Background The National Accreditation Program for Rectal Cancer, developed by the American College of Surgeons Commission on Cancer, was established to standardize and improve the quality of rectal cancer care. While prior research has focused primarily on clinical outcomes, limited evidence exists on how National Accreditation Program for Rectal Cancer accreditation affects patient volume and geographical reach in a community hospital setting. This project evaluates the impact of National Accreditation Program for Rectal Cancer accreditation on rectal cancer patient volume and the geographic distribution of patients seeking care. Study Design Retrospective observational study conducted from July 2016 through December 2024 at a single community-based hospital. Monthly and annual rectal cancer patient volumes and patient zip codes were collected and analyzed to determine changes over time. Results The average monthly rectal cancer patient volume increased from 1.0 patient per month preaccreditation to 4.58 patients per month postaccreditation. However, the segmented Poisson regression did not yield a statistically significant change across all periods. The geographic catchment area expanded from 22 zip codes to 79 zip codes after accreditation. Average patient distance traveled increased by 6 miles, but the change did not reach statistical significance. Conclusion National Accreditation Program for Rectal Cancer accreditation was associated with an increase in patient volume and a broader geographic scope of patients seeking care at a community hospital; however, this change cannot be disentangled from the hiring of 2 fellowship-trained colorectal surgeons. Accreditation may serve as a signal to patients and referring providers of high-quality, disease-specific care, potentially enhancing the institution's competitive standing and patient draw in the health care marketplace.
Background Pancreas transplantation provides durable metabolic control for selected patients with insulin-dependent diabetes mellitus but remains uniquely vulnerable to early technical failure. Ischemia-reperfusion injury is central to graft loss, yet the relative impact of discrete, time-dependent intervals during donor management, procurement, and implantation is incompletely defined. This systematic review evaluates how procurement-related temporal variables influence early complications and pancreas graft survival. Methods A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with PROSPERO (no. 1303859). MEDLINE, Embase, Scopus, and Web of Knowledge were searched from January 1996 to February 2026 for studies reporting donor-related timing variables and pancreas transplant outcomes. Primary exposure variables included brain-death–to-procurement time, donation after circulatory death agonal and asystolic times, pancreas extraction time, cold ischemia time, and vascular anastomosis time. Primary outcomes were technical graft failure and pancreas graft loss. Results Twelve studies met inclusion criteria. Prolonged brain-death–to-procurement time was paradoxically associated with improved long-term graft survival and reduced acute rejection, suggesting potential graft stabilization following brain death. In donation after circulatory death donors, functional warm ischemia and asystolic time—but not total time to death—were independently associated with increased graft loss, demonstrating a phase-specific vulnerability once circulation ceases. Pancreas extraction time showed inconsistent associations with postoperative complications and was not an independent predictor of graft survival. In contrast, cold ischemia time emerged as the most consistent and clinically significant determinant of outcome, with a nonlinear threshold effect: cold ischemia time ≥20–24 hours markedly increased technical failure, thrombosis, and early graft loss, whereas each additional hour incrementally worsened long-term survival. Anastomosis time was not independently associated with graft outcomes. Conclusion Pancreas graft outcomes are determined by the cumulative and phase-specific burden of ischemic injury accrued from donor management through implantation. Among all temporal variables, cold ischemia time remains the dominant modifiable risk factor, while minimizing asystolic and functional warm ischemia is critical in donation after circulatory death procurement. Emerging perfusion strategies may mitigate time-dependent injury and expand the donor pool. Optimizing each procurement interval remains essential to improving early technical success and durable graft survival in pancreas transplantation.
