JAMA surgery最新文献

{"title":"Management of Paraesophageal Hernia-Still a Controversial Topic.","authors":"Francisco Schlottmann, Fernando A M Herbella, Marco G Patti","doi":"10.1001/jamasurg.2024.5765","DOIUrl":"10.1001/jamasurg.2024.5765","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"255-256"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877062","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":"Racial and Ethnic Disparities in Use of Helicopter Transport After Severe Trauma in the US.","authors":"Christian Mpody, Maíra I Rudolph, Alexandra Bastien, Ibraheem M Karaye, Tracey Straker, Felix Borngaesser, Matthias Eikermann, Olubukola O Nafiu","doi":"10.1001/jamasurg.2024.6402","DOIUrl":"10.1001/jamasurg.2024.6402","url":null,"abstract":"<p><strong>Importance: </strong>In the US, traumatic injuries are a leading cause of mortality across all age groups. Patients with severe trauma often require time-sensitive, specialized medical care to reduce mortality; air transport is associated with improved survival in many cases. However, it is unknown whether the provision of and access to air transport are influenced by factors extrinsic to medical needs, such as race or ethnicity.</p><p><strong>Objective: </strong>To examine the current trends of racial and ethnic disparities in air transport use for patients who sustain severe trauma.</p><p><strong>Design, setting, and participants: </strong>This population-based cohort study used data from the National Trauma Data Bank from 2016 to 2022. Participants were patients older than 15 years who sustained a severe injury and required an urgent surgical procedure or intensive care unit (ICU) admission at level I or II trauma centers with helicopter service.</p><p><strong>Exposure: </strong>Severe injury requiring treatment at a level I or II trauma center.</p><p><strong>Main outcomes and measures: </strong>The primary mode of transport, categorized as either helicopter ambulance or ground ambulance. A multifaceted approach was used to narrow the observed racial and ethnic disparities in helicopter deployment. The secondary outcome was mortality after helicopter transport vs ground ambulance transport.</p><p><strong>Results: </strong>Data were included for 341 286 patients at 458 level I or II trauma centers with helicopter service. Their mean (SD) age was 47 (20) years; 243 936 patients (71.6%) were male and 96 633 (28.4%) female. Asian individuals were less likely to receive helicopter transport compared with White individuals (6.8% vs 21.8%; aRR, 0.38; 95% CI, 0.30-0.48; P < .001), driven by lower use for Asian patients in teaching hospitals (aRR, 0.29; 95% CI, 0.21-0.40; P < .001) and level I trauma centers (aRR, 0.33; 95% CI, 0.24-0.44; P < .001). In addition, Black patients were less likely to receive helicopter transport (8.7% vs 21.8%; aRR, 0.42; 95% CI, 0.36-0.49; P < .001), particularly in teaching hospitals (aRR, 0.41; 95% CI, 0.33-0.50; P < .001) and level I trauma centers (aRR, 0.40; 95% CI, 0.34-0.49; P < .001). A similar but less pronounced disparity was noted for Hispanic patients. Helicopter transport was associated with a lower mortality risk compared with ground transport (37.7% vs 42.6%; adjusted relative risk [aRR], 0.87; 95% CI, 0.85-0.89; P < .001).</p><p><strong>Conclusion and relevance: </strong>This study found that racial and ethnic minority patients, particularly Asian and Black patients, and notably those treated at level I teaching hospitals were less likely to receive airlift services compared with White patients. The current expansion of helicopter emergency medical services has yet to translate into equitable care for patients of all races and ethnicities.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"313-321"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005648","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":"Oral vs Intravenous Antibiotics for Fracture-Related Infections: The POvIV Randomized Clinical Trial.","authors":"William T Obremskey, Robert V O'Toole, Saam Morshed, Paul Tornetta, Clinton K Murray, Clifford B Jones, Daniel O Scharfstein, Tara J Taylor, Anthony R Carlini, Jennifer M DeSanto, Renan C Castillo, Michael J Bosse, Madhav A Karunakar, Rachel B Seymour, Stephen H Sims, David A Weinrib, Christine Churchill, Eben A Carroll, Holly T Pilson, James Brett Goodman, Martha B Holden, Anna N Miller, Debra L Sietsema, Philip F Stahel, Hassan Mir, Andrew H Schmidt, Jerald R Westberg, Brian Mullis, Karl D Shively, Robert A Hymes, Sanjit R Konda, Heather A Vallier, Mary Alice Breslin, Christopher S Smith, Colin V Crickard, J Spence Reid, Mitch Baker, W Andrew Eglseder, Christopher LeBrun, Theodore Manson, Daniel C Mascarenhas, Jason Nascone, Andrew N Pollak, Michael G Schloss, Marcus F Sciadini, Yasmin Degani, Theodore Miclau, David B Weiss, Seth R Yarboro, Eric D McVey, Reza Firoozabadi, Julie Agel, Eduardo J Burgos, Vamshi Gajari, Andres Rodriguez-Buitrago, Rajesh R Tummuru, Karen M Trochez","doi":"10.1001/jamasurg.2024.6439","DOIUrl":"10.1001/jamasurg.2024.6439","url":null,"abstract":"<p><strong>Importance: </strong>Fracture-related infection (FRI) is a serious complication following fracture fixation surgery. Current treatment of FRIs entails debridement and 6 weeks of intravenous (IV) antibiotics. Lab data and retrospective clinical studies support use of oral antibiotics, which are less expensive and may have fewer complications than IV antibiotics.</p><p><strong>Objective: </strong>To evaluate the effectiveness of treatment of FRI with oral vs IV antibiotics.