JAMA surgery最新文献

{"title":"Disability in Surgery-A Call to Action.","authors":"Priyanka V Chugh,Brian A Jones,Kathryn E Twomey","doi":"10.1001/jamasurg.2025.1006","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.1006","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"104 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893280","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":"Surgical Performance Metrics for 1-Year Patient-Reported Outcomes After Radical Prostatectomy.","authors":"John R Heard,Umar Ghaffar,Runzhuo Ma,Cherine H Yang,Melissa Assel,Christian Wagner,Geoffrey A Sonn,Alvin C Goh,Shady Saikali,Vipul Patel,Andrew Vickers,Jim C Hu,Andrew J Hung","doi":"10.1001/jamasurg.2025.0931","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0931","url":null,"abstract":"ImportanceThere is a dearth of surgical performance measures that accurately predict long-term patient outcomes.ObjectiveTo develop surgical performance measures collected at the time of surgery that accurately predict future outcomes.Design, Setting, and ParticipantsIn this cohort study, surgical video of 157 patients undergoing robotic-assisted radical prostatectomy by 28 surgeons from 4 tertiary referral hospitals across the US and 1 hospital in Germany was analyzed. Four trained and blinded raters annotated video clips of the bilateral nerve-sparing step using standardized tools for identifying surgical gestures and assessing technical skills. Patients were prospectively enrolled from July 2016 to January 2023 and followed up for 12 months postoperatively. Data were analyzed from April to August 2024. Patients with clinically localized prostate cancer undergoing robotic-assisted radical prostatectomy were eligible. Inclusion criteria included adequate erectile function prior to surgery and access to complete surgical video.Interventions/ExposuresRobotic-assisted radical prostatectomy.Main Outcomes and MeasuresPerformance metrics were compared between patients who recovered erectile function and those who did not. Erectile function recovery was defined as achieving erections sufficient for intercourse measured using the Sexual Health Inventory for Men.ResultsFifty-three patients (34%) recovered erectile function at 12 months after surgery. The median age was 64 (IQR, 59-68) years and median body mass index was 28 (IQR, 26-30). In total, 80 957 surgical gestures were annotated and 2568 technical skills scores were evaluated. The impact of performance factors on erectile function recovery was evaluated using univariate logistic regression. Recovery was associated with a greater proportion of peel/push gestures (odds ratio [OR], 1.72; 95% CI, 1.24-2.42, per 0.1 increase; P = .001), lower proportion of energy gestures applied to the neurovascular bundle (OR, 0.35; 95% CI, 0.13-0.81, per 0.1 increase; P = .03), and less gestures grabbing the neurovascular bundle (OR, 0.02; 95% CI, 0.00-0.47, per 0.1 increase; P = .02). Erectile function recovery was associated with higher tissue handling skill scores (OR, 3.43; 95% CI, 1.23-10.90, P = .03). On multivariable regression the association between peel/push gestures and erectile function recovery remained significant (OR, 1.66; 95% CI, 1.18-2.39, per 0.1 increase; P = .005).Conclusions and RelevanceSurgical performance can be assessed from data collected during surgery and used to predict erectile function 12 months later. This was not previously feasible due to a lack of quantitative methods for assessing surgical performance. Combining surgical gestures and skills assessment demonstrates a novel opportunity for advancing surgical performance.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"71 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893287","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":"Postoperative Outcomes Among Sodium-Glucose Cotransporter 2 Inhibitor Users.","authors":"Roberta Teixeira Tallarico,Bocheng Jing,Kaiwei Lu,Shweta Amy Chawla,Yanting Luo,Anusha Badathala,Catherine L Chen,Arthur W Wallace,Matthieu Legrand","doi":"10.1001/jamasurg.2025.0940","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0940","url":null,"abstract":"ImportanceCase reports and small retrospective studies have suggested that there is an increased risk of postoperative euglycemic ketoacidosis (eKA) and acute kidney injury (AKI) among patients using sodium-glucose cotransporter 2 inhibitors (SGLT2i) preoperatively. However, there has not been a representative assessment of the risks of these agents among patients undergoing surgery.ObjectiveTo evaluate the risk of postoperative eKA, AKI, and mortality within 30 days