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  • Transposed Data in a Table
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-13

    In the Original Investigation titled “Effect of Incorporation of Pretreatment Serum Carcinoembryonic Antigen Levels Into AJCC Staging for Colon Cancer on 5-Year Survival,” published in the August 2015 issue of JAMA Surgery,1 2 columns of data were transposed in a table. In Table 1, the information in the column headings was correct; however, the entire column of data for all patients should have appeared in the column for patients with C0 disease, and the column of data for patients with C0 disease should have appeared in the column for all patients. This article was corrected online.

    更新日期:2019-02-14
  • Cost and Outcomes Information Should Be Part of Shared Decision Making—Reply
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-13
    Margaret L. Schwarze, David Urbach, Kimberly E. Kopecky

    In Reply We appreciate the comments from Weeks and Weinstein regarding our article.1 We agree with Weeks and Weinstein that information about mortality and out-of-pocket costs matter to patients who are considering surgical intervention. Like other types of information, eg, risks or alternative treatments, we worry that simple disclosure of data is not enough to make a shared decision. Policies designed ostensibly to promote shared decision making that instead target types of information for disclosure encourage a buyer-beware attitude for patients, with little regard for the clinical skill required to present choices, elicit preferences, and ensure the treatment plan is aligned with the patient’s goals and values. After all, decisions around out-of-pocket costs and location of surgery have tradeoffs. Some patients may prefer a small increase in mortality to have care closer to home, while others might prefer to receive care from a specific surgeon or institution despite large out-of-pocket costs. To support shared decision making, the surgeon’s job is not to simply disclose information but instead to assist patients as they navigate this unfamiliar territory.

    更新日期:2019-02-14
  • Cost and Outcomes Information Should Be Part of Shared Decision Making
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-13
    William B. Weeks, James N. Weinstein

    To the Editor We applaud Kopecky et al1 for articulating that a shared decision-making process for determining whether to obtain a preference-sensitive elective surgery requires more than asking a patient to watch a video, read a document, or fill in numbers on a risk calculator. Clearly, a surgeon should agree that the surgery is a reasonable treatment option, be able to modify treatment recommendations based on a patient’s risk profile, and weigh in on what the surgeon believes to be the best treatment pathway. Along the way, patients should be informed of the short-term and long-term risks and benefits of different treatment options, including adverse effect profiles that might influence decision making for reasonable patients with distinct sets of values.

    更新日期:2019-02-14
  • Interest of Eosinophil Count in Bacterial Infections to Predict Antimicrobial Therapy Efficacy—Reply
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-13
    Audrey Stokes Kulaylat, Erica L. Buonomo, David B. Stewart

    In Reply We appreciate the interest of Davido et al in our 2018 publication1 in JAMA Surgery regarding Clostridium difficile infection (CDI), and we equally appreciate the opportunity provided by the journal to respond to their comments. It is important to note that the impetus for this study rests on in vivo translational work in a murine model of C difficile2,3 by one of our study collaborators (E.L.B.). This previous work demonstrated that microbiota induction of the cytokine IL-25 protected from death from C difficile colitis via eosinophils. The focus of our studies is the host-pathogen interaction. In particular, we are interested in host response to CDI and how that may predict the development of disease-related adverse events.

    更新日期:2019-02-14
  • Interest of Eosinophil Count in Bacterial Infections to Predict Antimicrobial Therapy Efficacy
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-13
    Benjamin Davido, Pierre de Truchis, Aurélien Dinh

    To the Editor We read with great interest the article published by Kulaylat et al1 concerning the use of peripheral eosinopenia to predict the outcomes of 2065 patients with Clostridium difficile infections (CDIs). In multivariate analysis, the authors found that undetectable eosinophil count was associated with increased in-hospital mortality and therefore was a marker of sepsis severity and admission in intensive care units. As CDI is one of the most common causes of nosocomial infection in the Unites States2 and has a high mortality rate, some points could be discussed.

    更新日期:2019-02-14
  • Does This Patient Have a Severe Snake Envenomation?The Rational Clinical Examination Systematic Review
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-13
    Charles J. Gerardo, João R. N. Vissoci, C. Scott Evans, David L. Simel, Eric J. Lavonas
    更新日期:2019-02-14
  • The Realities of Liver Transplantation and Biliary Anastomosis—Heroes, Heroics, Heels, and Healing
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-13
    Steven D. Colquhoun

