Quality of Life and Patient Satisfaction After Antibiotic Therapy vs Appendectomy
To the Editor We read with great interest the article by Sippola et al, “Quality of Life and Patient Satisfaction at 7-Year Follow-up of Antibiotic Therapy vs Appendectomy for Uncomplicated Acute Appendicitis: A Secondary Analysis of a Randomized Clinical Trial.” This is a post hoc analysis of patients enrolled in the Appendicitis Acuta (APPAC) trial out of Finland. The topic of nonsurgical management of acute appendicitis (AA) is under debate, with challenges to the gold standard of appendectomy. We extend our gratitude toward the authors for their impactful work. However, we wish to raise a few questions. (Source: JAMA Surgery)
Source: JAMA Surgery - July 8, 2020 Category: Sports Medicine Source Type: research

Quality of Life and Patient Satisfaction After Antibiotic Therapy vs Appendectomy
To the Editor Sippola et al report additional long-term follow-up results from the Antibiotic Therapy vs Appendectomy for Uncomplicated Acute Appendicitis (APPAC) trial, specifically focusing on patient quality of life and satisfaction. We commend the investigators for reporting these patient-centered outcomes and their emphasis on the importance of these outcomes on the shared decision-making process for the treatment of uncomplicated appendicitis. (Source: JAMA Surgery)
Source: JAMA Surgery - July 8, 2020 Category: Sports Medicine Source Type: research

Quality of Life and Patient Satisfaction After Antibiotic Therapy vs Appendectomy —Reply
In Reply We thank our colleagues for their interest in our study. We fully agree with Minneci and Deans regarding advocating shared decision-making and more patient-centric outcomes. However, the Appendicectomy Versus Antibiotics in the Treatment of Acute Uncomplicated Appendicitis (APPAC) trial was designed as a randomized clinical trial to test the hypothesis that uncomplicated acute appendicitis can be successfully treated with antibiotics by comparing antibiotic therapy with emergency appendectomy, which at that time had not yet been established. Because we know that even at long-term follow-up, antibiotic treatment is...
Source: JAMA Surgery - July 8, 2020 Category: Sports Medicine Source Type: research

Effect of Surgical Skin Antisepsis on Surgical Site Infections in Gynecological Laparoscopic Surgery
This double-blind randomized clinical trial compares rates of port-site infections, organ or space infections, and any type of surgical site infections among patients who underwent gynecological laparoscopies and received 1 of 3 types of skin preparation solutions. (Source: JAMA Surgery)
Source: JAMA Surgery - July 8, 2020 Category: Sports Medicine Source Type: research

Very Early Recurrence After Liver Resection for Intrahepatic Cholangiocarcinoma
This cohort study examines very early recurrence following resection for intrahepatic cholangiocarcinoma in the preoperative and postoperative setting. (Source: JAMA Surgery)
Source: JAMA Surgery - July 8, 2020 Category: Sports Medicine Source Type: research

The Current Status of Women in Surgery
This narrative review provides an overview of research delineating gender disparities in surgery and investigating the causes underlying such issues and proposes recommended action. (Source: JAMA Surgery)
Source: JAMA Surgery - July 8, 2020 Category: Sports Medicine Source Type: research

Restructuring of a General Surgery Residency Program in an Epicenter of the COVID-19 Pandemic
This Special Communication describes a New York City hospital ’s restructuring of general surgery resident teams and educational infrastructure in response to the coronavirus disease 2019 pandemic. (Source: JAMA Surgery)
Source: JAMA Surgery - July 7, 2020 Category: Sports Medicine Source Type: research

Pain Scores in Geriatric vs Nongeriatric Patients With Rib Fractures
This research study compares the self-reported pain levels of geriatric vs nongeriatric patients with rib fractures. (Source: JAMA Surgery)
Source: JAMA Surgery - July 1, 2020 Category: Sports Medicine Source Type: research

Evidence-Based and Patient-Centered Decisions Regarding Bariatric Surgery
To the Editor In a national multicenter cohort, Courcoulas et al compared the risk of interventions, operations, and hospitalizations between patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). The authors concluded that interventions, operations, and hospitalizations were more often associated with RYGB than SG. While the results are noteworthy, we highlight some aspects that should be considered to better interpret their results. (Source: JAMA Surgery)
Source: JAMA Surgery - July 1, 2020 Category: Sports Medicine Source Type: research