after surgery among preoperative long-term SGLT2i users compared with nonusers.Design, Settings, and ParticipantsThis is a multicenter, propensity-matched, retrospective case-control study from the Veterans Affairs Health Care System (VAHCS) National Registry performed from January 1, 2014, to December 31, 2022. Adult patients using SGLT2i preoperatively who underwent inpatient surgical procedures were compared with a 1:5 matched control group using propensity score matching, including the patient's demographic characteristics, comorbidities, and surgical characteristics. Data analysis was performed from June 2023 to August 2024.ExposureLong-term use of SGLT2i, defined as having more than 3 fills of outpatient prescription or less than a 180-day gap of the last fill according to the VAHCS pharmacy registries.Main Outcomes and MeasuresThe primary outcome was the rate of postoperative eKA among SGLT2i users vs control patients. Secondary outcomes included postoperative AKI and 30-day mortality after surgery.ResultsAmong 462 968 patients undergoing surgery, 7448 SGLT2i users (mean [SD] age, 67.7 [8.1] years; 7204 [96.7%] male) and 455 520 nonusers (mean [SD] age, 65.8 [11.0] years; 424 785 [93.3%] male) were identified. After propensity score matching, 7439 patients were identified as SGLT2i users and compared with 33 489 control patients. SGLT2i use was associated with an increased risk of eKA (odds ratio [OR], 1.11; 95% CI, 1.05-1.17) but reduced risks of perioperative AKI (OR, 0.69; 95% CI, 0.62-0.78) and 30-day mortality (OR, 0.70; 95% CI, 0.55-0.88). The mortality rate 30 days after surgery was 1.1% among SGLT2i users vs 1.6% among control patients. The median hospital length of stay among the patients presenting with eKA increased by 3 days (median [IQR], 6 [3-10] days for those with eKA vs 3 [2-6] days for those without eKA).Conclusions and RelevancePatients treated with SGLT2i had a small but significantly higher risk of postoperative eKA but lower risks of postoperative AKI and 30-day mortality.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"8 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893283","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":"Identity Concordance-a Key Component of Optimal Surgical Outcomes.","authors":"Christopher J D Wallis,Raj Satkunasivam,Angela Jerath","doi":"10.1001/jamasurg.2025.0857","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0857","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"3 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143866776","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":"Long-Term Postoperative Outcomes by Surgeon Gender and Patient-Surgeon Gender Concordance in the US","authors":"Ryo Ikesu, Hiroshi Gotanda, Tara A. Russell, Melinda Maggard-Gibbons, Marcia McGory Russell, Ryu Yoshida, Ruixin Li, Alexandra Klomhaus, Christian de Virgilio, Yusuke Tsugawa","doi":"10.1001/jamasurg.2025.0866","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0866","url":null,"abstract":"ImportanceEvidence suggests that physician gender and patient-physician gender concordance have the potential to improve patient outcomes, especially for female patients. However, whether long-term outcomes differ by surgeon gender and patient-surgeon gender concordance has not been studied in the US.ObjectiveTo compare long-term postoperative outcomes by surgeon gender and patient-surgeon gender concordance.Design, Setting, and ParticipantsA population-based cross-sectional study was conducted based on 100% Medicare fee-for-service claims data from 2016 through 2019. Data analysis was performed between October 17, 2023, and January 28, 2025. The study took place at acute care hospitals in the US. Participants included Medicare fee-for-service beneficiaries aged 65 to 99 years who underwent 1 of 14 elective or emergent surgeries.ExposuresSurgeon gender and patient-surgeon gender concordance.Main Outcomes and MeasuresNinety-day and 1-year postoperative mortality, readmission, and complication rates were compared by surgeon gender and patient-surgeon gender concordance. The study team adjusted for patient and surgeon characteristics and hospital fixed effects, effectively comparing patients within the same hospital.ResultsAmong 2 288 279 patients who underwent surgery, 129 528 were operated on by female surgeons (5.7%) and 2 158 751 were by male surgeons (94.3%). Patients treated by female surgeons experienced a lower long-term mortality rate compared with those treated by male surgeons (adjusted 90-day mortality rates, 2.6% for female surgeons vs 3.0% for male surgeons; adjusted risk difference [aRD], −0.3 percentage points [pp]; 95% CI, −0.5 pp to −0.2 pp; <jats:italic>P</jats:italic> &amp;amp;lt; .001), similarly for both female and male patients. For female patients, the patient-surgeon gender concordance was associated with lower long-term readmission (adjusted 90-day readmission rates, 7.3% vs 7.7%; aRD, −0.4 pp; 95% CI, −0.7 pp to −0.2 pp; <jats:italic>P</jats:italic> = .001) and complication rates (adjusted 90-day complication rates, 12.2% vs 12.8%; aRD, −0.5 pp; 95% CI, −0.9 pp to −0.2 pp; <jats:italic>P</jats:italic> = .005). For male patients, long-term readmission and complication rates did not differ between patients treated by female vs male surgeons. Similar patterns were found between 90-day and 1-year patient outcomes.Conclusions and RelevanceIn this study, both female and male patients treated by female surgeons experienced lower long-term postoperative mortality rates compared with those treated by male surgeons. Patient-surgeon gender concordance was associated with lower long-term readmission and complication rates for female patients, but not for male patients. These patterns were observed only for elective procedures and may not be generalizable to other populations, such as younger patients.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"37 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143867008","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":"Trends in Clinical Outcomes After Major Emergency Abdominal Surgery in Denmark, Data From 2002-2022","authors":"Johanne Gormsen, Dunja Kokotovic, Thomas Korgaard Jensen, Jakob Burcharth","doi":"10.1001/jamasurg.2025.0858","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0858","url":null,"abstract":"ImportanceMajor emergency abdominal surgery is associated with high morbidity and mortality. Understanding trends in outcomes over time can reveal critical practice-changing improvements, identify gaps in postoperative care, and establish a large-scale benchmark for future research.ObjectiveTo investigate trends in morbidity and mortality after major emergency abdominal surgery in Denmark.Design, Setting, and ParticipantsThis was a nationwide, population-based cohort study. Analyses were performed based on data from Danish nationwide administrative registries. Within the public health care system in Denmark, all adult patients undergoing major emergency abdominal surgery from 2002 to 2022 were included. Major emergency abdominal surgeries included laparotomy or laparoscopy due to intra-abdominal pathologies, including intestinal perforation, ischemia, bowel obstruction, abscess, or bleeding.ExposureMajor emergency abdominal surgery.Main Outcomes and MeasuresThe primary outcome was the trend in 30- and 90-day mortality after major emergency abdominal surgery over time.ResultsA total of 61 476 patients (mean [SD] age, 66.2 [16.3] years; 34 827 female [56.7%]) were included. The annual number of surgeries remained constant, with a mean (SD) of 3044 (165) surgeries per year. The 30- and 90-day mortality was reduced from 25% and 33%, respectively, to 13% and 18%, respectively (<jats:italic>P</jats:italic> &amp;amp;lt; .001). Median (IQR) hospital length of stay was decreased from 10 (5-17) days to 6 (4-13) days (<jats:italic>P</jats:italic> &amp;amp;lt; .001). The rate of 30-day postoperative complications (classified Clavien-Dindo ≥3a) was reduced from 49% to 44% (<jats:italic>P</jats:italic> &amp;amp;lt;.001) and the 90-day rate was reduced from 53% to 48% (<jats:italic>P </jats:italic>&amp;amp;lt;.001), however, with a tendency toward more patients undergoing earlier intervention. The 30- and 90-day readmission rate increased drastically from 9% and 13%, respectively, to 25% and 33%, respectively (<jats:italic>P</jats:italic> &amp;amp;lt; .001).Conclusions and RelevanceResults of this cohort study suggest notable reductions in mortality and hospital length of stay after major emergency abdominal surgery. A marked increased readmission rate and a persistently high rate of postoperative complications were found. These shifts underscore the need for enhanced postoperative monitoring and postdischarge follow-up.