Patient-Centered Time-at-Home Outcomes in Older Adults After Surgical Cancer Treatment
This cohort study evaluates the time at home vs time at institutions after surgical care in older patients with newly diagnosed cancer. (Source: JAMA Surgery)
Source: JAMA Surgery - November 18, 2020 Category: Surgery Source Type: research

The Utility of Perforated Appendix Rate as a Proxy for Timely Access to Care
To the Editor We read with great interest the article by Golz et al regarding the association of acute appendicitis and socioeconomic status. The authors present compelling data about geospatial incidence of appendicitis (perforated and nonperforated) by both insurance and socioeconomic status. However, their discussion of these data risks inappropriately discounts the utility of perforated appendix rate as a measure of timely access to care. (Source: JAMA Surgery)
Source: JAMA Surgery - November 1, 2020 Category: Surgery Source Type: research

The Utility of Perforated Appendix Rate as a Proxy for Timely Access to Care —Reply
In Reply In our article, we emphasized the importance of population-based methodologies in the study of appendicitis. Our assertion that the disease state appendicitis exists on a spectrum of severity is not meant to suggest the complete absence of a time-dependent association between some cases of appendicitis and perforation. Obviously, some appendicitis is progressive, and this is the portion of the disease that Scott and Loehrer describe as within certain theoretical bounds of incidence. However, as they acknowledge in their letter, these theoretical bounds are “as yet undefined,” which is exactly why inter...
Source: JAMA Surgery - November 1, 2020 Category: Surgery Source Type: research

Evidence-Based Orthopedic Surgery —From Synthesis to Practice
This Viewpoint discusses the adoption of evidence-based surgery in orthopedics. (Source: JAMA Surgery)
Source: JAMA Surgery - November 1, 2020 Category: Surgery Source Type: research

Indications for Total Gastrectomy and Outcomes of Minimally Invasive and Open Gastrectomies
This cohort study assesses the association between CDH1 variant pathogenicity or family history of cancer and signet ring cell cancer and describes outcomes of minimally invasive and open total gastrectomy. (Source: JAMA Surgery)
Source: JAMA Surgery - November 1, 2020 Category: Surgery Source Type: research

Refining Assumptions About Specialty Compensation Rates
To the Editor Childers and Maggard-Gibbons found that overall compensation rates under the Medicare Physician Fee Schedule fell within a narrow range for most specialties. We applaud their effort to perform a comprehensive assessment that includes a broad range of clinical activities. However, we believe that the study relies on 2 potentially problematic assumptions. (Source: JAMA Surgery)
Source: JAMA Surgery - November 1, 2020 Category: Surgery Source Type: research

Refining Assumptions About Specialty Compensation Rates —Reply
In Reply We thank Xiao and Rathi for their insightful comments on our article. In brief, we used 2017 fee-for-service Medicare data to calculate compensation rates (measured in work relative value units [RVUs] per minute) for 42 medical and surgical specialties. We found a relatively narrow range, with less than a 2-fold difference between the highest and lowest specialties. Our subsequent analyses suggest why this may be the case. First, physicians perform a great diversity of services: general surgeons, for example, billed more than 4000 distinct current procedural terminology (CPT) codes. Second, and perhaps more import...
Source: JAMA Surgery - November 1, 2020 Category: Surgery Source Type: research

JAMA Surgery
Mission Statement: To promote the art and science of surgery by publishing relevant peer-reviewed research to assist the surgeon in optimizing patient care. JAMA Surgery will also serve as a forum for the discussion of issues pertinent to surgery, such as the education and training of the surgical workforce, quality improvement, and the ethics and economics of health care delivery. (Source: JAMA Surgery)
Source: JAMA Surgery - November 1, 2020 Category: Surgery Source Type: research

Organ Donation After Euthanasia
Since its inception, clinical transplantation has been fraught with ethical issues. Activities we consider routine practice today (eg, living donation or declaration of brain death) underwent contentious debate just a few decades ago. In this issue of JAMA Surgery, van Reeven et al raise additional ethical issues in their discussion of liver donation after euthanasia. An important point is that euthanasia, legal in only a few countries, differs from medically assisted suicide. In medically assisted suicide, the physician provides the means of suicide and the patient self-administers it. In euthanasia, the physician adminis...
Source: JAMA Surgery - October 1, 2020 Category: Surgery Source Type: research

A Move to Demarginalize the Liver Donor Allograft
Progress in liver transplantation during the past 30 years has been dramatic. The complexities of the operation have been standardized, candidate mortality has been objectified (Model for End-stage Liver Disease [MELD]), and survival has been maximized. Historically, the use of “marginal” liver allografts has often resulted in suboptimal results; thus, these grafts were often discarded except in the direst of circumstances. The more contemporary era of liver transplantation, perhaps the MELD era, has seen increasing use of marginal allografts owing to many factors, inc luding the proliferation of transplant cen...
Source: JAMA Surgery - October 1, 2020 Category: Surgery Source Type: research