    In the Trojan war, Achilles was the strongest and most capable of the Greek Heroes. Held by a single heel, his mother bathed him as an infant in the River Styx to make him all but immortal. Her hand left a seemingly trivial area unexposed, and thus became the vulnerability that led to his demise. In the battle for health, the results of liver transplant are nothing less than heroic. The final and seemingly most trivial step of completing a transplant is the biliary anastomosis; yet sadly, it often remains one of the most problematic. Indeed, since the earliest published reports, it has been termed the procedure’s Achilles’ Heel.1

    更新日期:2019-02-14
  • Fixing the Problem of Discard of Livers From Older Donors
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-13
    Seth A. Waits, Michael J. Englesbe

    Haugen et al1 present an important article that should change practice. Despite improved outcomes in recipients of older donor livers, rates of discard of old livers have increased significantly. Of importance, this article raises the questions of why older livers are commonly discarded and what we can do to fix this problem. Donor logistics are a key reason for these discards. When a surgeon is in the donor operating room evaluating a liver, it is not a simple assessment to determine whether the liver is usable. Instead, the donor liver is evaluated within the context of the recipient. When the liver does not look great (like many older livers), the decision is commonly made to pass for the intended recipient, who is thought to be better off waiting for a better liver. For the liver to be used, it must be reallocated in a short amount of time. At best, it requires 4 to 6 hours to identify a new recipient and bring them in for the transplant. Other transplant teams are present in the operating room procuring other thoracic and abdominal organs. Having the entire system stop for 6 hours is rarely feasible. Also, receiving a call from a surgeon you do not know saying that “the liver does not look great, is usable, but we are passing” is not appealing. The recipient is likely just as sick as the recipient they are passing for and may also do poorly with a mediocre liver. Unfortunately, the end result is that these organs are often discarded.

    更新日期:2019-02-14
  • Assessment of Anastomotic Biliary Complications in Adult Patients Undergoing High-Acuity Liver Transplant
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-13
    Fady M. Kaldas, Islam M. Korayem, Tara A. Russell, Vatche G. Agopian, Antony Aziz, Joseph DiNorcia, Douglas G. Farmer, Hasan Yersiz, Jonathan R. Hiatt, Ronald W. Busuttil
    更新日期:2019-02-14
  • Assessment of Trends in Transplantation of Liver Grafts From Older Donors and Outcomes in Recipients of Liver Grafts From Older Donors, 2003-2016
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-13
    Christine E. Haugen, Courtenay M. Holscher, Xun Luo, Mary Grace Bowring, Babak J. Orandi, Alvin G. Thomas, Jacqueline Garonzik-Wang, Allan B. Massie, Benjamin Philosophe, Mara McAdams-DeMarco, Dorry L. Segev
    更新日期:2019-02-14
  • Left Ventricular Function as a Predictor of Noncardiac Surgical Procedural Outcome
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-12
    John S. Ikonomidis

    A new study1 published in the February 12, 2019, issue of JAMA documents the negative association of depressed left ventricular function and associated heart failure symptoms on outcomes with noncardiac surgical procedures. Risk stratification prior to the performance of surgery has become an important aspect of preoperative planning. Robust databases now exist to allow surgeons to calculate surgical risk of mortality and other complications for a wide variety of procedures adjusted for a myriad of comorbidities. In the cardiac surgical realm, an important predictor of adverse outcome is depressed left ventricular function, a factor that is so important it often dominates multivariable regression analyses predictive of mortality and other postoperative complications. Poor left ventricular function has also long been known to be a predictor of adverse outcome in noncardiac surgery, but this knowledge alone is an incomplete assessment. More information is needed regarding the effects of varying degrees of ventricular dysfunction, the presence or absence of heart failure symptoms, different heart failure types (reduced ejection fraction heart failure and normal ejection fraction heart failure), and the influence of procedural complexity. In this week’s issue of JAMA, Lerman and colleagues1 determined the postoperative mortality risk of symptomatic and asymptomatic patients with heart failure, with and without preserved ejection fraction, compared with patients without heart failure. The data set was assembled from 609 735 non–cardiac surgical patient records in the Veterans Affairs Surgical Quality Improvement Project database from 2009 to 2017. Left ventricular ejection fraction estimates were taken from associated echocardiogram reports, heart failure was documented by frequency of hospital admissions with a heart failure diagnosis and the presence of heart failure symptoms, and 3 levels of surgical procedural complexity were defined using the VA Surgical Complexity Matrix. Three multivariable mixed-effects logistic regression models were generated, the first comparing the postoperative mortality risk of all patients with and without heart failure, the second classifying patients with heart failure by left ventricular ejection fraction stratified into 4 levels, and the third model classifying patients with heart failure by the presence of heart failure symptoms.

