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Progression-Free Survival for Liver Transplant vs Alternative Therapy in Unresectable Colorectal Liver Metastasis JAMA Surg. (IF 15.7) Pub Date : 2024-07-24 Matthew M. Byrne, Mariana Chávez-Villa, Luis I. Ruffolo, Kerollos Nashat Wanis, Brian Belt, Koji Tomiyama, Roberto Hernandez-Alejandro
This cohort study compares survival outcomes between patients with unresectable colorectal liver metastasis who received chemotherapy-based multimodal therapy and patients who underwent liver transplant.
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Futility of Up-Front Resection for Anatomically Resectable Pancreatic Cancer JAMA Surg. (IF 15.7) Pub Date : 2024-07-24 Stefano Crippa, Giuseppe Malleo, Vincenzo Mazzaferro, Serena Langella, Claudio Ricci, Fabio Casciani, Giulio Belfiori, Sara Galati, Vincenzo D’Ambra, Gabriella Lionetto, Alessandro Ferrero, Riccardo Casadei, Giorgio Ercolani, Roberto Salvia, Massimo Falconi, Alessandro Cucchetti
ImportanceThere are currently no clinically relevant criteria to predict a futile up-front pancreatectomy in patients with anatomically resectable pancreatic ductal adenocarcinoma.ObjectivesTo develop a futility risk model using a multi-institutional database and provide unified criteria associated with a futility likelihood below a safety threshold of 20%.Design, Setting, and ParticipantsThis retrospective
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Gender-Based Variations in Medicare Reimbursements Among Different Surgical Subspecialties JAMA Surg. (IF 15.7) Pub Date : 2024-07-24 Muhammad Musaab Munir, Mary Dillhoff, Susan Tsai, Courtney Collins, Priya Dedhia, Timothy M. Pawlik
ImportanceGender inequities and limited representation are an obstacle to surgical workforce diversification. There has been limited examination of gender-based disparities in billing practices among surgeons.ObjectiveTo evaluate variations in practice metrics and billing practices among female and male surgeons and identify factors associated with gender disparities in Medicare reimbursements.Design
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Pregnancy and Parenthood Among US Surgical Residents JAMA Surg. (IF 15.7) Pub Date : 2024-07-17 Ruojia Debbie Li, Lauren M. Janczewski, Joshua S. Eng, Darci C. Foote, Christine Wu, Julie K. Johnson, Sarah Rae Easter, Eugene Kim, Jo Buyske, Patricia L. Turner, Thomas J. Nasca, Karl Y. Bilimoria, Yue-Yung Hu, Erika L. Rangel
ImportanceThe ability to pursue family planning goals is integral to gender equity in any field. Procedural specialties pose occupational risks to pregnancy. As the largest procedural specialty, general surgery provides an opportunity to understand family planning, workplace support for parenthood, obstetric outcomes, and the impact of these factors on workforce well-being, gender equity, and attrition
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Electronic Health Record–Based Nudge Intervention and Axillary Surgery in Older Women With Breast Cancer JAMA Surg. (IF 15.7) Pub Date : 2024-07-17 Neil Carleton, Thomas R. Radomski, Danyang Li, Jian Zou, John Harris, Megan Hamm, Ziqi Wang, Gilan Saadawi, Gary S. Fischer, Jonathan Arnold, Michael S. Cowher, Kristin Lupinacci, Quratulain Sabih, Jennifer Steiman, Ronald R. Johnson, Atilla Soran, Emilia J. Diego, Steffi Oesterreich, George Tseng, Adrian V. Lee, Priscilla F. McAuliffe
ImportanceChoosing Wisely recommendations advocate against routine use of axillary staging in older women with early-stage, clinically node-negative (cN0), hormone receptor–positive (HR+), and HER2-negative breast cancer. However, rates of sentinel lymph node biopsy (SLNB) in this population remain persistently high.ObjectiveTo evaluate whether an electronic health record (EHR)–based nudge intervention
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Delivering Impactful Scientific Oral Presentations JAMA Surg. (IF 15.7) Pub Date : 2024-07-10 Jeff Choi, David A. Spain
This Viewpoint highlights specific challenges of facing a scientific conference audience and provides practical recommendations to overcome these challenges.
