IMPORTANCE Despite limited capacity and expensive cost, there are minimal objective data to guide postoperative allocation of intensive care unit (ICU) beds. The Surgical Risk Preoperative Assessment System (SURPAS) uses 8 preoperative variables to predict many common postoperative complications, but it has not yet been evaluated in predicting postoperative ICU admission. OBJECTIVE To determine if

IMPORTANCE The long-term benefits of off-pump ("beating heart") vs on-pump coronary artery bypass grafting (CABG) remain controversial. OBJECTIVE To evaluate the 10-year outcomes and costs of off-pump vs on-pump CABG in the Department of Veterans Affairs (VA) Randomized On/Off Bypass (ROOBY) trial. DESIGN, SETTING, AND PARTICIPANTS From February 27, 2002, to May 7, 2007, 2203 veterans in the ROOBY

In Reply We thank Bhatt and colleagues for their interesting comments on our article. First, they consider the median baseline peritoneal cancer index (PCI) of 5 to be low. Importantly, the surgical baseline PCI was determined by laparoscopy in 74% of patients. Compared with laparotomy, laparoscopy may underestimate the PCI. This potential underestimation is reflected by the higher median PCI of 9

To the Editor We read with interest the results of phase 2 of the CAIRO6 trial that showed the feasibility and safety of perioperative chemotherapy in patients with resectable colorectal peritoneal metastases (CPM). The major postoperative morbidity was similar in both arms, although the absolute figures showed a lower morbidity in the experimental arm (22% vs 33% in the control arm).

In Reply We would like to thank Aini et al for commenting on our article on liver transplant (LT) in colorectal cancer liver metastases. Our results were presented as Kaplan-Maier–estimated overall survival (OS) because not all patients were observed for 5 years or until death. According to Aini et al, patients receiving portal vein embolization (PVE) and liver resection (LR) had a 5-year OS of 54

To the Editor Liver transplant (LT) has already become one of the major approaches to manage advanced liver diseases, including colorectal cancer liver metastasis (CRLM). Dueland et al reported their single-institutional retrospective cohort analysis on LT for CRLM, which was compared with those who received portal vein embolization (PVE) with intent to undergo liver resection (LR). Their results were

In Reply With great interest we read the Letters from Nittala et al and de Steur et al, and we thank them for their thoughtful comments on our study.

To the Editor With interest we have read the randomized clinical trial by van Workum et al. In their article, the authors show a reduction in anastomotic leakage rate from 31.7% to 12.3% with the introduction of an intrathoracic anastomosis. They conclude that “intrathoracic, as opposed to cervical, anastomosis resulted in better outcome for patients treated with transthoracic MIE [minimally invasive

To the Editor The ICAN trial has provided level 1 evidence favoring intrathoracic anastomosis after a total or hybrid minimally invasive esophagectomy. We commend the authors on a robust study design for a purely surgical trial. The quality control of the surgical technique before participation and later during the trial is meticulous and may lay the standard for future surgical trials.

This article describes telestration, a method of using augmented reality to assist surgeons in training during minimally invasive surgery.

In Reply We thank Lin and colleagues for the comments on our study comparing survival following breast conservation vs mastectomy. As the authors confirm, whole-breast radiotherapy was a requirement for all individuals in our study undergoing breast-conserving surgery, and those in whom it was omitted (n = 2390) were excluded from analysis. Although we agree that the register we used does not give

To the Editor We read with great interest the results from the study by de Boniface et al, which indicated a significantly higher comorbidity burden in patients using mastectomy irrespective of postoperative radiotherapy, compared with those treated with breast-conserving surgery with radiotherapy in patients with early-stage breast cancer. Moreover, after stepwise adjustment for all covariates, overall

This Viewpoint presents 5 plans for analyses that can be used to advance investigations into the causes of regional variation in procedure rates.

This cross-sectional study of physician referrals to surgeons examines whether the number and types of referrals are influenced by the sex of the referring physician.

Sex differences in physician salary persist, with the largest pay gap in surgical subspecialties. The explanations for sex pay gap remain elusive, despite accounting for multiple factors. Although anecdotally lifestyle choices by female surgeons have been considered a contributing factor to sex pay gap, no data support this common misconception. Practicing surgeons often depend on referrals from physician

This cohort study examines differing types of total pancreatectomy and presents 4 proposed categories based on extent, complexity, and technical aspects of the procedure.

Pancreatic surgery is major surgery which, according to international consensus, should be centralized into units with adequate expertise, experience, case load, and facilities. However, even between high-volume pancreatic surgery centers, heterogenous operative procedures, such as total pancreatectomy (TP), are in use, leading to wide variability in the outcomes. Thus, more accurate classification

This Viewpoint describes the use of randomized clinical trial data to construct prediction models that allow for the assessment of counterfactual scenarios, providing complete information on the value of specific treatment options.

This cohort study develops a practical percent total body surface area burn estimation tool that accounts for exact burn injury pattern, sex, and body habitus.

This qualitative study evaluates attitudes and perceptions of US surgical program directors on leave for nonchildbearing or male surgical residents.

This cohort study describes patient- and surgeon-level sexual function outcomes among patients undergoing radical prostatectomy in the Michigan Urological Surgery Improvement Collaborative (MUSIC) and examines the association between surgeon case volume and sexual function outcomes.