    更新日期:2019-02-13
  • Correction to Add Description of and Citation to Related articles and Complete Description of Study Methods
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-06

    In the Original Investigation titled “Association of O6-Methylguanine-DNA Methyltransferase Protein Expression With Postoperative Prognosis and Adjuvant Chemotherapeutic Benefits Among Patients With Stage II or III Gastric Cancer,”1 the authors had failed to provide citations to and description of the previously published and related 9 studies; a more complete explanation of the role of Shanghai Outdo Biotech Co, Ltd, in creating the tissue microarrays and evaluating the immunohistochemistry scores; and a better explanation of the rationale for use of R software, version 3.3.2, in the Abstract, Introduction, Methods, and eMethods 1 and eMethods 2 in the Supplement. These omissions did not affect the conclusions of the article. A Letter of Explanation2 has been published that details the source of these errors. This article has been corrected online.

    更新日期:2019-02-06
  • Considerations in Prehabilitation for Esophagogastric Cancer Surgery—Reply
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-06
    Enrico Maria Minnella, Lorenzo Ferri, Francesco Carli

    In Reply We appreciate Wee’s interest and comments on our article,1 and we are grateful for the opportunity to provide a more detailed description of our work. All the points raised are addressed in detail below. First, the key role of psychosocial well-being in cancer care was highlighted, and we were asked the reason why specific assessment and intervention were not added to the prehabilitation program. The nature of impaired functional capacity in patients undergoing cancer treatment is complex and multifactorial, and our research group has directed their interest in implementing a multimodal, multidisciplinary, and multiphasic intervention addressing this complexity. As main determinants of functional status, our prehabilitation model includes exercise, nutritional therapy, and psychosocial intervention.2 In this case, as specified in the article,1 psychological assessment and referral are part of the standard preoperative pathway for esophagectomy at McGill University Health Centre (Montreal, Quebec, Canada), and patients in both groups received it if a specific distress was detected.

    更新日期:2019-02-06
  • Considerations in Prehabilitation for Esophagogastric Cancer Surgery
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-06
    Ian Jun Yan Wee

    To the Editor I read with great interest the study by Minnella et al.1 However, I wish to highlight the following issues. The authors implemented a bimodal prehabilitation program consisting of exercise and nutrition programs. However, have they considered incorporating psychosocial interventions as part of prehabilitation? Psychological assessments and health-related quality-of-life measurements are well established and are important aspects of cancer and surgical care. Hence, the prehabilitation programs should be trimodal, comprising physical, nutrition, and psychosocial components.2

    更新日期:2019-02-06
  • Gastroschisis and Autism—Dual Canaries in the Californian Coalmine—Reply
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-06
    Jamie Anderson, Shinjiro Hirose

    In Reply In their letter, Reece and Hulse suggest there may be a correlation between cannabis consumption and gastroschisis based on the high consumption of cannabis in counties where we have found high rates of gastroschisis. To be clear, Reece and Hulse are inaccurate in their statement that we “found rurality was a risk factor for cannabis use.” Instead, we found higher rates of gastroschisis in rural counties.1 In a follow-up study,2 we found that fetal exposure to drugs other than alcohol, cocaine, narcotics, or hallucinogenics (odds ratio [OR], 3.27; 95% CI, 1.05-10.15; P = .04) and other noxious substances (OR, 2.02; 95% CI, 1.29-3.18; P = .002) increased the risk of gastroschisis in univariate analyses. The risk of combined exposure to other drugs and noxious substances persisted even when adjusting for rurality in a multivariate analysis (OR, 1.58; 95% CI, 1.01-2.49; P = .005). These drugs could include cannabis, among others, although this is impossible to determine, given the limitations of International Classification of Diseases, Ninth Revision coding used in this administrative database.

    更新日期:2019-02-06
  • Gastroschisis and Autism—Dual Canaries in the Californian Coalmine
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-06
    Albert Stuart Reece, Gary Kenneth Hulse

    To the Editor We note the report on the gastroschisis incidence rising 3.1-fold from 1995 to 2012.1 The 20-fold variation across California mirrors the 10-fold variation across Canada,2 where the distribution pattern closely mirrored cannabis consumption and from where a cannabis-adjusted odds ratio (OR) of 3.54 (95% CI, 2.22-5.63) has been reported.3

    更新日期:2019-02-06
  • Failure to Cite Related Studies and Report Complete Information on Patients and Tissue Samples
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-06
    Jiejie Xu

