Pub Date : 2026-02-04DOI: 10.1001/jamasurg.2025.6406
Pawan Acharya, Kristan Staudenmayer, Molly P. Jarman, Russell Griffin, Jeffrey D. Kerby, Zain G. Hashmi
Importance As trauma care–related demand continues to rise, the US trauma system’s current utilization and ability to accommodate surges from mass casualty events or disasters remain uncertain. Understanding existing trauma bed occupancy and reserve capacity is essential for national preparedness. Objective To assess the current occupancy and distribution of adult trauma-designated beds across US hospitals and evaluate the system’s ability to absorb a sudden and sustained surge in trauma volume. Design, Setting, and Participants This cross-sectional study analyzed 121 weeks (January 2022–April 2024) of facility-level bed availability and occupancy data from the US Department of Health and Human Services for 2027 hospitals with trauma center designation. Simulation modeling was conducted to evaluate bed capacity under various casualty influx scenarios, assuming a 10% allocation (n = 3610) of the 36 101 adult-trauma designated beds in level I/II centers nationwide. Exposures Various casualty influx scenarios. Main Outcomes and Measures Primary outcomes included mean weekly occupancy rates for adult inpatient and intensive care unit (ICU) beds by trauma center level and region, percentage of centers exceeding 80% occupancy for prolonged durations, and simulated bed deficits under sustained patient influx scenarios. Results Level I and II trauma centers consistently operated at high occupancy, exceeding 80% for inpatient beds and 75% for ICU beds across most regions. Nearly 80% of level I/II centers in the South and West exceeded 80% inpatient occupancy for 75 weeks or longer. In contrast, level III and lower-level centers showed lower occupancy but notable regional variation. Simulation modeling revealed that at sustained influx rates of 1500 to 2000 patients per day, national trauma bed deficits exceeded 20 000 beds within 45 days. Even modest influxes of 241 patients per day saturated all designated trauma beds within 90 days under dynamic length-of-stay assumptions. Conclusions and Relevance The US trauma system, particularly its tertiary centers (level I/II) are operating under sustained high occupancy with limited reserve capacity for patient surges. These findings highlight the urgent need for national trauma capacity planning, regional load-balancing mechanisms, and scalable infrastructure to enhance trauma system resilience.
{"title":"Bed Capacity and Utilization at Hospitals With Trauma Centers","authors":"Pawan Acharya, Kristan Staudenmayer, Molly P. Jarman, Russell Griffin, Jeffrey D. Kerby, Zain G. Hashmi","doi":"10.1001/jamasurg.2025.6406","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6406","url":null,"abstract":"Importance As trauma care–related demand continues to rise, the US trauma system’s current utilization and ability to accommodate surges from mass casualty events or disasters remain uncertain. Understanding existing trauma bed occupancy and reserve capacity is essential for national preparedness. Objective To assess the current occupancy and distribution of adult trauma-designated beds across US hospitals and evaluate the system’s ability to absorb a sudden and sustained surge in trauma volume. Design, Setting, and Participants This cross-sectional study analyzed 121 weeks (January 2022–April 2024) of facility-level bed availability and occupancy data from the US Department of Health and Human Services for 2027 hospitals with trauma center designation. Simulation modeling was conducted to evaluate bed capacity under various casualty influx scenarios, assuming a 10% allocation (n = 3610) of the 36 101 adult-trauma designated beds in level I/II centers nationwide. Exposures Various casualty influx scenarios. Main Outcomes and Measures Primary outcomes included mean weekly occupancy rates for adult inpatient and intensive care unit (ICU) beds by trauma center level and region, percentage of centers exceeding 80% occupancy for prolonged