{"id":"https://openalex.org/W7225786123","doi":"https://doi.org/10.1097/xcs.0000000000002288","title":"Advanced Practice Providers Assistant-at-Surgery Services Across Surgical Specialties in Medicare: 2017-2024","display_name":"Advanced Practice Providers Assistant-at-Surgery Services Across Surgical Specialties in Medicare: 2017-2024","publication_year":2026,"publication_date":"2026-11-11","ids":{"openalex":"https://openalex.org/W7225786123","doi":"https://doi.org/10.1097/xcs.0000000000002288","pmid":"https://pubmed.ncbi.nlm.nih.gov/43012390"},"language":"en","primary_location":{"id":"doi:10.1097/xcs.0000000000002288","doi":"https://doi.org/10.1097/xcs.0000000000002288","is_oa":true,"landing_page_url":"https://doi.org/10.1097/xcs.0000000000002288","pdf_url":null,"source":{"id":"https://openalex.org/S134316426","display_name":"Journal of the American College of Surgeons","issn_l":"1072-7515","issn":["1072-7515","1879-1190"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-b","doyens","jufo-3","ki-jl-1","medline","norway-1","poland-140","russia-white-list-1"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of the American College of Surgeons","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"hybrid","oa_url":"https://doi.org/10.1097/xcs.0000000000002288","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5028534004","display_name":"Jacob G. Guorgui","orcid":"https://orcid.org/0009-0009-3339-1486","observed_orcids":["https://orcid.org/0009-0009-3339-1486"]},"institutions":[{"id":"https://openalex.org/I4210137306","display_name":"Stanford Medicine","ror":"https://ror.org/03mtd9a03","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210137306","https://openalex.org/I97018004"]},{"id":"https://openalex.org/I97018004","display_name":"Stanford University","ror":"https://ror.org/00f54p054","country_code":"US","type":"education","lineage":["https://openalex.org/I97018004"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Jacob G Guorgui","raw_affiliation_strings":["Department of Surgery, Stanford University School of Medicine, Stanford, CA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Surgery, Stanford University School of Medicine, Stanford, CA","institution_ids":["https://openalex.org/I4210137306","https://openalex.org/I97018004"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5091072989","display_name":"Christopher P. Childers","orcid":"https://orcid.org/0000-0002-6489-8222","observed_orcids":["https://orcid.org/0000-0002-6489-8222"]},"institutions":[{"id":"https://openalex.org/I201448701","display_name":"University of Washington","ror":"https://ror.org/00cvxb145","country_code":"US","type":"education","lineage":["https://openalex.org/I201448701"]},{"id":"https://openalex.org/I4210089486","display_name":"Fred Hutch Cancer Center","ror":"https://ror.org/007ps6h72","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I4210089486"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Christopher P Childers","raw_affiliation_strings":["Department of Surgery, University of Washington School of Medicine, Seattle, WA","Fred Hutch Cancer Center, Seattle, WA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Surgery, University of Washington School of Medicine, Seattle, WA","institution_ids":["https://openalex.org/I201448701"]},{"raw_affiliation_string":"Fred Hutch Cancer Center, Seattle, WA","institution_ids":["https://openalex.org/I4210089486"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":4,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":{"value":3600,"currency":"USD","value_usd":3600},"apc_paid":{"value":3600,"currency":"USD","value_usd":3600},"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.0,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11816","display_name":"Nursing Roles and Practices","score":0.9994999766349792,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11816","display_name":"Nursing Roles and Practices","score":0.9994999766349792,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.00019999999494757503,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T10843","display_name":"Diversity and Career in Medicine","score":0.0,"subfield":{"id":"https://openalex.org/subfields/3318","display_name":"Gender Studies"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9043999910354614},{"id":"https://openalex.org/C2780642338","wikidata":"https://www.wikidata.org/wiki/Q7632042","display_name":"Subspecialty","level":2,"score":0.873199999332428},{"id":"https://openalex.org/C2777512617","wikidata":"https://www.wikidata.org/wiki/Q1783605","display_name":"Staffing","level":2,"score":0.8098000288009644},{"id":"https://openalex.org/C2778139618","wikidata":"https://www.wikidata.org/wiki/Q13440398","display_name":"Workforce","level":2,"score":0.7081999778747559},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.4296000003814697},{"id":"https://openalex.org/C3020008087","wikidata":"https://www.wikidata.org/wiki/Q718927","display_name":"Physician assistants","level":4,"score":0.42579999566078186},{"id":"https://openalex.org/C68312169","wikidata":"https://www.wikidata.org/wiki/Q216685","display_name":"Orthopedic surgery","level":2,"score":0.40070000290870667},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.39910000562667847},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.35740000009536743},{"id":"https://openalex.org/C2779513377","wikidata":"https://www.wikidata.org/wiki/Q964984","display_name":"Current Procedural Terminology","level":2,"score":0.33149999380111694},{"id":"https://openalex.org/C155663085","wikidata":"https://www.wikidata.org/wiki/Q1056396","display_name":"Workforce