    To the Editor I write on behalf of my coauthors to explain several important reporting failures in our article, “Association of O6-Methylguanine-DNA Methyltransferase Protein Expression With Postoperative Prognosis and Adjuvant Chemotherapeutic Benefits Among Patients With Stage II or III Gastric Cancer,” that was published online on September 13, 2017, and in the November 2017 issue of JAMA Surgery.1 This included failure to cite related articles with similar study designs that included many patients from the same overall sample. In our JAMA Surgery article, we examined O6-methylguanine-DNA methyltransferase protein expression as a prognostic factor among patients with gastric cancer who had undergone gastrectomy with D2 lymphadenectomy. This study was conducted at Zhongshan Hospital at Fudan University in Shanghai, China, between August 1, 2007, and December 30, 2008. We had conducted similar studies on different biomarkers in many of the same patients at this hospital.2-10 We should have informed the editors of these related studies and should have discussed and cited these studies in our JAMA Surgery article as is required by the journal.11

    更新日期:2019-02-06
  • Factors Associated With Unplanned Reoperation After Above-Knee Amputation
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-06
    Jeffrey B. Edwards, Mathew D. Wooster, Thanh Tran, Paul A. Armstrong, Neil Moudgill, Murray L. Shames, James D. Brooks
    更新日期:2019-02-06
  • Optimizing Prehospital Trauma Triage—A Step Closer?
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-06
    Jason S. Haukoos, Eric M. Campion, Peter T. Pons

    Identifying patients with severe injuries in the prehospital setting remains the first step in a series of interventions that aim to reduce trauma-related morbidity and mortality. In 2011, the Centers for Disease Control and Prevention and the American College of Surgeons Committee on Trauma partnered to revise and update the Field Triage Decision Scheme (FTDS) with the goal of providing a structure to decision making by paramedics when determining appropriate destinations for patients with injuries.1 Recent research suggests that the sensitivity of the FTDS is lower than previously described, particularly for vulnerable populations (eg, elderly people), and lower than the target of 95% (ie, 5% undertriage rate).2-4

    更新日期:2019-02-06
  • Rapid Emergency Medical Services Response Saves Lives of Persons Injured in Motor Vehicle Crashes
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-06
    Marie Crandall

    In this issue of JAMA Surgery, Byrne et al1 describe their analysis of the association between emergency medical service (EMS) response time and motor vehicle crash (MVC) mortality using US county-level data. The study used information from the National EMS Information System related to ground EMS activations from 2013 through 2015. These data were linked to fatalities reported to the Fatality Analysis Reporting System of the National Highway Traffic Safety Administration. The methods were robust, with well-defined inclusion and exclusion criteria and adjustment for important covariates, such as on-scene EMS times, EMS transport times, proximity of trauma centers, traffic safety laws, rural or urban setting, and availability of helicopter or air medical transport.

    更新日期:2019-02-06
  • Development and Validation of a Prediction Model for Prehospital Triage of Trauma Patients
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-06
    Eveline A. J. van Rein, Rogier van der Sluijs, Frank J. Voskens, Koen W. W. Lansink, R. Marijn Houwert, Rob A. Lichtveld, Mariska A. de Jongh, Marcel G. W. Dijkgraaf, Howard R. Champion, Frank J. P. Beeres, Luke P. H. Leenen, Mark van Heijl
    更新日期:2019-02-06
  • Association Between Emergency Medical Service Response Time and Motor Vehicle Crash Mortality in the United States
    JAMA Surg. (IF 8.498) Pub Date : 2019-02-06
    James P. Byrne, N. Clay Mann, Mengtao Dai, Stephanie A. Mason, Paul Karanicolas, Sandro Rizoli, Avery B. Nathens
    更新日期:2019-02-06
  • Just-in-Time Instructions for Layperson Tourniquet Application—Reply
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-30
    Eric Goralnick, Justin McCarty, Adil Haider

    In Reply We thank Goolsby et al for their letter regarding our article titled, “Effectiveness of Instructional Interventions for Hemorrhage Control Readiness for Laypersons in the Public Access and Tourniquet Training Study (PATTS): A Randomized Clinical Trial.”1 The prior just-in-time instructions for layperson tourniquet application investigations2,3 by Goolsby et al are an exemplary model of innovation.

    更新日期:2019-01-31
  • Just-in-Time Instructions for Layperson Tourniquet Application
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-30
    Craig A. Goolsby, Arthur L. Kellermann, Thomas D. Kirsch

    To the Editor We applaud Goralnick et al1 for their report that a classroom-based “Stop the Bleed” course resulted in roughly half of participants applying a tourniquet correctly 3 to 9 months after training. However, we disagree with the authors’ assertion, “Formal hands-on hemorrhage control training was found to be the most effective method to enable laypersons to control hemorrhage.”1 Their study allocated 103 participants to each of 3 experimental arms and 1 control arm. The experimental arms sought to compare educational effects of flashcards, audio kits, and classroom education with untrained controls.