durations, and simulated bed deficits under sustained patient influx scenarios. Results Level I and II trauma centers consistently operated at high occupancy, exceeding 80% for inpatient beds and 75% for ICU beds across most regions. Nearly 80% of level I/II centers in the South and West exceeded 80% inpatient occupancy for 75 weeks or longer. In contrast, level III and lower-level centers showed lower occupancy but notable regional variation. Simulation modeling revealed that at sustained influx rates of 1500 to 2000 patients per day, national trauma bed deficits exceeded 20 000 beds within 45 days. Even modest influxes of 241 patients per day saturated all designated trauma beds within 90 days under dynamic length-of-stay assumptions. Conclusions and Relevance The US trauma system, particularly its tertiary centers (level I/II) are operating under sustained high occupancy with limited reserve capacity for patient surges. These findings highlight the urgent need for national trauma capacity planning, regional load-balancing mechanisms, and scalable infrastructure to enhance trauma system resilience.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"301 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-04DOI: 10.1001/jamasurg.2025.6386
Abdulaziz Elemosho, Odysseas P. Chatzipanagiotou, Meher Angez, Andrea Baldo, Areesh Mevawalla, Sebastian O. Ekenze, Qaidar Alizai, Timothy M. Pawlik
Importance Sleep plays a critical role in postoperative recovery, influencing immune function, pain perception, neurocognitive performance, and wound healing. Although surgical interventions are known to disrupt sleep, the extent and trajectory of these disruptions across varying procedural risks remain poorly characterized. Objective To characterize postoperative alterations in sleep stages and determine how these trajectories vary across different surgical procedures. Design, Setting, and Participants This retrospective cohort study used wearable device–derived sleep data linked to electronic health records from US participants in the prospectively maintained All of Us Research Program database. Adults undergoing surgery from January 2012 to December 2024 with 90 days or more of preoperative and 30 days or more of postoperative wearable sleep data were included. Data analyses were performed from July to November 2025. Exposure Surgical intervention stratified by procedural risk levels. Main Outcomes and Measures The primary outcome was sleep metrics, including total sleep and rapid eye movement (REM), deep, light, and wake-stage durations, compared across 9 postoperative epochs and stratified by surgical risk (low, intermediate, or high). Linear mixed-effects models were fitted for each metric with opioid exposure, dose, and patient age as covariates. Association between each sleep metric and postoperative complications was assessed using multivariate logistic regression analysis. Results A total of 634 unique surgical procedures in 512 patients were included in the analytic cohort; median (IQR) patient age at the time of surgery was 59 (46-67) years, and 558 patients (88.0%) were female. High-risk procedures were associated with significant and sustained mean (SD) reductions in REM and deep sleep through postoperative day 7 (deep: Δ, –18.7 [48.6] minutes; <jats:italic toggle="yes">P</jats:italic> &lt; .001; REM: Δ, –12.4 [30.1] minutes; <jats:italic toggle="yes">P</jats:italic> &lt; .001), while total sleep was reduced acutely (Δ, –19.4 [145.3] minutes; <jats:italic toggle="yes">P</jats:italic> = .004). Light sleep decreased transiently; wake-stage duration increased significantly (mean [SD] Δ, +13.9 [31.8] minutes; <jats:italic toggle="yes">P</jats:italic> &lt; .001). Intermediate-risk procedures were associated with milder disruptions, primarily limited to days 0 through 3. In contrast, low-risk procedures were not associated with significant changes in any sleep metric at any postoperative epoch. Opioid exposure was associated with increased light (β, approximately +5.1 minutes; <jats:italic toggle="yes">P</jats:italic> &lt; .001) and wake-stage (+10.2 minutes; <jats:italic toggle="yes">P</jats:italic> &lt; .001) durations but suppressed deep sleep (–5.1 minutes; <jats:italic toggle="yes">P</jats:italic> &lt; .001). Age was similarly linked to greater wake-stage sleep (+0.30 minutes/y) and red
