JAMA surgery最新文献

{"title":"Durability Wins-BIOLAP and the Case for Synthetic Mesh.","authors":"Kate V Lauer,Victoria R Rendell,Luke M Funk","doi":"10.1001/jamasurg.2025.4004","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.4004","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"25 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246431","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":"Biological vs Synthetic Mesh in Laparoendoscopic Inguinal Hernia Repair","authors":"Claudia Simone Seefeldt, Judith Knievel, Muneer Deeb, Niels-Torsten Hoedt, Claudia Rudroff, Ralf Essen, Dirk Antoine, Gernot Maximilian Kaiser, Christoph Andreas Jacobi, Wilhelm Gross-Weege, Wolfgang Gänsler, Bernhard Johannes Lammers, Christoph Bonk, Frauke Hildebrandt, Thomas Carus, Moritz Meyer, Mathias Bebobru, Alexander Krökel, Jan Dornbusch, Mark Schneider, Nicola Cerasani, Bernd Stechemesser, Rolf Lefering, Dirk Rolf Bulian, Michael Alfred Ströhlein, Anna Rieger, Jonas Lange, Jürgen Stephan Meyer-Zillekens, Claus Ferdinand Eisenberger, Markus Maria Heiss","doi":"10.1001/jamasurg.2025.4071","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.4071","url":null,"abstract":"ImportanceChronic postoperative pain and recurrence are relevant complications after inguinal hernia repair. Biological meshes have been proposed as a resorbable alternative to synthetic implants that may reduce postoperative pain.ObjectiveTo compare postoperative pain and recurrence rates between biological and synthetic meshes in laparoendoscopic inguinal hernia repair using a self-controlled design.Design, Setting, and ParticipantsThe Biological vs Synthetic Mesh in Laparoendoscopic Inguinal Hernia Repair (BIOLAP) trial was a multicenter, randomized, self-controlled clinical trial conducted between August 2017 and February 2021 across 21 certified German hernia centers. A total of 491 adult patients with primary bilateral inguinal hernias underwent laparoendoscopic repair using 1 biological mesh and 1 synthetic mesh. Data analysis was performed from July 2023 to June 2024.InterventionPatients were randomized to receive a biological or synthetic mesh on the right side; the contralateral side received the alternate material. All patients underwent standardized laparoendoscopic repair (transabdominal preperitoneal plasty or total extraperitoneal plasty), and both patients and assessors were blinded to mesh assignment.Main Outcomes and MeasuresThe coprimary outcomes were pain intensity at 6 months (measured using the visual analog scale) and hernia recurrence at 2 years. Secondary outcomes included seroma, hematoma, surgical site infection, and patient satisfaction.ResultsAmong 491 patients (mean [SD] age, 58.5 [14.1] years; 457 [93.1%] male), there was no significant difference in pain at 6 months between biological and synthetic meshes (mean [SD] visual analog scale score at rest, 0.3 [0.9] for both; <jats:italic>P</jats:italic> = .76). However, the 2-year recurrence rate was significantly higher for biological meshes (53 recurrences [11.2%]) compared with synthetic meshes (12 recurrences [2.5%]) (<jats:italic>P</jats:italic> &amp;amp;lt; .001). Seroma rates were also significantly higher with biological meshes than with synthetic meshes (164 patients [33.4%] vs 106 patients [21.6%], respectively; <jats:italic>P</jats:italic> &amp;amp;lt; .001).Conclusions and RelevanceBiological meshes did not reduce postoperative pain but were associated with significantly higher recurrence and seroma rates compared with synthetic meshes. These findings do not support the routine use of biological meshes in laparoendoscopic inguinal hernia repair.Trial RegistrationGerman Clinical Trials Register Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://drks.de/search/en/trial/DRKS00010178/details\">DRKS00010178</jats:ext-link>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"39 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145241365","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":"Implementing a Patient-Centered Education Bundle to Improve Venous Thromboembolism Prevention","authors":"Elliott R. Haut, Oluwafemi P. Owodunni, Dauryne L. Shaffer, Danielle McQuigg, Deborah Samuel, Deborah B. Hobson, Peggy S. Kraus, Jiangxia Wang, Kristen L. W. Webster, Mindy Kantsiper, James E. Harris, Christine G. Holzmueller, Mujan Varasteh Kia, Michael B. Streiff, Brandyn D. Lau","doi":"10.1001/jamasurg.2025.4136","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.4136","url":null,"abstract":"ImportanceVenous