of a Single-Blinded Randomized Trial
Our aim was assess whether an integrated Advanced Modular Manikin (AMM) provides improved participant experience compared with use of peripheral simulators alone during a standardized trauma team scenario. Simulation-based team training has been shown to improve team performance. To address limitations of existing manikin simulators, the AMM platform was created that enables interconnectedness, interoperability, and integration of multiple simulators ( “peripherals”) into an adaptable, comprehensive training system. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 27, 2021 Category: Surgery Authors: Dimitrios Stefanidis, Rajesh Aggarwal, Robert M. Rush, Gyusung Lee, Patrice G. Blair, David Hananel, Yoon Soo Park, Robert M. Sweet, Gordon G. Wisbach, Ajit K. Sachdeva Tags: Original scientific article Source Type: research

Can Gasless Laparoscopy Be an Alternative to Conventional Laparoscopy in Low-to Middle-Income Countries? A Practical Quandary
We read with great interest the article by Mishra and colleagues1 “Evaluation of Gasless Laparoscopy as a Tool for Minimal Access Surgery in Low-to Middle-Income Countries: A Phase II Noninferiority Randomized Controlled Study.” We congratulate the authors for successfully conducting a randomized controlled trial on a pivotal topic, and we especially appreciat e recognizing the poor accessibility of minimal access surgery in low-to middle-income countries and trying to make laparoscopic surgery accessible to the rural population through this study. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 26, 2021 Category: Surgery Authors: Niroop BS, Manoj Kumar, Manoj Kumar Tags: Letter Source Type: research

Buy-In, Get More: Protocols to Increase Multi-Arterial Grafting Use
Coronary artery bypass grafting (CABG) remains the most common adult cardiac operation performed, with more than 150,000 isolated CABGs performed in 2018, per the Society of Thoracic Surgeons (STS) 2019 Annual Report.1 The survival impact and robustness of grafting the left internal mammary artery (LIMA) to the left anterior descending (LAD) has been well established and is considered a Class 1 indication and the standard of care.2,3 However, for patients with multivessel coronary artery disease (CAD), there is much debate over the best approach for additional bypass conduits. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 25, 2021 Category: Surgery Authors: Evan P. Rotar, Irving L. Kron Tags: Invited Commentary Source Type: research

Strengths and Limitations of Machine Learning in Surgical Care
Bertsimas and co-authors1 should be commended on the development of the Predictive Optimal Trees in Emergency Surgery Risk (POTTER) tool, and its most recent application in emergency general surgery.2 The use of machine learning-based risk prediction tools as the basis for this study opens the door to a timely discussion about the role of machine learning approaches in support of decision-making in surgery. The following critical concepts must be explored before the adoption of POTTER and similar models for use in clinical settings: strengths and limitations of machine learning methods, including mechanisms to fairly asses...
Source: Journal of the American College of Surgeons - May 25, 2021 Category: Surgery Authors: Rachel R. Kelz, Edoardo M. Airoldi, Luke Keele Tags: Invited Commentary Source Type: research

Invited Commentary
Due to the potential for manipulation of all 4 parathyroid glands during total thyroidectomy, postoperative hypocalcemia (usually transient) is one of the most common complications of bilateral thyroid operation. Despite the ubiquity of concern for hypocalcemia in post-thyroidectomy patients, there is significant heterogeneity in the available data regarding its incidence and treatment, and no consensus exists regarding an optimal regimen for perioperative calcium management. Professional society guidelines are, therefore, somewhat vague: The American Thyroid Association (ATA) Statement on Hypoparathyroidism recommends, &l...
Source: Journal of the American College of Surgeons - May 25, 2021 Category: Surgery Authors: Meredith J. Sorensen Tags: New England surgical society article Source Type: research

Invited Commentary
The US is facing an opioid epidemic that claims tens of thousands of lives and costs the economy billions of dollars annually.1,2 US physicians prescribe an alarmingly high amount of opioids postoperatively when compared with their counterparts in the rest of the world. Unfortunately, diversion of these unused opioid pills can subsequently feed into the epidemic.3 Porter and colleagues4 conducted a clinical trial to validate patient-centered guidelines for opioid prescribing and test a set of interventions aimed at improving the safe disposal of unused prescribed opioid pills. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 25, 2021 Category: Surgery Authors: Haytham M. Kaafarani Tags: New England surgical society article Source Type: research

Invited Commentary
In this issue of the Journal of the American College of Surgeons, Storino and colleagues1 review an experience of 41 patients diagnosed with neoplasm best classified as malignant cutaneous adnexal tumor (MCAT). MCAT includes multiple histologic subtypes of apocrine and eccrine cancer. I congratulate the authors on presenting a contemporary series (2000 –present) of this rare disease, with a rigorous approach to pathologic classification. This diagnosis occurred, on average, twice a year at this high-volume academic center. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 25, 2021 Category: Surgery Authors: Timothy L. Fitzgerald Tags: New England surgical society article Source Type: research

Invited Commentary
In this thought-provoking work, Dr Dipp Ramos and colleagues1 use the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database to quantify and identify risk factors for one of the hernia surgeon ’s most feared complications: mesh explantation due to infection. Fortunately, in this population of 103,869 patients who underwent hernia operation, mesh explantation was found to be rare. Only 347 patients underwent subsequent explantation, representing 0.1% of inguinal hernia, 0.6% of umbilical hernia, and 1.5% of ventral hernia repairs. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 25, 2021 Category: Surgery Authors: Sarah E. Billmeier Tags: New England surgical society article Source Type: research