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Prehospital Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Exsanguinating Subdiaphragmatic Hemorrhage JAMA Surg. (IF 15.7) Pub Date : 2024-07-10 Robbie A. Lendrum, Zane Perkins, Max Marsden, Claire Cochran, Ross Davenport, Frank Chege, Virginia Fitzpatrick-Swallow, Rob Greenhalgh, Jared M. Wohlgemut, Christine L. Henry, Ben Singer, Gareth Grier, Gareth Davies, Nick Bunker, Daniel Nevin, Mike Christian, Marion K. Campbell, Nigel Tai, Austin Johnson, Jan O. Jansen, Samy Sadek, Karim Brohi
ImportanceHemorrhage is the most common cause of preventable death after injury. Most deaths occur early, in the prehospital phase of care.ObjectiveTo establish whether prehospital zone 1 (supraceliac) partial resuscitative endovascular balloon occlusion of the aorta (Z1 P-REBOA) can be achieved in the resuscitation of adult trauma patients at risk of cardiac arrest and death due to exsanguination
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Population-Based Intraoperative Disease Severity Criteria for Pediatric Appendicitis JAMA Surg. (IF 15.7) Pub Date : 2024-07-03 Kerri A. McKie, Donne A. Graham, Shannon L. Cramm, Jacqueline M. Saito, Shawn J. Rangel
ImportanceA standardized severity assessment approach is needed in children with appendicitis for postoperative adverse event estimation and severity adjustment for hospital-level comparative performance reporting.ObjectiveTo examine the association between the presence and number of National Surgical Quality Improvement Program (NSQIP) Pediatric–defined intraoperative criteria for complicated appendicitis
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Biliary Dyskinesia—Controversies, Diagnosis, and Management JAMA Surg. (IF 15.7) Pub Date : 2024-07-03 Bryan K. Richmond
ImportanceBiliary dyskinesia is a disorder characterized by biliary pain, a sonographically normal gallbladder, and a reduced gallbladder ejection fraction on cholecystokinin-cholescintigraphy (CCK-HIDA) scan. Laparoscopic cholecystectomy remains a common treatment for biliary dyskinesia despite a lack of high-quality evidence supporting the practice. The following review summarizes the current biliary
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Gastric Bypass vs Diet and Cardiovascular Risk Factors JAMA Surg. (IF 15.7) Pub Date : 2024-07-03 Cecilia Karlsson, Line Kristin Johnson, Peter J. Greasley, Kjetil Retterstøl, Jonatan Hedberg, Martin Hall, Noele Hawker, Ida Robertsen, Jesper Havsol, Jens Kristoffer Hertel, Rune Sandbu, Eva Skovlund, Thomas Olsen, Hege Christensen, Rasmus Jansson-Löfmark, Shalini Andersson, Anders Åsberg, Jøran Hjelmesæth
ImportanceRoux-en-Y gastric bypass (RYGB) is associated with reduced cardiovascular (CV) risk factors, morbidity, and mortality. Whether these effects are specifically induced by the surgical procedure or the weight loss is unclear.ObjectiveTo compare 6-week changes in CV risk factors in patients with obesity undergoing matching caloric restriction and weight loss by RYGB or a very low-energy diet
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Patient-Reported Outcome Measures Within a National Multispecialty Surgical Quality Improvement Program JAMA Surg. (IF 15.7) Pub Date : 2024-06-26 Larissa K. F. Temple, Andrea L. Pusic, Jason B. Liu, Alexa D. Melucci, Courtney E. Collins, Hadiza S. Kazaure, Brian C. Brajcich, Matthew J. Fordham, Jakob C. Lapsley, Clifford Y. Ko
ImportancePatient-reported outcome measures (PROMs) are increasingly recognized for their ability to promote patient-centered care, but concerted health information technology (HIT)–enabled PROM implementations have yet to be achieved for national surgical quality improvement.ObjectiveTo evaluate the feasibility of collecting PROMs within a national surgical quality improvement program.Design, Setting
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Institutional Diversity in the Selection Process for General Surgery Residency JAMA Surg. (IF 15.7) Pub Date : 2024-06-26 Reagan A. Collins, Cody Lendon Mullens, Justin B. Dimick
This Viewpoint examines the challenges faced by students from diverse institutional backgrounds in pursuing academic surgery and recommends measures to promote institutional diversity by adopting a more holistic approach in the selection process for general surgery residency.
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Preventing Surgical Site Infections in the Era of Escalating Antibiotic Resistance and Antibiotic Stewardship JAMA Surg. (IF 15.7) Pub Date : 2024-06-26 Dustin R. Long, Adam Cifu, Stephen J. Salipante, Robert G. Sawyer, Kaylie Machutta, John C. Alverdy
ImportanceAccording to the Centers for Disease Control and Prevention and governing bodies within the American College of Surgeons, the administration of antibiotics as prophylaxis against infection prior to a planned elective procedure is, with rare exception, routinely recommended. The goal of “getting to zero” infections remains a high priority for policymakers, practitioners, and certainly for
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Feasibility of Extended Postoperative Follow-Up in Patients With Gastric Cancer JAMA Surg. (IF 15.7) Pub Date : 2024-06-18 Ju-Hee Lee, Jiyeong Kim, Ji Yoon Choi
ImportanceConventional research and guidelines on postgastrectomy follow-up for gastric cancer often restrict their focus to the first 5 years after surgery.ObjectiveTo evaluate the association of extended regular follow-up after 5 years postgastrectomy in patients with gastric cancer with overall and postrecurrence survival rates.Design, Setting, and ParticipantsThis population-based, retrospective
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Variation in Postoperative Outcomes Across Federally Designated Hospital Star Ratings JAMA Surg. (IF 15.7) Pub Date : 2024-06-18 Adrian Diaz, Calista Harbaugh, Justin B. Dimick, Nicholas Kunnath, Andrew M. Ibrahim
ImportanceDespite widespread use to guide patients to hospitals providing the best care, it remains unknown whether Centers for Medicare & Medicaid Services (CMS) hospital star ratings are a reliable measure of hospital surgical quality.ObjectiveTo examine the CMS hospital star ratings and hospital surgical quality measured by 30-day postoperative mortality, serious complications, and readmission
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Time to Rethink the Approach to Treating Obesity JAMA Surg. (IF 15.7) Pub Date : 2024-06-12 Jason M. Samuels, Mayur B. Patel, Kevin D. Niswender
This Viewpoint describes potential benefits and hurdles to implementing a more personalized approach to obesity treatment through a comprehensive multidisciplinary evaluation that considers surgical, medical, and combined therapies.
