JAMA surgery最新文献

{"title":"Surgery' s 8-Year Edge in Adult Lumbar Scoliosis-Reply.","authors":"Justin S Smith,Michael P Kelly,Keith H Bridwell","doi":"10.1001/jamasurg.2025.3421","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.3421","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"14 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gynecologic Surgery Deserves Its Own Residency.","authors":"Gregory E Zemtsov,Jocelyn J Fitzgerald","doi":"10.1001/jamasurg.2025.3415","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.3415","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"67 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unpacking the Benefits and Trade-offs of Scarless Thyroidectomy.","authors":"Alexis Korman, Insoo Suh, Quan-Yang Duh","doi":"10.1001/jamasurg.2025.3257","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.3257","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":14.9,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transoral Endoscopic and Minimally Invasive Thyroidectomy","authors":"Ting-Chun Kuo, Kuen-Yuan Chen, Chieh-Wen Lai, Ming-Tsan Lin, Chin-Hao Chang, Ming-Hsun Wu","doi":"10.1001/jamasurg.2025.3248","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.3248","url":null,"abstract":"ImportanceThe transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a scarless surgical technique gaining popularity; however, its safety, cost, and impact on pathological evaluation compared with minimally invasive nonendoscopic thyroidectomy (MINET) remain under evaluation.ObjectiveTo compare surgical outcomes, pathological considerations, and cost profiles following TOETVA vs MINET using a propensity-matched cohort.Design, Setting, and ParticipantsThis cohort study included 720 patients undergoing oncoplastic thyroidectomy between January 2021 and January 2023, with 12-month follow-up, at a tertiary referral center in Taipei, Taiwan. Propensity score matching was used to generate balanced cohorts of 210 patients each.Main Outcomes and MeasuresPrimary outcomes included operative duration (measured from incision to closure), intraoperative neuromonitoring (IONM) alerts (recorded in real time via standard IONM systems), parathyroid preservation (assessed by identification and in situ preservation), postoperative pain (evaluated using the visual analog scale [VAS] score on postoperative day 1), specimen integrity (as documented in final pathology reports), postoperative complications, and overall cost (derived from itemized hospital billing records).ResultsAmong 420 matched patients (mean age [SD], 45.6 [12.3] years; 371 [88.3%] female), TOETVA was associated with longer mean (SD) operative time (127.9 [43.8] vs 68.1 [23.3] minutes; mean difference, 59.73 minutes; 95% CI, 53.20-66.26; <jats:italic>P</jats:italic> &amp;amp;lt; .001), fewer IONM alerts (4/255 [1.6%] vs 13/262 [5.0%]; risk difference, −3.39%; 95% CI, −6.54 to 0.08; <jats:italic>P</jats:italic> = .04), and fewer inadvertently resected parathyroid glands (24/510 [4.7%] vs 57/524 [10.9%]; risk difference, −6.17%; 95% CI, −9.42 to −2.85; <jats:italic>P</jats:italic> &amp;amp;lt; .001). Pain scores were slightly higher in TOETVA (mean [SD] VAS score: 0.88 [0.22] vs 0.38 [0.13]; mean difference, 0.50; 95% CI, 0.47-0.54; <jats:italic>P</jats:italic> &amp;amp;lt; .001). Specimen disruption was more frequent with TOETVA (27/210 [12.9%] vs 8/210 [3.8%]; risk difference, 9.05%; 95% CI, 3.52 to 14.28; <jats:italic>P</jats:italic> = .008). Total costs were higher in TOETVA (mean [SD], $4680 [328] vs $2734 [296]; mean difference, $1946; 95% CI, 1885.19 to 2006.87; <jats:italic>P</jats:italic> &amp;amp;lt; .001).Conclusions and RelevanceIn this propensity-matched cohort study, TOETVA was associated with favorable cosmetic outcomes and improved nerve and parathyroid preservation but longer operative times, higher costs, and greater risk of specimen disruption. These findings support the need for careful patient selection and further prospective evaluation.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"38 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Normovolemic Hemodilution-Adored in Theory, Avoided in Practice.","authors":"Faisal G Bakaeen, Marta Kelava","doi":"10.1001/jamasurg.2025.3245","DOIUrl":"10.1001/jamasurg.2025.3245","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":14.9,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dexmedetomidine for Analgesia in Nonintubated Patients With Traumatic Rib Fractures","authors":"Jeffry Nahmias, Stephen Stopenski, Mallory Jebbia, Steven Atallah, Katharine A. Kirby, Claudia A. Alvarez, Negaar Aryan, Erika Tay-Lasso, Matthew Dolich, Michael Lekawa, Lourdes Swentek, Jeffrey Santos, Sebastian Schubl, Catherine Kuza, Ninh Nguyen, Areg Grigorian","doi":"10.1001/jamasurg.2025.3221","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.3221","url":null,"abstract":"ImportanceTraumatic