Surgery (SURGERY)

Publisher: Society of University Surgeons; Society for Vascular Surgery (U.S.); Central Surgical Association, Elsevier

Journal description

For over 60 years, Surgery has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncologic, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons. The journal ranks in the top 3.6% of the 4,779 scientific journals most frequently cited (Science Citation Index). Surgery is recommended for initial purchase in the Brandon-Hill study, Selected List of Books and Journals for the Small Medical Library (1997/98 Edition). Editors: Andrew L. Warshaw, M.D., Michael G. Sarr, M.D.

Current impact factor: 3.11

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 3.105
2012 Impact Factor 3.373
2011 Impact Factor 3.103
2010 Impact Factor 3.406
2009 Impact Factor 3.603
2008 Impact Factor 3.389
2007 Impact Factor 3.004
2006 Impact Factor 2.977
2005 Impact Factor 2.566
2004 Impact Factor 2.355
2003 Impact Factor 2.611
2002 Impact Factor 2.631
2001 Impact Factor 2.615
2000 Impact Factor 2.456
1999 Impact Factor 2.344
1998 Impact Factor 2.243
1997 Impact Factor 2.109
1996 Impact Factor 2.499
1995 Impact Factor 2.063
1994 Impact Factor 2.038
1993 Impact Factor 1.991
1992 Impact Factor 1.856

Impact factor over time

Impact factor

Additional details

5-year impact 3.85
Cited half-life 0.00
Immediacy index 0.43
Eigenfactor 0.03
Article influence 1.28
Website Surgery website
Other titles Surgery
ISSN 0039-6060
OCLC 1645314
Material type Periodical, Internet resource
Document type Journal / Magazine / Newspaper, Internet Resource

Publisher details


  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Pre-print allowed on any website or open access repository
    • Voluntary deposit by author of authors post-print allowed on authors' personal website, or institutions open scholarly website including Institutional Repository, without embargo, where there is not a policy or mandate
    • Deposit due to Funding Body, Institutional and Governmental policy or mandate only allowed where separate agreement between repository and the publisher exists.
    • Permitted deposit due to Funding Body, Institutional and Governmental policy or mandate, may be required to comply with embargo periods of 12 months to 48 months .
    • Set statement to accompany deposit
    • Published source must be acknowledged
    • Must link to journal home page or articles' DOI
    • Publisher's version/PDF cannot be used
    • Articles in some journals can be made Open Access on payment of additional charge
    • NIH Authors articles will be submitted to PubMed Central after 12 months
    • Publisher last contacted on 18/10/2013
  • Classification
    ​ green