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Surgical Approach and Long-Term Recurrence After Ventral Hernia Repair JAMA Surg. (IF 15.7) Pub Date : 2024-06-12 Brian T. Fry, Ryan A. Howard, Jyothi R. Thumma, Edward C. Norton, Justin B. Dimick, Kyle H. Sheetz
ImportanceThe prevalence of robotic-assisted anterior abdominal wall (ventral) hernia repair has increased dramatically in recent years, despite conflicting evidence of patient benefit. Whether long-term hernia recurrence rates following robotic-assisted repairs are lower than rates following more established laparoscopic or open approaches remains unclear.ObjectiveTo evaluate the association between
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Open Retromuscular Sugarbaker vs Keyhole Mesh Placement for Parastomal Hernia Repair JAMA Surg. (IF 15.7) Pub Date : 2024-06-12 Sara M. Maskal, Ryan C. Ellis, Aldo Fafaj, Adele Costanzo, Jonah D. Thomas, Ajita S. Prabhu, David M. Krpata, Lucas R. A. Beffa, Chao Tu, Xinyan Zheng, Benjamin T. Miller, Michael J. Rosen, Clayton C. Petro
ImportanceDurable parastomal hernia repair remains elusive. There is limited evidence comparing the durability of the open retromuscular Sugarbaker and keyhole mesh configurations.ObjectiveTo determine if the open retromuscular Sugarbaker mesh placement technique would lower parastomal hernia recurrence rates.Design, Setting, and ParticipantsIn this single-center, randomized clinical trial, 150 patients
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Time From Colorectal Cancer Surgery to Adjuvant Chemotherapy JAMA Surg. (IF 15.7) Pub Date : 2024-06-12 Mikail Gögenur, Andreas Weinberger Rosen, Timothy Iveson, Rachel S. Kerr, Mark P. Saunders, Jim Cassidy, Josep Tabernero, Andrew Haydon, Bengt Glimelius, Andrea Harkin, Karen Allan, Sarah Pearson, Kathleen A. Boyd, Andrew H. Briggs, Ashita Waterston, Louise Medley, Richard Ellis, Amandeep S. Dhadda, Mark Harrison, Stephen Falk, Charlotte Rees, Rene K. Olesen, David Propper, John Bridgewater, Ashraf
ImportanceThe timing of adjuvant chemotherapy after surgery for colorectal cancer and its association with long-term outcomes have been investigated in national cohort studies, with no consensus on the optimal time from surgery to adjuvant chemotherapy.ObjectiveTo analyze the association between the timing of adjuvant chemotherapy after surgery for colorectal cancer and disease-free survival.Design
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Large Language Model Capabilities in Perioperative Risk Prediction and Prognostication JAMA Surg. (IF 15.7) Pub Date : 2024-06-05 Philip Chung, Christine T. Fong, Andrew M. Walters, Nima Aghaeepour, Meliha Yetisgen, Vikas N. O’Reilly-Shah
ImportanceGeneral-domain large language models may be able to perform risk stratification and predict postoperative outcome measures using a description of the procedure and a patient’s electronic health record notes.ObjectiveTo examine predictive performance on 8 different tasks: prediction of American Society of Anesthesiologists Physical Status (ASA-PS), hospital admission, intensive care unit (ICU)
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The Carceral State, Social Disorganization, and Firearm Homicides in Chicago JAMA Surg. (IF 15.7) Pub Date : 2024-06-05 Michael Poulson, Kian Riley, Maha Haqqani, Kaye-Alese Green, Kelly Kenzik, Dane Scantling
ImportanceBlack and other racially minoritized groups are overrepresented among those who experience firearm homicide. There has been a stark increase in incarcerated populations in the US since the 1980s, largely due to differential drug sentencing, of which racially minoritized individuals are also overrepresented; social disorganization theory postulates that community and family instability resulting
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Early Implementation of Exercise to Facilitate Recovery After Breast Cancer Surgery JAMA Surg. (IF 15.7) Pub Date : 2024-06-05 Jihee Min, Jee Ye Kim, Jiin Ryu, Seho Park, Kerry S. Courneya, Jennifer Ligibel, Seung Il Kim, Justin Y. Jeon
ImportanceRecovery of shoulder function following breast cancer surgery is crucial for physical functioning and quality of life. While early implementation of shoulder rehabilitation exercises may enhance recovery, the optimal timing and exercise program remain unclear.ObjectiveTo investigate whether an early exercise intervention, initiated 1 day postsurgery and continued for 1 month through subsequent
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Liver Transplant Costs and Activity After United Network for Organ Sharing Allocation Policy Changes JAMA Surg. (IF 15.7) Pub Date : 2024-05-29 Ola Ahmed, Maria Bernadette Majella Doyle, Marwan S. Abouljoud, Diane Alonso, Ramesh Batra, Kenneth L. Brayman, Diane Brockmeier, Robert M. Cannon, Kenneth Chavin, Aaron M. Delman, Derek A. DuBay, Jan Finn, Jonathan A. Fridell, Barry S. Friedman, Danielle M. Fritze, Derek Ginos, David S. Goldberg, Glenn A. Halff, Seth J. Karp, Vivek K. Kohli, Sean C. Kumer, Alan Langnas, Jayme E. Locke, Daniel Maluf