Evidence-Based and Patient-Centered Decisions Regarding Bariatric Surgery —Reply
In Reply We thank Castillo-Castro et al for their comments and questions about our article. They are correct that the sleeve gastrectomy (SG) group at baseline was slightly younger (median age, 44 years in the SG group vs 46 years Roux-en-Y gastric bypass [RYGB]), with fewer comorbid conditions (26% patients with diabetes in the SG group vs 44% in the RYGB group), and a lower body mass index (calculated as weight in kilograms divided by height in meters squared; 46.8 SG vs 48.1 RYGB). In addition, the SG cases were performed later in the study, owing to time trends in procedure use, so the median follow-up was shorter for ...
Source: JAMA Surgery - July 1, 2020 Category: Sports Medicine Source Type: research

Association of Medicaid Expansion With Breast Cancer Stage at Diagnosis
This cohort study uses data from the National Cancer Database from 2007 to 2016 to investigate the association between breast cancer stage at diagnosis and patient insurance status, age, and race/ethnicity before and after the expansion of Medicaid. (Source: JAMA Surgery)
Source: JAMA Surgery - July 1, 2020 Category: Sports Medicine Source Type: research

Effectiveness of a Smoking Cessation Quitline Intervention in a Thoracic Surgery Clinic
This cohort study examines factors associated with smoking quitline engagement and smoking cessation among patients undergoing thoracic surgery who consented to a quitline electronic referral. (Source: JAMA Surgery)
Source: JAMA Surgery - July 1, 2020 Category: Sports Medicine Source Type: research

Dissecting the Important Difference Between Good Surgeons and Good Leaders
This Viewpoint imparts a leadership lesson from a surgeon whose career has included 12 years as the chief medical officer of a very large medical technology firm. (Source: JAMA Surgery)
Source: JAMA Surgery - July 1, 2020 Category: Sports Medicine Source Type: research

Inhalational Indocyanine Green to Visualize Lung Tumors: Defining the Margin of Error
The adoption of video-assisted thoracoscopic surgery and robotic-assisted thoracoscopic surgery has allowed for improved perioperative outcomes with equivalent long-term oncologic results for non –small cell lung cancer compared with traditional thoracotomy. One potential limitation of minimally invasive techniques is a decreased ability to palpate smaller lung nodules and determine an adequate margin of healthy tissue in patients who require lung-preserving resections. Robotic-assisted th oracoscopic surgery also has an absence of haptic feedback, and surgeons must learn to “feel with their eyes.” To imp...
Source: JAMA Surgery - June 24, 2020 Category: Sports Medicine Source Type: research

Career Satisfaction and Burnout in Surgery —The Complex Interplay of Self-care, Work Life, and Home Life
Prior studies characterizing burnout among surgeons have noted that 4 in 10 surgeons are experiencing burnout and 3 in 10 screen as positive for symptoms of depression. Perhaps even more alarming, the prevalence of suicidal ideation is 2 times higher among surgeons than the general population of the United States. Physician burnout has rightfully been declared a public health crisis. (Source: JAMA Surgery)
Source: JAMA Surgery - June 24, 2020 Category: Sports Medicine Source Type: research

Patient Expectations After Collis Gastroplasty
This case series study examines short-term and long-terms outcomes in patients who have undergone Collis gastroplasty with fundoplication and hiatal hernia repair. (Source: JAMA Surgery)
Source: JAMA Surgery - June 24, 2020 Category: Sports Medicine Source Type: research

Insights From Senior Surgeons
To the Editor I read with great interest the Research Letter by Stolarski et al, “Retired Surgeons’ Reflections on Their Careers.” In this observational study of survey data based on the American College of Surgeons’ retired membership, the authors present novel and interesting data summarizing the reflections of retired US surgeons regarding hypothetical career changes. The article has gained considerable traction on social media, attributable to the implicit indictment of surgical culture, and amplified by the prompt phrasing “what retired surgeons would have done differently,” and its...
Source: JAMA Surgery - June 24, 2020 Category: Sports Medicine Source Type: research