Publications in this journal

  • Surgery 07/2015;
  • Surgery 07/2015; 158(1):311-312. DOI:10.1016/j.surg.2015.03.002
  • [Show abstract] [Hide abstract]
    ABSTRACT: In 2011, the Accreditation Council for Graduate Medical Education (ACGME) implemented additional restrictions on resident work hours. Although the impact of these restrictions on the education of surgical trainees has been examined, the effect on patient safety remains poorly understood. We used national Medicare Claims data for patients undergoing general (n = 1,223,815) and vascular (n = 475,262) surgery procedures in the 3 years preceding the duty hour changes (January, 2009-June, 2011) and the 18 months thereafter (July, 2011-December, 2012). Hospitals were stratified into quintiles by teaching intensity using a resident to bed ratio. We utilized a difference-in-differences analytic technique, using nonteaching hospitals as a control group, to compare risk-adjusted 30-day mortality, serious morbidity, readmission, and failure to rescue (FTR) rates before and after the duty hour changes. After duty hour reform, no changes were seen in the measured outcomes when comparing teaching with nonteaching hospitals. Even when stratifying by teaching intensity, there were no differences. For example, at the highest intensity teaching hospitals (resident/bed ratio of ≥0.6), mortality rates before and after the duty hour changes were 4.2% and 4.0%, compared with 4.7% and 4.4% for nonteaching hospitals (relative risk [RR], 0.98; 95% CI, 0.89-1.07). Similarly, serious complication (RR, 1.02; 95% CI, 0.98-1.06), FTR (RR, 0.95; 95% CI, 0.87-1.04), and readmission (odds ratio, 1.00; 95% CI, 0.96-1.03) rates were unchanged. In Medicare beneficiaries undergoing surgery at teaching hospitals, outcomes have not improved since the 2011 ACGME duty hour regulations. Copyright © 2015 Elsevier Inc. All rights reserved.
    Surgery 06/2015; DOI:10.1016/j.surg.2015.05.002
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    ABSTRACT: Practice administration education and experience during surgery residency are variable among residency programs. To better understand these issues, a survey of recent General Surgery residency (GS) graduates was compared with the results from a survey of GS program directors (PD). All GS graduates completing residency from 2009 to 2013 (n = 5,512) were surveyed to assess opinions regarding the desire for more instruction during residency in practice administration. General surgeons were defined as those not pursuing fellowship training; specialist surgeons (SS) completed additional training after their GS residency. Separately, all GS residency PDs were surveyed regarding practice administration education in their programs. A total of 3,354 responded to the GS graduate survey (response rate = 61%). GS comprised 26% of the respondents. The vast majority of all respondents desired more training in practice administration. There were no significant differences in the degree to which instruction was desired among GS, SS, residency program type, or current practice setting. The GS PD response rate was 68% (171/252 programs). Only 28% of programs included practice administration in the residency curriculum. Practice administration education is highly desired by GS and SS graduates. Our findings indicate a clear need for a curriculum in practice administration during residency. Copyright © 2015 Elsevier Inc. All rights reserved.
    Surgery 06/2015; DOI:10.1016/j.surg.2015.02.028
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    ABSTRACT: The complexity of hepatic hilar anatomy is an obstacle to precise diagnosis of tumor spread and appropriate operative planning for biliary malignancies. Three-dimensional (3D) cholangiography and angiography may overcome this obstacle and facilitate curative resection. The objective of this study was to evaluate the impact of 3D CT cholangiography on operative planning and outcomes of biliary malignancies. From 2009 to 2014, 3DCT cholangiography was performed on 49 patients with biliary malignancies requiring major hepatic resection and extrahepatic bile duct resection. The 3D cholangiogram was merged with 3D angiography and portography to create an all-in-one 3D image of the hepatic hilum. The cutting line of the bile duct and the type of liver resection were determined based on the spatial relationship between tumor spread and the landmark vessels. The necessity of vascular reconstruction was also evaluated. Preoperative imaging and operative findings were compared. Operative curability was compared with that of the historical cohort before the introduction of 3D cholangiography. Histologic examination of the bile duct stump showed a negative margin in 39 (80%), carcinoma in situ in 7 (14%), and invasive cancer (IC) in 3 patients (6%) on the first cutting. The IC-free rate (94%) on the first cutting was superior to that in the historical cohort (80%; P = .02). The necessity for portal and arterial reconstruction was predicted with 98 and 94% accuracy, respectively. We found 3D cholangiography to provide accurate information about hilar anatomy and plays a role in facilitating adequate operative planning. Copyright © 2015 Elsevier Inc. All rights reserved.
    Surgery 06/2015; DOI:10.1016/j.surg.2015.04.021
