JAMA surgery最新文献

{"title":"Surgeon Type and Anastomotic Leaks in Ovarian Cancer.","authors":"Alexandra C Istl, Nerlyne Desravines, Ugwuji N Maduekwe","doi":"10.1001/jamasurg.2024.2929","DOIUrl":"10.1001/jamasurg.2024.2929","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"1194-1195"},"PeriodicalIF":15.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897386","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":"Minimal Access vs Conventional Nipple-Sparing Mastectomy.","authors":"Joo Heung Kim, Jai Min Ryu, Soong June Bae, Beom Seok Ko, Jung Eun Choi, Ku Sang Kim, Chihwan Cha, Young Jin Choi, Hye Yoon Lee, Sang Eun Nam, Zisun Kim, Young-Joon Kang, Moo Hyun Lee, Jong Eun Lee, Eunhwa Park, Hyuk Jai Shin, Min Kyoon Kim, Hee Jun Choi, Seong Uk Kwon, Nak-Hoon Son, Hyung Seok Park, Jeeyeon Lee","doi":"10.1001/jamasurg.2024.2977","DOIUrl":"10.1001/jamasurg.2024.2977","url":null,"abstract":"<p><strong>Importance: </strong>While nipple-sparing mastectomy (NSM) for breast cancer was only performed using the open method in the past, its frequency using endoscopic and robotic surgical instruments has been increasing rapidly. However, there are limited studies regarding postoperative complications and the benefits and drawbacks of minimal access NSM (M-NSM) compared with conventional NSM (C-NSM).</p><p><strong>Objective: </strong>To examine the differences in postoperative complications between C-NSM and M-NSM.</p><p><strong>Design, setting, participants: </strong>This was a retrospective multicenter cohort study enrolling 1583 female patients aged 19 years and older with breast cancer who underwent NSM at 21 university hospitals in Korea between January 2018 and December 2020. Those with mastectomy without preserving the nipple-areolar complex (NAC), clinical or pathological malignancy in the NAC, inflammatory breast cancer, breast cancer infiltrating the chest wall or skin, metastatic breast cancer, or insufficient medical records were excluded. Data were analyzed from November 2021 to March 2024.</p><p><strong>Exposures: </strong>M-NSM or C-NSM.</p><p><strong>Main outcomes and measures: </strong>Clinicopathological factors and postoperative complications within 3 months of surgery were assessed. Statistical analyses, including logistic regression, were used to identify the factors associated with complications.</p><p><strong>Results: </strong>There were 1356 individuals (mean [SD] age, 45.47 [8.56] years) undergoing C-NSM and 227 (mean [SD] age, 45.41 [7.99] years) undergoing M-NSM (35 endoscopy assisted and 192 robot assisted). There was no significant difference between the 2 groups regarding short- and long-term postoperative complications (<30 days: C-NSM, 465 of 1356 [34.29%] vs M-NSM, 73 of 227 [32.16%]; P = .53; <90 days: C-NSM, 525 of 1356 [38.72%] vs M-NSM, 73 of 227 [32.16%]; P = .06). Nipple-areolar complex necrosis was more common in the long term after C-NSM than M-NSM (C-NSM, 91 of 1356 [6.71%] vs M-NSM, 5 of 227 [2.20%]; P = .04). Wound infection occurred more frequently after M-NSM (C-NSM, 58 of 1356 [4.28%] vs M-NSM, 18 of 227 [7.93%]; P = .03). Postoperative seroma occurred more frequently after C-NSM (C-NSM, 193 of 1356 [14.23%] vs M-NSM, 21 of 227 [9.25%]; P = .04). Mild or severe breast ptosis was a significant risk factor for nipple or areolar necrosis (odds ratio [OR], 4.75; 95% CI, 1.66-13.60; P = .004 and OR, 8.78; 95% CI, 1.88-41.02; P = .006, respectively). Conversely, use of a midaxillary, anterior axillary, or axillary incision was associated with a lower risk of necrosis (OR for other incisions, 32.72; 95% CI, 2.11-508.36; P = .01). Necrosis occurred significantly less often in direct-to-implant breast reconstruction compared to other breast reconstructions (OR, 2.85; 95% CI, 1.11-7.34; P = .03).</p><p><strong>Conclusions and relevance: </strong>The similar complication rates between C-NSM and M-NSM demon","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"1177-1186"},"PeriodicalIF":15.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11325243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975719","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":"A Nudge in the Right Direction With Clinical Prompts.","authors":"Cara L Berkowitz, Rachel Berger, Oluwadamilola M Fayanju","doi":"10.1001/jamasurg.2024.2390","DOIUrl":"10.1001/jamasurg.2024.2390","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"1126"},"PeriodicalIF":15.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141626786","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":"Concerns About Recurrence Rate for Ventral Hernia Repair-Reply.","authors":"Priya Bhardwaj, Molly A Olson, Jeffrey E Janis","doi":"10.1001/jamasurg.2024.2998","DOIUrl":"10.1001/jamasurg.2024.2998","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"1222-1223"},"PeriodicalIF":15.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080287","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":"Social Work's Role in Bridging Breast Cancer Care Gaps.","authors":"Shijie Guo, Zihan Cai, Guang Yang","doi":"10.1001/jamasurg.2024.2930","DOIUrl":"10.1001/jamasurg.2024.2930","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"1220-1221"},"PeriodicalIF":15.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897384","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":"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":" ","pages":"1139-1147"},"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":" ","pages":"1217-1218"},"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":" ","pages":"1218-1220"},"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":"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":" ","pages":"1099-1100"},"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":" ","pages":"1196-1204"},"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}