rib fractures are associated with significant morbidity, including pulmonary complications and prolonged opioid use. Identifying adjunctive treatments that can reduce opioid consumption without compromising safety remains a clinical priority, particularly in nonintubated trauma patients.ObjectiveTo evaluate whether adding dexmedetomidine to standard multimodal analgesia reduces opioid consumption in nonintubated patients in the intensive care unit (ICU) with traumatic rib fractures. It was hypothesized that adjunctive dexmedetomidine would reduce opioid use and improve numerical pain scores.Design, Setting, and ParticipantsThis prospective, randomized, double-blind, placebo-controlled clinical trial was conducted from July 2021 to October 2023. Data were analyzed during January 2024. The study took place at a single academic level I trauma center ICU. Participants included nonintubated adult trauma patients (18 years or older) with 3 or more rib fractures who were admitted to the ICU. Exclusion criteria included a Glasgow Coma Scale score less than 14, bradycardia, hypotension, pregnancy, cirrhosis, chronic opioid use, or inability to consent. Of 41 enrolled patients, 19 received dexmedetomidine (46.3%).ExposureContinuous intravenous infusion of dexmedetomidine (0.4 to 0.6 µg/kg per hour) or placebo (normal saline) for up to 48 hours, in addition to standard multimodal pain management.Main Outcomes and MeasuresThe primary outcome was the numerical pain score (NPS) over 48 hours. Secondary outcomes included oral morphine equivalents (OME) at 24 and 48 hours and pulmonary complications.ResultsAmong 41 patients (median age, 62 years; median injury severity score, 20), no significant differences were found in baseline characteristics between groups. Mean OME at 24 hours was 59.2 mg (dexmedetomidine) vs 54.9 mg (placebo) and 125.5 mg vs 87.1 mg at 48 hours. Median NPS was 4 in both groups. Pulmonary complication rates and ICU length of stay were also similar. Dexmedetomidine was discontinued in 47.4% of patients due to adverse events or patient request.Conclusions and RelevanceAdjunctive dexmedetomidine did not reduce opioid consumption, improve pain scores, or lower pulmonary complication rates in nonintubated patients in the ICU with traumatic rib fractures. These findings do not support routine use of dexmedetomidine for analgesia in this patient population.Trial RegistrationClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/study/NCT05321121?term=NCT05321121&amp;amp;amp;rank=1\">NCT05321121</jats:ext-link>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"24 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Normovolemic Hemodilution in Adult Cardiac Surgery","authors":"Kenichi A. Tanaka, Kenneth E. Stewart, Kofi B. Vandyck, Harold M. Burkhart, Tabitha Garwe, Miklos D. Kertai, Amir L. Butt, Michael A. Mazzeffi","doi":"10.1001/jamasurg.2025.3238","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.3238","url":null,"abstract":"ImportanceAcute normovolemic hemodilution (ANH) is a well-known blood conservation technique, yet its adoption in the US remains low (&amp;amp;lt;20%), and cardiac surgery remains the largest consumer of blood components. Increasing vulnerabilities in the US blood supply underscore the need to reassess ANH effectiveness in blood conservation.ObjectiveTo evaluate ANH use in perioperative transfusion and blood component use in patients undergoing surgery with cardiopulmonary bypass (CPB).Design, Setting, and ParticipantsA retrospective propensity–score matched cohort study using data from the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (version 4.20.2). The study included adult patients (≥18 years) undergoing coronary artery bypass grafting (CABG) and/or valve surgery with CPB (July 2020 to September 2023).ExposureThe primary exposure was ANH, defined as any recorded use/volume in the STS database.Main Outcome and MeasuresThe primary outcome was intraoperative or postoperative transfusion of any blood component. The volume-dependent ANH effect estimate was also assessed using a cutoff value of 650 mL. Secondary outcomes included the total number of transfused red blood cells (RBC) and non-RBC components (platelets, plasma, and cryoprecipitate); bleeding reexplorations; length of stay in the intensive care unit; and estimates for blood acquisition and activity-based costs.ResultsAmong 16 795 patients (mean [SD] age, 65.3 [10.5] years; 12 114 male [72.1%]), ANH was reported in 2463 cases (14.7%). Patients receiving ANH had a significantly lower preoperative anemia rate and higher baseline hematocrit (mean difference: 2.5%; 95% CI, 2.3-2.7; <jats:italic>P</jats:italic> &amp;amp;lt; .001). After propensity score matching (n = 2282 pairs), transfusion rates were