ImportanceA new liver allocation policy was implemented by United Network for Organ Sharing (UNOS) in February 2020 with the stated intent of improving access to liver transplant (LT). There are growing concerns nationally regarding the implications this new system may have on LT costs, as well as access to a chance for LT, which have not been captured at a multicenter level.ObjectiveTo characterize
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Hemorrhage Sites and Mitigation Strategies After Pancreaticoduodenectomy JAMA Surg. (IF 15.7) Pub Date : 2024-05-22 William A. Preston, Micaela L. Collins, Mithat Gönen, Timothy Murtha, Victor Rivera, Ryan Lamm, Michelle Schafer, Hooman Yarmohammadi, Anne Covey, Lynn A. Brody, Stephen Topper, Avinoam Nevler, Harish Lavu, Charles J. Yeo, Vinod P. Balachandran, Jeffrey A. Drebin, Kevin C. Soares, Alice C. Wei, T. Peter Kingham, Michael I. D’Angelica, William R. Jarnagin
ImportancePostpancreatectomy hemorrhage is an uncommon but highly morbid complication of pancreaticoduodenectomy. Clinical evidence often draws suspicion to the gastroduodenal artery stump, even without a clear source.ObjectiveTo determine the frequency of gastroduodenal artery bleeding compared to other sites and the results of mitigation strategies.Design, Setting, and ParticipantsThis cohort study
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Pediatric Trauma Center Access, Regional Injury Burden, and Socioeconomic Disadvantage JAMA Surg. (IF 15.7) Pub Date : 2024-05-15 Dong G. Hur, Alexander L. Ren, Tiffany M. Yue, David A. Spain, Jeff Choi
This cross-sectional study assesses whether populations in socioeconomically disadvantaged regions in the US lack timely access to pediatric trauma centers.
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Breast Cancer Risk After Bariatric Surgery and Influence of Insulin Levels JAMA Surg. (IF 15.7) Pub Date : 2024-05-15 Felipe M. Kristensson, Johanna C. Andersson-Assarsson, Markku Peltonen, Peter Jacobson, Sofie Ahlin, Per-Arne Svensson, Kajsa Sjöholm, Lena M. S. Carlsson, Magdalena Taube
ImportanceObesity and insulin are risk factors for breast cancer, and retrospective studies suggest bariatric surgery reduces breast cancer risk in women. However, long-term prospective data on breast cancer risk after bariatric surgery and the role of baseline insulin levels are lacking.ObjectiveTo examine if bariatric surgery is associated with breast cancer incidence in women and if treatment benefit
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Collaborative Care for Injured Older Adults JAMA Surg. (IF 15.7) Pub Date : 2024-05-08 Ben L. Zarzaur, Emma Holler, Damaris Ortiz, Anthony Perkins, Sue Lasister, Sujuan Gao, Dustin D. French, Babar Khan, Malaz Boustani
ImportanceOlder adults with recent injuries can have impaired long-term biopsychosocial function and may benefit from interventions adapted to their needs.ObjectiveTo determine if a collaborative care intervention, Trauma Medical Home (TMH), improved the biopsychosocial function of older patients in the year after injury.Design, Setting, and ParticipantsThis was a single-blinded, randomized clinical
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Decision-Making Confidence of Clinical Competency Committees for Entrustable Professional Activities JAMA Surg. (IF 15.7) Pub Date : 2024-05-08 Kelsey B. Montgomery, John D. Mellinger, M. Chandler McLeod, Andrew Jones, Polina Zmijewski, George A. Sarosi, Karen J. Brasel, Mary E. Klingensmith, Rebecca M. Minter, Jo Buyske, Brenessa Lindeman
ImportanceA competency-based assessment framework using entrustable professional activities (EPAs) was endorsed by the American Board of Surgery following a 2-year feasibility pilot study. Pilot study programs’ clinical competency committees (CCCs) rated residents on EPA entrustment semiannually using this newly developed assessment tool, but factors associated with their decision-making are not yet
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Laparoscopic Spleen-Preserving Hilar Lymphadenectomy for Advanced Proximal Gastric Cancer Without Greater Curvature Invasion JAMA Surg. (IF 15.7) Pub Date : 2024-05-01 Jian-xian Lin, Bin-bin Xu, Hua-Long Zheng, Ping Li, Jian-wei Xie, Jia-bin Wang, Jun Lu, Qi-yue Chen, Long-long Cao, Mi Lin, Ru-hong Tu, Ze-ning Huang, Ju-li Lin, Zi-hao Yao, Chao-Hui Zheng, Chang-Ming Huang
ImportanceSplenic hilar lymphadenectomy has been recommended for locally advanced proximal gastric cancer (APGC) involving the greater curvature. However, it is unclear whether laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPSHL) is associated with a long-term survival benefit for APGC without greater curvature invasion.ObjectiveTo present the 5-year follow-up data from a randomized
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Management of Gallstone Pancreatitis JAMA Surg. (IF 15.7) Pub Date : 2024-05-01 James McDermott, Lillian S. Kao, Jessica A. Keeley, Jeffry Nahmias, Christian de Virgilio