Insights From Senior Surgeons
To the Editor The article by Stolarski et al draws needed attention to the important insights senior surgeons can provide to younger colleagues in the quest to “make the life and career of a surgeon healthier [and] more fulfilling.” Unfortunately, up until now, the issues faced by senior physicians have received scant attention, missing opportunities to enhance the final phases of the careers of these physicians and improving the lives of those in the pipeline. (Source: JAMA Surgery)
Source: JAMA Surgery - June 24, 2020 Category: Sports Medicine Source Type: research

Insights from Senior Surgeons —Reply
In Reply In our survey study, we strived to compile and share important life lessons acquired throughout the careers of retired surgeons that may provide perspective and prove meaningful to surgeons of all generations. Graffeo ’s letter raises a very important question: do our findings imply that burnout is perceived as more frequent in private vs academic practice? We agree with Graffeo that the answer to this question could have important implications on the career choice of our surgical trainees. (Source: JAMA Surgery)
Source: JAMA Surgery - June 24, 2020 Category: Sports Medicine Source Type: research

Intraoperative Fluorescence Visualization of Lung Tumor Margin With Indocyanine Green Inhalation
This in vivo and ex vivo diagnostic study examines the use of inhaled indocyanine green for intraoperative detection of the margin of lung tumors. (Source: JAMA Surgery)
Source: JAMA Surgery - June 24, 2020 Category: Sports Medicine Source Type: research

Career Satisfaction, Personal Life Factors, and Work-Life Integration Practiecs Among US Surgeons by Gender
This survey study evaluates the association between surgical career satisfaction and personal life factors and explores similarities between men and women surgeons. (Source: JAMA Surgery)
Source: JAMA Surgery - June 24, 2020 Category: Sports Medicine Source Type: research

Surgery and Population Health —Redesigning Surgical Quality for Greater Impact
This Viewpoint discusses how surgeons can enact behavioral modifications around the time of surgery to help impact population health issues. (Source: JAMA Surgery)
Source: JAMA Surgery - June 24, 2020 Category: Sports Medicine Source Type: research

Error in Acknowledgments
In the Special Communication “Blueprint for Restructuring a Department of Surgery in Concert With the Health Care System During a Pandemic: the University of Wisconsin Experience,” published online on April 14, 2020, in JAMA Surgery, 3 contributors were omitted from the Additional Contributions section: Andrew T. Braun, MD, MHS, Rima Rahal, MD, and Joshua M. Glazer, MD. Along with Hee Soo Jung, MD, who was not omitted, the authors report that these individuals had participated in the creation of content included in tables and figures, drafted and revised the guiding principles, and assisted with the development...
Source: JAMA Surgery - June 17, 2020 Category: Sports Medicine Source Type: research

Review of American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids
This JAMA Clinical Guidelines Synopsis summarizes the American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids guideline for patients with symptomatic hemorrhoids. (Source: JAMA Surgery)
Source: JAMA Surgery - June 17, 2020 Category: Sports Medicine Source Type: research

Prevention of Gallstone Formation After Gastrectomy
The adverse effects of vagotomy and the association of gastric distension with biliary physiology have been appreciated for decades. More recently, risk factors for the development of gallstones after gastrectomy have been described. In addition, the first prospective, randomized, multicenter clinical trial of the use of ursodeoxycholic acid (UDCA) to prevent gallstones after gastrectomy was published 25 years ago. However, that study and the vast majority of subsequent research have been performed for patients undergoing bariatric surgery. Thus, the study by Lee et al in this issue of JAMA Surgery is unique because it was...
Source: JAMA Surgery - June 17, 2020 Category: Sports Medicine Source Type: research

Dying of Traumatic Brain Injury
Severe traumatic brain injury (TBI) carries high mortality and survivors experience high rates of disability and functional dependence. With such poor outcomes, these are patients with substantial palliative care needs. High-quality care should include palliative care for all those whose outcomes do not align with their goals, not just those for whom death is imminent. However, in practice, providing this consistently for patients with severe TBI remains a challenge. Despite rates of death and disability, surgeons still struggle with when and whether to recommend a transition to palliative care or withdrawal of life suppor...
Source: JAMA Surgery - June 17, 2020 Category: Sports Medicine Source Type: research

