JAMA surgery最新文献

{"title":"Early Surgery for Painful Chronic Pancreatitis.","authors":"Rupjyoti Talukdar, Guduru Venkat Rao, Duvuur Nageshwar Reddy","doi":"10.1001/jamasurg.2025.0419","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0419","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763749","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":"Early Surgery for Painful Chronic Pancreatitis-Reply.","authors":"Charlotte L van Veldhuisen, Marja A Boermeester, Yama Issa","doi":"10.1001/jamasurg.2025.0422","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0422","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763838","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 Supplement and Change to Open Access.","authors":"","doi":"10.1001/jamasurg.2025.0799","DOIUrl":"10.1001/jamasurg.2025.0799","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763929","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":"Appendiceal Tumor Prevalence in Patients With Periappendicular Abscess.","authors":"Roosa Salminen, Jenny Alajääski, Tero Rautio, Saija Hurme, Pia Nordström, Elisa Mäkäräinen, Elina Lietzén, Tarja Pinta, Marie Grönroos-Korhonen, Tuomo Rantanen, Jan Andersén, Anne Mattila, Jyrki Kössi, Antti Riikola, Hannu Paajanen, Markku Matikainen, Vesa Pokela, Paulina Salminen","doi":"10.1001/jamasurg.2025.0312","DOIUrl":"10.1001/jamasurg.2025.0312","url":null,"abstract":"<p><strong>Importance: </strong>There are no large prospective cohort studies validating the previously reported high appendiceal tumor rate in patients with periappendicular abscess.</p><p><strong>Objective: </strong>To confirm the appendiceal neoplasm rate associated with periappendicular abscess.</p><p><strong>Design, setting, and participants: </strong>The Peri-Appendicitis Acuta Tumor prospective multicenter cohort study was conducted at 12 hospitals in Finland. All consecutive adult patients diagnosed with acute appendicitis were included, focusing on patients with imaging confirmed periappendicular abscess undergoing interval appendectomy or emergency appendectomy with available histopathology from December 3, 2020, through December 2, 2022. These data were analyzed from May 2023 to September 2024.</p><p><strong>Interventions: </strong>Recommended treatment was initial antibiotics and, if needed, drainage, followed by interval appendectomy at 3 months.</p><p><strong>Main outcomes and measures: </strong>The main outcome was appendiceal tumor rate associated with periappendicular abscess. Secondary outcomes included tumor histology and prognostic factors for appendiceal tumor (age, sex, body mass index, duration of symptoms, C-reactive protein level, white blood cell count, computed tomography findings, and tumor markers).</p><p><strong>Results: </strong>There were 6165 consecutive patients with acute appendicitis. Of these, 396 patients (6.4%) presented with periappendicular abscess, with 9 patients declining to participate and 17 patients without available appendiceal histopathology, leaving 370 patients for the analysis (181 female [48.8%] and 189 male [51.2%]; median age, 58 [range, 18-90] years). Appendiceal tumor rate in patients with periappendicular abscess was 14.3% (53 of 370; 95% CI, 10.8%-17.9%), which was higher compared with uncomplicated acute appendicitis (14.3% vs 1.5%; 48 of 3170; 95% CI, 1.1%-1.9%; P < .001) and complicated acute appendicitis without periappendicular abscess (14.3% vs 2.4%; 63 of 2599; 95% CI, 1.8%-3.0%; P < .001). Patient age (odds ratio, 1.06; 95% CI, 1.04-1.09; P < .001) was the only factor associated with periappendicular abscess tumor prevalence. A cutoff point of age 35 years with high sensitivity was chosen (area under the curve, 0.75; 95% CI, 0.68-0.82) and only 1 patient below this threshold presented with an appendiceal tumor (sensitivity, 98.1%; 95% CI, 94.5-100). Of the 54 tumors on 53 patients, there were 21 low-grade appendiceal mucinous neoplasms, 20 adenocarcinomas, 8 adenomas, and 5 neuroendocrine tumors. The complication rate of emergency appendectomy was higher than after interval appendectomy (31.3% [70 of 224] vs 4.8% [5 of 105], respectively [P < .001]).</p><p><strong>Conclusions and relevance: </strong>This large prospective cohort study confirmed a high appendiceal tumor rate associated with periappendicular abscess, especially in patients older than 35 years. At the least, all pati","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763824","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":"Operative vs Nonoperative Treatment for Adult Symptomatic Lumbar Scoliosis at 8-Year Follow-Up: A Nonrandomized Clinical Trial.","authors":"Justin S Smith, Michael P Kelly, Elizabeth L Yanik, Christine R Baldus, Vy Pham, David Ben-Israel, Jon D Lurie, Charles Edwards, Steven D Glassman, Lawrence G Lenke, Jacob M Buchowski, Leah Y Carreon, Charles H Crawford, Stephen J Lewis, Tyler Koski, Virginie Lafage, Munish C Gupta, Han Jo Kim, Christopher P Ames, Shay Bess, Frank J Schwab, Christopher I Shaffrey, Keith H Bridwell","doi":"10.1001/jamasurg.2025.0496","DOIUrl":"10.1001/jamasurg.2025.0496","url":null,"abstract":"<p><strong>Importance: </strong>Long-term follow-up studies of operative and nonoperative treatment of adult symptomatic lumbar scoliosis (ASLS) are needed to assess benefits and durability.