    更新日期:2019-01-31
  • Association of Emotional Intelligence With Malpractice Claims: A Review
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-30
    Daniel Shouhed, Catherine Beni, Nicholas Manguso, Waguih William IsHak, Bruce L. Gewertz
    更新日期:2019-01-31
  • Toward More Accurate Understanding of Lymph Node Metastasis Risk in Early Gastric Cancer
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-30
    Jashodeep Datta, Vivian E. Strong

    In this issue of JAMA Surgery, Chen et al1 add to an emerging understanding of biomarkers to determine individualized risk in gastric cancer. Early gastric cancer (EGC), in particular, requires precise risk stratification for more aggressive biology (ie, lymph node metastasis [LNM]). This concept is underscored by 3 findings: LNM has the strongest association with disease recurrence in resected EGC2; nodal positivity is reproducibly associated with disease-specific death3; and patients with T1a EGC are increasingly candidates for nonresectional interventions, such as endoscopic submucosal dissection, at expert centers.4

    更新日期:2019-01-31
  • Association of the Collagen Signature in the Tumor Microenvironment With Lymph Node Metastasis in Early Gastric Cancer
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-30
    Dexin Chen, Gang Chen, Wei Jiang, Meiting Fu, Wenju Liu, Jian Sui, Shuoyu Xu, Zhangyuanzhu Liu, Xiaoling Zheng, Liangjie Chi, Dajia Lin, Kai Li, Weisheng Chen, Ning Zuo, Jianping Lu, Jianxin Chen, Guoxin Li, Shuangmu Zhuo, Jun Yan
    更新日期:2019-01-31
  • Association of Surgical Intervention for Adhesive Small-Bowel Obstruction With the Risk of Recurrence
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-30
    Ramy Behman, Avery B. Nathens, Stephanie Mason, James P. Byrne, Nicole Look Hong, Petros Pechlivanoglou, Paul Karanicolas
    更新日期:2019-01-31
  • 更新日期:2019-01-23
  • A Video Is Worth a Thousand Operative Notes
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-23
    Justin B. Dimick, John W. Scott

    How serious are we about improving surgical quality? If we want to take the next step at improving the quality of our craft, we need to take advantage of the richest source of data available to us: operative video. Most efforts to improve surgical quality focus on optimizing care before surgery (eg, adhering to evidence-based processes around preventing wound infection and deep venous thrombosis) and the early recognition and treatment of complications to mitigate downstream harm (eg, failure to rescue). While these efforts will improve care, we need to push the frontier to improving what happens in the operating room—the quality of the operation itself.

    更新日期:2019-01-23
  • Racial Differences in Time to Breast Cancer Surgery and Overall Survival in the US Military Health System
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-23
    Yvonne L. Eaglehouse, Matthew W. Georg, Craig D. Shriver, Kangmin Zhu
    更新日期:2019-01-23
  • Comparison of Systematic Video Documentation With Narrative Operative Report in Colorectal Cancer Surgery
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-23
    Floyd W. van de Graaf, Marilyne M. Lange, Jolanda I. Spakman, Wilhelmina M. U. van Grevenstein, Daan Lips, Eelco J. R. de Graaf, Anand G. Menon, Johan F. Lange
    更新日期:2019-01-23
  • JAMA Surgery
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01

    Mission Statement: To promote the art and science of surgery by publishing relevant peer-reviewed research to assist the surgeon in optimizing patient care. JAMA Surgery will also serve as a forum for the discussion of issues pertinent to surgery, such as the education and training of the surgical workforce, quality improvement, and the ethics and economics of health care delivery.

    更新日期:2019-01-17
  • Error in Byline
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01

    In the Original Investigation titled “Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia: The IRIS Randomized Clinical Trial,”1 that was published online October 17, 2018, there was an error in the byline. In addition to the byline authors, the byline should read “for the IRIS Investigators Group.” The IRIS Investigators who were originally listed in the Additional Contributions section are now listed in the Group Information section. This article was corrected online.