Prehabilitation vs Postoperative Rehabilitation for Frail Patients
To the Editor With our interests in frailty and prehabilitation, we read the Carli et al article with great interest because they are leaders in the field who we look to for insight and evidence. While the authors are to be commended for this work, there are several key features that limit their conclusion. (Source: JAMA Surgery)
Source: JAMA Surgery - June 17, 2020 Category: Sports Medicine Source Type: research

Prehabilitation vs Postoperative Rehabilitation for Frail Patients
To the Editor Interest in surgical prehabilitation programs to improve postoperative patient-related and treatment-related outcomes is growing since our 2006 JAMA publication. Despite accumulating evidence about its effectiveness to improve preoperative physical fitness, there seems to be inconclusive and opposing evidence concerning its effect on postoperative outcomes. The trial of Carli et al significantly adds to this literature by demonstrating that prehabilitation in (pre)frail patients opting for resection of colorectal cancer did not reduce postoperative complications. Although suitably focused at including less ph...
Source: JAMA Surgery - June 17, 2020 Category: Sports Medicine Source Type: research

Prehabilitation vs Postoperative Rehabilitation for Frail Patients
To the Editor We read the article by Carli et al with great interest. The authors conducted a very important study, evaluating the effectiveness of multimodal prehabilitation on 30-day postoperative complications in frail patients undergoing colorectal cancer resection compared with those in patients undergoing postoperative rehabilitation. Unfortunately, their null hypothesis could not be rejected, and we would like to discuss a few issues that potentially affected the results. (Source: JAMA Surgery)
Source: JAMA Surgery - June 17, 2020 Category: Sports Medicine Source Type: research

Prehabilitation vs Postoperative Rehabilitation for Frail Patients
To the Editor We would like to congratulate Carli et al for exploring multimodal prehabilitation in frail patients prior to colorectal cancer resection. Before perioperative clinicians abandon prehabilitation in frail patients as a preemptive strategy to engender good postsurgical outcomes, we would like to draw attention to the necessity of optimal prehabilitation strategies and suggest that concluding that “alternate strategies should be considered to prepare frail patients for surgery” may be premature. (Source: JAMA Surgery)
Source: JAMA Surgery - June 17, 2020 Category: Sports Medicine Source Type: research

Prehabilitation vs Postoperative Rehabilitation for Frail Patients
To the Editor In the their article in JAMA Surgery, Carli et al reported their results of a well-designed and detailed randomized clinical trial on the effect of prehabilitation on postoperative complications in frail patients who underwent resection of colorectal cancer. The study design and interventions were aiming to answer the question to a frequently faced dilemma: whether we can actively improve outcomes of frail older adults undergoing major surgery by increasing their functional and nutritional reserves and therefore having less of a decline and morbidity in the postoperative period. They concluded that in frail p...
Source: JAMA Surgery - June 17, 2020 Category: Sports Medicine Source Type: research

Prehabilitation vs Postoperative Rehabilitation for Frail Patients
In Reply We appreciate the opportunity to reply to the comments regarding our article on prehabilitation for frail patients undergoing colorectal cancer resection. These comments reflect a growing and enthusiastic interest in improving the quality of surgical care using prehabilitation. (Source: JAMA Surgery)
Source: JAMA Surgery - June 17, 2020 Category: Sports Medicine Source Type: research

UDCA for the Prevention of Gallstone Formation After Gastrectomy
This randomized clinical trial evaluates the efficacy and safety of ursodeoxycholic acid (UDCA) in preventing gallstone formation after gastrectomy in patients with gastric cancer. (Source: JAMA Surgery)
Source: JAMA Surgery - June 17, 2020 Category: Sports Medicine Source Type: research

Withdrawal of Life-Supporting Treatment in Severe Traumatic Brain Injury
This cohort study examines the demographic and clinical factors associated with the decision to withdraw life-supporting treatment in patients with severe traumatic brain injury. (Source: JAMA Surgery)
Source: JAMA Surgery - June 17, 2020 Category: Sports Medicine Source Type: research

