JAMA surgery最新文献

{"title":"Adversity as Privilege-Poverty Has Made Me a Better Surgeon.","authors":"Annie M Q Wang","doi":"10.1001/jamasurg.2024.6312","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6312","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"36 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056904","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":"Benzodiazepine-Free Cardiac Anesthesia for Reduction of Postoperative Delirium: A Cluster Randomized Crossover Trial.","authors":"Jessica Spence,P J Devereaux,Shun-Fu Lee,Frédérick D'Aragon,Michael S Avidan,Richard P Whitlock,C David Mazer,Nicolas Rousseau-Saine,Raja Ramaswamy Rajamohan,Kane O Pryor,Rael Klein,Edmund Tan,Matthew J Cameron,Emily Di Sante,Erin DeBorba,Mary E Mustard,Etienne J Couture,Raffael Pereira Cezar Zamper,Michael W Y Law,George Djaiani,Tarit Saha,Stephen Choi,Peter Hedlin,D Ryan Pikaluk,Wing Lam,Alain Deschamps,Chinthanie F Ramasundarahettige,Jessica Vincent,William F McIntyre,Simon J W Oczkowski,Braden J Dulong,Christopher Beaver,Shelley A Kloppenburg,Andre Lamy,Eric Jacobsohn,Emilie P Belley-Côté,","doi":"10.1001/jamasurg.2024.6602","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6602","url":null,"abstract":"ImportanceDelirium is common after cardiac surgery and associated with adverse outcomes. Intraoperative benzodiazepines may increase postoperative delirium but restricting intraoperative benzodiazepines has not yet been evaluated in a randomized trial.ObjectiveTo determine whether an institutional policy of restricted intraoperative benzodiazepine administration reduced the incidence of postoperative delirium.Design, Setting, and ParticipantsThis pragmatic, multiperiod, patient- and assessor-blinded, cluster randomized crossover trial took place at 20 North American cardiac surgical centers. All adults undergoing open cardiac surgery at participating centers during the trial period were included through a waiver of individual patient consent between November 2019 and December 2022.InterventionInstitutional policies of restrictive vs liberal intraoperative benzodiazepine administration were compared. Hospitals (clusters) were randomized to cross between the restricted and liberal benzodiazepine policies 12 to 18 times over 4-week periods.Main Outcomes and MeasuresThe primary outcome was the incidence of delirium within 72 hours of surgery as detected in routine clinical care, using either the Confusion Assessment Method-Intensive Care Unit or the Intensive Care Delirium Screening Checklist. Intraoperative awareness by patient report was assessed as an adverse event.ResultsDuring the trial, 19 768 patients (mean [SD] age, 65 [12] years; 14 528 [73.5%] male) underwent cardiac surgery, 9827 during restricted benzodiazepine periods and 9941 during liberal benzodiazepine periods. During restricted periods, clinicians adhered to assigned policy in 8928 patients (90.9%), compared to 9268 patients (93.2%) during liberal periods. Delirium occurred in 1373 patients (14.0%) during restricted periods and 1485 (14.9%) during liberal periods (adjusted odds ratio [aOR], 0.92; 95% CI, 0.84-1.01; P = .07). No patient spontaneously reported intraoperative awareness.Conclusions and RelevanceIn intention-to-treat analyses, restricting benzodiazepines during cardiac surgery did not reduce delirium incidence but was also not associated with an increase in the incidence of patient-reported intraoperative awareness. Given that smaller effect sizes cannot be ruled out, restriction of benzodiazepines during cardiac surgery may be considered. Research is required to determine whether restricting intraoperative benzodiazepines at the patient level can reduce the incidence of postoperative delirium.Trial RegistrationClinicalTrials.gov Identifier: NCT03928236.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"28 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056967","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":"Improved Outcomes and Resource Use With Normothermic Machine Perfusion in Liver Transplantation","authors":"Michelle C. Nguyen, Chi Zhang, Yu-Hui Chang, Xingjie Li, Stephanie Y. Ohara, Kayla R. Kumm, Christopher P. Cosentino, Bashar A. Aqel, Blanca C. Lizaola-Mayo, Peter E. Frasco, Raphael Nunez-Nateras, Winston R. Hewitt, Jack W. Harbell, Nitin N. Katariya, Andrew L. Singer, Adyr A. Moss, Kunam S. Reddy, Caroline Jadlowiec, Amit K. Mathur","doi":"10.1001/jamasurg.2024.6520","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6520","url":null,"abstract":"ImportanceNormothermic machine perfusion (NMP) has been shown to reduce peritransplant complications. Despite increasing NMP use in liver transplant (LT), there is a scarcity of real-world clinical experience data.ObjectiveTo compare LT outcomes between donation after brain death (DBD) and donation after circulatory death (DCD) allografts preserved with NMP or static cold storage (SCS).Design, Setting, and ParticipantsThis single-center, retrospective observational cohort study included all consecutive adult LTs performed between January 2019 and December 2023 at the Mayo Clinic in Arizona. Data analysis was performed between February 2024 and June 2024. Outcomes of DBD-SCS, DBD-NMP, DCD-SCS, and