In this issue of JAMA Surgery, Castillo-Angeles and colleagues report on the perspective and experience of surgical program directors (PDs) on paternity leave. We agree with the article’s major conclusions, which highlight a stigma surrounding child-rearing, with the potential to negatively impact children. We also agree that fathers and nonbirthing partners in surgical residency programs are unlikely

Agochukwu-Mmonu and colleagues report surgeon-level variation in sexual function outcomes over a 2-year period among men undergoing radical prostatectomy. In a selected group of patients with good baseline function, they show substantial variation in outcomes achieved. Some surgeons had up to 40% of patients recover sexual function while others had none.

This narrative review explores some of the current issues surrounding the use of opioids in the perioperative period.

This study assesses outcomes associated with caustic ingestion in adults across a nationwide prospective database in France.

This cohort study examines the association between surgeon-patient sex discordance and postoperative outcomes.

Caustic esophageal injury remains an unfortunately common event that is difficult to assess and treat. The majority of patients require no aggressive intervention, either during their first hospital admission or subsequently. How to triage patients presenting with an urgent history of ingestion is standardized with guidelines, but some smaller hospitals do not have the capability of following such

Sex parity is a long-standing issue in the surgical workforce, contributing to inequities among surgeons and patients. Wallis et al present compelling data from a population-based cohort study analyzing the association between surgeon-patient sex concordance and surgical outcomes in Ontario, Canada. Unsurprisingly, most of the sex-discordant surgeon-patient dyads were male surgeons and female patients

In the Original Investigation titled “Stepped Collaborative Care Targeting Posttraumatic Stress Disorder Symptoms and Comorbidity for US Trauma Care Systems: A Randomized Clinical Trial,” published in the May 2021 issue, there was a repeated error in the Abstract and the Methods. In each place, the study end date given as “November 2018” should have been “November 2019.” This article has been corrected

In the Original Investigation titled “Sex Differences in the Pattern of Patient Referrals to Male and Female Surgeons,” published in the November 10, 2021, issue of JAMA Surgery, an incorrect term was used in the Referral Homophily subsection of the Results section. The third paragraph’s first sentence should have ended with physicians instead of surgeons. The full sentence should read as follows:

This article discusses the Bullet Related Injury Clinic in St Louis, Missouri, a program that seeks to provide care for people with bullet-related injury.

The Viewpoint titled “Regional Variation in Surgical Procedure Rates: Going Beyond Description,” published on November 3, 2021, was corrected to fix an incorrect word in the sentence “The presence of regional variation in surgical rates raises questions about the underlying causes, including whether the variation exceeds differences that could be expected due to differences in the prevalence of the

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 diversity, equity, and inclusion; the education and training of the surgical workforce; quality improvement; and the ethics and economics of health

In the Original Investigation titled “Challenging Traditional Paradigms in Posttraumatic Pulmonary Thromboembolism,” published online December 15, 2021, there was a spelling error in an author name. The spelling of the 10th author “Elliot R. Haut, MD,” should have been “Elliott R. Haut, MD.” This article was corrected online.

This stepped-wedge cluster randomized clinical trial examines whether a multifaceted prevention intervention is effective in reducing postoperative delirium incidence and prevalence among older patients after various major surgical procedures.

This cohort study of patients with trauma-associated venous thromboembolism risk factors assesses whether posttraumatic pulmonary clots are all pulmonary embolisms or whether some represent pulmonary thrombosis.

IMPORTANCE Neoadjuvant checkpoint inhibition in patients with high-risk stage III melanoma shows high pathologic response rates associated with a durable relapse-free survival. Whether a therapeutic lymph node dissection (TLND) can be safely omitted when a major pathologic response in the largest lymph node metastasis at baseline (index lymph node; ILN) is obtained is currently being investigated.

IMPORTANCE The lack of underrepresented in medicine physicians within US academic surgery continues, with Black surgeons representing a disproportionately low number. OBJECTIVE To evaluate the trend of general surgery residency application, matriculation, and graduation rates for Black trainees compared with their racial and ethnic counterparts over time. DESIGN, SETTING, AND PARTICIPANTS In this nationwide

IMPORTANCE There is substantial variability among emergency departments (EDs) in their readiness to care for acutely ill and injured children, including US trauma centers. While high ED pediatric readiness is associated with improved in-hospital survival among children treated at trauma centers, the association between high ED readiness and long-term outcomes is unknown. OBJECTIVE To evaluate the association

IMPORTANCE Venous thromboembolism (VTE) is a major cause of preventable morbidity and mortality after cancer surgery. Venous thromboembolism events that are significant enough to require hospital readmission are potentially life threatening, yet data regarding the frequency of these events beyond the 30-day postoperative period remain limited. OBJECTIVE To determine the rates, outcomes, and predictive

IMPORTANCE Thoracostomy, or chest tube placement, is used in a variety of clinical indications and can be lifesaving in certain circumstances. There have been developments and modifications to thoracostomy tubes, or chest tubes, over time, but they continue to be a staple in the thoracic surgeon's toolbox as well as adjacent specialties in medicine. This review will provide the nonexpert clinician