Diversification of Academic Surgery, Its Leadership, and the Importance of Intersectionality
This cross-sectional study evaluates trends among racial/ethnical minority groups stratified by gender along the surgical pipeline, as well as in surgical leadership. (Source: JAMA Surgery)
Source: JAMA Surgery - May 5, 2021 Category: Sports Medicine Source Type: research

Survival After Breast Conservation vs Mastectomy Adjusted for Comorbidity and Socioeconomic Status
This study determines whether the reported survival benefit of breast conservation is eliminated by adjustment for 2 pivotal confounders, comorbidity and socioeconomic status. (Source: JAMA Surgery)
Source: JAMA Surgery - May 5, 2021 Category: Sports Medicine Source Type: research

Dynamic α-Fetoprotein Response and Outcomes After Liver Transplant for Hepatocellular Carcinoma
This prognostic study examines the use of the dynamic α-fetoprotein response in selection of patients with hepatocellular carcinoma eligible for liver transplant. (Source: JAMA Surgery)
Source: JAMA Surgery - May 5, 2021 Category: Sports Medicine Source Type: research

Sentinel Lymph Node Concept in High –Risk Profile Endometrial Cancer—Reply
In Reply All prospective studies of sentinel lymph node (SLN) biopsy in endometrial cancer published to date have made valuable contributions to the literature because each has evaluated the diagnostic accuracy of SLN biopsy in a specific patient population of interest. The Sentinel Lymph Node Biopsy vs Lymphadenectomy for Intermediate- and High-Grade Endometrial Cancer Staging (SENTOR) study enrolled a uniform but pragmatic population of women with high-grade histology on endometrial biopsy and strictly clinical stage I disease (ie, no cervical/extrauterine disease on physical examination, preoperative imaging, or intraop...
Source: JAMA Surgery - May 5, 2021 Category: Sports Medicine Source Type: research

Sentinel Lymph Node Concept in High –Risk Profile Endometrial Cancer
To the Editor We have, with interest, read the Sentinel Lymph Node Biopsy vs Lymphadenectomy for Intermediate- and High-Grade Endometrial Cancer Staging (SENTOR) study by Cusimano and colleagues in which aspects of the preceding Pelvic Sentinel Lymph Node Detection in High-Risk Endometrial Cancer (SHREC) trial have been misinterpreted or omitted. Moreover, the authors inaccurately state that previous studies insufficiently investigated the diagnostic accuracy of the sentinel lymph node (SLN) concept in individuals with high-grade endometrial cancer. (Source: JAMA Surgery)
Source: JAMA Surgery - May 5, 2021 Category: Sports Medicine Source Type: research

Demographic, Clinical, and Mortality Trends of Law Enforcement –Related Trauma
This cross-sectional study examines demographic, clinical, and mortality trends of law enforcement –related traumatic injuries using 2014 to 2016 data from the Trauma Quality Improvement Program. (Source: JAMA Surgery)
Source: JAMA Surgery - May 5, 2021 Category: Sports Medicine Source Type: research

Time for Deliberate Organizational and Departmental Action
In this issue of JAMA Surgery, Riner et al report their analysis of the intersectionality of race and gender in surgical academic advancement. The authors found a decrease in female full professors who are underrepresented in medicine compared with their male colleagues despite a more positive trajectory at junior and midcareer levels and continued underrepresentation of both male and female individuals who are underrepresented in medicine in chair positions. Strikingly, since 2019, only 1 Black woman and 1 Latinx woman have served as surgical chairs. Despite mandates from the Accreditation Council for Graduate Medical Edu...
Source: JAMA Surgery - May 5, 2021 Category: Sports Medicine Source Type: research

Safety of Breast-Conserving Surgery in Breast Cancer and Risk of Overtreatment vs Undertreatment
The oncology community has advocated in favor of breast-conserving surgery (BCS) as an alternative to mastectomy in appropriately selected patients with breast cancer for several decades. This recommendation is supported by multiple prospective randomized clinical trials demonstrating overall survival equivalence for both operative approaches and is aligned with the paradigm shift in oncology to de-escalate all components of multidisciplinary care. Medical breast oncologists use less chemotherapy as a consequence of improved risk stratification by gene expression profiling and surgical breast oncology has also evolved. Tod...
Source: JAMA Surgery - May 5, 2021 Category: Sports Medicine Source Type: research