ImportanceGallstone pancreatitis (GSP) is the leading cause of acute pancreatitis, accounting for approximately 50% of cases. Without appropriate and timely treatment, patients are at increased risk of disease progression and recurrence. While there is increasing consensus among guidelines for the management of mild GSP, adherence to these guidelines remains poor. In addition, there is minimal evidence
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Serratus Anterior Plane Blocks for Early Rib Fracture Pain Management JAMA Surg. (IF 15.7) Pub Date : 2024-05-01 Christopher Partyka, Stephen Asha, Melanie Berry, Ian Ferguson, Brian Burns, Katerina Tsacalos, Daniel Gaetani, Matthew Oliver, Georgina Luscombe, Anthony Delaney, Kate Curtis
ImportanceRib fractures secondary to blunt thoracic trauma typically result in severe pain that is notoriously difficult to manage. The serratus anterior plane block (SAPB) is a regional anesthesia technique that provides analgesia to most of the hemithorax; however, SAPB has limited evidence for analgesic benefits in rib fractures.ObjectiveTo determine whether the addition of an SAPB to protocolized
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Elective Appendectomy Following Antibiotics for Appendicitis JAMA Surg. (IF 15.7) Pub Date : 2024-04-24 Dimitrios Moris, Theodore Pappas
This Viewpoint considers which may be the better long-term approach to appendicitis—interval elective appendectomy or nonsurgical treatment with antibiotics.
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Interval Appendectomy After Successful Antibiotic Treatment? JAMA Surg. (IF 15.7) Pub Date : 2024-04-24 David A. Talan, Peter C. Minneci
This Viewpoint discusses the pros and cons of performing interval appendectomy in patients who have recovered from successful antibiotic treatment of acute uncomplicated appendicitis.
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Plastic Wound Protector vs Surgical Gauze for Surgical Site Infection Reduction in Open GI Surgery JAMA Surg. (IF 15.7) Pub Date : 2024-04-24 Nina Yoo, Ji Yeon Mun, Bong-Hyeon Kye, Chang Woo Kim, Jae Im Lee, Youn Young Park, Byung Mo Kang, Byung Kwan Park, Han Deok Kwak, Won-Kyung Kang, Sung Uk Bae, Heung-Kwon Oh, Youngki Hong, Hyung Jin Kim
ImportanceSurgical site infections (SSIs) are prevalent hospital-acquired infections with significant patient impacts and global health care burdens. The World Health Organization recommends using wound protector devices in abdominal surgery as a preventive measure to lower the risk of SSIs despite limited evidence.ObjectiveTo examine the efficacy of a dual-ring, plastic wound protector in lowering
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Incisional Wound Irrigation for the Prevention of Surgical Site Infection JAMA Surg. (IF 15.7) Pub Date : 2024-04-24 Hannah Groenen, Nathan Bontekoning, Hasti Jalalzadeh, Dennis R. Buis, Yasmine E. M. Dreissen, Jon H. M. Goosen, Haitske Graveland, Mitchel Griekspoor, Frank F. A. IJpma, Maarten J. van der Laan, Roald R. Schaad, Patrique Segers, Wil C. van der Zwet, Ricardo G. Orsini, Anne M. Eskes, Niels Wolfhagen, Stijn W. de Jonge, Marja A. Boermeester
ImportanceSurgical site infections (SSIs) are common postoperative complications and associated with significant morbidity, mortality, and costs. Prophylactic intraoperative incisional wound irrigation is used to reduce the risk of SSIs, and there is great variation in the type of irrigation solutions and their use.ObjectiveTo compare the outcomes of different types of incisional prophylactic intraoperative
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Management of Diverticulitis JAMA Surg. (IF 15.7) Pub Date : 2024-04-17 Olivia A. Sacks, Jason Hall
ImportanceCare of patients with diverticulitis is undergoing a paradigm shift. This narrative review summarizes the current evidence for left-sided uncomplicated and complicated diverticulitis. The latest pathophysiology, advances in diagnosis, and prevention strategies are also reviewed.ObservationsTreatment is moving to the outpatient setting, physicians are forgoing antibiotics for uncomplicated
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Placebo Control and Blinding in Randomized Trials of Procedural Interventions JAMA Surg. (IF 15.7) Pub Date : 2024-04-17 Christopher A. Rajkumar, Katharine E. Thomas, Michael Foley, Sashiananthan Ganesananthan, Holli Evans, Florentina Simader, Sharan Syam, Daniel Nour, Catherine Beattie, Caitlin Khan, Rohin K. Reddy, Fiyyaz Ahmed-Jushuf, Darrel P. Francis, Matthew Shun-Shin, Rasha K. Al-Lamee
ImportanceUnlike medications, procedural interventions are rarely trialed against placebo prior to becoming accepted in clinical practice. When placebo-controlled trials are eventually conducted, procedural interventions may be less effective than previously believed.ObjectiveTo investigate the importance of including a placebo arm in trials of surgical and interventional procedures by comparing effect