Opportunities and Challenges in Using Social Media in Organ Donation
This Viewpoint describes social media platforms in terms of their potential to reach targeted organ donor audiences with ethical use of this technology. (Source: JAMA Surgery)
Source: JAMA Surgery - June 17, 2020 Category: Sports Medicine Source Type: research

Factors Associated With Surgical Mortality and Complications Among Patients With and Without COVID-19 in Italy
This cohort study compares early surgical outcomes of patients in Italy with and without COVID-19 in different subspecialties. (Source: JAMA Surgery)
Source: JAMA Surgery - June 12, 2020 Category: Sports Medicine Source Type: research

Better Biomarkers for Surgeons Treating Cancer
The field of cancer surgery needs new biomarkers. With all the advances in medical technology that have occurred since I was performing McBurney incisions as an intern 33 years ago, surgeons have not evolved in how we screen and follow up with most patients with solid tumors. Guo et al have described in this issue of JAMA Surgery what is to my knowledge the first study examining the long noncoding RNA (lncRNA) gastric cancer –associated lncRNA 1 (GClnc1) as a biomarker in circulating exosomes for gastric cancer. This represents a complete analysis in a relatively small cohort of patients, demonstrating promise as a s...
Source: JAMA Surgery - June 10, 2020 Category: Sports Medicine Source Type: research

Physician Suicide —Reflections on Relevance and Resilience
Physician burnout and suicide are a grim reality in health care, with the physician suicide rate 2-fold that of the general public and the highest among any US profession. In fact, a 2019 survey of more than 15 000 physicians revealed that, among physicians with depression, more than 20% thought about suicide and nearly 40% did not seek help. (Source: JAMA Surgery)
Source: JAMA Surgery - June 10, 2020 Category: Sports Medicine Source Type: research

Quality and Readability of Online Health Information on the Adverse Effects of Breast Cancer Treatments
This quality improvement study assesses the quality and readability of online health information that patients may encounter when seeking information on adverse effects of breast cancer treatment. (Source: JAMA Surgery)
Source: JAMA Surgery - June 10, 2020 Category: Sports Medicine Source Type: research

Use of Sports Hernia to Describe Groin Pain in Athletes
To the Editor In the light of consensus statements and adoption of common terminology from world groin pain experts, we were surprised by both title and content of the article “Groin Pain Syndrome Known as Sports Hernia: A Review” by Zuckerbraun et al. Groin pain in athletes can originate from many different anatomical structures but is most commonly related to the hip adductors, and more specifically to the adductor longus muscle, tendon, and insertion at the pubic b one. It has been recommended by leading groin pain experts to avoid using the term sports hernia because a hernia very rarely is present in athle...
Source: JAMA Surgery - June 10, 2020 Category: Sports Medicine Source Type: research

Use of Sports Hernia to Describe Groin Pain in Athletes —Reply
In Reply We thank Thorberg and H ölmich for their critical evaluation of our recent narrative review on groin pain in athletes. Many valid points are raised as potential shortcomings in this article. First, we agree that these disease entities should not be termed sports hernia. Because this is a common misnomer that continues to be used and recognized by many, this term was included in the title to allow readers to recognize the subject material that was being described. We also concur that there are many different pathologies that contribute to the noncommittal and very general term groin pain syndrome. Broad, inclu...
Source: JAMA Surgery - June 10, 2020 Category: Sports Medicine Source Type: research

Gastric Cancer –Associated Long Noncoding RNA1 as a Biomarker for Early Detection and Monitoring Progression of Gastric Cancer
This study evaluates the diagnostic value of circulating exosomal gastric cancer –associated long noncoding RNA1 for early detection and monitoring progression of gastric cancer. (Source: JAMA Surgery)
Source: JAMA Surgery - June 10, 2020 Category: Sports Medicine Source Type: research

Assessment of Risk Factors for Suicide Among US Health Care Professionals
This cohort study uses data from the National Violent Death Reporting System to identify individuals who died by suicide in the United States between 2003 and 2016 and to assess suicide risk factors among health care professionals compared with the general population. (Source: JAMA Surgery)
Source: JAMA Surgery - June 10, 2020 Category: Sports Medicine Source Type: research