Dynamic α-Fetoprotein Response
There is an important unmet need for better measures of liver tumor biologic and objective criteria that may be used to select patients who will benefit most from the limited pool of life-saving liver grafts. The New York/California (NYCA) score based on α-fetoprotein response (AFP-R) showed potential to increase patients’ candidacy for liver transplant without compromising outcomes compared with the widely used Milan criteria and French-AFP score. In this issue of JAMA Surgery, Halazun et al present a retrospective international multicenter anal ysis to externally validate the NYCA score and compare it with ot...
Source: JAMA Surgery - May 5, 2021 Category: Sports Medicine Source Type: research

Factors Associated With General Surgery Residents ’ Operative Experience During the COVID-19 Pandemic
This study examines the association of the COVID-19 pandemic with general surgical residents ’ operative experience by postgraduate year and case type. (Source: JAMA Surgery)
Source: JAMA Surgery - April 30, 2021 Category: Sports Medicine Source Type: research

Paradox of Resident Case Numbers
Numerous articles, lectures, and commentaries have debated the importance of and requirements regarding operative experience and competence of surgical residents. The authors of “Factors Associated with General Surgery Residents' Operative Experience During the COVID-19 Pandemic” expertly point out the negative effect of the COVID-19 pandemic on general surgery resident operative experience, identify case volume differences between level 1 trauma and nontrauma centers d uring the pandemic, and highlight important mitigation strategies. Graduating residents and those in surgical education have been concerned abo...
Source: JAMA Surgery - April 30, 2021 Category: Sports Medicine Source Type: research

Home Hospital for Surgery
This article describes the home hospital delivery model, which delivers monitored at-home treatment that would otherwise require inpatient hospital admission. (Source: JAMA Surgery)
Source: JAMA Surgery - April 28, 2021 Category: Sports Medicine Source Type: research

Association Between Gender-Affirming Surgeries and Mental Health Outcomes
This study evaluates associations between gender-affirming surgeries and mental health outcomes, including psychological distress, substance use, and suicide risk. (Source: JAMA Surgery)
Source: JAMA Surgery - April 28, 2021 Category: Sports Medicine Source Type: research

Does PROVE-IT Really Prove Anything of Value? —Reply
In Reply We appreciate the thoughtful commentary regarding our recently published study and feel that Novitsky et al bring up some valid points that we would like to address here. (Source: JAMA Surgery)
Source: JAMA Surgery - April 28, 2021 Category: Sports Medicine Source Type: research

Nonoperative Management for Pregnant Individuals With Gallstone Disease in the Third Trimester —Reply
In Reply We appreciate the interest in our work and the perspective presented by Fong and colleagues. Specifically, they raise concern with our recommendation to offer cholecystectomy to pregnant patients with symptomatic gallstone disease regardless of pregnancy trimester, particularly with regard to those in the third trimester. They refer us to their 2019 study comparing women who underwent cholecystectomy during the third trimester with those who underwent cholecystectomy within 3 months post partum. They queried the California Office of Statewide Health Planning and Development database to assess cholecystectomy-relat...
Source: JAMA Surgery - April 28, 2021 Category: Sports Medicine Source Type: research

Does PROVE-IT Really Prove Anything of Value?
To the Editor It is with interest that we read the study by Petro et al. While we commend the authors for tackling timely clinical questions, we have significant concerns about PROVE-IT methodology and resultant overstated conclusions. (Source: JAMA Surgery)
Source: JAMA Surgery - April 28, 2021 Category: Sports Medicine Source Type: research

Nonoperative Management for Pregnant Individuals With Gallstone Disease in the Third Trimester
To the Editor We read with interest the recent JAMA Network Insight by Schwulst and Son on the management of gallstone disease during pregnancy advocating cholecystectomy in all trimesters. While the authors emphasized the importance of trimester in the setting of gallbladder disease, their recommendations are based on small case series, as are the SAGES (Society of American Gastrointestinal Endoscopic Surgeons) guidelines. These reports are too small to distinguish the effect of timing of treatment in pregnancy on outcome. Conversely, we recently published a large series of pregnant women with gallstone disease treated in...
Source: JAMA Surgery - April 28, 2021 Category: Sports Medicine Source Type: research

Assessment of Emotional Outcomes of Intraoperative Death on Surgical Team Members
This cohort study surveys surgeons, anesthesiologists, residents, nurses, and technicians at a single institution regarding their experiences of intraoperative death, particularly emotional outcomes. (Source: JAMA Surgery)
Source: JAMA Surgery - April 28, 2021 Category: Sports Medicine Source Type: research

