JAMA surgery最新文献

{"title":"Futility of Up-Front Resection for Anatomically Resectable Pancreatic Cancer.","authors":"Stefano Crippa, Giuseppe Malleo, Vincenzo Mazzaferro, Serena Langella, Claudio Ricci, Fabio Casciani, Giulio Belfiori, Sara Galati, Vincenzo D'Ambra, Gabriella Lionetto, Alessandro Ferrero, Riccardo Casadei, Giorgio Ercolani, Roberto Salvia, Massimo Falconi, Alessandro Cucchetti","doi":"10.1001/jamasurg.2024.2485","DOIUrl":"10.1001/jamasurg.2024.2485","url":null,"abstract":"<p><strong>Importance: </strong>There are currently no clinically relevant criteria to predict a futile up-front pancreatectomy in patients with anatomically resectable pancreatic ductal adenocarcinoma.</p><p><strong>Objectives: </strong>To develop a futility risk model using a multi-institutional database and provide unified criteria associated with a futility likelihood below a safety threshold of 20%.</p><p><strong>Design, setting, and participants: </strong>This retrospective study took place from January 2010 through December 2021 at 5 high- or very high-volume centers in Italy. Data were analyzed during April 2024. Participants included consecutive patients undergoing up-front pancreatectomy at the participating institutions.</p><p><strong>Exposure: </strong>Standard management, per existing guidelines.</p><p><strong>Main outcomes and measures: </strong>The main outcome measure was the rate of futile pancreatectomy, defined as an operation resulting in patient death or disease recurrence within 6 months. Dichotomous criteria were constructed to maintain the futility likelihood below 20%, corresponding to the chance of not receiving postneoadjuvant resection from existing pooled data.</p><p><strong>Results: </strong>This study included 1426 patients. The median age was 69 (interquartile range, 62-75) years, 759 patients were male (53.2%), and 1076 had head cancer (75.4%). The rate of adjuvant treatment receipt was 73.7%. For the model construction, the study sample was split into a derivation (n = 885) and a validation cohort (n = 541). The rate of futile pancreatectomy was 18.9% (19.2% in the development and 18.6% in the validation cohort). Preoperative variables associated with futile resection were American Society of Anesthesiologists class (95% CI for coefficients, 0.68-0.87), cancer antigen (CA) 19.9 serum levels (95% CI, for coefficients 0.05-0.75), and tumor size (95% CI for coefficients, 0.28-0.46). Three risk groups associated with an escalating likelihood of futile resection, worse pathological features, and worse outcomes were identified. Four discrete conditions (defined as CA 19.9 levels-adjusted-to-size criteria: tumor size less than 2 cm with CA 19.9 levels less than 1000 U/mL; tumor size less than 3 cm with CA 19.9 levels less than 500 U/mL; tumor size less than 4 cm with CA 19.9 levels less than 150 U/mL; and tumor size less than 5 cm with CA 19.9 levels less than 50 U/mL) were associated with a futility likelihood below 20%. Both disease-free survival and overall survival were significantly longer in patients fulfilling the criteria.</p><p><strong>Conclusions and relevance: </strong>In this study, a preoperative model (MetroPancreas) and dichotomous criteria to determine the risk of futile pancreatectomy were developed. This might help in selecting patients for up-front resection or neoadjuvant therapy.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751685","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":"Percutaneous Cryoneurolysis for Pain Control After Rib Fractures in Older Adults.","authors":"Simeng Wang, Michelle Earley, Andrew Kesselman, Alexander M Vezeridis, Andrew C Picel, Nishita Kothary, Joseph D Forrester","doi":"10.1001/jamasurg.2024.2063","DOIUrl":"10.1001/jamasurg.2024.2063","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11307162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897382","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":"An Emerging Racial Disparity in US Motor Vehicle Fatalities.","authors":"Maxim Massenkoff, Aaron Chalfin, Aartik Sarma","doi":"10.1001/jamasurg.2024.2247","DOIUrl":"10.1001/jamasurg.2024.2247","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11325238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975716","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":"Primary Care Use and 90-Day Mortality Among Older Adults Undergoing Cancer Surgery.","authors":"Hadiza S Kazaure, N Ben Neely, Lauren E Howard, Terry Hyslop, Mohammad Shahsahebi, Leah L Zullig, Kevin C Oeffinger","doi":"10.1001/jamasurg.2024.2598","DOIUrl":"10.1001/jamasurg.2024.2598","url":null,"abstract":"<p><strong>Importance: </strong>Multimorbidity and postoperative clinical decompensation are common among older surgical patients with cancer, highlighting the importance of primary care to optimize survival. Little is known about the association between primary care use and survivorship among older adults (aged ≥65 years) undergoing cancer surgery.