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    ABSTRACT: Extralaryngeal terminal bifurcation (ETB) of the recurrent laryngeal nerve (RLN) is an anatomic variation that threatens the safety of thyroid operation. Therefore, it is important to identify motor function in nerve branches to preserve appropriate motor activity. Intraoperative neuromonitoring (IONM) is an accepted procedure to identify motor function of the RLN. We established the operative anatomy of RLNs with ETB in 47 patients. The main trunk, bifurcation point, and the branches were identified and exposed completely during thyroid operation. The location of motor fibers within nerve branches was investigated by identifying motor function via IONM. Wave amplitudes were recorded after electrophysiologic stimulation. A total of 61 RLNs had ETBs with anterior and posterior branches. Bifurcation occurred early along the pre-arterial (proximal) segment in 13% of bifid RLNs. IONM showed motor function in all anterior branches. IONM identified motor activity in 4 (18%) posterior branches of 22 right, 3 (8%) posterior branches of 39 left, and 7 (12%) posterior branches of all 61 RLNs with ETB. The rate of recorded wave amplitudes of motor function in seven posterior branches was between 14 and 78% of those of corresponding anterior branches. In the RLN, the anterior branch always and the posterior branch uncommonly contain motor fibers. Wave amplitude analysis showed that motor function in the posterior branch is weaker than that in the anterior branch. On the basis of the location of motor fibers in both branches, total exposure and preservation of anatomy and function of all branches of the RLN is mandatory for complication-free thyroid surgery. Electrophysiologic testing may be as an important adjunct to visualization of the nerve with anatomic variation. Copyright © 2015 Elsevier Inc. All rights reserved.
    Surgery 06/2015; DOI:10.1016/j.surg.2015.04.019
  • Surgery 06/2015; DOI:10.1016/j.surg.2015.04.033
  • Surgery 06/2015; DOI:10.1016/j.surg.2015.04.015
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    ABSTRACT: There is currently little information regarding the impact of procedure volume on outcomes after open inguinal hernia repair in the United States. Our hypothesis was that increasing procedure volume is associated with lesser rates of reoperation and resource use. The database of the Statewide Planning and Research Cooperative System was queried for elective open initial inguinal hernia repairs performed in New York State from 2001 to 2008 via the use of International Classification of Diseases, 9th Revision and Current Procedural Terminology codes. Surgeon and hospital procedure volumes were grouped into tertiles based on the number of open inguinal hernia repairs performed per year. Bivariate, hierarchical mixed effects Cox proportional-hazards, and negative binomial regression analyses were performed assessing for factors associated with reoperation for recurrence, procedure time, and downstream total charges. Among 151,322 patients who underwent open inguinal hernia repair, the overall rate of reoperation for recurrence within 5 years was 1.7% with a median time to reoperation of 1.9 years. An inverse relationship was seen between surgeon volume and reoperation rate, procedure time, and health care costs (P < .001). After we controlled for surgeon, facility, operative and patient characteristics, low-volume surgeons (<25 repairs/year) had greater rates of reoperation (hazard ratio 1.23,95% confidence interval [95% CI] 1.11-1.36), longer procedure times (incidence rate ratio 1.22, 95% CI 1.21-1.24), and greater downstream costs (incidence rate ratio 1.13,95% CI 1.10-1.17) than high-volume surgeons (≥25 repairs/year). Surgeon volume <25 cases per year for open inguinal hernia repair was independently associated with greater rates of reoperation for recurrence, worse operative efficiency, and greater health care costs. Referral to surgeons who perform ≥25 inguinal hernia repairs per year should be considered to decrease reoperation rates and resource use. Copyright © 2015 Elsevier Inc. All rights reserved.
    Surgery 05/2015; DOI:10.1016/j.surg.2015.03.058
  • Surgery 05/2015; DOI:10.1016/j.surg.2015.04.018
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    ABSTRACT: The role of immunohistochemistry (IHC) for detecting occult lymph node disease in patients initially found to be node-negative by routine pathology is controversial. In this study, we evaluated trends associated with overall survival in node-negative breast cancer patients staged by IHC. The Surveillance, Epidemiology, and End Results database was queried for all patients with invasive breast adenocarcinoma and negative lymph nodes on routine pathology between 2004 and 2011 who underwent IHC to evaluate for occult nodal disease. Overall survival stratified by N-stage was compared with Kaplan-Meier analysis. Multivariate analysis was performed using a Cox proportional hazards model. Overall, 93,070 patients were identified, including 4,657 patients with isolated tumor cells (<0.2 mm diameter or <200 cells) and 6,720 patients with micrometastases (0.2-2 mm diameter). Kaplan-Meier curves demonstrated a difference in overall survival across all groups (P < .0001). On multivariate analysis, micrometastases remained an independent predictor for survival compared with IHC-negative patients (hazard ratio 1.40, 95% confidence interval 1.28-1.53), whereas isolated tumor cells were not a significant predictor (hazard ratio 1.05, 95% confidence interval 0.92-1.20). Patients with occult micrometastases in axillary lymph nodes found via IHC demonstrated a significant overall survival difference, but isolated tumor cells have no prognostic significance. Copyright © 2015 Elsevier Inc. All rights reserved.
    Surgery 05/2015; 158(2). DOI:10.1016/j.surg.2015.03.049