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Three-Year Outcomes of Oral Antibiotics vs Intravenous and Oral Antibiotics for Uncomplicated Acute Appendicitis JAMA Surg. (IF 15.7) Pub Date : 2024-04-17 Liisa Selänne, Jussi Haijanen, Suvi Sippola, Saija Hurme, Tero Rautio, Pia Nordström, Tuomo Rantanen, Tarja Pinta, Imre Ilves, Anne Mattila, Jukka Rintala, Harri Marttila, Sanna Meriläinen, Johanna Laukkarinen, Eeva-Liisa Sävelä, Hannu Paajanen, Juha Grönroos, Paulina Salminen
ImportanceCurrent short-term evidence has shown that uncomplicated acute appendicitis can be treated successfully with oral antibiotics alone, but longer-term results are lacking.ObjectiveTo assess the treatment effectiveness of oral antibiotic monotherapy compared with combined intravenous (IV) and oral antibiotics in computed tomography–confirmed uncomplicated acute appendicitis at a longer-term
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Operating Room Organization and Methodology of Surgical Activity Regulation JAMA Surg. (IF 15.7) Pub Date : 2024-04-10 Bertrand Mathon, Frédéric Kletz
This article discusses the implementation of surgical activity regulation methodology in the operating room to reduce organizational dysfunction, improve quality of work life of the surgical staff, and decrease staff overtime.
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Extracorporeal Shockwave for Intermittent Claudication and Quality of Life JAMA Surg. (IF 15.7) Pub Date : 2024-04-10 Paris Cai, Sean Pymer, Said Ibeggazene, Ali Raza, Louise Hitchman, Ian Chetter, George Smith
ImportanceIntermittent lower limb claudication limits function and quality of life. Supervised exercise programs are not readily available, and a noninvasive alternative is needed.ObjectiveTo assess extracorporeal corporeal shockwave therapy in improving quality of life in patients with claudication.Design, Setting, and ParticipantsIn this double-blind, placebo-controlled randomized clinical trial
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Traumatic Brain Injuries After Falls From Height vs Falls at the US-Mexico Border Wall JAMA Surg. (IF 15.7) Pub Date : 2024-04-10 Alexander Tenorio, Michael G. Brandel, Carson P. McCann, Jay J. Doucet, Todd W. Costantini, Alexander A. Khalessi, Joseph D. Ciacci
This cohort study examines the incidence, severity, and mortality of fall-related injuries among migrants at the US-Mexico border in San Diego, California.
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Automated CT Analysis of Body Composition as a Frailty Biomarker in Abdominal Surgery JAMA Surg. (IF 15.7) Pub Date : 2024-04-10 Ijeamaka Anyene Fumagalli, Sidney T. Le, Peter D. Peng, Patricia Kipnis, Vincent X. Liu, Bette Caan, Vincent Chow, Mirza Faisal Beg, Karteek Popuri, Elizabeth M. Cespedes Feliciano
ImportancePrior studies demonstrated consistent associations of low skeletal muscle mass assessed on surgical planning scans with postoperative morbidity and mortality. The increasing availability of imaging artificial intelligence enables development of more comprehensive imaging biomarkers to objectively phenotype frailty in surgical patients.ObjectiveTo evaluate the associations of body composition
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Disparities in Mentorship and Implications for US Surgical Resident Education and Wellness JAMA Surg. (IF 15.7) Pub Date : 2024-04-03 Casey M. Silver, Tarik K. Yuce, Callisia N. Clarke, Cary Jo R. Schlick, Rhami Khorfan, Daniela Amortegui, Michael Nussbaum, Patricia L. Turner, Karl Y. Bilimoria, Yue-Yung Hu
ImportanceMany surgeons cite mentorship as a critical component of training. However, little evidence exists regarding factors associated with mentorship and the influence of mentorship on trainee education or wellness.ObjectivesTo evaluate factors associated with surgical trainees’ perceptions of meaningful mentorship, assess associations of mentorship with resident education and wellness, and evaluate
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Adjuvant Transarterial Chemoembolization With Sorafenib for Portal Vein Tumor Thrombus JAMA Surg. (IF 15.7) Pub Date : 2024-04-03 Zhenwei Peng, Wenzhe Fan, Zelong Liu, Han Xiao, Jian Wu, Rong Tang, Jianfei Tu, Liangliang Qiao, Fuxi Huang, Wenxuan Xie, Wenquan Zhuang, Wenbo Guo, Shaoqiang Li, Yunpeng Hua, Shunli Shen, Qiang He, Dongming Li, Jiaping Li, Ming Kuang
ImportanceCertain patients with hepatocellular carcinoma with portal vein tumor thrombus could benefit from surgical resection, and postoperative adjuvant therapy may lower the incidence of tumor recurrence.ObjectiveTo compare the efficacy and safety of sorafenib plus transarterial chemoembolization vs sorafenib alone as postoperative adjuvant therapy for patients with hepatocellular carcinoma with
