JAMA surgery最新文献

{"title":"Rethinking Local Therapy for Rectal Cancer in the Era of Precision Oncology-When Less Is More.","authors":"Aron Bercz, Philip S Bauer, J Joshua Smith","doi":"10.1001/jamasurg.2025.1377","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.1377","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159125","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":"Tracheobronchial Replacement: A Systematic Review.","authors":"Emmanuel Martinod, Dana M Radu, Ilaria Onorati, Xavier Chapalain, Ana Maria Santos Portela, Marine Peretti, Olivia Freynet, Yurdagül Uzunhan, Kader Chouahnia, Boris Duchemann, Charles Juvin, Guillaume Lebreton, Hélène Rouard, Guillaume Van der Meersch, Geraud Galvaing, Jean-Baptiste Chadeyras, François Tronc, Paulina Kuczma, Christophe Trésallet, Nicolas Vénissac, Sadek Beloucif, Olivier Huet, Eric Vicaut","doi":"10.1001/jamasurg.2025.1378","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.1378","url":null,"abstract":"<p><strong>Importance: </strong>Tracheobronchial replacement remains a surgical and biological challenge despite several decades of experimental and clinical research.</p><p><strong>Objective: </strong>To compile a comprehensive state-of-the-science review examining the current indications, techniques, and outcomes of tracheobronchial replacement in human patients.</p><p><strong>Evidence review: </strong>A systematic review of the literature was conducted on July 1, 2024, to identify studies examining tracheobronchial replacement. This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines and the PRISMA 2020 statement. We selected the following 3 databases: (1) PubMed via the US National Library of Medicine's PubMed.gov; (2) Embase via Elsevier's Embase.com; and (3) the Cochrane Central Register of Controlled Trials (CENTER) via Wiley's Cochrane Library. An additional search was performed using the following clinical trials registers: the World Health Organization's International Clinical Trials Registry Platform and ClinicalTrials.gov, provided by the US National Library of Medicine.</p><p><strong>Findings: </strong>The initial search produced 6043 results, with a total of 126 publications included in the final review. Only 1 prospective cohort study and 1 registry, both concerning the use of cryopreserved aortic allografts, were identified. Most publications were case reports and series. From July 1, 2002, to July 1, 2024, a total of 137 cases of tracheobronchial replacement were published. Tracheobronchial replacement was indicated for extensive neoplastic tumors (108 cases [78.8%]) or benign stenoses (29 cases [21.2%]). The most common malignancies were thyroid cancers and adenoid cystic carcinomas. The most frequent resections involved the upper half of the trachea, with reconstructions using muscle flaps, or, most notably, cryopreserved aortic allografts, which have shown promising outcomes and have become the most widely used method since 2022. In the only available registry, the 30-day postoperative mortality and morbidity rates were 2.9% and 22.9%, respectively. Long-term follow-up showed that mortality was related to local recurrences and metastases in patients with cancer.</p><p><strong>Conclusions and relevance: </strong>This systematic review indicates that extensive malignant lesions are the primary indication for tracheobronchial replacement, with cryopreserved aortic allografts being the only scientifically evaluated surgical technique. Postoperative outcomes were comparable to other major thoracic surgical procedures, while long-term results depended on the underlying disease, especially in cancer cases.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159183","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":"Hospital Ownership and Surgical Outcomes in East, Central, and Southern Africa.","authors":"Robert K Parker, Yves Yankunze, Andrea S Parker, Eric O'Flynn, Niraj Bachheta, Abebe Bekele, Michael M Mwachiro","doi":"10.1001/jamasurg.2025.1430","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.1430","url":null,"abstract":"<p><strong>Importance: </strong>Surgical mortality remains a critical public health issue in resource-limited settings. Hospital ownership type may influence surgical outcomes, yet this relationship is not well understood in East, Central, and Southern Africa, where a diverse mix of public, private, and faith-based hospitals provides care.</p><p><strong>Objective: </strong>To determine whether hospital ownership type (public, private, or faith-based) is associated with differences in surgical mortality rates in East, Central, and Southern Africa.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study analyzed operative cases recorded by 214 general surgery trainees enrolled in surgical training programs at 85 public, private, and faith-based hospitals in East, Central, and Southern Africa from January 1, 2005, to December 31, 2020. Cases were documented in mandatory operative logbooks. Reported mortalities were analyzed using multilevel logistic regression to account for clustering by trainee while controlling for age category, emergency status, case complexity, specialty type, country Human Development Index, trainee postgraduate year, and self-reported autonomy. Data were analyzed in July 2024.