    更新日期:2019-01-17
  • Interpreting the Long-term Prognostic Value of Total Mesorectal Excision Plane Quality in Rectal Adenocarcinoma
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Ryan Sun, Hwajeong Lee, Lee-Jen Wei

    To the Editor Kitz et al1 evaluated the prognostic value of total mesorectal excision (TME) plane in patients with rectal cancer. Total mesorectal excision plane quality was grouped into 3 categories: mesorectal, intramesorectal, and muscularis propria. One end point was disease-free survival (DFS). The authors quantified the between-group differences using 3-year event-free rates and hazard ratios (HRs). Three-year DFS rate estimates for mesorectal, intramesorectal, and muscularis propria TME were 75.9% (95% CI, 73.1-78.8), 68.4% (95% CI, 61.6-76.0), and 67.2% (95% CI, 55.6-81.3), respectively. Because these confidence intervals overlap, it is unclear whether there is a true difference between certain pairs, eg, between intramesorectal and muscularis propria TME. Moreover, in Figure 2A,1 the DFS curves extend up to 60 months. Thus, the 3-year event rate provides a local profile of DFS only. To use data after 3 years, the authors reported HRs for DFS (intramesorectal vs mesorectal TME: HR, 1.35; 95% CI, 1.01-1.80; muscularis propria vs mesorectal TME: HR, 1.73; 95% CI, 1.13-2.66). However, it is difficult to interpret HRs in the clinical context. The hazard is not a chance or probability measure and therefore is not equivalent to risk. Thus, an HR of 1.35 cannot be translated into a 35% risk increase. Also, no reference hazard value from mesorectal TME was provided. If mesorectal TME hazard is low, a 35% increase in hazard may not be clinically significant. Other issues and concerns in using HRs to quantify between-group differences have been discussed extensively.2-4

    更新日期:2019-01-17
  • Prehospital Advanced Life Support for Out-of-Hospital Cardiac Arrest in Blunt Trauma Patients
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Vikram Aakash Khanna, Swathikan Chidambaram, En Lin Goh

    To the Editor We thank Fukuda et al1 for their study analyzing the association of prehospital advanced life support (ALS) with the outcomes of out-of-hospital cardiac arrest. The authors conclude that ALS by physicians resulted in a higher 30-day survival than ALS by emergency medical service (EMS) personnel and basic life support (BLS). However, the implications of the study may be overstated. First, given the retrospective design of the study, there are multiple confounding factors that the authors have not accounted for. These mainly include patient demographic characteristics, like age and sex; modifiable predictors of survival outcomes, like body mass index; general health status as assessed by the American Society of Anesthesiologists index; and comorbidities present, as shown in Table 1.1 Importantly, the extent of blunt injury (assessed by the Injury Severity Score or Abbreviated Injury Scale score) and etiology of cardiac arrest were not evaluated. A major predictor of survival was time to response,2 which was statistically different between the various cohorts (Tables 1 and 3).1 When comparing between EMS and physicians, it is pertinent to match their expertise, since physicians, unlike EMS, may have differing experience and hence success in providing life support.3 Similarly, many patients who survive long enough to reach the hospital for ALS by physicians fare better because of other above-mentioned factors.

    更新日期:2019-01-17
  • Avoidable Blood Transfusions—Reply
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Ruchika Goel, Eshan U. Patel, Aaron A. R. Tobian

    In Reply We thank Sterpetti for his response and close attention to our study.1 We agree with the author’s assertion that in the United States, there has been an immense focus on reducing unnecessary blood transfusions, supported by clinical practice guidelines and patient blood management programs.2 The effect of patient blood management initiatives in the United States is evident by recent data showing nationwide decreases in red blood cell (RBC) and plasma transfusions.3

    更新日期:2019-01-17
  • Avoidable Blood Transfusions
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Antonio V. Sterpetti

    To the Editor I read with much interest the article by Goel et al,1 titled, “Association of Perioperative Red Blood Cell Transfusions With Venous Thromboembolism in a North American Registry.” The authors should be congratulated for their efforts to find causes for postoperative deep vein thrombosis and, eventually, pulmonary embolism. They analyzed data from the American College of Surgeons National Surgical Quality Improvement Program registry regarding 750 937 patients who had surgery in 525 hospitals over a 1-year period. They found that there was a higher incidence of deep vein thrombosis and pulmonary embolism within 30 days from surgery in patients who had received perioperative blood transfusion. About 6.3% of the patients received at least 1 blood transfusion. In a retrospective analysis, they found that blood transfusion was an independent risk factor for thromboembolism and deep vein thrombosis.