thromboembolism (VTE) is one of the most common causes of preventable harm in hospitals. While numerous efforts have been made to increase prescription of evidence-based VTE prophylaxis for hospitalized patients, many prescribed doses are either refused or missed for other reasons. Successful interventions to decrease these missed doses have been developed and tested in academic hospitals, but it remains unclear if these interventions can be scaled and implemented in community hospitals.ObjectiveTo disseminate and implement an evidence-based, comprehensive strategy to reduce missed doses of VTE prophylaxis.Design, Setting, and ParticipantsThis prospective cohort study was conducted on 7 floors across a community hospital within a large health system. Participants were all hospitalized adult patients admitted from July 1, 2018, to June 30, 2019 (preintervention), and July 1 to December 31, 2019 (postintervention), who were prescribed at least 1 dose of pharmacologic VTE prophylaxis. Data analysis was performed from January 2020 to January 2022.InterventionsImplementation of a dynamic, scenario-based nurse education module combined with a patient-centered education bundle triggered by a real-time alert sent to the charge nurse when a dose of prescribed VTE prophylaxis was not administered.Main Outcomes and MeasuresPrimary outcome was the proportion of any missed doses of prescribed pharmacologic prophylaxis. Secondary outcomes were proportions of doses refused and missed for reasons other than refusal.ResultsA total of 15 752 patients were included, 8714 (55.3%) female and 7038 (44.7%) male. The mean (SD) age was 63.9 (18.5) years. Missed doses decreased significantly in the postimplementation period, 10 643 of 82 269 doses (12.9%) vs 2718 of 29 338 doses (9.3%) (OR, 0.60; 95% CI, 0.55-0.66). There were significant improvements in patient refusal (7280 doses [8.8%] vs 1696 doses [5.8%]; OR, 0.51; 95% CI, 0.46-0.58) and doses missed for reasons other than patient refusal (3363 [4.1%] vs 1022 [3.5%]; OR, 0.87; 95% CI, 0.77-0.99). There was no difference in the proportion of patients with VTE (9 patients [0.08%] vs 6 patients [0.1%]; <jats:italic>P</jats:italic> = .58).Conclusion and RelevanceThis study found that providing engaging education to frontline nurses and just-in-time, patient-centered education to patients significantly improved administration and acceptance of prescribed VTE prophylaxis for hospitalized patients across an entire community hospital. These findings show that proven interventions developed at academic hospitals can be successfully implemented broadly in community hospitals.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"30 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145241422","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":"Minimally Invasive vs Open Left Pancreatectomy for Resectable Pancreatic Cancer: Long-Term Results of the Randomized DIPLOMA Trial.","authors":"Caro L Bruna,Jony van Hilst,Maarten Korrel,Leia R Jones,Gianpaolo Balzano,Bergthor Björnsson,Ugo Boggi,Svein Olav Bratlie,Olivier R Busch,Giovanni Butturini,Giovanni Capretti,Riccardo Casadei,Safi Dokmak,Bjørn Edwin,Alessandro Esposito,Massimo Falconi,Giovanni Ferrari,Thilo Hackert,Geert Kazemier,Bas Groot Koerkamp,Ruben H de Kleine,Tobias Keck,Dyre B Kleive,Arto Kokkola,David Kooby,Daan J Lips,Misha D P Luyer,Martina Guerra,Ravi Marudanayagam,Krishna Menon,I Quintus Molenaar,Matteo de Pastena,Nicolò Pecorelli,John N Primrose,Claudio Ricci,Olivier Saint Marc,Roberto Salvia,Per Sandström,Ales Tomazic,Ulrich F Wellner,Vincent S Yip,Alessandro Zerbi,Mahsoem Ali,Marcel G W Dijkgraaf,Marc G Besselink,Mohammad Abu Hilal, ","doi":"10.1001/jamasurg.2025.4054","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.4054","url":null,"abstract":"ImportanceThe DIPLOMA trial showed comparable radical resection rates after minimally invasive left pancreatectomy (MILP) and open left pancreatectomy (OLP) in patients with upfront resectable pancreatic cancer. Data on long-term overall survival (OS) and disease-free survival (DFS) are currently lacking, but are required before the oncological efficacy of MILP can be confirmed.ObjectiveTo determine the long-term oncological outcome, including OS and DFS, of MILP vs OLP in patients with upfront resectable left-sided pancreatic cancer in the DIPLOMA trial.Design, Setting, and ParticipantsThe randomized, patient-blinded and pathologist-blinded DIPLOMA trial was conducted between 2018 and 2021, with a