</p><p><strong>Exposures: </strong>Hospital ownership type categorized as public, private, or faith-based.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was perioperative mortality, defined as in-hospital, all-cause mortality before discharge. Mortality rates were compared across hospital types.</p><p><strong>Results: </strong>Of the 106 106 operative cases analyzed, 48 474 (45.7%) were performed in public, 3507 (3.3%) in private, and 54 125 (51.0%) in faith-based hospitals. Patients' median (IQR) age was 34 (20-51) years, and 61.5% were male. The overall perioperative mortality rate was 1.6% (95% CI, 1.5%-1.6%). Among major cases (mortality, 1138 of 53 718 [2.1%; 95% CI, 2.0%-2.2%]), faith-based hospitals had 57% lower mortality (518 of 35 370 [1.5%; 95% CI, 1.3%-1.6%]) than public hospitals (589 of 17 223 [3.4%; 95% CI, 3.2%-3.7%]) and 47% lower mortality than private hospitals (31 of 1125 [2.8%; 95% CI, 1.9%-3.9%]). Mixed-effects logistic regression revealed that faith-based hospitals had lower odds of mortality compared with public hospitals (odds ratio, 0.67; 95% CI, 0.51-0.86; P = .002) and private hospitals (odds ratio, 0.57; 95% CI, 0.34-0.95; P = .03).</p><p><strong>Conclusions: </strong>In this study, faith-based hospitals in East, Central, and Southern Africa were associated with significantly lower surgical mortality rates compared with public and private hospitals. These findings suggest that practices and resources in faith-based hospitals contribute to improved surgical outcomes, warranting further investigation to inform health care policy and improve surgical care and outcomes in the region.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159120","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":"Association of Familiarity of the Surgeon-Anesthesiologist Dyad With Major Morbidity After Surgery.","authors":"Jasmine Hwang, Rachel R Kelz","doi":"10.1001/jamasurg.2025.1376","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.1376","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159149","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":"Familiarity of the Surgeon-Anesthesiologist Dyad and Major Morbidity After High-Risk Elective Surgery.","authors":"Julie Hallet, Angela Jerath, Pablo Perez d'Empaire, François Carrier, Alexis F Turgeon, Daniel I McIsaac, Chris Idestrup, Gianni Lorello, Alana Flexman, Biniam Kidane, Wing C Chan, Anna Gombay, Natalie Coburn, Antoine Eskander, Rinku Sutradhar","doi":"10.1001/jamasurg.2025.1386","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.1386","url":null,"abstract":"<p><strong>Importance: </strong>The surgeon-anesthesiologist teamwork is a core component of performance in the operating room, which can influence patient outcomes.</p><p><strong>Objective: </strong>To examine the association between surgeon-anesthesiologist dyad familiarity (as dyad volume, the number of procedures done together) with 90-day postoperative major morbidity for high-risk elective surgery.</p><p><strong>Design, setting, and participants: </strong>This population-based retrospective cohort study used administrative health care data from Ontario, Canada. Participants included high-risk elective operations (cardiac, low- and high- risk gastrointestinal [GI], genitourinary, gynecology oncology, neurosurgery, orthopedic, spine, vascular, and head and neck) from 2009 through 2019. Data were analyzed from January 2009 to March 2020.</p><p><strong>Exposure: </strong>Dyad familiarity, as the annual volume of procedures done by the surgeon-anesthesiologist dyad in 4 years prior to index surgery.</p><p><strong>Main outcomes and measures: </strong>90-day major morbidity (any Clavien-Dindo grade 3 to 5). The association between exposure and outcome was examined using multivariable logistic regression, stratified by type of procedure.</p><p><strong>Results: </strong>Among 711 006 index procedures, the median dyad volume and rate of 90-day major morbidity varied by type of procedure. There was higher median volume and dyad consistency for cardiac, orthopedic, and lung surgery. For other procedures, the median dyad volume was low (3 or less procedures per dyad per year). An independent association was observed between dyad volume and 90-day major morbidity for high-risk GI surgery (odds ratio [OR], 0.92; 95% CI, 0.88-0.96), low-risk GI surgery (OR, 0.96; 95% CI, 0.95-0.98), gynecology oncology surgery (OR, 0.97; 95% CI, 0.94-0.99), and spine surgery (OR, 0.97; 95% CI, 0.96-0.99), after adjusting for hospital setting, hospital, surgeon and anesthesiologist volume, and patient age, sex, and comorbidity burden. The adjusted associations were not significant for other types of procedures.