</p><p><strong>Design, setting, and participants: </strong>The POvIV multicenter, prospective randomized clinical trial was conducted across 24 trauma centers in the US among patients aged 18 to 84 years who had fracture repair or arthrodesis with fixation with implants and developed an FRI without radiographic evidence of osteomyelitis. Patients were enrolled between March 2013 and September 2018 and followed up for 12 months after hospitalization for treatment of their FRI.</p><p><strong>Intervention: </strong>Oral vs IV antibiotics following FRI.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was number of surgical interventions, and the primary hypothesis was noninferiority of oral vs IV antibiotics with respect to the number of study injury-related surgical interventions by 1 year. Unadjusted modified intent-to-treat (mITT) and adjusted per-protocol (PP) analyses were prespecified. A post hoc adjusted mITT analysis was conducted to resolve discrepancies between the results of the prespecified mITT and PP analyses. Recurrence of a deep surgical site infection was a key secondary outcome.</p><p><strong>Results: </strong>Among 233 total patients, mean (SD) age was 46.0 (13.9) years, and 53 patients were female (22.7%). The mean number of surgical interventions within 1 year was 1.3 and 1.1 for the oral and IV groups, respectively. The upper bound of the 95% confidence interval of the mean difference with unadjusted mITT analysis was 0.59, which was lower than the prespecified noninferiority margin of 0.67, indicating noninferiority of oral to IV antibiotics. Adjusted PP analysis did not support noninferiority of the number of reoperations. A post hoc adjusted mITT analysis also showed noninferiority. The treatment effects estimates for the key secondary outcome of reinfection showed a similar pattern as those for the primary outcome.</p><p><strong>Conclusions and relevance: </strong>In this prospective randomized clinical trial, oral antibiotic treatment was noninferior to IV treatment with respect to the primary outcome of number of surgical interventions based on mITT analysis. However, there is some uncertainty in these findings based on preplanned and post hoc secondary analyses. A similar pattern of treatment effect estimates was observed for the secondary outcome of recurrence of infection.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT01714596.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"276-284"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005744","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":"Practical Guide to Administrative and Billing Big Data Sources.","authors":"Rachel A Greenup, Danny Chu, Timothy M Pawlik","doi":"10.1001/jamasurg.2024.6003","DOIUrl":"10.1001/jamasurg.2024.6003","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"342-343"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949206","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":"Novel Posterior Rectus Sheath Flap for Paraesophageal Hernia Repairs.","authors":"Yalini Vigneswaran, Lawrence J Gottlieb, Mustafa Hussain","doi":"10.1001/jamasurg.2024.2561","DOIUrl":"10.1001/jamasurg.2024.2561","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"349-350"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983636","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":"Multicomponent Deimplementation Strategy to Reduce Low-Value Preoperative Testing.","authors":"Alexis G Antunez, Ruby J Kazemi, Caroline Richburg, Cecilia Pesavento, Andrew Vastardis, Erin Kim, Abigail L Kappelman, Devak Nanua, Hiba Pediyakkal, Faelan Jacobson-Davies, Shawna N Smith, James Henderson, Valerie Gavrila, Anthony Cuttitta, Hari Nathan, Lesly A Dossett","doi":"10.1001/jamasurg.2024.6063","DOIUrl":"10.1001/jamasurg.2024.6063","url":null,"abstract":"<p><strong>Importance: </strong>Routine preoperative blood tests and electrocardiograms before low-risk surgery do not prevent adverse events or change management but waste resources and can cause patient harm. Given this, multispecialty organizations recommend against routine testing before low-risk surgery.</p><p><strong>Objective: </strong>To determine whether a multicomponent deimplementation strategy (the intervention) would reduce low-value preoperative testing before low-risk general surgery operations.</p><p><strong>Design, setting, and participants: </strong>This study had a pre-post quality improvement interventional design using interrupted time series and difference-in-difference analytic approaches. The setting was a single academic, quaternary referral hospital with 2 freestanding ambulatory surgery centers and a central preoperative clinic. Included in the study were adult patients undergoing nonurgent outpatient inguinal hernia repairs, lumpectomy, or laparoscopic cholecystectomy between June 2022 and August 2023. Eligible clinicians included those treating at least 1 patient during both the preintervention and postintervention periods.</p><p><strong>Interventions: </strong>All clinicians were exposed to the multicomponent deimplementation intervention, and their testing practices were compared before and after the intervention. The strategy components were evidenced-based decisional support, multidisciplinary stakeholder engagement, educational sessions, and consensus building with surgeons and physician assistants staffing a preoperative clinic.</p><p><strong>Main outcomes and measures: </strong>The primary end point of the trial was the rate of unnecessary preoperative tests across each trial period.