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"65 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143867003","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":"New International Editorial Board Member-February 2025.","authors":"Melina R Kibbe","doi":"10.1001/jamasurg.2025.0743","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0743","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"22 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846386","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":"A Surgeon's Simplified Guide to US Patents.","authors":"Ammar Saed Aldien,Hassan ElHawary,Shafic Abdulkarim,Jeffrey E Janis","doi":"10.1001/jamasurg.2025.0725","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0725","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"45 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846387","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":"Intraoperative Trauma Video Review","authors":"Daniel N. Holena, Marc A. de Moya","doi":"10.1001/jamasurg.2025.0721","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0721","url":null,"abstract":"This Surgical Innovation describes the use of video review of intraoperative trauma care and the potential to improve the quality of trauma care and create opportunities for coaching.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"16 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836916","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":"Operative vs Nonoperative Treatment of Acute Cholecystitis in Older Adults With Multimorbidity","authors":"Rachael C. Acker, Sara P. Ginzberg, James Sharpe, Luke Keele, Jasmine Hwang, Emna Bakillah, Drew Goldberg, Elinore Kaufman, Rachel R. Kelz","doi":"10.1001/jamasurg.2025.0729","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0729","url":null,"abstract":"ImportanceAcute cholecystitis in older patients with multimorbidity is associated with a high risk of morbidity and mortality. Debate exists as to whether operative or nonoperative treatment is the most appropriate approach.ObjectivesTo compare the effectiveness of operative and nonoperative treatment in older adults with multimorbidity who are hospitalized emergently with acute cholecystitis.Design, Setting, and ParticipantsThis was a nationwide retrospective comparative effectiveness research study conducted in the US from 2016 to 2018 that used both an inverse propensity weight analysis and an instrumental variable analysis. The study participants were Medicare beneficiaries with multimorbidity hospitalized emergently with acute cholecystitis. Previously validated qualifying comorbidity sets were used to identify multimorbidity. Data were analyzed from April 1, 2016, to December 31, 2018.ExposuresTreatment assignment of operative or nonoperative treatment for acute cholecystitis.Main Outcomes and MeasuresThe primary outcome was 30- and 90-day mortality. Secondary outcomes included readmission rates, emergency department (ED) revisit rates, and cost. A preference-based instrumental variable approach was used to isolate circumstances for which the decision to operate is in clinical equipoise. Our hypothesis was that operative treatment would be associated with decreased mortality compared with nonoperative management.ResultsAmong the 32 527 included patients, the median age was 78.8 years (IQR, 72.4-85.2 years), and 21 728 patients (66.8%) underwent cholecystectomy. Of the 10 799 patients (33.2%) who received nonoperative treatment, 3462 (32.1%) received a percutaneous cholecystostomy tube. Among all patients, operative treatment was associated with a lower risk of 30-day mortality (risk difference [RD], −0.03; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001) and 90-day mortality (RD, −0.04; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001) compared with nonoperative treatment. Among patients for whom the treatment decision was in clinical equipoise, mortality was similar for the operative and nonoperative treatment groups; operative treatment was associated with a lower risk of 30-day readmissions (RD, −0.15; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001) and 90-day readmissions (RD, −0.23; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001) as well as a lower risk of 30-day ED revisits (RD, −0.09; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001) and 90-day ED revisits (RD, −0.12; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001). The risk-adjusted cost of operative treatment was higher at the index hospitalization (+$2870.84; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001) and lower at 90 days (−$5495.38; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001) and 180 days (−$9134.66; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001) compared with nonoperative treatment.Conclusions and RelevanceThe findings of this comparative effectiveness research study sugges","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"108 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143841298","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}