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US Liver Transplant Outcomes After Normothermic Regional Perfusion vs Standard Super Rapid Recovery JAMA Surg. (IF 15.7) Pub Date : 2024-04-03 Aleah L. Brubaker, Marty T. Sellers, Peter L. Abt, Kristopher P. Croome, Shaheed Merani, Anji Wall, Phillipe Abreu, Musab Alebrahim, Roy Baskin, Humberto Bohorquez, Robert M. Cannon, Kelly Cederquist, John Edwards, Benjamin G. Huerter, Mark J. Hobeika, Lori Kautzman, Alan N. Langnas, David D. Lee, Joao Manzi, Ahmed Nassar, Nikole Neidlinger, Trevor L. Nydam, Gabriel T. Schnickel, Farjad Siddiqui, Ashley
ImportanceNormothermic regional perfusion (NRP) is an emerging recovery modality for transplantable allografts from controlled donation after circulatory death (cDCD) donors. In the US, only 11.4% of liver recipients who are transplanted from a deceased donor receive a cDCD liver. NRP has the potential to safely expand the US donor pool with improved transplant outcomes as compared with standard super
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Quality of Life After Axillary Lymph Node Dissection Among Racial and Ethnic Minority Women JAMA Surg. (IF 15.7) Pub Date : 2024-03-27 Danielle R. Heller, Bayley Axelrod, Varadan Sevilimedu, Monica Morrow, Babak J. Mehrara, Andrea V. Barrio
ImportanceHigher lymphedema rates after axillary lymph node dissection (ALND) have been found in Black and Hispanic women; however, there is poor correlation between subjective symptoms, quality of life (QOL), and measured lymphedema. Additionally, racial and ethnic differences in QOL have been understudied.ObjectiveTo evaluate the association of race and ethnicity with long-term QOL in patients with
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Year-Over-Year Ventral Hernia Recurrence Rates and Risk Factors JAMA Surg. (IF 15.7) Pub Date : 2024-03-27 Priya Bhardwaj, Maria T. Huayllani, Molly A. Olson, Jeffrey E. Janis
ImportanceRecurrence is one of the most challenging adverse events after ventral hernia repair as it impacts quality of life, utilization of resources, and subsequent need for re-repair. Rates of recurrence range from 30% to 80% after ventral hernia repair.ObjectiveTo determine the contemporary ventral hernia recurrence rate over time in patients with previous hernia repair and to determine risk factors
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Metabolic Bariatric Surgery—A Vastly Underused Treatment JAMA Surg. (IF 15.7) Pub Date : 2024-03-20 Bruce Schirmer
This Viewpoint discusses the disease of obesity: treatment options, disease management, and the need for legislation for obesity-related discrimination.
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Cost-Effectiveness of Parathyroid Cryopreservation and Autotransplantation JAMA Surg. (IF 15.7) Pub Date : 2024-03-20 C. Corbin Frye, Janessa Sullivan, Sai Anusha Sanka, Eileen R. Smith, Brian Goetz, L. Michael Brunt, William Gillanders, Taylor C. Brown, John A. Olson, Bruce Hall, T. K. Pandian
ImportanceDelayed autotransplantation of cryopreserved parathyroid tissue (DACP) is the only surgical treatment for permanent postoperative hypoparathyroidism. Studies suggest that only a small minority of cryopreserved samples are ultimately autotransplanted with highly variable outcomes. For these reasons, many have questioned the economic utility of the process, although, to the authors’ knowledge
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Modifier 22 Use in Fee-for-Service Medicare JAMA Surg. (IF 15.7) Pub Date : 2024-03-20 Christopher P. Childers, Naveen V. Manisundaram, Chung-Yuan Hu, George J. Chang
ImportanceModifier 22 is a mechanism designed for surgeons to identify cases that are more complex than their Current Procedural Terminology code accounts for. However, empirical studies of the use and efficacy of modifier 22 are lacking.ObjectiveTo assess the use of modifier 22 in common surgical procedures and the association of use with compensation.Design, Setting, and ParticipantsThis was a cross-sectional
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Morbidity After Mechanical Bowel Preparation and Oral Antibiotics Prior to Rectal Resection JAMA Surg. (IF 15.7) Pub Date : 2024-03-20 Laura Koskenvuo, Pipsa Lunkka, Pirita Varpe, Marja Hyöty, Reetta Satokari, Carola Haapamäki, Anna Lepistö, Ville Sallinen
ImportanceSurgical site infections (SSIs)—especially anastomotic dehiscence—are major contributors to morbidity and mortality after rectal resection. The role of mechanical and oral antibiotics bowel preparation (MOABP) in preventing complications of rectal resection is currently disputed.ObjectiveTo assess whether MOABP reduces overall complications and SSIs after elective rectal resection compared
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Entrustable Professional Activities in Surgery JAMA Surg. (IF 15.7) Pub Date : 2024-03-13 Kelsey B. Montgomery, John D. Mellinger, Brenessa Lindeman
ImportanceEntrustable professional activities (EPAs) compose a competency-based education (CBE) assessment framework that has been increasingly adopted across medical specialties as a workplace-based assessment tool. EPAs focus on directly observed behaviors to determine the level of entrustment a trainee has for a given activity of that specialty. In this narrative review, we highlight the rationale