</p><p><strong>Conclusions and relevance: </strong>In this study, increasing familiarity of the surgeon-anesthesiologist dyad was associated with improved postoperative outcomes for patients undergoing low- and high-risk GI surgery, gynecology oncology surgery, and spine surgery. For each additional time that a unique surgeon-anesthesiologist dyad worked together, the odds of 90-day major morbidity decreased by 4% for low-risk GI surgery, 8% for high-risk GI surgery, 3% for gynecology oncology surgery, and 3% for spine surgery. Additional research is needed to determine the most effective care structures that harness the benefits of surgeon-anesthesiologist familiarity to potentially improve patient outcomes.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159154","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":"Mitigating the Blood Pressure Fall With Propofol.","authors":"Brandi Bottiger,Jessica Zvara,Michael Mazzeffi","doi":"10.1001/jamasurg.2025.1290","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.1290","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"31 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103786","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":"Hemodynamic Impact of Cipepofol vs Propofol During Anesthesia Induction in Patients With Severe Aortic Stenosis: A Randomized Clinical Trial.","authors":"Tingting Ni,Xiaoxia Zhou,Shuguang Wu,Tao Lv,Yujiao Hu,Qi Gao,Ge Luo,Chen Xie,Jingcheng Zou,Yuexiu Chen,Linqian Zhao,Jie Xiao,Xincheng Tao,Yu Yi,Zhili Xu,Tingting Wang,Junyu Zhou,Yuanyuan Yao,Min Yan","doi":"10.1001/jamasurg.2025.1299","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.1299","url":null,"abstract":"ImportancePostinduction hemodynamic instability is a frequent complication among patients with severe aortic stenosis (AS). Using cipepofol as the anesthesia agent may reduce the incidence and severity of hemodynamic instability.ObjectiveTo assess whether cipepofol outperforms propofol in maintaining postinduction hemodynamic stability in patients with AS.Design, Setting, and ParticipantsThis single-center, randomized clinical trial was conducted from June 29, 2023, to July 8, 2024, at the Second Affiliated Hospital of Zhejiang University School of Medicine in China. Patients with AS scheduled for transcatheter aortic valve replacement (TAVR) were eligible for inclusion.InterventionsParticipants were randomized 1:1 to receive either cipepofol or propofol as anesthesia induction agents at equipotent doses.Main Outcomes and MeasuresThe primary outcome was the area under the curve (AUC) of the mean arterial pressure (MAP) difference from baseline during the initial 15 minutes postinduction.ResultsA total of 124 patients with AS scheduled for TAVR were randomized into either the cipepofol group (n = 62) or the propofol group (n = 62). Of 124 patients randomized, 1 patient from each group was excluded due to ineligibility for the TAVR procedure, and data were analyzed for 122 patients (61 patients per group) based on the intention-to-treat principle. Among 122 total patients, mean (SD) age was 72.2 (5.0) years, and 53 patients (43.4%) were female. The cipepofol group exhibited a significantly smaller median (IQR) AUC (-8505.0 mm Hg · s [-12 402.8 to -5130.0]) compared with the propofol group (-13 189.0 mm Hg · s [-17 006.7 to -7593.3]; P < .001). Moreover, compared with the propofol group, the cipepofol group demonstrated a significantly lower incidence of postinduction hypotension (70.5% vs 88.5%; P = .01) and required a smaller median (IQR) dose of norepinephrine during the first 15 minutes postinduction (6.0 μg [0.0-10.0] vs 10.0 μg [5.0-20.0]; P = .006). Additionally, the 2 groups' bispectral indices were comparable.Conclusions and RelevanceIn this randomized clinical trial, cipepofol provided superior hemodynamic stability as an induction agent compared to propofol at equipotent doses and similar anesthesia depths for patients with AS. Therefore, cipepofol could serve as an alternative induction agent to propofol for patients at high cardiovascular risk.Trial RegistrationClinicalTrials.gov Identifier: NCT05881291.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"18 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103804","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":"Error in Byline.","authors":"","doi":"10.1001/jamasurg.2025.1626","DOIUrl":"10.1001/jamasurg.2025.1626","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of Laparoscopic vs Robotic-Assisted Cholecystectomy in Acute Care Surgery.","authors":"Nathnael Abera Woldehana,Andrew Jung,Brett Colton Parker,Alisa Mae Coker,Elliott Richard Haut,Gina Lynn Adrales","doi":"10.1001/jamasurg.2025.1291","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.1291","url":null,"abstract":"ImportanceThe use of robotic-assisted cholecystectomy in acute care surgery is increasing, but its safety and efficacy compared with laparoscopic cholecystectomy remain unclear.ObjectiveTo compare clinical outcomes and bile duct injury rates between robotic-assisted cholecystectomy and laparoscopic cholecystectomy in acute care surgery.Design, Setting, and ParticipantsThis was a retrospective cohort study using patient data from a commercial claims and encounter database from 2016 to 2021. Included in the study were adult patients undergoing robotic-assisted cholecystectomy or laparoscopic cholecystectomy in acute care surgery. Data were analyzed from January to October 2024.ExposuresRobotic-assisted or laparoscopic cholecystectomy in acute