follow-up duration of at least 36 months. It was a multicenter international trial that took place in 35 centers in 12 countries worldwide. Patients with upfront resectable pancreatic ductal adenocarcinoma of the body or tail of the pancreas were included.InterventionsParticipants were randomly assigned to undergo MILP (laparoscopic and robotic) or OLP. Patients were blinded for the surgical approach.Main Outcomes and MeasuresMain outcomes included OS and DFS. Other outcomes include receipt of adjuvant therapy and time to start of adjuvant therapy.ResultsBetween May 2018 and May 2021, 258 patients were randomized to the MILP (131 patients) and OLP (127 patients) groups. After a median follow-up of 38 (IQR 36-46) months, 134 patients (52%) had died and 127 patients (55%) experienced disease recurrence. OS did not differ significantly between the MILP and OLP groups (median, 32 vs 34 months; stratified hazard ratio, 1.02; 95% CI, 0.72-1.44; P = .92). Also, DFS did not significantly differ between the MILP and OLP groups (median, 21 vs 17 months; stratified hazard ratio, 0.96; 95% CI, 0.68-1.35; P = .81). Adjuvant therapy was administered in 79 patients after MILP (79 of 113 [70%]) and 79 patients after OLP (79 of 110 [72%]) (P = .63). Time to adjuvant therapy was comparable between groups (median 59 vs 56 days; P = .92).Conclusions and RelevanceIn this long-term follow-up of the randomized DIPLOMA trial in patients with upfront resectable pancreatic cancer, oncological outcomes after MILP and OLP did not differ significantly, confirming the oncological safety of MILP.Trial RegistrationInternational Standard Registered Clinical/Social Study Number Registry Identifier: ISRCTN44897265.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"9 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246491","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":"Revisiting Minimally Invasive Distal Pancreatectomy.","authors":"Adrian Diaz, Melissa E Hogg","doi":"10.1001/jamasurg.2025.4068","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.4068","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":14.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251119","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":"Dexmedetomidine Infusion for Rib Fractures-Still in Search of the Right Indication?","authors":"Joshua B Brown","doi":"10.1001/jamasurg.2025.3235","DOIUrl":"10.1001/jamasurg.2025.3235","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"1057"},"PeriodicalIF":14.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954756","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 Risk of Mesh Infection Requiring Removal After Elective Ventral Hernia Repair.","authors":"Anne P Ehlers,Joshua K Sinamo,Ryan Howard,Alex K Hallway,Sean M O'Neill,Courtney Collins,Michael Rubyan,Jenny M Shao,Dana A Telem","doi":"10.1001/jamasurg.2025.3915","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.3915","url":null,"abstract":"ImportanceHundreds of thousands of people have mesh placed for ventral hernia repair every year, but the long-term risks of clinically significant mesh infection requiring mesh removal remain unknown.ObjectiveTo examine the risk of clinically significant mesh infection requiring removal after ventral hernia repair.Design, Setting, and ParticipantsThis retrospective cohort study included 100% Medicare fee-for-service administrative claims data from January 1, 2011, to December 31, 2021, for adults aged 18 years or older who underwent elective inpatient open ventral hernia repair with mesh. Data were analyzed from October 21, 2024, to May 2, 2025.ExposureMesh placed at the time of ventral hernia repair.Main Outcomes and MeasuresThe primary outcome was mesh removal up to 10 years after the index operation. Current Procedural Terminology codes were used to identify mesh removal, which was used as a surrogate measure for a clinically significant mesh infection. Secondary outcomes included the association between 30-day wound complications and subsequent mesh removal.ResultsOf 59 453 people (35 209 female [59.2%]), 1330 (2.2%) underwent mesh removal with a median time to mesh removal of 8 months (238 days; 25th to 75th percentile = 49 to 757 days = 2 to 25 months). People who underwent mesh removal were more often female than people who did not undergo mesh removal (63.0% [838] vs 59.1% [34 371]; P = .005), more often underwent enterectomy (3.5% [46] vs 2.3% [1342]; P = .008), and more often experienced a wound complication within 30 days (23.6% [314] vs 6.6% [3825]; P < .001). The cumulative hazard percentage of mesh removal for a patient with wound complications at 10-year follow-up was 7.94 (95% CI, 7.03-8.84) compared with 2.48 (95% CI, 2.31-2.64) for patients without. Most mesh removals occurred within the first 5 years after surgery.Conclusions and RelevanceThese findings suggest that the risk of mesh removal is low overall, even for people who experience a wound complication. These findings support the broad use of mesh for people undergoing elective open ventral hernia repair.