{"title":"Postoperative Sleep Dynamics Across Surgical Risk Using Wearable Device Technology","authors":"Abdulaziz Elemosho, Odysseas P. Chatzipanagiotou, Meher Angez, Andrea Baldo, Areesh Mevawalla, Sebastian O. Ekenze, Qaidar Alizai, Timothy M. Pawlik","doi":"10.1001/jamasurg.2025.6386","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6386","url":null,"abstract":"Importance Sleep plays a critical role in postoperative recovery, influencing immune function, pain perception, neurocognitive performance, and wound healing. Although surgical interventions are known to disrupt sleep, the extent and trajectory of these disruptions across varying procedural risks remain poorly characterized. Objective To characterize postoperative alterations in sleep stages and determine how these trajectories vary across different surgical procedures. Design, Setting, and Participants This retrospective cohort study used wearable device–derived sleep data linked to electronic health records from US participants in the prospectively maintained All of Us Research Program database. Adults undergoing surgery from January 2012 to December 2024 with 90 days or more of preoperative and 30 days or more of postoperative wearable sleep data were included. Data analyses were performed from July to November 2025. Exposure Surgical intervention stratified by procedural risk levels. Main Outcomes and Measures The primary outcome was sleep metrics, including total sleep and rapid eye movement (REM), deep, light, and wake-stage durations, compared across 9 postoperative epochs and stratified by surgical risk (low, intermediate, or high). Linear mixed-effects models were fitted for each metric with opioid exposure, dose, and patient age as covariates. Association between each sleep metric and postoperative complications was assessed using multivariate logistic regression analysis. Results A total of 634 unique surgical procedures in 512 patients were included in the analytic cohort; median (IQR) patient age at the time of surgery was 59 (46-67) years, and 558 patients (88.0%) were female. High-risk procedures were associated with significant and sustained mean (SD) reductions in REM and deep sleep through postoperative day 7 (deep: Δ, –18.7 [48.6] minutes; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001; REM: Δ, –12.4 [30.1] minutes; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001), while total sleep was reduced acutely (Δ, –19.4 [145.3] minutes; <jats:italic toggle=\"yes\">P</jats:italic> = .004). Light sleep decreased transiently; wake-stage duration increased significantly (mean [SD] Δ, +13.9 [31.8] minutes; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001). Intermediate-risk procedures were associated with milder disruptions, primarily limited to days 0 through 3. In contrast, low-risk procedures were not associated with significant changes in any sleep metric at any postoperative epoch. Opioid exposure was associated with increased light (β, approximately +5.1 minutes; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001) and wake-stage (+10.2 minutes; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001) durations but suppressed deep sleep (–5.1 minutes; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001). Age was similarly linked to greater wake-stage sleep (+0.30 minutes/y) and red","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"9 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-04DOI: 10.1001/jamasurg.2025.6382
Bao Ngoc Vi Do, Jayson Willard Myers, Paras Singh Minhas
{"title":"Distance of Mass School Shootings From Trauma Centers.","authors":"Bao Ngoc Vi Do, Jayson Willard Myers, Paras Singh Minhas","doi":"10.1001/jamasurg.2025.6382","DOIUrl":"10.1001/jamasurg.2025.6382","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":14.9,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12874072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-04DOI: 10.1001/jamasurg.2025.6415