Trauma as an Entry Point to the Health Care System
This study examines unmanaged chronic medical and psychiatric conditions in hospitalized trauma patients. (Source: JAMA Surgery)
Source: JAMA Surgery - October 1, 2020 Category: Surgery Source Type: research

Evaluation of Liver Graft Donation After Euthanasia
This cohort study explores the concept, processes, implications, and outcomes of liver organ donation after a donor ’s death from euthanasia in the Netherlands and Belgium. (Source: JAMA Surgery)
Source: JAMA Surgery - October 1, 2020 Category: Surgery Source Type: research

Trends in Outcomes for Marginal Allografts in Liver Transplant
This cohort study examines the time trends in the outcomes of marginal liver allografts as defined by 6 different sets of criteria. (Source: JAMA Surgery)
Source: JAMA Surgery - October 1, 2020 Category: Surgery Source Type: research

Error in Author Byline
This article has been corrected online. (Source: JAMA Surgery)
Source: JAMA Surgery - October 1, 2020 Category: Surgery Source Type: research

Additional Affiliations and Conflict of Interest Disclosures
This article was corrected online. (Source: JAMA Surgery)
Source: JAMA Surgery - October 1, 2020 Category: Surgery Source Type: research

JAMA Surgery
Mission Statement: To promote the art and science of surgery by publishing relevant peer-reviewed research to assist the surgeon in optimizing patient care. JAMA Surgery will also serve as a forum for the discussion of issues pertinent to surgery, such as the education and training of the surgical workforce, quality improvement, and the ethics and economics of health care delivery. (Source: JAMA Surgery)
Source: JAMA Surgery - October 1, 2020 Category: Surgery Source Type: research

Early Saphenous Ablation for Patients With Venous Ulcers
Chronic nonhealing lower extremity wounds are common throughout the world and increasing in prevalence, with an economic burden on the US health care system of nearly $15 billion annually. Optimal management of venous leg ulcers (VLUs) associated with chronic venous insufficiency has long been debated. High-strength compression, wound care, and venous intervention all have a role to play, but the cost-efficacy of venous intervention as an adjunctive therapy has been poorly defined, leading to limited utilization. (Source: JAMA Surgery)
Source: JAMA Surgery - September 23, 2020 Category: Sports Medicine Source Type: research

Unravelling the Obesity Paradox Through Bariatric Surgery
To the Editor We thank Sheetz et al for their work in determining whether bariatric surgery (BS) is associated with improved long-term survival among patients with obesity with end-stage kidney disease (ESKD). They found that BS was associated with a lower all-cause mortality rate at 3, 5, and 7 years postoperatively when compared with the nonsurgical group. (Source: JAMA Surgery)
Source: JAMA Surgery - September 23, 2020 Category: Sports Medicine Source Type: research

Unravelling the Obesity Paradox Through Bariatric Surgery
To the Editor We applaud the efforts of Sheetz et al to address the association of bariatric surgery for patients with obesity with end-stage kidney disease (ESKD), which presents an important dilemma for both the patient and their treating nephrologist. However, there are a few issues we would like to highlight when interpreting this population-based study. (Source: JAMA Surgery)
Source: JAMA Surgery - September 23, 2020 Category: Sports Medicine Source Type: research

Unravelling the Obesity Paradox Through Bariatric Surgery —Reply
In Reply It is clear that the surgical community is reconsidering the risks and benefits of expanding bariatric surgery to patients with end-stage kidney disease (ESKD). While the best clinical intuition a decade ago would suggest that these patients are of prohibitive risk, new data from our group and others offer a different take. Not only is bariatric surgery safe for patients with obesity and ESKD, but it is also associated with long-term survival benefits that merit ongoing discussion. (Source: JAMA Surgery)
Source: JAMA Surgery - September 23, 2020 Category: Sports Medicine Source Type: research

Association of Sarcopenia and Body Composition With Outcomes After Liver Resection for Tumors
This cohort study investigates the role of sarcopenia as a risk factor associated with morbidity after liver resection for malignant tumors. (Source: JAMA Surgery)
Source: JAMA Surgery - September 23, 2020 Category: Sports Medicine Source Type: research

Long-Term Clinical and Cost-Effectiveness of Early Endovenous Ablation in Venous Ulceration
This randomized clinical trial uses data from the Early Venous Reflux Ablation trial to evaluate the long-term clinical and cost benefits of combined early endovenous ablation and compression compared with compression therapy alone and deferred ablation for treating superficial venous reflux of the leg. (Source: JAMA Surgery)
Source: JAMA Surgery - September 23, 2020 Category: Sports Medicine Source Type: research