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"6 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194517","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":"Another Reason to Operate in Primary Hyperparathyroidism.","authors":"Martin Almquist","doi":"10.1001/jamasurg.2025.3075","DOIUrl":"10.1001/jamasurg.2025.3075","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"1132"},"PeriodicalIF":14.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954693","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 Market Competition, Morbidity, and Resource Utilization Following Elective Cancer Resection.","authors":"Sara Sakowitz,Syed Shahyan Bakhtiyar,Nicholas S Siena,Peyman Benharash,Timothy R Donahue","doi":"10.1001/jamasurg.2025.3643","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.3643","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"91 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194463","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":"Non-β-Lactam Antibiotic Use, β-Lactam Allergy, and Surgical Site Infections.","authors":"Prateek Agarwal,Rohit Prem Kumar,Louise-Marie Oleksiuk,Victoria Crall,Andrej A Petrov,Erin K McCreary,Jennifer Holder-Murray,Yue-Fang Chang,Nitin Agarwal,D Kojo Hamilton,Robert M Friedlander","doi":"10.1001/jamasurg.2025.3789","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.3789","url":null,"abstract":"ImportanceSurgical site infections (SSIs) pose significant health and economic burdens. β-lactams are the recommended prophylactic antibiotics for most surgical procedures; however, the association of non-β-lactam antibiotics with SSI incidence is controversial.ObjectiveTo evaluate the association between reported β-lactam allergy status, β-lactam antibiotics, and SSIs across various surgical specialties.Design, Setting, and ParticipantsThis was a retrospective cohort study of a prospectively recorded database. The setting was a quaternary health center. Included in the study were patients who underwent surgery from January 2021 to February 2024.ExposuresStudy exposures included antibiotic choice and reported β-lactam allergy, with covariates including demographics, comorbidities, and procedure details.Main Outcomes and MeasuresThe primary study outcome was 30- to 90-day SSI incidence.ResultsThe study included 49 279 procedures across 10 specialties, with a total of 41 100 patients (mean [SD] age, 61.0 [15.9] years; range, 13-103 years; 21 237 male [51.7%]). Procedures with non-β-lactam antibiotic use had a higher incidence of SSI than procedures with β-lactam antibiotic use (2.2% vs 1.3%; risk ratio [RR], 1.69; 95% CI, 1.28-2.01; P < .001). Procedures in patients with reported β-lactam allergy had a higher incidence of SSI (1.8% vs 1.3%; RR, 1.38; 95% CI, 1.15-1.64; P = .003). These associations were present in logistic regression as well. However, on controlling for covariates and β-lactam allergy, non-β-lactam antibiotic use remained significantly associated with higher SSI incidence (odds ratio [OR], 1.33; 95% CI, 1.00-1.74; P = .04), whereas the association between β-lactam allergy and SSI incidence became nonsignificant (OR, 1.21; 95% CI, 0.97-1.49; P = .09). In subspecialty analysis, only orthopedic surgery retained a significant association between non-β-lactam use and increased SSI (OR, 3.01; 95% CI, 1.41-6.01; P = .003).Conclusions and RelevanceThis cohort study found that β-lactam prophylaxis was associated with significantly lower SSI rates than non-β-lactam agents, and a reported β-lactam allergy did not independently predict infection risk. Implementation of an allergy-focused stewardship guideline was associated with a marked reduction in non-β-lactam use, underscoring the importance of precise allergy assessment to avoid unnecessary alternative prophylaxis.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"6 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194460","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}