    更新日期:2019-01-17
  • Systolic and Diastolic Blood Pressure Variability as Risk Factors for Adverse Events After Coronary Artery Bypass Grafting
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Cornelius M. Dyke, Cecilia L. Benz, Chani M. Taggart, Marilyn G. Klug, Marc D. Basson
    更新日期:2019-01-17
  • 更新日期:2019-01-17
  • Association of Hospital Length of Stay and Complications With Readmission After Open Pancreaticoduodenectomy
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Jerry Jiang, Alex Upfill-Brown, Amanda M. Dann, Stephanie S. Kim, Mark D. Girgis, Jonathan C. King, Timothy R. Donahue
    更新日期:2019-01-17
  • Postmortem Incidence of Acute Surgical- and Trauma-Associated Pathologic Conditions in Prison Inmates in Miami Dade County, Florida
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Alexander Busko, Hahn Soe-Lin, Cecily Barber, Rishi Rattan, Roderick King, Tanya L. Zakrison
    更新日期:2019-01-17
  • Patient With Unexplained Weight Loss, Anorexia, and Back Pain
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Sachinder Hans, Robert J. Acho
    更新日期:2019-01-17
  • Chronic Bowel Obstruction in a Middle-aged Man
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Ross M. Beckman, Kent A. Stevens, Christian Jones
    更新日期:2019-01-17
  • Minimum Specifications for a Lifebox Surgical Headlight for Resource-Constrained Settings
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Jared A. Forrester, Kris Torgeson, Thomas G. Weiser
    更新日期:2019-01-17
  • The Fragility Index in Randomized Clinical Trials as a Means of Optimizing Patient Care
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Christopher J. Tignanelli, Lena M. Napolitano
    更新日期:2019-01-17
  • Should Aspirin Be Routinely Used for Venous Thromboembolism Prophylaxis After Total Knee Arthroplasty?Even the Authors of This Commentary Cannot Agree
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Robert S. Sterling, Elliott R. Haut

    Venous thromboembolism (VTE) is a recognized risk after total knee arthroplasty (TKA).1 While nearly all orthopedic surgeons agree that pharmacologic prophylaxis is the standard of care, major disagreements remain about the optimal, or even acceptable, medication regimens. Even evidence-based guidelines from different national societies,2,3 using the same published literature, often make different recommendations.4

    更新日期:2019-01-17
  • The Third Postmastectomy Reconstruction Option—Autologous Fat Transfer
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Kimberly S. Khouri, Roger K. Khouri, Roger K. Khouri

    Krastev and colleagues1 should be commended for their carefully matched cohort study that supports the long-term oncological safety of postmastectomy autologous fat transfer (AFT). It is currently recommended that, before undergoing a mastectomy, patients should have the opportunity to meet with a plastic surgeon to discuss their reconstructive options. Patients are then offered the standard implant-based or tissue flap–based reconstructions. Autologous fat transfer is rarely mentioned.

    更新日期:2019-01-17
  • Chemoradiotherapy and Local Excision for Organ Preservation in Early Rectal Cancer—The End of the Beginning?
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Julio Garcia-Aguilar

    Treatments that have the potential to both cure rectal cancer and preserve the rectum may offer a considerable advantage over total mesorectal excision (TME), which provides excellent tumor control but often entails a permanent colostomy or a coloanal anastomosis. In this issue of JAMA Surgery, Stijns et al1 report the results of a multicenter, nonrandomized feasibility study that investigated whether chemoradiotherapy followed by local excision (CRT-LE) is an oncologically acceptable rectum-preserving strategy for rectal cancer in stage cT1 3N0. Although the study was not powered to demonstrate the efficacy of CRT-LE compared with TME (which is the benchmark for any new treatment), it adds to the growing body of evidence supporting CRT-LE as an alternative to TME.

    更新日期:2019-01-17
  • Radioguided Surgery With Gallium for Neuroendocrine Tumors
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    James R. Howe

    Radioisotopes have been used as an adjunct during surgery for the past few decades and have been especially useful in operations for breast cancer1 and melanoma.2 Technetium 99m–labeled sulfur colloid is injected intradermally and accumulates in the first regional lymph node draining that area, which is detected using a handheld gamma counter. Sentinel lymph node biopsy has proven valuable for staging patients, determining the need for adjuvant therapy, and, previously, selecting patients for lymphadenectomy. Radiopharmaceuticals given intravenously may also accumulate within tumors and aid in their localization. Fluorodeoxyglucose is taken up in rapidly metabolizing cells, and technetium 99 sestamibi is retained in mitochondria and has shown utility in radioguided surgery (RGS) for hyperparathyroidism.3 Neuroendocrine tumors (NETs) commonly express high levels of the somatostatin type 2 receptor, which has also been used as a target for radiopharmaceuticals.

    更新日期:2019-01-17
  • Every Trauma System Is Perfectly Designed to Get the Results It Gets
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Steven M. Steinberg

    Although attribution of the title of this commentary remains uncertain, the phrase definitely applies to trauma systems. When discussing any aspect of our trauma system, one must realize that we do not have a single trauma system. Every region has a different set of “rules,” resulting in their system being different than the trauma system of any other region. What we do have as a trauma system is nicely reviewed by Eastman1 in his 2009 Scudder Oration on Trauma and is well worth reading.