Background Despite a rising incidence among older adults, the effect of malnutrition on perioperative morbidity remains unclear. We assessed the prognostic value of the geriatric nutritional risk index for outcomes after major surgery. Methods The nationwide Epic COSMOS electronic health record database identified adults undergoing coronary artery bypass grafting, lung resection, abdominal aortic aneurysm repair, or major gastrointestinal resection. The geriatric nutritional risk index was calculated from serum albumin and anthropometric measurements and categorized using established cutoffs as major risk (<82), moderate risk (82–91), low risk (92–98), and no risk (>98). Associations with 30-day mortality, complications, readmission, and nonhome discharge were evaluated using entropy-balanced weighted logistic regression adjusted for patient and operative factors. Results Among 506,040 patients undergoing major surgery, mean age was 66.9 years and 46.2% were female. Patients with a major geriatric nutritional risk index were older than patients with no geriatric nutritional risk index (median, 71 vs 68 years), more often had a Charlson Comorbidity Index ≥1 (81.1% vs 75.2%), and were Black (16.4% vs 11.5%) (all P < .001). Outcomes worsened with increasing geriatric nutritional risk index: mortality (no risk, 1.7%; low risk, 4.1%; moderate risk, 6.6%; and major risk, 13.3%), readmission (no risk, 12.3%; low risk, 17.0%; moderate risk, 19.0%; and major risk, 23.5%), and nonhome discharge (no risk, 33.1%; low risk, 46.1%; moderate risk, 53.3%; and major risk, 64.3%) (all P < .001). Compared with no geriatric nutritional risk index, low and major geriatric nutritional risk index were independently associated with higher odds of any 30-day complication (low risk: adjusted odds ratio, 1.79; 95% confidence interval, 1.75–1.82; major risk: adjusted odds ratio, 2.47; 95% confidence interval, 2.40–2.54) and mortality (low risk: adjusted odds ratio, 3.35; 95% confidence interval, 3.20–3.50; major risk: adjusted odds ratio, 8.03; 95% confidence interval, 7.70–8.38) (all P < .001). The geriatric nutritional risk index demonstrated a strong inverse association with 30-day mortality, with the highest risk observed among patients with a major geriatric nutritional risk index. Conclusion Greater geriatric nutritional risk index–defined nutrition-related risk was independently associated with higher mortality, major complications, and readmission compared with no geriatric nutritional risk index. Geriatric nutritional risk index–based assessment may identify nutritionally vulnerable patients for preoperative optimization, early intervention, and tailored postoperative discharge planning.
Background Surgical adverse events remain a source of patient harm despite increased focus on their prevention. High-reliability organizations reduce these events by fostering a just culture promoting transparency, shared accountability, and continuous improvement. This review article summarizes the systems and processes that promote safety in surgery, including incident reporting, root cause analyses, peer-review processes, and ongoing professional practice evaluations. Principle Results Systems employing a just culture encourage health care professionals to report adverse events through nonpunitive incident reporting systems to enable identification of trends and avenues for improvement. Root cause and apparent cause analyses are structured investigations that guide corrective actions rather than place individual blame. Ongoing professional practice evaluations and focused professional practice evaluations provide longitudinal assessment of provider performance, facilitating early identification of practice gaps. Collectively, these processes support continuous quality improvement and strengthen institutional shared accountability. Conclusion Safety in surgery depends on the integration of robust reporting systems, structured event analyses, and continuous improvement, all within a just culture framework. By emphasizing a system of shared accountability over individual blame, health care organizations can transform adverse events into opportunities for learning and promote safer surgical care.
The operating room is a high-risk, high-entropy environment, prone to human error and preventable adverse events. Drawing on lessons from high-reliability organizations such as the aviation industry, Aimbient (formerly Operating Room Black Box by Surgical Safety Technologies, New York, NY) collects continuous, multimodal audiovisual and physiologic data capture to deepen our understanding of surgical safety. This platform has demonstrated improvements in patient safety domains across several metrics, including ground-truth benchmarking of checklist adherence, video-based multidisciplinary review conferences, and automated physiologic event tagging. Recent integration of key postoperative morbidity and mortality metrics into the data streams collected by Aimbient monitoring platforms allows for us to achieve a holistic understanding of the perioperative record. As artificial intelligence capabilities rapidly expand and begin to integrate into our health care systems, ambient data capture is uniquely poised to generate real-time insights and open new frontiers in surgical patient safety.
