JAMA surgery最新文献

{"title":"Diagnosis of Respiratory Sarcopenia for Stratifying Postoperative Risk in Non-Small Cell Lung Cancer.","authors":"Changbo Sun, Yoshifumi Hirata, Takuya Kawahara, Mitsuaki Kawashima, Masaaki Sato, Jun Nakajima, Masaki Anraku","doi":"10.1001/jamasurg.2024.4800","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4800","url":null,"abstract":"<p><strong>Importance: </strong>Physical biomarkers for stratifying patients with lung cancer into subtypes suggestive of outcomes are underexplored.</p><p><strong>Objective: </strong>To investigate the clinical utility of respiratory sarcopenia for optimizing postoperative risk stratification in patients with non-small cell lung cancer (NSCLC).</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study reviewed consecutive patients undergoing lobectomy and mediastinal lymph node dissection for NSCLC at 2 institutions in Tokyo, Japan, between 2009 and 2018. Eligible patients underwent electronic computed tomography image analysis. Follow-up began at the date of surgery and continued until death, the last contact, or March 2022. Data analysis was performed from April 2022 to March 2023.</p><p><strong>Main outcomes and measures: </strong>Respiratory sarcopenia was identified by poor respiratory strength (peak expiratory flow rate) and was confirmed by a low pectoralis muscle index (PMI; pectoralis muscle area/body mass index). Patients with poor peak expiratory flow rate but normal PMI received a diagnosis of pre-respiratory sarcopenia. Short-term and long-term postoperative outcomes were compared among patients with a normal status, pre-respiratory sarcopenia, and respiratory sarcopenia. Group differences were analyzed using the Kruskal-Wallis test and Pearson χ2 test for continuous and categorical data, respectively. Survival differences were compared using the log-rank test. Univariable and multivariable analyses were conducted using the Cox proportional hazards model.</p><p><strong>Results: </strong>Of a total of 1016 patients, 806 (497 men [61.7%]; median [IQR] age, 69 [64-76] years) were eligible for electronic computed tomography image analysis. The median (IQR) duration of follow-up for survival was 5.2 (3.6-6.4) years. Respiratory strength was more closely correlated with PMI than pectoralis muscle radiodensity (Pearson r2, 0.58 vs 0.29). Respiratory strength and PMI declined with aging simultaneously (both P for trend < .001). Pre-respiratory sarcopenia was present in 177 patients (22.0%), and respiratory sarcopenia was present in 130 patients (16.1%). The risk of postoperative complications escalated from 82 patients (16.4%) with normal status to 39 patients (22.0%) with pre-respiratory sarcopenia to 39 patients (30.0%) with respiratory sarcopenia (P for trend < .001), as did the risk of delayed recovery after surgery (P for trend < .001). Compared with patients with normal status or pre-respiratory sarcopenia, patients with respiratory sarcopenia exhibited worse 5-year overall survival (438 patients [87.2%] vs 133 patients [72.9%] vs 85 patients [62.5%]; P for trend < .001). Multivariable analysis identified respiratory sarcopenia as a factor independently associated with increased risk of mortality (hazard ratio, 1.83; 95% CI, 1.15-2.89; P = .01) after adjustment for sex, age, smoking status, performance ","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545516","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":"Elimination of the Percentile Score From the Surgical ABSITE-The Fellowship Director Perspective.","authors":"Jason T Lee","doi":"10.1001/jamasurg.2024.4506","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4506","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545517","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":"Time Since Prior NSTEMI and Major Adverse Cardiovascular and Cerebrovascular Events After Noncardiac Surgery.","authors":"Laurent G Glance, Karen E Joynt Maddox, Sabu Thomas, Mark J Sorbero, Lee A Fleisher, Stewart J Lustik, Heather L Lander, Jingjing Shang, Patricia W Stone, Michael P Eaton, Marjorie S Gloff, Andrew W Dick","doi":"10.1001/jamasurg.2024.4683","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4683","url":null,"abstract":"<p><strong>Importance: </strong>Delaying elective noncardiac surgery after a recent acute myocardial infarction is associated with better outcomes, but current American Heart Association recommendations are based on data that are more than 20 years old.</p><p><strong>Objective: </strong>To examine the association between the time since a non-ST-segment elevation myocardial infarction (NSTEMI) and the risk of postoperative major adverse cardiovascular and cerebrovascular events (MACCE).</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study examined Medicare claims data between 2015 and 2020 for patients 67 years or older who had major noncardiac surgery. Data were analyzed from September 21, 2023, to February 1, 2024.</p><p><strong>Exposure: </strong>Time elapsed between a prior NSTEMI and surgery.</p><p><strong>Main outcomes and measures: </strong>MACCE (30-day mortality, in-hospital myocardial infarction, heart failure, or stroke) and all-cause 30-day mortality. Multivariable logistic regression was used to estimate the association between outcomes and time since a prior NSTEMI.</p><p><strong>Results: </strong>The sample included 5 227 473 surgeries. The mean (SD) age was 75.7 (6.6) years; 2 981 239 (57.0%) were female, and 2 246 234 (43%) were male. There were 42 278 patients (0.81%) with a previous NSTEMI. Compared with patients without a prior NSTEMI, patients with an NSTEMI within 30 days of elective surgery had higher odds of MACCE, regardless of whether they had undergone coronary revascularization (adjusted odds ratio [aOR], 2.15; 95% CI, 1.09-4.23; P = .03) or not (aOR, 2.04; 95% CI, 1.31-3.16; P = .001). The odds of postoperative MACCE leveled off after 30 days in patients who had undergone any coronary revascularization procedure (and after 90 days in patients with drug-eluting stents) and then increased after 180 days (any revascularization at 181-365 days: aOR, 1.46; 95% CI, 1.25-1.71; P < .001; patients with drug-eluting stents at 181-365 days: aOR, 1.73; 95% CI, 1.42-2.12; P < .001). The odds of MACCE did not level off for patients who did not have revascularization. Findings for all-cause 30-day mortality were similar to those for MACCE, except that the odds of mortality in patients with previous NSTEMI who had revascularization leveled off after 60 days in elective surgeries and 90 days for nonelective surgeries (elective 30-day: aOR, 2.88; 95% CI, 1.30-6.36; P = .009; elective 61- to 90-day: aOR, 1.03; 95% CI, 0.57-1.86; P = .92; nonelective 30-day: aOR, 1.91; 95% CI, 1.52-2.40; P < .001; nonelective 91- to 120-day: aOR, 1.00; 95% CI, 0.73-1.37; P = .99).