Unintended Consequences of Centralization? Increased Care Fragmentation and Subsequent Mortality after Complex Cancer Surgery
High-risk cancer surgeries, specifically for gastric and hepatopancreatobiliary (HPB) cancer, are complex major abdominal operations with significant known associated morbidity and mortality.1 Centralization, or the selective performance of high-risk operations by experienced surgeons at high-volume hospitals (HVH), is important to consider because it is based on the well-documented inverse relationship between both surgeon- and hospital-specific volume and operative and surgical mortality, respectively, for cancer operations. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 25, 2021 Category: Surgery Authors: Allison M. Ammann, Shimul A. Shah Tags: Invited Commentary Source Type: research

Direct Oral Anticoagulant and Head Trauma: Much Ado About Nothing
In this paper by Puzio and colleagues,1 the authors have performed a systematic review and meta-analysis of published data to compare the relative risk of delayed intracranial hemorrhage after blunt head trauma in patients on direct oral anticoagulants (DOACs) compared with warfarin. We know that patients with head trauma who are on anticoagulants are more likely to have cerebral hemorrhage and worse outcomes. With an aging population and rapidly increasing use of DOACs, every trauma center is seeing an increasing number of elderly patients on these agents, who present after blunt head injury, most frequently due to low in...
Source: Journal of the American College of Surgeons - May 25, 2021 Category: Surgery Authors: Hasan B. Alam Tags: Invited Commentary Source Type: research

Artificial Intelligence-Assisted Surgical Quality Assessment: Hype or Hope?
In this issue of the Journal, Zhu and colleagues1 present the external validation of a machine-learning (ML)-based automated surveillance algorithm to detect surgical site infection (SSI) from the electronic healthcare record (EHR). I commend the authors for undertaking an ambitious, technically challenging endeavor and bringing a rigorous method to validate their approach. Overall, the authors conclude that SSI detection algorithms developed in one institution can generalize and be readily applicable to a second institution, therefore giving a practical approach to accelerated chart reviews for surgical site infection det...
Source: Journal of the American College of Surgeons - May 25, 2021 Category: Surgery Authors: Brian T. Bucher Tags: Invited Commentary Source Type: research

Digit Replantation Outcomes at High-Volume Hospitals
Hand and finger injury results in more than 4.8 million emergency room visits in the US each year.1 Traumatic amputation accounts for many of these, with an incidence of 7.5/100,000 person-years.2 Though not all patients are candidates for replantation, advances in microvascular technique have expanded indication, especially in tertiary care centers. Replantation has a high level of patient satisfaction and can be cost-effective.3,4 (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 25, 2021 Category: Surgery Authors: Aaron L. Morgan, Sarah E. Sasor Tags: Invited Commentary Source Type: research

Invited Commentary
Posterior retroperitoneoscopic adrenalectomy (PRA) offers numerous benefits compared with traditional laparoscopic operation. It provides direct access to the retroperitoneal space and can avoid intraperitoneal adhesions from earlier operations. In their article “Contemporary Experience of Posterior Retroperitoneoscopic Adrenalectomy in the US,” Chiu and colleagues1 described a large experience, including 249 cases in 7 years' time. The authors used this technique for a variety of adrenal pathologies, including pheochromocytoma, aldosteronoma, and nonfu nctioning adenomas predominantly. (Source: Journal of the ...
Source: Journal of the American College of Surgeons - May 25, 2021 Category: Surgery Authors: Matthew A. Nehs Tags: New England surgical society article Source Type: research

Invited Commentary
In this interesting article, the authors highlighted the importance of sleep to the wellbeing of hospitalized surgical patients.1 Although inpatient sleep disturbances have been evaluated extensively in critically ill patients, the authors are to be commended for examining an elective surgical population. Through a series of questionnaire instruments and information from Fitbit devices, the authors demonstrated that sleep disturbances are common. Notably, most elective surgical patients in their cohort received little to no sleep on the first postoperative night. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 25, 2021 Category: Surgery Authors: Damien Carter Tags: New England surgical society article Source Type: research

Invited Commentary
Breast cancer-related lymphedema (BCRL) results in a significant disease burden in the US, and subsequently, a high cost burden. It is estimated that approximately 20% of breast cancer survivors experience BCRL, and although de-escalation of axillary surgery has reduced surgical BCRL, nodal radiation bears an expanded role, and given the improvements in overall survival, the evolving rates of BCRL remain uncertain.1 Further, while breast cancer is the most commonly associated cancer, survivors of gynecologic cancer, head and neck cancer, and melanoma, sarcoma, and urologic tumors may also experience treatment-related lymph...
Source: Journal of the American College of Surgeons - May 25, 2021 Category: Surgery Authors: David Linshaw, Jennifer S. Gass Tags: New England surgical society article Source Type: research

Invited Commentary
In the last decade, considerable work has been done to de-escalate local treatment for breast cancer. One aim of this effort is to minimize the risk of lymphedema, a dreaded but common side effect. In the US, approximately 200,000 new cases of lymphedema are diagnosed annually, with millions of breast cancer survivors affected. Although lymphedema is not curable, treatment options exist, and emerging surgical techniques may offer relief for select patients. (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 25, 2021 Category: Surgery Authors: Brigid Killelea Tags: New England surgical society article Source Type: research

Contents
(Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - May 25, 2021 Category: Surgery Source Type: research