significantly lower in the ANH group (31.2% vs 36.4%; <jats:italic>P &amp;amp;lt; </jats:italic>.001). ANH was associated with 27% lower odds of any transfusion (odds ratio, 0.73; 95% CI, 0.60-0.89). High-volume ANH (≥650 mL) further reduced the odds of transfusion by 47% to 64% for both RBC and non-RBC components. The cumulative number of transfused erythrocyte and platelet units was 167 and 295 units lower, respectively, in the ANH group compared with the control group, with lower estimates for both acquisition and activity-based costs.Conclusions and RelevanceIn this study, a volume-dependent association was found between ANH and reduced RBC and non-RBC transfusion rates in patients undergoing cardiac surgery. Despite being safe and cost-effective, ANH remains underused as a blood conservation strategy.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"66 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parathyroidectomy and Risk of Incident Diabetes in Patients With Primary Hyperparathyroidism","authors":"Xiaodong Liu, David Tak Wai Lui, Xi Xiong, Lanlan Li, Yan Luk, Chun Ho Wong, Chi Ho Lee, Carlos King Ho Wong, Matrix Man Him Fung, Brian Hung Hin Lang","doi":"10.1001/jamasurg.2025.3081","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.3081","url":null,"abstract":"ImportancePrimary hyperparathyroidism (PHPT) is linked to insulin resistance, glucose intolerance, and diabetes. Whether parathyroidectomy is associated with lower risk of diabetes has not been evaluated in a large cohort.ObjectiveTo examine the independent association between parathyroidectomy and the risk of incident diabetes in patients with PHPT.Design, Setting, and ParticipantsPatients diagnosed with PHPT between January 2006 and December 2023 were identified from a territorywide electronic health database in Hong Kong and classified into surgical and nonsurgical groups based on presence of subsequent parathyroidectomy. They were followed up with from the index date (first diagnosis of PHPT), until the outcome of interest (incident diabetes), death, or end of the study period (December 2023), whichever came first.ExposureParathyroidectomy vs nonsurgical management.Main Outcomes and MeasuresThe primary outcome of this study was incident diabetes. Inverse probability of treatment weighting was used to balance all baseline characteristics. Cox proportional hazards regression was used to evaluate the hazard of incident diabetes associated with parathyroidectomy.ResultsA total of 3135 patients with PHPT were included (596 [19.0%] surgical and 2539 [81.0%] nonsurgical). The mean (SD) age was 67.5 (14.2) years, and 2211 (70.5%) individuals were female. A total of 518 patients in the nonsurgical group developed incident diabetes during a median (IQR) follow-up of 2.2 (0.9-4.3) years, compared to 156 patients in the surgical group during a median (IQR) follow-up of 5.5 (3.3-8.0) years. Parathyroidectomy was associated with lower risk of incident diabetes (hazard ratio [HR], 0.68 [95% CI, 0.65-0.71]; <jats:italic>P</jats:italic> &amp;amp;lt; .001). Results were consistent across multiple sensitivity analyses. Subgroup analyses revealed more prominent protective associations among younger patients (age ≤65 years vs &amp;amp;gt;65 years: HR, 0.64 [95% CI, 0.60-0.68] vs HR, 0.68 [95% CI, 0.63-0.72]; interaction <jats:italic>P</jats:italic> &amp;amp;lt; .001) and those with more severe PHPT (parathyroid hormone [PTH] &amp;amp;gt; twice the upper limit of normal vs PTH ≤ twice the upper limit of normal: HR, 0.58 [95% CI, 0.53-0.63] vs HR, 0.73 [95% CI, 0.69-0.77]; calcium &amp;amp;gt; 2.8 vs calcium ≤ 2.8 mmol/L : HR, 0.58 [95%CI, 0.54-0.63] vs HR, 0.69 [95%CI, 0.66-0.73]; interaction <jats:italic>P</jats:italic> &amp;amp;lt; .001).Conclusions and RelevanceIn this cohort of patients with PHPT, parathyroidectomy was associated with a lower risk of incident diabetes. The association was more prominent in younger patients and those with more severe PHPT. These results may suggest potential additional metabolic benefits of parathyroidectomy in PHPT.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"381 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Another Reason to Operate in Primary Hyperparathyroidism.","authors":"Martin Almquist","doi":"10.1001/jamasurg.2025.3075","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.3075","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":14.9,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Textbook Outcomes 2.0-Using Data to Inform Preoperative Surgical Discussions.","authors":"Jacquelyn E Fitzgerald, Olivia Monton, Kimberly E Kopecky","doi":"10.1001/jamasurg.2025.3077","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.3077","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":14.9,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}