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    ABSTRACT: The majority of patients with primary hyperparathyroidism (PHPT) are diagnosed without the classic signs of renal or osseous complications. Vague and subjective symptoms have been attributed to PHPT but have been difficult to measure during the medical encounter. The Patient-Reported Outcomes Measurement Information System (PROMIS) of the National Institutes of Health contains validated measures of physical and mental health that can be administered by the use of computer-adaptive testing (CAT). The objective of this study was to evaluate the feasibility of PROMIS assessment in the clinical setting to measure changes in patient-reported health before and after parathyroidectomy. We hypothesized that patients undergoing parathyroidectomy for PHPT would report greater improvement in mental and physical health compared with control patients. Adult PHPT patients scheduled for parathyroidectomy and control patients requiring diagnostic thyroid operation were enrolled prospectively during a 6-month period. Patients were administered clinically relevant PROMIS health domains via CAT at a preoperative visit and 3 weeks after operation. A change in score of 5 or greater for each PROMIS instrument was defined as clinically important. Statistical significance of pre/post-surgery changes in scores was determined using paired t tests. A total of 35 patients with PHPT and 9 control patients completed the study. The mean number of PROMIS items answered during an assessment was 67 (range 51-121, SD 15.4). Median completion time was 8.2 minutes (range 3.4-38.4, SD 4.7). Clinically important improvement after parathyroidectomy in the PHPT group was greater than in the control group in 5 PROMIS domains. The score improvement experienced by PHPT patients was 8.8 in Fatigue, 6.7 in Sleep-Related Impairment, 5.0 in Anxiety, 7.0 in Applied Cognition, and 6.2 in Depression (all P < .05). PROMIS is an efficient clinical assessment platform for measuring patient-reported outcomes in PHPT via CAT. Several domains of physical and mental health in patients with PHPT show statistically and clinically important improvement after parathyroidectomy. Copyright © 2015 Elsevier Inc. All rights reserved.
    Surgery 05/2015; DOI:10.1016/j.surg.2015.03.054
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    ABSTRACT: This study examined the effects of the use of anxiolytic medications (AXM) and antidepressant medications (ADMs) on outcomes after noncardiac surgery. A single-center review of prospectively obtained, perioperative and 30-day outcome data, including AXM and ADM use at admission, as part of the National Surgery Quality Improvement Program. Of the 1846 patients undergoing surgery, 380 (20.6%) were taking an ADM, 288 (15.6%) AXM, 124 (6.7%) were taking both, and 545 (29.5%) were taking either at the time of admission. Both ADM and AXM patients more often were female than nonusers, had a greater American Society of Anesthesiologists class and suffered more from hypertension, COPD, and dyspnea (all P < .005). AXM patients also were more often smokers. ADM patients had a greater mortality and a greater risk of an infective complication, but these effects did not remain after adjustment for procedure and comorbid risks. Patients taking AXM had greater duration of stay, as well as an increased incidence of return to the operating room, infections, wound occurrences, and cardiovascular or cerebrovascular events (all P < .005). After adjustment, AXM was associated with greater combined major morbidity or mortality (odds ratio 1.72, 95% confidence interval 1.08-2.73, P = .023). AXM was used by 16% of patients in our institution undergoing a noncardiac operation and was an independent risk factor for poorer short-term outcome after surgery. ADM was found to be used by 21% of patients but was not an independent risk factor for poor outcome. Copyright © 2015 Elsevier Inc. All rights reserved.
    Surgery 05/2015; 158(2). DOI:10.1016/j.surg.2015.03.050
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    ABSTRACT: There is strong evidence supporting the efficacy of adjuvant chemotherapy for patients with pathologic, stage III colon cancer. This study examines differences in adherence to evidence-based adjuvant chemotherapy guidelines for pathologic, stage III colon cancer cases across hospital and patient subgroups. Patients with stage III colon cancer were identified from the 2003 to 2011 National Cancer Data Base (NCDB). A logistic regression model was used to estimate the odds of receipt of adjuvant chemotherapy across varying hospital and patient characteristics. A multivariable Cox proportional hazards model was used to estimate the association between receipt of adjuvant chemotherapy and 5-year survival. Risk adjusted observed/expected (O/E) outcome ratios were calculated for each hospital to compare hospital-specific quality of care during the study period. A total of 124,008 patients met the inclusion criteria. Adjuvant chemotherapy was not administered to 34%. The rates of adjuvant chemotherapy have shown little improvement over time (63% in 2003 vs 66% in 2011). The Cox model indicates that patients receiving adjuvant chemotherapy had better survival (hazard ratio = 0.48, 95% confidence interval 0.47-0.49). Analysis of risk adjusted O/E ratios indicated no consistent pattern as to which hospitals were performing optimally or subopitmally over time. There has been no meaningful improvement in receipt of chemotherapy in patients with stage III colon cancer. The fact that chemotherapy is not being considered or offered to more than 20% of patients with node-positive colon cancer suggests that there are substantial process failures across many institutions and regions in the United States. Copyright © 2015 Elsevier Inc. All rights reserved.
    Surgery 05/2015; DOI:10.1016/j.surg.2015.03.057