DCD-NMP transplants were compared.ExposureDBD and DCD livers preserved on NMP or SCS.Main Outcomes and MeasuresThe primary outcomes were early allograft dysfunction (EAD), intraoperative transfusion, and post-LT hospital resource use, including length of stay (LOS) and readmissions. Secondary outcomes included acute kidney injury (AKI) and 1-year graft and patient survival.ResultsA total of 1086 LTs were included in the following 4 groups: DBD-SCS (n = 480), DBD-NMP (n = 63), DCD-SCS (n = 264), and DCD-NMP (n = 279). Among LT recipients, median (IQR) age was 60.0 years (52.0-66.0); 399 LT recipients (36.7%) were female. DCD-NMP had the lowest EAD rate (17.5%), followed by DCD-SCS (50.0%), DBD-NMP (36.8%), and DBD-SCS (27.3%) (<jats:italic>P</jats:italic> &amp;amp;lt; .001). DCD-NMP had the lowest intraoperative transfusion requirement compared to all other groups. Hospital and intensive care unit (ICU) LOS were shortest in DCD-NMP (median [IQR] hospital LOS, 5.0 days [4.0-7.0]; <jats:italic>P</jats:italic> = .01; median [IQR] ICU LOS, 1.5 days [1.2-3.1]; <jats:italic>P</jats:italic> = .01). One-year cumulative readmission probability was 86% lower for DCD-NMP vs DCD-SCS (95% CI, 0.09-0.22; <jats:italic>P</jats:italic> &amp;amp;lt; .001) and 53% lower for DBD-NMP vs DBD-SCS (95% CI, 0.26-0.87; <jats:italic>P</jats:italic> &amp;amp;lt; .001). AKI events were lower in DCD-NMP (31.1%) vs DCD-SCS (47.4%) (<jats:italic>P</jats:italic> = .001). Compared to SCS, the NMP group had a 78% overall reduction in graft failure (hazard ratio [HR], 0.22; 95% CI, 0.10-0.49; <jats:italic>P</jats:italic> &amp;amp;lt; .001). For those receiving DCD allografts, the risk reduction was even more pronounced, with an 87% decrease in graft failure (HR, 0.13; 95% CI, 0.05-0.33; <jats:italic>P</jats:italic> &amp;amp;lt; .001). NMP was significantly protective from patient mortality vs SCS (HR, 0.31; 95% CI, 0.12-0.80; <jats:italic>P</jats:italic> = .02).Conclusions and RelevanceIn this observational high-volume cohort study, NMP significantly improved LT clinical outcomes and reduced hospital resource use, especially in DCD allografts. NMP may enhance access to LT by addressing the challenges historically linked with DCD liver use.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"14 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056251","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":"Postdocs Focus on Research-Surgeons Provide Patient Care.","authors":"Isain Zapata","doi":"10.1001/jamasurg.2024.6583","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6583","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"48 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056905","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":"Benzodiazepines Not Main Suspect in Cardiac Surgery Delirium.","authors":"Amanda M Kleiman,Michael P Calgi,John S McNeil","doi":"10.1001/jamasurg.2024.6603","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6603","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"23 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056907","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":"Postdocs Focus on Research-Surgeons Provide Patient Care-Reply.","authors":"Jennifer E B Harman,David C Linehan,Anusha Naganathan","doi":"10.1001/jamasurg.2024.6586","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6586","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"53 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056903","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":"Technique for Laparoscopic Fluorescence–Guided Retroperitoneal Lymph Node Dissection","authors":"Luigi Boni, Elisa Cassinotti, Ludovica Baldari","doi":"10.1001/jamasurg.2024.4110","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4110","url":null,"abstract":"This Surgical Innovation describes a technique to identify the retroperitoneal lymph using ICG fluorescence, enabling a clear visualization of lymphatics, and nodes that need to be dissected from the surrounding structures.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"13 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056295","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":"Machine Perfusion and Liver Transplantation-The Future Is Now.","authors":"Daniel Borja-Cacho,Zachary Dietch,Satish N Nadig","doi":"10.1001/jamasurg.2024.6529","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6529","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"20 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056902","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":"Mixed Results With Oral Antibiotics for Fracture-Related Infections.","authors":"Kamal M F Itani, William G Henderson","doi":"10.1001/jamasurg.2024.6440","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6440","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005731","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":"Disparities in Access to Time-Sensitive Emergency Trauma Care.","authors":"Cherisse Berry","doi":"10.1001/jamasurg.2024.6411","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6411","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005722","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}