    更新日期:2019-01-17
  • Is 30 Newtons of Prevention Worth a Pound of a Cure?—Cricoid Pressure
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Samuel A. Tisherman, Megan G. Anders, Samuel M. Galvagno

    Aspiration remains one of the most dreaded complications of endotracheal intubation. To mitigate the risk of aspiration in patients who are at high risk, rapid sequence induction (RSI) is used with an anesthetic and short-acting neuromuscular blocking agent. Cricoid pressure (the Sellick maneuver) has frequently been used for physically preventing aspiration. Recognizing the lack of clinical trials that demonstrate clinically relevant beneficial outcomes, the use of cricoid pressure during RSI has been debated over the past decade.1-3 Regarding efficacy, although cricoid pressure is often not performed appropriately (ie, applying 30 newtons of pressure in the proper location), most studies demonstrate that cricoid pressure may prevent gastric insufflation by occluding the esophagus and postcricoid hypopharynx.4,5 However, other studies have suggested that cricoid pressure may displace the esophagus laterally or decrease lower esophageal sphincter pressure, thus increasing the risk of regurgitation.6 In addition, cricoid pressure may worsen the laryngoscopic view, further providing equipoise for studying its effectiveness.

    更新日期:2019-01-17
  • Patient Preferences for Bariatric Surgery: Findings From a Survey Using Discrete Choice Experiment Methodology
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Michael D. Rozier, Amir A. Ghaferi, Angela Rose, Norma-Jean Simon, Nancy Birkmeyer, Lisa A. Prosser
    更新日期:2019-01-17
  • Association of Opioid Prescribing With Opioid Consumption After Surgery in Michigan
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Ryan Howard, Brian Fry, Vidhya Gunaseelan, Jay Lee, Jennifer Waljee, Chad Brummett, Darrell Campbell, Elizabeth Seese, Michael Englesbe, Joceline Vu
    更新日期:2019-01-17
  • Association of Aspirin With Prevention of Venous Thromboembolism in Patients After Total Knee Arthroplasty Compared With Other Anticoagulants: A Noninferiority Analysis
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Brandon R. Hood, Mark E. Cowen, Huiyong T. Zheng, Richard E. Hughes, Bonita Singal, Brian R. Hallstrom
    更新日期:2019-01-17
  • Long-term Follow-up of Autologous Fat Transfer vs Conventional Breast Reconstruction and Association With Cancer Relapse in Patients With Breast Cancer
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Todor Krastev, Arjen van Turnhout, Eline Vriens, Luc Smits, René van der Hulst
    更新日期:2019-01-17
  • Long-term Oncological and Functional Outcomes of Chemoradiotherapy Followed by Organ-Sparing Transanal Endoscopic Microsurgery for Distal Rectal Cancer: The CARTS Study
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Rutger C. H. Stijns, Eelco J. R. de Graaf, Cornelis J. A. Punt, Iris D. Nagtegaal, Joost J. M. E. Nuyttens, Esther van Meerten, Pieter J. Tanis, Ignace H. J. T. de Hingh, George P. van der Schelling, Yair Acherman, Jeroen W. A. Leijtens, Andreas J. A. Bremers, Geerard L. Beets, Christiaan Hoff, Cornelis Verhoef, Corrie A. M. Marijnen, Johannes H. W. de Wilt
    更新日期:2019-01-17
  • Radioguided Surgery With Gallium 68 Dotatate for Patients With Neuroendocrine Tumors
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Mustapha El Lakis, Andreas Gianakou, Pavel Nockel, Douglas Wiseman, Amit Tirosh, Martha A. Quezado, Dhaval Patel, Naris Nilubol, Karel Pacak, Samira M. Sadowski, Electron Kebebew
    更新日期:2019-01-17
  • Evaluation of Clinical Outcomes of Sutureless vs Sutured Closure Techniques in Gastroschisis Repair
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Russell G. Witt, Michael Zobel, Benjamin Padilla, Hanmin Lee, Tippi C. MacKenzie, Lan Vu
    更新日期:2019-01-17
  • Biliary-Enteric Drainage vs Primary Liver Transplant as Initial Treatment for Children With Biliary Atresia
    JAMA Surg. (IF 8.498) Pub Date : 2019-01-01
    Elyse LeeVan, Lea Matsuoka, Shu Cao, Susan Groshen, Sophoclis Alexopoulos
    更新日期:2019-01-17
Some contents have been Reproduced with permission of the American Chemical Society.
Some contents have been Reproduced by permission of The Royal Society of Chemistry.
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