Gender-Affirming Surgeries and Improved Psychosocial Health Outcomes
There is a growing body of literature supporting the positive outcomes of gender-affirming surgery (GAS) on transgender and gender diverse individuals. Mental health outcomes are among the most vital end points to study, given the fundamental intent of GAS to provide patients with relief from gender dysphoria and improvement of psychosocial distress. Much of the data on this topic come from observational studies that lack either control groups or adequate sample size. In this issue of JAMA Surgery, Almazan and Keuroghlian contribute an analysis of the US Transgender Survey (USTS), examining the topic of mental health outco...
Source: JAMA Surgery - April 28, 2021 Category: Sports Medicine Source Type: research

Opportunities and Challenges for the Next Phase of ERAS
This narrative review describes how Enhanced Recovery After Surgery (ERAS) has continued to develop since inception, opportunities and challenges in the field of enhanced recovery today, and how ERAS represents an opportunity to manage the problems for surgery arising from the COVID-19 pandemic. (Source: JAMA Surgery)
Source: JAMA Surgery - April 21, 2021 Category: Sports Medicine Source Type: research

Oxygenated End-Hypothermic Machine Perfusion in Expanded Criteria Donor Kidney Transplant
This randomized clinical trial compares the effect of short-term oxygenated hypothermic machine perfusion preservation after static cold storage vs static cold storage alone on 1-year graft survival in expanded criteria donor kidneys from donors who are brain dead. (Source: JAMA Surgery)
Source: JAMA Surgery - April 21, 2021 Category: Sports Medicine Source Type: research

Axillary Pathologic Complete Response After Neoadjuvant Systemic Therapy by Breast Cancer Subtype
This systematic review and meta-analysis pools data from studies in the neoadjuvant setting on axillary pathologic complete response rates for different breast cancer subtypes in patients with initial clinically node-positive disease. (Source: JAMA Surgery)
Source: JAMA Surgery - April 21, 2021 Category: Sports Medicine Source Type: research

Time at Home as a Patient-Centered End Point for Surgical Cancer Treatment —Reply
In Reply Broadening our understanding of what matters to older adults considering surgery for cancer is essential to advancing patient-centered care. Conventional outcomes of survival, cancer control, and early postoperative morbidity alone are insufficient. Outcomes of importance to older adults include disability, maintenance of function, role and social engagement, quality of life, and well-being; prioritizing outcomes is unique to individual patients. Understanding these outcomes is imperative to support patient-centered preoperative decision-making and postoperative support. (Source: JAMA Surgery)
Source: JAMA Surgery - April 21, 2021 Category: Sports Medicine Source Type: research

Time at Home as a Patient-Centered End Point for Surgical Cancer Treatment
To the Editor I thank Chesney et al for their cohort study using time at home as a measure to assess functional outcomes during the 5 years after surgical cancer treatment. They conclude that time at home can be used as a patient-centered end point and can be useful for cancer surgery planning and minimizing institutional days. (Source: JAMA Surgery)
Source: JAMA Surgery - April 21, 2021 Category: Sports Medicine Source Type: research

Maintaining Good Mental Health for Physicians and Staff
To the Editor The Viewpoint by Fu et al is an important article but needs details about specific approaches. Physician health programs are available in almost every state and offer confidential evaluation, referral for treatment, and, when indicated, long-term monitoring. The concept that surgery is special and that other specialties are not so affected is itself a stigma and could lead to more untreated illness in other specialties. (Source: JAMA Surgery)
Source: JAMA Surgery - April 21, 2021 Category: Sports Medicine Source Type: research

Decreasing Failure-to-Rescue From Severe Maternal Morbidity at Cesarean Delivery
This cohort study examines recent US trends in patient characteristics and perioperative morbidity and mortality at time of cesarean delivery. (Source: JAMA Surgery)
Source: JAMA Surgery - April 21, 2021 Category: Sports Medicine Source Type: research

US National Trends in Vascular Surgical Practice During the COVID-19 Pandemic
This national cohort study examines changes in the number of vascular surgical procedures completed in the US before and during the COVID-19 pandemic. (Source: JAMA Surgery)
Source: JAMA Surgery - April 15, 2021 Category: Sports Medicine Source Type: research

Addressing Challenges Faced by Female Surgical Trainees With Children During Protected Academic Periods
This Viewpoint discusses intricacies of childbearing and adoption during surgical training and advises changes to help surgical trainees, particularly women, achieve their professional goals without sacrificing their careers. (Source: JAMA Surgery)
Source: JAMA Surgery - April 14, 2021 Category: Sports Medicine Source Type: research