</p><p><strong>Conclusions and relevance: </strong>This study found that among older patients undergoing noncardiac surgery who had revascularization, the odds of postoperative MACCE and mortality leveled off between 30 and 90 days and then increased after 180 days. The odds did not level off for patients who did not have revascularization. Delayin","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545523","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":"The Ongoing Dilemma of Timing Noncardiac Surgery After NSTEMI.","authors":"Emily Smith, Laura Young, Faisal G Bakaeen","doi":"10.1001/jamasurg.2024.4698","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4698","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545522","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 Call for Standardization in Rural Surgery Training.","authors":"Aaron Erickson,Nina M Clark,Dana C Lynge","doi":"10.1001/jamasurg.2024.3403","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.3403","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":16.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488279","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":"Patient-Centered Outcomes and Preoperative Discussions.","authors":"Charlotte M Rajasingh, Sherry M Wren","doi":"10.1001/jamasurg.2024.4699","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4699","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500669","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":"Limitations in Gauging the Effects of Allocation Policy Changes on Liver Transplant-Reply.","authors":"Maria Bernadette Majella Doyle,Ola Ahmed,Susan L Orloff","doi":"10.1001/jamasurg.2024.4362","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4362","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":16.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488280","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":"Limitations in Gauging the Effects of Allocation Policy Changes on Liver Transplant.","authors":"Ri-Hui Xiong,Zhao-Ping Wu,Deng-Chao Wang","doi":"10.1001/jamasurg.2024.4359","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4359","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":16.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488278","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 Trajectories of Postoperative Recovery in Younger and Older Veterans.","authors":"Michael A Jacobs,Carly A Jacobs,Orna Intrator,Rajesh Makineni,Ada Youk,Monique Y Boudreaux-Kelly,Jennifer L McCoy,Bruce Kinosian,Paula K Shireman,Daniel E Hall","doi":"10.1001/jamasurg.2024.4691","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4691","url":null,"abstract":"ImportanceMajor surgery sometimes involves long recovery or even permanent institutionalization. Little is known about long-term trajectories of postoperative recovery, as surgical registries are limited to 30-day outcomes and care can occur across various institutions.ObjectiveTo characterize long-term postoperative recovery trajectories.Design, Setting, and ParticipantsThis retrospective cohort study used Veterans Affairs (VA) Surgical Quality Improvement Program data (2016 through 2019) linked to the Residential History File, combining data from the VA, Medicare/Medicaid, and other sources to capture most health care utilization by days. Patients were divided into younger (younger than 65 years) or older (65 years or older) subgroups, as Medicare eligibility is age dependent. Latent-class, group-based trajectory models were developed for each group. These data were analyzed from February 2023 through August 2024.ExposureSurgical care in VA hospitals.Main Outcomes and MeasuresDays elsewhere than home (DEH) were counted in 30-day periods for 275 days presurgery and 365 days postsurgery.ResultsA 5-trajectory solution was optimal and visually similar for both age groups (cases: 179 879 younger [mean age (SD) 51.2 (10.8) years; most were male [154 542 (83.0%)] and 198 803 older [mean (SD) age, 72.2 (6.0) years; 187 996 were male (97.6%)]). Most cases were in trajectories 1 and 2 (T1 and T2). T1 cases returned home within 30 days (younger, 74.0%; older, 54.2%), while T2 described delayed recovery within 30 to 60 days (younger, 21.6%; older, 35.5%). Trajectory 3 (T3) and trajectory 4 (T4) were similar for the first 30 days postsurgery, but subsequently separated with T3 representing protracted recovery of 6 months or longer (younger, 2.7%; older, 3.8%) and T4 indicating long-term loss of independence (younger, 1.3%; older, 5.2%). Few (trajectory 5) were chronically dependent, with 20 to 30 DEH per month before and after surgery (younger, 0.4%; older, 1.3%).Conclusions and RelevanceIn this study, trajectory models demonstrated clinically meaningful differences in postoperative recovery that should inform surgical decision-making. Registries should include longer-term outcomes to enable future research to distinguish patients prone to long-term loss of independence vs protracted, but meaningful recovery.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":16.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488275","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":"Outcomes Following Resection of Stage I to III Thymic Tumors in High-Volume Centers.","authors":"Sara Sakowitz,Syed Shahyan Bakhtiyar,Saad Mallick,Jane Yanagawa,Peyman Benharash","doi":"10.1001/jamasurg.2024.4093","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4093","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":16.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443678","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}