care surgery.Main Outcomes and MeasuresThe primary outcome was bile duct injury.ResultsA total of 844 428 patients (mean [SD] age, 45.6 [12.5] years; 547 665 female [64.9%]) were included in this analysis. After propensity score matching, robotic-assisted cholecystectomy (n = 35 037) and laparoscopic cholecystectomy (n = 35 037) had similar bile duct injury rates (0.37% [128 of 35 037] vs 0.39% [138 of 35 037]; odds ratio [OR], 0.93; 95% CI, 0.73-1.18; P = .54). Robotic-assisted cholecystectomy had higher major postoperative complications (8.37% [2934 of 35 037] vs 5.50% [1926 of 35 037]; OR, 1.57; 95% CI, 1.48-1.67; P < .001), more postoperative drain use (0.63% [219 of 35 037] vs 0.48% [132 of 35 037]; OR, 1.66; 95% CI, 1.34-2.07; P < .001), and longer median (IQR) hospital length of stay (3 [2-4] days vs 2 [1-4] days; P < .001).Conclusions and RelevanceIn this large, propensity-matched cohort analysis of acute care surgery cholecystectomy, robotic-assisted and laparoscopic cholecystectomy had similar bile duct injury rates, but robotic-assisted cholecystectomy was associated with higher postoperative complications, longer hospital stays, and increased drain use. Further research is needed to optimize the use of robotic-assisted cholecystectomy for acute gallbladder disease. These findings suggest that, under current practice conditions, robotic-assisted cholecystectomy may not offer clear benefits compared with the standard, established laparoscopic cholecystectomy approach.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"18 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103785","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":"Role of Preoperative Antibiotic Treatment While Awaiting Appendectomy: The PERFECT-Antibiotics Randomized Clinical Trial.","authors":"Karoliina Jalava,Ville Sallinen,Hanna Lampela,Hanna Malmi,Ingeborg Steinholt,Knut Magne Augestad,Ari Leppäniemi,Panu Mentula","doi":"10.1001/jamasurg.2025.1212","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.1212","url":null,"abstract":"ImportanceAntibiotics are thought to decelerate inflammation progression and reduce complications in acute uncomplicated appendicitis. The evidence of their effectiveness is insufficient, and treatment practices vary widely.ObjectiveTo investigate the effect of preoperatively started antibiotic treatment on the rate of appendiceal perforation.Design, Setting, and ParticipantsThis multicenter, noninferiority, open-label randomized clinical trial was conducted in 2 hospitals in Finland and 1 hospital in Norway between May 18, 2020, and January 22, 2023. Data analysis was performed from March 2023 to March 2024. Eligible patients were adults (aged >18 years) diagnosed with presumed uncomplicated acute appendicitis. Patients with allergies or other contraindications to study antibiotics, previously started antibiotic treatment, pregnancy, a suspicion of perforated appendicitis, or other reasons to perform prompt surgery were excluded. Patients were randomized 1:1 with a web-based service simultaneously as the laparoscopic appendectomy was scheduled.InterventionsAntibiotic treatment started while waiting for surgery (cefuroxime, 1500 mg, and metronidazole, 500 mg, every 8 hours until the surgery) or waiting without antibiotic treatment. Patients in both groups received a single prophylactic dose of antibiotics in the induction of anesthesia.Main Outcomes and MeasuresThe primary outcome was perforated appendicitis diagnosed during surgery. The absolute difference in perforation rates was compared between the groups by an intention-to-treat analysis, and the predefined noninferiority margin was 5 percentage points. Secondary outcomes included surgical site infections within 30 days.ResultsA total of 1797 patients were randomly assigned to either the antibiotic group (n = 901) or no-antibiotic group (n = 896). Median (IQR) patient age was 35 (28-46) years, and 793 patients (45%) were female. After randomization, 23 patients (1.3%) were excluded, leaving 1774 patients for the intention-to-treat analyses. The difference between the appendiceal perforation rates met the noninferiority threshold: 74 of 888 patients in the antibiotic group (8.3%) vs 79 of 886 patients in the no-antibiotic group (8.9%; absolute difference, 0.6 percentage points; 95% CI, -2.0 to 3.2 percentage points; P = .66; risk ratio, 1.07; 95% CI, 0.79 to 1.45). For secondary outcome, the surgical site infection rate was slightly lower in the antibiotic group (14 of 887 [1.6%]) vs the no-antibiotic group (28 of 886 [3.2%]; absolute difference, 1.6 percentage points; 95% CI, 0.2 to 3.0 percentage points; P = .03).Conclusions and RelevanceIn this multicenter noninferiority randomized clinical trial, preoperatively started antibiotic treatment did not decrease the risk of appendiceal perforation when appendectomy was performed within 24 hours in adult patients with presumed uncomplicated acute appendicitis.Trial RegistrationEudraCT Identifier: 2019-002348-26.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"10 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945540","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}