Incidence of COVID-19 in Pediatric Surgical Patients Among 3 US Children ’s Hospitals
This cohort study assesses the incidence of coronavirus disease 2019 (COVID-19) in pediatric patients presenting for surgery at 3 tertiary care children ’s hospitals across the US. (Source: JAMA Surgery)
Source: JAMA Surgery - June 4, 2020 Category: Sports Medicine Source Type: research

Gastric Bypass vs Medical Treatment in Renoprotection for Patients with Class 1 Obesity, Type 2 Diabetes, and Albuminuria
The superiority of bariatric surgery over best medical therapy (BMT) in the treatment of type 2 diabetes has been well demonstrated in high-quality randomized clinical trials. Furthermore, there is sufficient clinical and mechanistic evidence to support consideration of metabolic surgery for the patients with class 1 obesity (body mass index [BMI], 30.0-34.9; calculated as weight in kilograms divided by height in meters squared), type 2 diabetes, and inadequately controlled hyperglycemia. At 5-year follow-up, compared with BMT, the Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (ST...
Source: JAMA Surgery - June 3, 2020 Category: Sports Medicine Source Type: research

Turnbull-Cutait Pull-Through –An Old Procedure With a New Indication?
In the study by Biondo et al in this issue of JAMA Surgery, although 30-day postoperative morbidity was similar between the Turnbull-Cutait pull-through procedure with 2-stage hand-sewn coloanal anastomosis (TCA) and a standard hand-sewn coloanal anastomosis and diverting loop ileostomy (CAA/DLI), the anastomotic leak rate was 24% vs 13% for the CAA/DLI and TCA groups, respectively, suggesting a possible trend toward superiority of TCA over CAA/DLI in terms of anastomotic leakage. This is consistent with systematic reviews. Of note, the anastomotic leak rate may be further lowered following a TCA by delaying the hand-sewn ...
Source: JAMA Surgery - June 3, 2020 Category: Sports Medicine Source Type: research

Decompressing Stoma vs Stent in Left-Sided Obstructive Colon Cancer
To the Editor We read with great interest the article “Comparison of Decompressing Stoma vs Stent as a Bridge to Surgery for Left-Sided Obstructive Colon Cancer” by Veld et al, comparing 242 propensity score–matched patients treated with diverting stoma or self-expanding metallic stents (SEMS) as bridge to resection of left-sided obstructive colo n cancer. The authors found similar intermediate-term oncologic outcomes between the groups, which is in line with our own experience of a smaller cohort. (Source: JAMA Surgery)
Source: JAMA Surgery - June 3, 2020 Category: Sports Medicine Source Type: research

Decompressing Stoma vs Stent in Left-Sided Obstructive Colon Cancer
To the Editor I read with much interest the article by Veld et al. The authors analyzed 3253 patients with left-sided malignant colorectal obstruction operated on from January 2009 to December 2016 collected from the Netherlands national data. In a propensity score –matching analysis, they compared 121 patients who had stenting vs 121 patients who had proximal diverting stoma as a bridge to colorectal resection. Patients undergoing stenting had more primary anastomoses, more postresection stomas, fewer major complications, and more subsequent interventions, including stoma reversal. After diverting stoma and stenting...
Source: JAMA Surgery - June 3, 2020 Category: Sports Medicine Source Type: research

Decompressing Stoma vs Stent in Left-Sided Obstructive Colon Cancer
To the Editor Veld et al conducted a national, population-based cohort study to compare decompressing stoma with self-expandable metal stent as a bridge to surgery for advanced left-sided obstructive colon cancer using propensity score matching. We congratulate the authors on their important contributions. However, while reading the article, a few questions arose that we would like to address. (Source: JAMA Surgery)
Source: JAMA Surgery - June 3, 2020 Category: Sports Medicine Source Type: research

Decompressing Stoma vs Stent in Left-Sided Obstructive Colon Cancer
In Reply With interest, we read the letters from Hallqvist-Everhov et al, Sterpetti, and Zhou et al regarding our article “Comparison of Decompressing Stoma vs Stent as a Bridge to Surgery for Left-Sided Obstructive Colon Cancer.” (Source: JAMA Surgery)
Source: JAMA Surgery - June 3, 2020 Category: Sports Medicine Source Type: research