JAMA surgery最新文献

{"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":"Rediscovering the Clitoris-Sexual Function After Transvaginal Surgery.","authors":"Neha G Gaddam, Bayley E Clarke, Cheryl B Iglesia","doi":"10.1001/jamasurg.2024.6912","DOIUrl":"10.1001/jamasurg.2024.6912","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"407"},"PeriodicalIF":15.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399255","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":"Postoperative Sexual Function After Vaginal Surgery and Clitoral Size, Position, and Shape.","authors":"Shaniel T Bowen, Pamela A Moalli, Rebecca G Rogers, Marlene M Corton, Uduak U Andy, Charles R Rardin, Michael E Hahn, Alison C Weidner, David R Ellington, Donna Mazloomdoost, Amaanti Sridhar, Marie G Gantz","doi":"10.1001/jamasurg.2024.6922","DOIUrl":"10.1001/jamasurg.2024.6922","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Transvaginal surgery is commonly performed to treat pelvic organ prolapse. Little research focuses on how sexual function relates to clitoral anatomy after vaginal surgery despite the clitoris' role in the sexual response.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine how postoperative sexual function after vaginal surgery is associated with clitoral features (size, position, shape).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This was a cross-sectional ancillary study of magnetic resonance imaging (MRI) data from the Defining Mechanisms of Anterior Vaginal Wall Descent (DEMAND) study. The setting comprised 8 clinical sites in the US Pelvic Floor Disorders Network and included the MRI data of 88 women with uterovaginal prolapse previously randomized to either vaginal mesh hysteropexy or vaginal hysterectomy with uterosacral ligament suspension between 2013 and 2015. Data were analyzed between September 2021 and June 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Participants underwent postoperative pelvic MRI at 30 to 42 months (or earlier if reoperation was desired) between June 2014 and May 2018. Sexual activity and function at baseline (preoperatively) and 24- to 48-month follow-up (postoperatively) were assessed using the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, International Urogynecological Association Revised (PISQ-IR). Clitoral features were derived from postoperative MRI-based 3-dimensional models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Correlations between (1) PISQ-IR mean, subscale, and item scores and (2) clitoral size, position, and shape (principal component scores).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 82 women (median [range] age, 65 [47-79] years) were analyzed (41 received hysteropexy and 41 received hysterectomy). Postoperatively, 37 were sexually active (SA), and 45 were not SA (NSA). Among SA women, better overall postoperative sexual function (higher PISQ-IR summary score) correlated with a larger clitoral glans width (Spearman ρ = 0.37; 95% CI, 0.05-0.62; P = .03) and thickness (Spearman ρ = 0.38; 95% CI, 0.06-0.63; P = .02). Among NSA women, sexual inactivity related to postoperative dyspareunia correlated with a more lateral clitoral position (Spearman ρ = 0.45; 95% CI, 0.18-0.66; P = .002), and sexual inactivity related to incontinence/prolapse correlated with a more posterior clitoral position (Spearman ρ = -0.36; 95% CI, -0.60 to -0.07; P = .02) (farther from the pubic symphysis). Shape analysis demonstrated that poorer postoperative sexual function outcomes in SA women and sexual inactivity in NSA women correlated with a more posteriorly positioned glans, anteriorly oriented clitoral body, medially positioned crura, and lateral vestibular bulbs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;Results of this cross-sectional study suggest that postoperative sexual function after vaginal surgery was associated with clitoral glans size, position,","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"396-406"},"PeriodicalIF":15.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399254","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":"SGLT2 Inhibitors in Perioperative Care-Continue or Hold?","authors":"Maximilian Wagner, Jennifer Waljee","doi":"10.1001/jamasurg.2024.7046","DOIUrl":"10.1001/jamasurg.2024.7046","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"430-431"},"PeriodicalIF":15.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449085","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":"Using Pooled Registry Data to Assess Complication Risk by Breast Implant Type.","authors":"Katherine Anne Rodby, Sonja Samant, Adeyemi A Ogunleye","doi":"10.1001/jamasurg.2024.6913","DOIUrl":"10.1001/jamasurg.2024.6913","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"422"},"PeriodicalIF":15.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447634","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 Morbidity of a Perineal Wound.","authors":"Traci L Hedrick, Christopher A Campbell","doi":"10.1001/jamasurg.2024.6817","DOIUrl":"10.1001/jamasurg.2024.6817","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"385-386"},"PeriodicalIF":15.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188710","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":"JAMA Surgery.","authors":"","doi":"10.1001/jamasurg.2024.4432","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4432","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"160 4","pages":"362"},"PeriodicalIF":15.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811476","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":"Timing Ticagrelor-Risks of Rapid CABG Surgery.","authors":"Bryant Fisher, Danny Chu","doi":"10.1001/jamasurg.2024.7045","DOIUrl":"10.1001/jamasurg.2024.7045","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"395"},"PeriodicalIF":15.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449089","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}