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    ABSTRACT: Low-income, minority women with breast cancer experience a range of barriers to receiving survivorship information. Our objective was to test a novel, patient-centered intervention aimed at improving communication about survivorship care. We developed a wallet card to provide oncologic and follow-up care survivorship information to breast cancer patients. We used a prospective, pre-post design to assess the intervention at a safety net hospital. The intervention was given by a patient navigator or community health worker. Patient knowledge (n = 130) of personal cancer history improved from baseline pretest to 1 week after the intervention for stage (66-93%; P < .05), treatment (79-92%; P < .05), and symptoms of recurrence (48-89%; P < .05), which was retained at 3 months. The intervention reduced the number of patients who were unsure when their mammogram was due (15-5% at 1 week and 6% at 3 months; P < .05). Nearly 90% reported they would be likely to share their survivorship card with their providers. A patient-centered survivorship card improved short-term recall of key survivorship care knowledge and seems to be effective at reducing communication barriers for this population. Further studies are warranted to assess long-term retention and the impact on receipt of appropriate survivorship follow-up care. Published by Elsevier Inc.
    Surgery 05/2015; DOI:10.1016/j.surg.2015.03.056
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    ABSTRACT: Little evidence currently exists regarding the clinical or financial impact of intraoperative adverse events (iAEs). We sought to study the additional health care charges attributable to the occurrence of an iAE. The administrative and ACS-NSQIP databases at our tertiary academic medical center were linked for all patients undergoing abdominal surgery (January 2007-October 2012). The ICD-9-CM-based Patient Safety Indicator "accidental puncture/laceration" was used to screen the linked database for potential iAEs. All iAEs were confirmed subsequently through standardized review of all flagged medical records. Multivariate analyses controlling for demographics, comorbidities/laboratory values, procedure type, and approach and complexity of surgery were performed to assess the increase in health care charges independently predicted by the occurrence of iAEs. Of 9,111 patients, 183 were confirmed to have iAEs. Patients in the iAE group had higher median total charges ($27,169 [IQR, 17,302-44,952] vs $13,312 [IQR, 8,586-22,012]; P < .001), direct charges ($17,808 [IQR, 11,520-28,930] vs $8,738 [IQR, 5,686-14,227]; P < .001) and indirect charges ($9,396 [IQR, 5,932-16,144] vs $4,568 [IQR, 2,887-7,824]; P < .001) when compared with patients without iAEs. Multivariate analyses demonstrated that iAEs independently predict an increase in total hospitalization charges by 41% (95% CI, 30-52%; P < .001). Specifically, the direct, indirect, operating room, laboratory/radiology, and alimentation/medical therapy charges increased by 42, 39, 27, 54, and 48%, respectively (all P < .001). In addition to the morbidity incurred by patients, the occurrence of an iAE is associated with major additional health care charges. In an era of value-based health care, understanding and preventing iAEs can lead to major cost savings alongside improvements in patient safety and surgical quality. Copyright © 2015 Elsevier Inc. All rights reserved.
    Surgery 05/2015; DOI:10.1016/j.surg.2015.04.023
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    ABSTRACT: The Consortium of American College of Surgeons Accredited Education Institutes (ACS-AEIs) was created to promote patient safety through the use of simulation, develop innovative education and training, advance technologies, identify best practices, and encourage research and collaboration. During the seventh annual meeting of the consortium, leaders from across the consortium who have developed institution-wide simulation centers were invited to participate in a panel to discuss their experiences and the lessons learned. These discussions resulted in definition of 5 key areas that need to be addressed effectively to support efforts of the ACS-AEIs. Copyright © 2015 Elsevier Inc. All rights reserved.
    Surgery 05/2015; DOI:10.1016/j.surg.2015.03.040
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    ABSTRACT: Nodal metastasis is a known prognostic factor for small bowel adenocarcinoma. The goals of this study were to evaluate the number of lymph nodes (LNs) that should be retrieved and the impact of lymph node ratio (LNR) on survival. Surveillance, Epidemiology, and End Results was queried to identify patients with small bowel adenocarcinoma who underwent resection from 1988 to 2010. Survival was calculated with the Kaplan-Meier method. Multivariate analysis identified predictors of survival. A total of 2,772 patients underwent resection with at least one node retrieved, and this sample included equal numbers of duodenal (n = 1,387) and jejunoileal (n = 1,386) adenocarcinomas. There were 1,371 patients with no nodal metastasis (N0, 49.4%), 928 N1 (33.5%), and 474 N2 (17.1%). The median numbers of LNs examined for duodenal and jejunoileal cancers were 9 and 8, respectively. Cut-point analysis demonstrated that harvesting at least 9 for jejunoileal and 5 LN for duodenal cancers resulted in the greatest survival difference. Increasing LNR at both sites was associated with decreased overall median survival (LNR = 0, 71 months; LNR 0-0.02, 35 months; LNR 0.21-0.4, 25 months; and LNR >0.4, 16 months; P < .001). Multivariate analysis confirmed number of LNs examined, T-stage, LN positivity, and LNR were independent predictors of survival. LNR has a profound impact on survival in patients with small bowel adenocarcinoma. To achieve adequate staging, we recommend retrieving a minimum of 5 LN for duodenal and 9 LN for jejunoileal adenocarcinomas. Copyright © 2015 Elsevier Inc. All rights reserved.
    Surgery 05/2015; DOI:10.1016/j.surg.2015.03.048