</p><p><strong>Results: </strong>A total of 1143 patients (mean [SD] age, 58.7 [15.5] years; 643 female [56.3%]) underwent 261 operations (23%) in the preintervention period, 510 (45%) in the intervention period, and 372 (33%) in the postintervention period. Unnecessary testing rates decreased over each period (intervention testing rate, -16%; 95% CI, -4% to -27%; P = .01; postintervention testing rate, -27%; 95% CI, -17% to -38%; P = .003) and within each test category. The decrease in overall testing was not observed at other hospitals in the state on adjusted difference-in-difference analysis.</p><p><strong>Conclusions and relevance: </strong>In this quality improvement study, a multicomponent deimplementation strategy was associated with a reduction in unnecessary preoperative testing before low-risk general surgery operations. The resulting changes in testing practice patterns were not associated with temporal trends within or outside the study hospital. Results suggest that this intervention was effective, applicable to common general surgery operations, and adaptable for expansion into appropriate clinical settings.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"304-311"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983626","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":"Racing Against Time in Thoracotomy for Traumatic Cardiac Arrest.","authors":"Christine M Leeper, Josh B Brown, Brian S Zuckerbraun","doi":"10.1001/jamasurg.2024.7231","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.7231","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501368","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":"Indocyanine Green for Vagus Nerve-Preserving Gastrectomy-Reply.","authors":"Zhibo Yan, Meng Wei, Wenbin Yu","doi":"10.1001/jamasurg.2024.7204","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.7204","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501335","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":"Prehospital Resuscitative Thoracotomy for Traumatic Cardiac Arrest.","authors":"Zane B Perkins, Robert Greenhalgh, Ewoud Ter Avest, Shadman Aziz, Andrew Whitehouse, Steve Read, Liz Foster, Frank Chege, Christine Henry, Richard Carden, Laura Kocierz, Gareth Davies, Tom Hurst, Robbie Lendrum, Stephen H Thomas, David J Lockey, Michael D Christian","doi":"10.1001/jamasurg.2024.7245","DOIUrl":"10.1001/jamasurg.2024.7245","url":null,"abstract":"<p><strong>Importance: </strong>Traumatic cardiac arrest (TCA) presents a critical challenge in trauma care, often occurring rapidly after injury before effective interventions are available.</p><p><strong>Objective: </strong>To evaluate the association of prehospital resuscitative thoracotomy with survival outcomes for TCA.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study examined all cases of prehospital resuscitative thoracotomy for TCA in London from January 1999 to December 2019. Data were analyzed from July 2022 to July 2023.</p><p><strong>Exposure: </strong>Prehospital resuscitative thoracotomy for TCA.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was survival to hospital discharge. Secondary outcomes included survival to hospital admission and neurological status at discharge.</p><p><strong>Results: </strong>Prehospital resuscitative thoracotomy was undertaken in 601 patients with out-of-hospital TCA. The median (IQR) age was 25 (20-37) years; 538 (89.5%) were male and 63 (10.5%) female. A total of 529 patients (88.0%) had a penetrating mechanism of injury. TCA occurred at a median (IQR) of 12 (6-22) minutes after the emergency call, with 491 arrests (81.7%) before the advanced trauma team's arrival. TCA was the result of cardiac tamponade (105 patients, 17.5%), exsanguination (418 patients, 69.6%), and exsanguination combined with cardiac tamponade (72 patients, 12.0%). Thirty patients (5.0%) survived to hospital discharge, with a favorable neurological outcome observed in 23 survivors (76.6%). Survival varied significantly with the cause of TCA: 22 of 105 patients (21%) with cardiac tamponade, 8 of 418 patients (1.9%) with exsanguination, and none of the 72 patients with combined or other pathologies survived. There were no survivors beyond 15 minutes of TCA for cardiac tamponade and 5 minutes after exsanguination. Multivariable analysis revealed that the cause of TCA (adjusted odds ratio [aOR], 21.1; 95% CI, 8.1-54.7; P < .001), duration of TCA (aOR, 20.9; 95% CI, 4.4-100.6, P < .001), and absence of the need for internal cardiac massage (AOR, 0.2; 95% CI, 0.06-0.5; P = .001) were independently associated with survival.</p><p><strong>Conclusions and relevance: </strong>TCA occurs soon after injury, with only a brief window available for effective intervention. This study found that resuscitative thoracotomy is feasible in a mature, physician-led, urban prehospital system and is associated with improved survival for patients with out-of-hospital TCA, particularly when caused by cardiac tamponade, in situations where other treatment options are limited.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501363","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":"Bias in Treatment of Claudication-Where Do We Go From Here?","authors":"Jason M Johanning","doi":"10.1001/jamasurg.2024.7232","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.7232","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501407","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}