</p><p><strong>Objective: </strong>To examine primary care use among older surgical patients with cancer and its association with mortality.</p><p><strong>Design, setting, and participants: </strong>In this retrospective cohort study, data were abstracted from the electronic health record of a single health care system for older adults undergoing cancer surgery between January 1, 2017, and December 31, 2019. There were 3 tiers of stratification: (1) patients who had a primary care practitioner (PCP) (physician, nurse practitioner, or physician assistant) vs no PCP, (2) those who had a PCP and underwent surgery in the same health system (unfragmented care) vs not (fragmented care), and (3) those who had a primary care visit within 90 postoperative days vs not. Data were analyzed between August 2023 and January 2024.</p><p><strong>Exposure: </strong>Primary care use after surgery for colorectal, head and neck, prostate, ovarian, pancreatic, breast, liver, renal cell, non-small cell lung, endometrial, gastric, or esophageal cancer.</p><p><strong>Main outcomes and measures: </strong>Postoperative 90-day mortality was analyzed using inverse propensity weighted Kaplan-Meier curves, with log-rank tests adjusted for propensity scores.</p><p><strong>Results: </strong>The study included 2566 older adults (mean [SEM] age, 72.9 [0.1] years; 1321 men [51.5%]). Although 2404 patients (93.7%) had health insurance coverage, 743 (28.9%) had no PCP at the time of surgery. Compared with the PCP group, the no-PCP group had a higher 90-day postoperative mortality rate (2.0% vs 3.6%, respectively; adjusted P = .03). For the 823 patients with unfragmented care, 400 (48.6%) had a primary care visit within 90 postoperative days (median time to visit, 34 days; IQR, 20-57 days). Patients who had a postoperative primary care visit were more likely to be older, have a higher comorbidity burden, have an emergency department visit, and be readmitted. However, they had a significantly lower 90-day postoperative mortality rate than those who did not have a primary care visit (0.3% vs 3.3%, respectively; adjusted P = .001).</p><p><strong>Conclusions and relevance: </strong>These findings suggest that follow-up with primary care within 90 days after cancer surgery is associated with improved survivorship among older adults.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11307163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897383","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":"Expanding the Surgical Armamentarium Through Meaningful Use of the Electronic Health Record.","authors":"Jeniann Yi, Chen-Tan Lin, Sarah Tevis","doi":"10.1001/jamasurg.2024.2240","DOIUrl":"10.1001/jamasurg.2024.2240","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975717","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":"Insurance-Related Disparities in Withdrawal of Life Support and Mortality After Spinal Cord Injury.","authors":"Husain Shakil, Ahmad Essa, Armaan K Malhotra, Rachael H Jaffe, Christopher W Smith, Eva Y Yuan, Yingshi He, Jetan H Badhiwala, François Mathieu, Michael C Sklar, Duminda N Wijeysundera, Karim Ladha, Avery B Nathens, Jefferson R Wilson, Christopher D Witiw","doi":"10.1001/jamasurg.2024.2967","DOIUrl":"10.1001/jamasurg.2024.2967","url":null,"abstract":"<p><strong>Importance: </strong>Identifying disparities in health outcomes related to modifiable patient factors can improve patient care.</p><p><strong>Objective: </strong>To compare likelihood of withdrawal of life-supporting treatment (WLST) and mortality in patients with complete cervical spinal cord injury (SCI) with different types of insurance.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study collected data between 2013 and 2020 from 498 trauma centers participating in the Trauma Quality Improvement Program. Participants included adult patients (older than 16 years) with complete cervical SCI. Data were analyzed from November 1, 2023, through May 18, 2024.</p><p><strong>Exposure: </strong>Uninsured or public insurance compared with private insurance.</p><p><strong>Main outcomes and measures: </strong>Coprimary outcomes were WLST and mortality. The adjusted odds ratio (aOR) of each outcome was estimated using hierarchical logistic regression. Propensity score matching was used as an alternative analysis to compare public and privately insured patients. Process of care outcomes, including the occurrence of a hospital complication and length of stay, were compared between matched patients.