planning","level":3,"score":0.32499998807907104},{"id":"https://openalex.org/C201236551","wikidata":"https://www.wikidata.org/wiki/Q7310809","display_name":"Relative value","level":2,"score":0.32100000977516174},{"id":"https://openalex.org/C2780877353","wikidata":"https://www.wikidata.org/wiki/Q2518253","display_name":"Health services research","level":3,"score":0.3158999979496002},{"id":"https://openalex.org/C127598652","wikidata":"https://www.wikidata.org/wiki/Q558635","display_name":"Per capita","level":3,"score":0.3050999939441681},{"id":"https://openalex.org/C186711583","wikidata":"https://www.wikidata.org/wiki/Q7315782","display_name":"Resource-based relative value scale","level":2,"score":0.301800012588501},{"id":"https://openalex.org/C3019611579","wikidata":"https://www.wikidata.org/wiki/Q6641956","display_name":"Surgical procedures","level":2,"score":0.3000999987125397},{"id":"https://openalex.org/C20387591","wikidata":"https://www.wikidata.org/wiki/Q930752","display_name":"Specialty","level":2,"score":0.2808000147342682},{"id":"https://openalex.org/C2910449239","wikidata":"https://www.wikidata.org/wiki/Q559392","display_name":"Medicare Part B","level":3,"score":0.2734000086784363}],"mesh":[],"locations_count":2,"locations":[{"id":"doi:10.1097/xcs.0000000000002288","doi":"https://doi.org/10.1097/xcs.0000000000002288","is_oa":true,"landing_page_url":"https://doi.org/10.1097/xcs.0000000000002288","pdf_url":null,"source":{"id":"https://openalex.org/S134316426","display_name":"Journal of the American College of Surgeons","issn_l":"1072-7515","issn":["1072-7515","1879-1190"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-b","doyens","jufo-3","ki-jl-1","medline","norway-1","poland-140","russia-white-list-1"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of the American College of Surgeons","raw_type":"journal-article"},{"id":"pmid:43012390","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/43012390","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of the American College of Surgeons","raw_type":"Journal Article"}],"best_oa_location":{"id":"doi:10.1097/xcs.0000000000002288","doi":"https://doi.org/10.1097/xcs.0000000000002288","is_oa":true,"landing_page_url":"https://doi.org/10.1097/xcs.0000000000002288","pdf_url":null,"source":{"id":"https://openalex.org/S134316426","display_name":"Journal of the American College of Surgeons","issn_l":"1072-7515","issn":["1072-7515","1879-1190"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-b","doyens","jufo-3","ki-jl-1","medline","norway-1","poland-140","russia-white-list-1"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of the American College of Surgeons","raw_type":"journal-article"},"sustainable_development_goals":[],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":[],"abstract_inverted_index":{"BACKGROUND:":[0],"Advanced":[1],"practice":[2],"providers":[3],"(APPs),":[4],"including":[5],"nurse":[6],"practitioners":[7],"and":[8,21,37,83,218],"physician":[9],"assistants":[10,29],"(PAs),":[11],"increasingly":[12],"participate":[13],"in":[14,40,72,115,134,149,153,196],"surgical":[15,27,76,142,204,223],"care,":[16],"but":[17,144],"the":[18,68,210],"national":[19,207],"extent":[20],"evolution":[22],"of":[23,52,74,130,162,188,213],"their":[24],"role":[25],"as":[26],"first":[28],"remain":[30],"poorly":[31],"characterized.":[32],"We":[33,46,66],"evaluated":[34],"longitudinal":[35],"trends":[36,208],"specialty-level":[38],"variation":[39],"APP":[41,92,131,136,156],"assistant-at-surgery":[42,85,93,105,189],"use.":[43],"STUDY":[44],"DESIGN:":[45],"conducted":[47],"a":[48],"repeated":[49],"cross-sectional":[50],"analysis":[51],"CMS":[53],"Physician/Supplier":[54],"Procedure":[55],"Summary":[56],"100%":[57],"Medicare":[58],"Part":[59],"B":[60],"files":[61],"from":[62,147],"2017":[63,116],"through":[64],"2024.":[65,135],"examined":[67,203],"10":[69],"highest-volume":[70],"operations":[71,110,195],"each":[73],"14":[75,141],"subspecialty":[77],"groups":[78],"with":[79,113,172,198],"90-day":[80],"global":[81],"periods":[82],"unrestricted":[84],"eligibility":[86],"(140":[87],"procedures).":[88],"The":[89],"outcome":[90],"was":[91,158],"services":[94,106,133,190],"per":[95],"1,000":[96],"index":[97],"operations.":[98],"RESULTS:":[99],"In":[100],"2024,":[101],"APPs":[102,181,214],"billed":[103],"784,066":[104],"across":[107,139,175,201],"2,094,083":[108],"eligible":[109,193],"(37.4%),":[111],"compared":[112],"30.2%":[114],"(mean":[117],"annual":[118],"change,":[119],"1.01":[120],"percentage":[121],"points;":[122],"95%":[123],"CI,":[124],"0.95-1.07).":[125],"PAs":[126],"accounted":[127],"for":[128,160,184],"86%":[129],"assistant":[132],"utilization":[137,173,200],"increased":[138],"all":[140,202],"specialties":[143,176],"varied":[145],"substantially,":[146],"1.8%":[148],"ophthalmology":[150],"to":[151,192,215,221],"57.5%":[152],"orthopedic":[154],"surgery.":[155],"assistance":[157],"reported":[159],"65.1%":[161],"total":[163],"knee":[164],"arthroplasties.":[165],"Plastic":[166],"surgery":[167],"demonstrated":[168],"105%":[169],"relative":[170,191],"growth,":[171],"differences":[174],"narrowing":[177],"over":[178],"time.":[179],"CONCLUSIONS:":[180],"now":[182],"account":[183],"more":[185],"than":[186],"one-third":[187],"major":[194],"Medicare,":[197],"increasing":[199],"specialties.":[205],"These":[206],"establish":[209],"growing":[211],"contribution":[212],"operative":[216],"staffing":[217],"provide":[219],"evidence":[220],"inform":[222],"workforce":[224],"planning.":[225]},"counts_by_year":[],"updated_date":"2026-11-12T12:28:57.059296","created_date":"2026-11-12T00:00:00"}