Outcomes With Surgery vs Functional Bracing for Patients With Closed, Displaced Humeral Shaft Fractures
This secondary analysis of the FISH randomized clinical trial compares the 2-year outcomes of patients who required secondary surgery with the outcomes of patients with successful initial operative or nonoperative treatment. (Source: JAMA Surgery)
Source: JAMA Surgery - April 14, 2021 Category: Sports Medicine Source Type: research

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality
This systematic review and meta-analysis with meta-regression of 216 randomized clinical trials assesses the association between intravenous administration of tranexamic acid and vascular occlusive events in patients undergoing surgery or experiencing bleeding. (Source: JAMA Surgery)
Source: JAMA Surgery - April 14, 2021 Category: Sports Medicine Source Type: research

Implant Surface Texture and Breast Cancer Recurrence —Reply
In Reply We deeply appreciate valuable comments provided by de Andrade Urban et al, Bijlard and Mureau, and Maarse and Teunis in response to our study. Thankfully, they addressed several critical points that had not been fully considered during preparation of our original study. (Source: JAMA Surgery)
Source: JAMA Surgery - April 14, 2021 Category: Sports Medicine Source Type: research

Blunt Splenic Injury and Prophylactic Splenic Artery Embolization —Reply
In Reply We are happy that our article published in JAMA Surgery, “Effect of Prophylactic Embolization on Patients With Blunt Trauma at High Risk of Splenectomy: A Randomized Clinical Trial,” has stimulated discussion on the feasibility and benefits, or not, of prophylactic splenic artery embolization. (Source: JAMA Surgery)
Source: JAMA Surgery - April 14, 2021 Category: Sports Medicine Source Type: research

Implant Surface Texture and Breast Cancer Recurrence
To the Editor There have been concerns regarding breast implants for a long time. On one hand, unfounded claims about autoimmune and connective tissue disease led to unnecessary fear and large-scale litigation. On the other hand, an increased risk of anaplastic large cell lymphoma is now recognized. These contrasting results emphasize the need for close and careful scrutiny. (Source: JAMA Surgery)
Source: JAMA Surgery - April 14, 2021 Category: Sports Medicine Source Type: research

Implant Surface Texture and Breast Cancer Recurrence
To the Editor With great interest, we read the study by Lee et al, who investigated the association of breast implant surface texture with the oncological safety in postmastectomy breast reconstruction. They found textured implants are associated with lower disease-free survival, which requires careful interpretation and definitely warrants further research. (Source: JAMA Surgery)
Source: JAMA Surgery - April 14, 2021 Category: Sports Medicine Source Type: research

Implant Surface Texture and Breast Cancer Recurrence
To the Editor We read with great interest the study “Association of the Implant Surface Texture Used in Reconstruction With Breast Cancer Recurrence.” This is a retrospective cohort study from a single institution in South Korea. The authors compared local and regional recurrence-free survival and disease-free survival rates among patients with s mooth and textured implant after reconstruction, finding worse disease-free survival in the textured implant group. It was hypothesized that a chronic inflammatory process could explain the results, just as it happens in breast implant–associated anaplastic large...
Source: JAMA Surgery - April 14, 2021 Category: Sports Medicine Source Type: research

Blunt Splenic Injury and Prophylactic Splenic Artery Embolization
To the Editor We write regarding the recent article by Arvieux et al, which was recently presented at CRAMSURG, an online journal club based in the UK (http://www.cramsurg.org). We would like to congratulate the authors for their efforts in performing a multicenter randomized clinical trial in such a complex area. We discussed a number of issues that we would like to raise. (Source: JAMA Surgery)
Source: JAMA Surgery - April 14, 2021 Category: Sports Medicine Source Type: research

Blunt Splenic Injury and Prophylactic Splenic Artery Embolization
To the Editor We read with interest the article by Arvieux et al, who reported no significant difference in the 1-month spleen salvage rate between prophylactic splenic artery embolization (pSAE) compared with surveillance and then embolization only if necessary (SURV) among patients with splenic trauma at a high risk of rupture. While the researchers concluded that both pSAE and SURV are defendable, they identified some key differences in terms of the secondary outcomes. Namely, pSAE was associated with fewer splenic pseudoaneurysms by day 5 of hospitalization (P  = .03), fewer secondary embolizations (P 
Source: JAMA Surgery - April 14, 2021 Category: Sports Medicine Source Type: research