</p><p><strong>Objective: </strong>To assess the durability of treatment outcomes for operative vs nonoperative treatment of ASLS.</p><p><strong>Design, setting, and participants: </strong>The Adult Symptomatic Lumbar Scoliosis 1 (ASLS-1) study was a multicenter, prospective study with randomized and observational cohorts designed to assess operative vs nonoperative ASLS treatment. Operative and nonoperative patients were compared using as-treated analysis of combined randomized and observational cohorts. Patients with ASLS aged 40 to 80 years were enrolled at 9 centers in North America. Data were analyzed from November 2023 to July 2024.</p><p><strong>Interventions: </strong>Operative and nonoperative treatment approaches.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes measures were the Oswestry Disability Index (ODI) and Scoliosis Research Society 22 (SRS-22) at 2-, 5-, and 8-year follow-up.</p><p><strong>Results: </strong>The 286 enrolled patients (104 in the nonoperative group: median [IQR] age, 61.9 [54.4-68.8] years; 97 female [93%]; 182 in the operative group: median [IQR] age, 60.2 [53.5-66.6] years; 161 female [88%]) had follow-up rates at 2, 5, and 8 years of 90% (256 of 286), 70% (199 of 286), and 72% (205 of 286), respectively. At 2 years, compared with those in the nonoperative group, patients in the operative group had better ODI (mean difference = -12.98; 95% CI, -16.08 to -9.88; P < .001) and SRS-22 (mean difference = 0.57; 95% CI, 0.45-0.70; P < .001) scores, with mean differences exceeding the minimal detectable measurement difference (MDMD) for ODI (7) and SRS-22 (0.4). Mean differences at 5 years (ODI = -11.25; 95% CI, -15.20 to 7.31; P <.001; SRS-22 = 0.58; 95% CI, 0.44-0.72; P < .001) and 8 years (ODI = -14.29; 95% CI, -17.81 to -10.78; P <.001; SRS-22 = 0.74; 95% CI, 0.57-0.90; P < .001) remained as favorable as at 2 years without evidence of degradation. The treatment-related serious adverse event (SAE) incidence rates for operative patients at 2, 2 to 5, and 5 to 8 years were 22.24, 9.08, and 8.02 per 100 person-years, respectively. At 8 years, operative patients with 1 treatment-related SAE still had significant improvement, with mean treatment differences that exceeded MDMD (ODI = -9.49; 95% CI, -14.23 to -4.74; P < .001; SRS-22 = 0.62; 95% CI, 0.41-0.84; P < .001).</p><p><strong>Conclusions and relevance: </strong>Results of this nonrandomized clinical trial reveal that, on average, operative treatment for ASLS provided significantly greater clinical improvement than nonoperative treatment at 2-, 5- and 8-year follow-up, with no evidence of deterioration. Operative patients with a treatment-related SAE still maintained greater improvement than nonoperative patients. These findings suggest long-term durability of","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763930","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":"Survival and Cost-Effectiveness of Bariatric Surgery Among Patients With Obesity and Cirrhosis.","authors":"Shalini Bansal, Amanda Bader, Nadim Mahmud, David E Kaplan","doi":"10.1001/jamasurg.2025.0490","DOIUrl":"10.1001/jamasurg.2025.0490","url":null,"abstract":"<p><strong>Importance: </strong>Obesity and steatotic liver disease are associated with excess morbidity and mortality from cardiovascular, pulmonary, metabolic, and hepatic causes. Bariatric surgery has demonstrated long-term benefits in terms of weight loss and mortality rates, but barriers to its utilization persist.</p><p><strong>Objective: </strong>To evaluate the impact of bariatric surgery on outcomes and cost-effectiveness among patients with obesity, focusing on those with cirrhosis.</p><p><strong>Design, setting, and participants: </strong>This economic evaluation was a retrospective cohort study including US veterans older than 18 years with a body mass index (BMI) higher than 35 or with a BMI higher than 30 and more than 1 major metabolic comorbidity. These veterans were referred to a structured lifestyle modification program (MOVE!), and a subset proceeded to bariatric surgery, including sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) from 2008 to 2020. Risk set matching was used to match bariatric surgery cases 1:5 with nonsurgical controls. Data were analyzed from September 2008 to September 2023.</p><p><strong>Exposures: </strong>Bariatric surgery (SG or RYGB) or structured lifestyle intervention (MOVE!).</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were the incremental cost-effectiveness ratio (ICER) of SG or RYGB vs MOVE! over 10 years. Secondary outcomes included overall survival, quality-adjusted survival, and weight loss achieved.</p><p><strong>Results: </strong>The final cohort included 4301 SG, 1906 RYGB, and 31 055 MOVE! participants, among whom 64, 8, and 354, respectively, had cirrhosis. The median (IQR) age of the cohort was 52 (44-59) years; there were 25 581 male patients (68.7%) and 11 681 female (31.3%). Compared with MOVE!, bariatric surgery was associated with longer observed survival (9.67 years vs 9.46 years overall; 9.09 years vs 8.23 years in cirrhosis). The ICER was $132 207 for SG and $159 027 for RYGB in the overall cohort, and $18 679 for SG and $44 704 for RYGB in the cirrhosis cohorts. Bariatric surgery was cost-effective at a willingness-to-pay threshold of $100 000 per quality-adjusted life-year among patients with cirrhosis.