</p><p><strong>Results: </strong>The study included 8421 patients with complete cervical SCI treated across 498 trauma centers (mean [SD] age, 49.1 [20.2] years; 6742 male [80.1%]). Among the 3524 patients with private insurance, 503 had WLST (14.3%) and 756 died (21.5%). Among the 3957 patients with public insurance, 906 had WLST (22.2%) and 1209 died (30.6%). Among the 940 uninsured patients, 156 had WLST (16.6%) and 318 died (33.8%). A significant difference was found between uninsured and privately insured patients in the adjusted odds of WLST (aOR, 1.49; 95% CI, 1.11-2.01) and mortality (aOR, 1.98; 95% CI, 1.50-2.60). Similar results were found in subgroup analyses. Matched public compared with private insurance patients were found to have significantly greater odds of hospital complications (odds ratio, 1.27; 95% CI, 1.14-1.42) and longer hospital stay (mean difference 5.90 days; 95% CI, 4.64-7.20), which was redemonstrated on subgroup analyses.</p><p><strong>Conclusions and relevance: </strong>Health insurance type was associated with significant differences in the odds of WLST, mortality, hospital complications, and days in hospital among patients with complete cervical SCI in this study. Future work is needed to incorporate patient perspectives and identify strategies to close the quality gap for the large number of patients without private insurance.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11325240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975718","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":"Cracks in the Glass Ceiling-Except for Pregnant Surgery Residents.","authors":"Jamie E Anderson, Diana L Farmer","doi":"10.1001/jamasurg.2024.2404","DOIUrl":"10.1001/jamasurg.2024.2404","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141626787","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":"Providing a Safe Pregnancy Experience for Surgeons: A Review.","authors":"Tiffany A Glazer, Kirsten A Gunderson, Elise Deroo, Ellen C Shaffrey, Hayley Mann, Maya N Matabele, Rebecca M Minter, J Igor Iruretagoyena, John E Rectenwald","doi":"10.1001/jamasurg.2024.0979","DOIUrl":"10.1001/jamasurg.2024.0979","url":null,"abstract":"<p><strong>Importance: </strong>Childbearing has been a particular barrier to successful recruitment and retention of women in surgery. Pregnant surgeons are more likely to have major pregnancy complications, such as preterm delivery, intrauterine growth restriction, infertility, and miscarriage, compared with nonsurgeons. The average obstetric complication rate for surgeons ranges between 25% and 82% in the literature and is considerably higher than that in the general US population at 5% to 15%.</p><p><strong>Observations: </strong>The risks that pregnant surgeons experience were individually analyzed. These risks included missed prenatal care; musculoskeletal hazards, such as prolonged standing, lifting, and bending; long work hours; overnight calls; exposure to teratogenic agents, such as ionizing radiation, anesthetic gases, chemotherapy agents, and methyl methacrylate; and psychological stress and discrimination from the long-standing stigma associated with balancing motherhood and professional life.</p><p><strong>Conclusions and relevance: </strong>A clear, translatable, and enforceable policy addressing perinatal care of surgeons was proposed, citing evidence of the risks reviewed from the literature. A framework of protection for pregnant individuals is essential for attracting talented students into surgery, retaining talented surgical trainees and faculty, and protecting pregnant surgeons and their fetuses.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975721","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":"Postlumpectomy Mammography for Management of Breast Cancers With Microcalcifications.","authors":"Josh Johnson, Georgia Syrnioti, Claire M Eden, Genevieve Fasano, Anni Liu, Xi Kathy Zhou, Lisa A Newman","doi":"10.1001/jamasurg.2024.2054","DOIUrl":"10.1001/jamasurg.2024.2054","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11292560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141855526","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":"Strategies to Mitigate Food Insecurity in Patients Undergoing Surgery.","authors":"Anam N Ehsan, Seth A Berkowitz, Kavitha Ranganathan","doi":"10.1001/jamasurg.2024.2570","DOIUrl":"10.1001/jamasurg.2024.2570","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017423","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}