Kelly A Boyle, David Milia, Marc de Moya
{"title":"National System Preparation in Dire Need-Call for Action.","authors":"Kelly A Boyle, David Milia, Marc de Moya","doi":"10.1001/jamasurg.2025.6415","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6415","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":14.9,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ImportanceFrailty is associated with functional decline and increased postoperative morbidity. Prehabilitation may complement Enhanced Recovery After Surgery (ERAS) care to improve patient outcomes.ObjectiveTo evaluate the effect of a multimodal prehabilitation program on functional capacity and clinical outcomes in older patients with frailty undergoing radical gastrectomy.Design, Setting, and ParticipantsThis randomized clinical trial was conducted at 15 centers in China. Participants aged 65 to 85 years with frailty (Geriatric 8 screening tool score ≤14) scheduled for elective gastrectomy or neoadjuvant chemotherapy prior to elective gastrectomy were randomized 1:1 to ERAS care either with or without prehabilitation. Recruitment for the study began in September 2022 and was completed in April 2024; data analysis was completed from September 2024 to April 2025.InterventionsThe prehabilitation group (PG) underwent multimodal prehabilitation for at least 2 weeks in combination with ERAS care, while the standard ERAS group (SG) followed a well-defined ERAS pathway.Main Outcomes and MeasuresThe primary outcome was the proportion of patients with postoperative complications within 30 days after surgery. Secondary outcomes included functional capacity, surgical resilience, and other short-term postoperative outcomes.ResultsA total of 368 participants were randomized to either the PG or SG group. In the modified intention-to-treat population of 347 participants (PG: n = 169; SG: n = 178), overall compliance with prehabilitation was 93.75%; median (IQR) participant age was 70 (68-73) years, and 95 participants (27.4%) were female. The rate of complications was lower in PG compared to SG (17.2% vs 28.7%; P = .01). In particular, significant benefits were observed in minor complications (PG: 18 of 169 patients [10.7%]; SG: 36 of 178 patients [20.2%]; P = .01) and medical complications (PG: 14 of 169 patients [8.3%]; SG: 30 of 178 patients [16.9%]; P = .02). The PG showed increased functional capacity before surgery compared to baseline (mean [SD] 6-minute walk test change, +24 [12.5] m; P < .001). Four weeks after surgery, the mean walking distance of the PG remained above baseline levels. Moreover, secondary parameters, such as chronic low-grade inflammation, preoperative physical quality of life, length of intensive care unit stay, mechanical ventilation time, and length of hospital stay, generally favored prehabilitation compared with standard ERAS care.Conclusions and RelevancePer the results of this randomized clinical trial, a multimodal prehabilitation program may enhance physiological reserve, reduce morbidity, and promote surgical resilience in older patients with frailty undergoing radical gastrectomy.Trial RegistrationClinicalTrials.gov Identifier: NCT05352802.
虚弱与功能下降和术后发病率增加有关。预康复可以补充术后增强恢复（ERAS）护理，以改善患者的预后。目的评价多模式康复方案对行根治性胃切除术的老年虚弱患者功能能力和临床预后的影响。设计、环境和参与者本随机临床试验在中国的15个中心进行。年龄在65 ~ 85岁之间，体弱者（Geriatric 8筛查工具评分≤14）计划择期胃切除术或择期胃切除术前新辅助化疗的参与者按1:1的比例随机分配到有或没有预适应的ERAS治疗组。该研究的招募于2022年9月开始，并于2024年4月完成；数据分析于2024年9月至2025年4月完成。干预措施：预康复组（PG）在ERAS护理的同时进行至少2周的多模式预康复，而标准ERAS组（SG）则遵循明确的ERAS途径。主要结局和措施主要结局是术后30天内出现术后并发症的患者比例。次要结局包括功能能力、手术恢复力和其他短期术后结局。结果共有368名参与者被随机分为PG组和SG组。在347名受试者（PG: n = 169; SG: n = 178）的改良意向治疗人群中，总体康复依从性为93.75%；参与者年龄中位数（IQR）为70（68-73）岁，95名参与者（27.4%）为女性。PG组并发症发生率低于SG组（17.2% vs 28.7%; P = 0.01）。特别是，在轻微并发症方面观察到显著的益处(PG: 169例患者中有18例[10.7%]；SG: 178例患者中有36例[20.2%];P =。01)和医学并发症（169例患者中PG: 14例[8.3%]；178例患者中SG: 30例[16.9%];P = 0.02）。与基线相比，PG术前功能能力增加（平均[SD] 6分钟步行测试变化，+24 [12.5]m; P < .001）。术后4周，PG的平均步行距离仍高于基线水平。此外，次要参数，如慢性低度炎症、术前身体生活质量、重症监护病房住院时间、机械通气时间和住院时间，与标准ERAS护理相比，普遍倾向于康复治疗。结论和相关性根据这项随机临床试验的结果，多模式的康复计划可以增强接受根治性胃切除术的老年虚弱患者的生理储备，降低发病率，并提高手术恢复能力。临床试验注册号：NCT05352802。