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Accreditation Council for Graduate Medical Education Milestone Training Ratings and Surgeons’ Early Outcomes JAMA Surg. (IF 15.7) Pub Date : 2024-03-13 Brigitte K. Smith, Kenji Yamazaki, Ara Tekian, Benjamin S. Brooke, Erica L. Mitchell, Yoon Soo Park, Eric S. Holmboe, Stanley J. Hamstra
ImportanceNational data on the development of competence during training have been reported using the Accreditation Council for Graduate Medical Education (ACGME) Milestones system. It is now possible to consider longitudinal analyses that link Milestone ratings during training to patient outcomes data of recent graduates.ObjectiveTo evaluate the association of in-training ACGME Milestone ratings in
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Electronic Patient-Reported Symptoms After Ambulatory Cancer Surgery JAMA Surg. (IF 15.7) Pub Date : 2024-03-13 Jennifer R. Cracchiolo, Amy L. Tin, Melissa Assel, Taylor M. McCready, Cara Stabile, Brett Simon, Sigrid V. Carlsson, Andrew J. Vickers, Vincent Laudone
ImportanceComplex cancer procedures are now performed in the ambulatory surgery setting. Remote symptom monitoring (RSM) with electronic patient-reported outcomes (ePROs) can identify patients at risk for acute hospital encounters. Defining normal recovery is needed to set patient expectations and optimize clinical team responses to manage evolving problems in real time.ObjectiveTo describe the patterns
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Anatomic Liver Resection Based on Portal Territory With Margin Priority for Hepatocellular Carcinoma JAMA Surg. (IF 15.7) Pub Date : 2024-03-13 Xingru Wang, Jun Cao, Jianwei Li
This Surgical Innovation describes the use of anatomic resection of the liver based on portal territory with margin priority for the treatment of hepatocellular carcinoma.
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Robotic Technology in Emergency General Surgery Cases in the Era of Minimally Invasive Surgery JAMA Surg. (IF 15.7) Pub Date : 2024-03-06 Nicole Lunardi, Aida Abou-Zamzam, Katherine L. Florecki, Swathikan Chidambaram, I-Fan Shih, Alistair J. Kent, Bellal Joseph, James P. Byrne, Joseph V. Sakran
ImportanceAlthough robotic surgery has become an established approach for a wide range of elective operations, data on its utility and outcomes are limited in the setting of emergency general surgery.ObjectivesTo describe temporal trends in the use of laparoscopic and robotic approaches and compare outcomes between robotic and laparoscopic surgery for 4 common emergent surgical procedures.Design, Setting
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Performance in Irish Selection and Future Performance in Surgical Training JAMA Surg. (IF 15.7) Pub Date : 2024-03-06 Conor Toale, Marie Morris, Sara Gross, Dara A. O’Keeffe, Donncha M. Ryan, Fiona Boland, Eva M. Doherty, Oscar J. Traynor, Dara O. Kavanagh
ImportanceSelection processes for surgical training should aim to identify candidates who will become competent independent practitioners and should aspire to high standards of reliability and validity.ObjectiveTo determine the association between measured candidate factors at the time of an Irish selection and assessment outcomes in surgical training, examined via rate of progression to Higher Specialist
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Is Preoperative Optimization Right for Every Hernia Patient? JAMA Surg. (IF 15.7) Pub Date : 2024-03-06 Serena S. Bidwell, Brian T. Fry, Dana A. Telem
This Viewpoint discusses developing a more nuanced preoperative optimization strategy for hernia repair that considers patient and disease factors to determine the right operation for the right patient at the right time.
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Glucagon-Like Peptide-1 Receptor Agonist Use and Residual Gastric Content Before Anesthesia JAMA Surg. (IF 15.7) Pub Date : 2024-03-06 Sudipta Sen, Paul P. Potnuru, Nadia Hernandez, Christina Goehl, Caroline Praestholm, Srikanth Sridhar, Omonele O. Nwokolo
ImportanceGlucagon-like peptide-1 receptor agonist (GLP-1 RA) use is rapidly increasing in the US, driven by its expanded approval for weight management in addition to hyperglycemia management in patients with type 2 diabetes. The perioperative safety of these medications, particularly with aspiration risk under anesthesia, is uncertain.ObjectiveTo assess the association between GLP-1 RA use and prevalence
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Optimal Practices for Suspected Nodal Melanoma—The Role of the General Surgeon JAMA Surg. (IF 15.7) Pub Date : 2024-02-28 Colin J. Rog, Igor Puzanov, Joseph Skitzki
This Viewpoint describes results of trials on neoadjuvant checkpoint inhibitor immunotherapy for patients with metastatic melanoma and recommends increased use of this approach.