Analysis of Price Transparency for Oncologic Surgery in National Cancer Institute –Designated Cancer Centers in 2020
This cross-sectional analysis reviews hospital chargemasters for a range of cancer surgeries to determine hospitals ’ legal compliance with disclosure requirements and the specific prices disclosed. (Source: JAMA Surgery)
Source: JAMA Surgery - April 14, 2021 Category: Sports Medicine Source Type: research

Tranexamic Acid and Safety in the Right Patient
Tranexamic acid (TXA), an antifibrinolytic agent approved for use in menorrhagia for many decades, has experienced a resurgence of interest and use for both prophylaxis and treatment. TXA works by blocking lysine-binding sites in plasminogen, preventing its binding to fibrin, where it would normally be available for activation by tissue plasminogen activator. It attenuates bleeding if administered early when tissue plasminogen activator is prominent but promotes bleeding if given late when urokinase plasminogen activator is dominant, thereby providing a possible explanation for the observed outcomes of TXA administered aft...
Source: JAMA Surgery - April 14, 2021 Category: Sports Medicine Source Type: research

TREND Reporting Guidelines for Nonrandomized/Quasi-Experimental Study Designs
This Guide to Statistics and Methods summarizes the use, required items, and limitations of the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) reporting guidelines for nonrandomized/quasi-experimental study designs. (Source: JAMA Surgery)
Source: JAMA Surgery - April 7, 2021 Category: Sports Medicine Source Type: research

The CONSORT Framework
This Guide to Statistics and Methods provides an overview of the Consolidated Standards of Reporting Trials framework, emphasizes several important considerations when using it, and points out its limitations. (Source: JAMA Surgery)
Source: JAMA Surgery - April 7, 2021 Category: Sports Medicine Source Type: research

PRISMA Reporting Guidelines for Meta-analyses and Systematic Reviews
This Guide to Statistics and Methods describes the Preferred Reporting Items of Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. (Source: JAMA Surgery)
Source: JAMA Surgery - April 7, 2021 Category: Sports Medicine Source Type: research

AAPOR Reporting Guidelines for Survey Studies
This Guide to Statistics and Methods summarizes the use, required items, and limitations of the American Association for Public Opinion Research (AAPOR) reporting guidelines for survey studies. (Source: JAMA Surgery)
Source: JAMA Surgery - April 7, 2021 Category: Sports Medicine Source Type: research

CHEERS Reporting Guidelines for Economic Evaluations
This Guide to Statistics and Methods provides an overview of the Consolidated Health Economic Evaluation Reporting Standards. (Source: JAMA Surgery)
Source: JAMA Surgery - April 7, 2021 Category: Sports Medicine Source Type: research

TRIPOD Reporting Guidelines for Diagnostic and Prognostic Studies
This Guide to Statistics and Methods provides an overview of the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) guidelines, including its uses and limitations. (Source: JAMA Surgery)
Source: JAMA Surgery - April 7, 2021 Category: Sports Medicine Source Type: research

ISPOR Reporting Guidelines for Comparative Effectiveness Research
This Guide to Statistics and Methods summarizes the key characteristics, strengths, and limitations of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) reporting guidelines for comparative effectiveness research studies using nonrandomized, secondary data sources. (Source: JAMA Surgery)
Source: JAMA Surgery - April 7, 2021 Category: Sports Medicine Source Type: research

SQUIRE Reporting Guidelines for Quality Improvement Studies
This Guide to Statistics and Methods summarizes the key characteristics, strengths, and limitations of the Standards for Quality Improvement Reporting Excellence (SQUIRE) reporting guideline, a tool for the communication, review, and appraisal of all types of studies reporting on systemic health care improvement. (Source: JAMA Surgery)
Source: JAMA Surgery - April 7, 2021 Category: Sports Medicine Source Type: research

STROBE Reporting Guidelines for Observational Studies
This Guide to Statistics and Methods provides an overview of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline, including its benefits and limitations. (Source: JAMA Surgery)
Source: JAMA Surgery - April 7, 2021 Category: Sports Medicine Source Type: research

SRQR and COREQ Reporting Guidelines for Qualitative Studies
This Guide to Statistics and Methods describes Standards for Reporting Qualitative Research (SRQR) and the Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guidelines for qualitative research. (Source: JAMA Surgery)
Source: JAMA Surgery - April 7, 2021 Category: Sports Medicine Source Type: research

MOOSE Reporting Guidelines for Meta-analyses of Observational Studies
This Guide to Statistics and Methods provides an overview of the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. (Source: JAMA Surgery)
Source: JAMA Surgery - April 7, 2021 Category: Sports Medicine Source Type: research