{"title":"Supervised Multimodal Prehabilitation and Clinical Outcomes in Older Patients With Frailty and Gastric Cancer: The GISSG+2201 Randomized Clinical Trial.","authors":"Yuqi Sun,Yulong Tian,Shougen Cao,Leping Li,Wenbin Yu,Yinlu Ding,Xixun Wang,Ying Kong,Xinjian Wang,Hao Wang,Xizeng Hui,Jianjun Qu,Hongbo Wang,Quanhong Duan,Daogui Yang,Huanhu Zhang,Shaofei Zhou,Xiaodong Liu,Zequn Li,Qi Liu,Yanbing Zhou","doi":"10.1001/jamasurg.2025.6256","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6256","url":null,"abstract":"ImportanceFrailty is associated with functional decline and increased postoperative morbidity. Prehabilitation may complement Enhanced Recovery After Surgery (ERAS) care to improve patient outcomes.ObjectiveTo evaluate the effect of a multimodal prehabilitation program on functional capacity and clinical outcomes in older patients with frailty undergoing radical gastrectomy.Design, Setting, and ParticipantsThis randomized clinical trial was conducted at 15 centers in China. Participants aged 65 to 85 years with frailty (Geriatric 8 screening tool score ≤14) scheduled for elective gastrectomy or neoadjuvant chemotherapy prior to elective gastrectomy were randomized 1:1 to ERAS care either with or without prehabilitation. Recruitment for the study began in September 2022 and was completed in April 2024; data analysis was completed from September 2024 to April 2025.InterventionsThe prehabilitation group (PG) underwent multimodal prehabilitation for at least 2 weeks in combination with ERAS care, while the standard ERAS group (SG) followed a well-defined ERAS pathway.Main Outcomes and MeasuresThe primary outcome was the proportion of patients with postoperative complications within 30 days after surgery. Secondary outcomes included functional capacity, surgical resilience, and other short-term postoperative outcomes.ResultsA total of 368 participants were randomized to either the PG or SG group. In the modified intention-to-treat population of 347 participants (PG: n = 169; SG: n = 178), overall compliance with prehabilitation was 93.75%; median (IQR) participant age was 70 (68-73) years, and 95 participants (27.4%) were female. The rate of complications was lower in PG compared to SG (17.2% vs 28.7%; P = .01). In particular, significant benefits were observed in minor complications (PG: 18 of 169 patients [10.7%]; SG: 36 of 178 patients [20.2%]; P = .01) and medical complications (PG: 14 of 169 patients [8.3%]; SG: 30 of 178 patients [16.9%]; P = .02). The PG showed increased functional capacity before surgery compared to baseline (mean [SD] 6-minute walk test change, +24 [12.5] m; P < .001). Four weeks after surgery, the mean walking distance of the PG remained above baseline levels. Moreover, secondary parameters, such as chronic low-grade inflammation, preoperative physical quality of life, length of intensive care unit stay, mechanical ventilation time, and length of hospital stay, generally favored prehabilitation compared with standard ERAS care.Conclusions and RelevancePer the results of this randomized clinical trial, a multimodal prehabilitation program may enhance physiological reserve, reduce morbidity, and promote surgical resilience in older patients with frailty undergoing radical gastrectomy.Trial RegistrationClinicalTrials.gov Identifier: NCT05352802.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"87 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-28DOI: 10.1001/jamasurg.2025.6255
Liane S Feldman,Franco Carli,Janius Tsang
{"title":"Expanding the Prehabilitation Team Beyond the Clinic.","authors":"Liane S Feldman,Franco Carli,Janius Tsang","doi":"10.1001/jamasurg.2025.6255","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6255","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"12 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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