CONTENTS Volume 233 Number 1 July 2021 Western Surgical Association Presidential Address 1 Make No Assumptions, Give Lots of Tests David R Farley, MD, FACS Western Surgical Association Articles 9 State-Level Examination of Clinical Outcomes and Costs for Robotic and Laparoscopic Approach to Diaphragmatic Hernia Repair Sujay Kulshrestha, MD , Haroon M Janjua, MS , Corinne Bunn, MD , Michael Rogers, MD , Christopher DuCoin, MD, FACS , Zaid M Abdelsattar, MD, MS , Fred A Luchette, MD, MS, FACS , Paul C Kuo, MD, MS, MBA, FACS , Marshall S Baker, MD, MBA, FACS Operative management of diaphragmatic hernia continues to evolve, with increased use of robotic assistance. For patients undergoing minimally invasive repair, robotic assistance is associated with increased length of stay and index hospitalization cost without clear clinical benefit. Laparoscopic repair is the most cost-effective approach. 21 Outcomes of Complex Gastrointestinal Cancer Resection at US News & World Report Top-Ranked vs Non-Ranked Hospitals Erika Tay, MD , Sahil Gambhir, MD , Stephen Stopenski, MD , Samuel Hohmann, PhD , Brian R Smith, MD, FACS , Shaun Daly, MD, FACS , Marcelo W Hinojosa, MD, FACS , Ninh T Nguyen, MD, FACS Within the context of complex gastrointestinal cancer resection, hospitals designated as US News & World Report top-ranked in gastroenterology and gastrointestinal surgery performed a 4-fold higher annual case volume and have a significantly lower risk of mortality as well as lower failure-to-rescue rates compared with non-ranked hospitals. 29 Association Between Trimester and Outcomes after Cholecystectomy During Pregnancy Vincent Cheng, MD , Kazuhide Matsushima, MD, FACS , Matthew Ashbrook, MD , Koji Matsuo, MD, PhD , Morgan Schellenberg, MD, FACS , Kenji Inaba, MD, FACS , Kulmeet Sandhu, MD, FACS Overall maternal and fetal complication rate is 2.8 times higher when cholecystectomy is performed during the third trimester compared with the second trimester (p < 0.001). First and second trimester complication rates did not significantly differ (p = 0.68). Cholecystectomy for pregnant women should not be delayed until the third trimester. Publisher: Journal of the American College of Surgeons (ISSN 1072-7515) ª 2021 by the American College of Surgeons is published monthly by Elsevier Inc., 230 Park Avenue, Suite 800, New York, NY 10169-0901, USA. Periodicals postage paid at New York, NY and additional mailing offices. (For Post Office use only: Volume 233 issue 1 of 6.) Annual Subscription: United States and Canada: Personal, US$ 371.00; Student/Resident, US$ 137.00; ACS Member, membership benefit; All other countries (surface airlift delivery): Personal, US$ 514.00; Student/Resident, US$ 316.00. Prices include postage and are subject to change without notice. Customer Service (orders, claims, online, change of address): Please visit our Support Hub page https://service.elsevier.com for assistance. Postmaster: Send address changes to Elsevier, Journal Returns, 1799 Highway 50 East, Linn, MO 65051, USA. U.S.P.S. 529-760.