</p><p><strong>Conclusions and relevance: </strong>Bariatric surgery was associated with improved survival and expected weight loss and was cost-effective. These findings support the expanded use of bariatric surgery in appropriately selected patients, including those with cirrhosis, to improve outcomes and reduce long-term health care costs.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763933","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":"Surgery for Appendicitis-Still Controversial?","authors":"Lawrence Lee, Liane S Feldman","doi":"10.1001/jamasurg.2025.0396","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0396","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763931","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":"Faculty Characteristics and Surgery Trainee Attrition.","authors":"Haley Harris, Isabelle M C Tan, Yuqing Qiu, Julianna Brouwer, Julie Ann Sosa, Heather Yeo","doi":"10.1001/jamasurg.2025.0274","DOIUrl":"10.1001/jamasurg.2025.0274","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709816","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":"Options for Management of Fractures of the Humeral Diaphysis.","authors":"Kevin C Chung","doi":"10.1001/jamasurg.2025.0395","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0395","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709819","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 Management of Fractures of the Humeral Diaphysis: The Humeral Shaft Fracture Fixation Randomized Clinical Trial.","authors":"William M Oliver, Katrina R Bell, Thomas H Carter, Catriona Graham, Timothy O White, Nicholas D Clement, Andrew D Duckworth, Samuel G Molyneux","doi":"10.1001/jamasurg.2025.0301","DOIUrl":"10.1001/jamasurg.2025.0301","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Humeral shaft fractures are routinely managed nonoperatively, but this approach is potentially associated with higher nonunion rates and inferior functional outcomes when compared with operative fixation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess whether there is any difference in outcome between surgery and functional bracing for adults with an isolated, closed humeral shaft fracture.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This prospective, superiority, parallel-group randomized clinical trial was conducted between September 2018 and October 2023 and took place at an academic major trauma center in the United Kingdom. Patients were reviewed at 2 and 6 weeks and 3, 6, and 12 months postintervention. Patients included 70 adults with an isolated, closed humeral shaft fracture. Exclusion criteria included absolute indications for surgery, pathological/periprosthetic fractures, multiple traumas, significant frailty, and inability to comply with follow-up. Data were analyzed from November 2023 through January 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Open reduction and plate fixation (n = 36) or functional bracing (n = 34). Seven patients did not receive their assigned treatment (operative, 5; nonoperative, 2).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome measure was the Disabilities of the Arm, Shoulder, and Hand score (DASH) at 3 months postintervention. Secondary outcomes included health-related quality of life (EuroQol 5-Dimension [EQ-5D]/health visual analog scale [EQ-VAS] and Short Form [SF]-12 Physical Component Summary [PCS]/Mental Component Summary [MCS] scores), pain, shoulder/elbow range of motion, and complications. Intention-to-treat analyses were used.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study included 70 patients (mean [SD] age, 49 [17.1] years; 38 female [54%] and 32 male [46%]). At 3 months, 66 patients (94%) had completed follow-up. The operative group had a significantly better DASH score (difference, 15.0; P = .01). Surgery was also associated with a superior DASH score at 6 weeks (difference, 14.7; P = .01), but not at 6 months (P = .10) or at 12 months (P = .78). Surgery was further associated with a higher EQ-5D score (6 weeks: difference, 0.126, P = .03), EQ-VAS score (6 months: difference, 7; P = .04), and SF-12 MCS score (6 weeks: difference, 9.3; P = .001; 3 months: difference, 6.9; P = .01; and 6 months: difference, 7.1; P = .01). Brace-related dermatitis was significantly more common in the nonoperative group (18% vs operative 3%; P = .05). There were 8 nonunions (11%; operative 6% vs nonoperative 18%, P = .14).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;For patients with a humeral shaft fracture in this study, surgery conferred early functional advantages over bracing. However, these benefits should be considered in the context of potential operative risks and the absence of any difference in outcomes at 1 year.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial reg","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709818","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}