Medicaid Expansion and Surgical Care —Evaluating the Evidence
This Viewpoint discusses how expanded Medicare coverage has affected the rate of uninsured individuals, timing of presentation, and access to care among surgical patients. (Source: JAMA Surgery)
Source: JAMA Surgery - September 23, 2020 Category: Sports Medicine Source Type: research

Incorrect Study Type Given
This study should have been identified as a cohort study. This article was corrected online. (Source: JAMA Surgery)
Source: JAMA Surgery - September 16, 2020 Category: Sports Medicine Source Type: research

How Should SPLASH Inform the Care of Patients With Blunt Splenic Trauma?
Management of blunt splenic injury has evolved over time, with nonoperative management being the recommended initial management strategy among hemodynamically stable adult patients without peritonitis. Although advances have resulted in the improved success of nonoperative management and in the identification of patients at high risk for splenic failure, questions remain regarding the optimal role of angioembolization for these patients. In this issue of JAMA Surgery, Arvieux et al randomized 140 patients with grade 3 or higher blunt splenic injuries to prophylactic splenic angioembolization or surveillance with as-needed ...
Source: JAMA Surgery - September 16, 2020 Category: Sports Medicine Source Type: research

Changes in Diagnosis of Thyroid Cancer Among Medicaid Beneficiaries Following Medicaid Expansion
This cohort study uses the National Cancer Database to examine changes in rates of diagnosis of thyroid cancer among Medicaid beneficiaries after Medicaid expansion in 2014. (Source: JAMA Surgery)
Source: JAMA Surgery - September 16, 2020 Category: Sports Medicine Source Type: research

Change the Trainee, or Change the Training Environment?
To the Editor In “Reflections of a Millennial Surgeon: The Changing Face of Medical Education,” Clifton traces the arc of medical education toward increasing learner control over the process. Citing Golding’s Lord of the Flies as a cautionary tale, Clifton warns that this ideological shift fails to acknowledge the self-destructive potential of autonomy granted too soon. Rather than duty hour restrictions and student evaluations of curricula, Clifton argues learners’ needs would be best served by an attitudinal shift of learners to embrace humility and seek out wisdom dispensed from critical mentors....
Source: JAMA Surgery - September 16, 2020 Category: Sports Medicine Source Type: research

Change the Trainee, or Change the Training Environment? —Reply
In Reply I sincerely thank Sue-Chue-Lam for his interest in the published article in JAMA Surgery, “Reflections of a Millennial Surgeon: The Changing Face of Medical Education.” His view on the importance of critical appraisal of teaching strategy within the constant flux of educational development between generations of learners is of paramount importance. A field cannot move forward without first looking back through the lens of process improvement. I soundly agree with the claim that human behavior is significantly influenced by material conditions, especially within the context of medical training. In recip...
Source: JAMA Surgery - September 16, 2020 Category: Sports Medicine Source Type: research

Breast Cancer Surgery and Quality of Life and Psychosocial Well-being in Young Breast Cancer Survivors
This study evaluates the differential associations of surgery with quality of life and psychosocial outcomes among women with breast cancer from 1 to 5 years following diagnosis. (Source: JAMA Surgery)
Source: JAMA Surgery - September 16, 2020 Category: Sports Medicine Source Type: research

Effect of Prophylactic Embolization on Trauma Patients at High Risk of Splenectomy
This randomized clinical trial assesses whether the 1-month spleen salvage rate among patients with splenic trauma at high risk of rupture is higher after prophylactic splenic arterial embolization or surveillance and then embolization only if necessary. (Source: JAMA Surgery)
Source: JAMA Surgery - September 16, 2020 Category: Sports Medicine Source Type: research

Perioperative Immunization for Splenectomy and the Surgeon ’s Responsibility
This narrative review provides information on infectious disease risk in patients who have undergone splenectomy and discusses infection prevention with a variety of vaccination strategies, including perioperative vaccination by surgeons. (Source: JAMA Surgery)
Source: JAMA Surgery - September 16, 2020 Category: Sports Medicine Source Type: research

Combating the Peacetime Effect in Military Medicine
This Viewpoint proposes the term peacetime effect to describe the erosion of skills needed by military surgeons during periods of relative peace and discusses partnerships for maintaining the edge in casualty care that may also benefit civilian trauma patients. (Source: JAMA Surgery)
Source: JAMA Surgery - September 16, 2020 Category: Sports Medicine Source Type: research

NICE Guidelines on the Diagnosis and Management of Pancreatic Cancer
This article summarizes “Diagnosis and Management of Pancreatic Cancer in Adults: A Summary of Guidelines From the UK National Institute for Health and Care Excellence,” which is aimed at improving outcomes in pancreatic cancer. (Source: JAMA Surgery)
Source: JAMA Surgery - September 9, 2020 Category: Sports Medicine Source Type: research

Broadening the Discussion on Physician Burnout
In their study in this issue of JAMA Surgery, Hewitt et al have compared definitions and thresholds of burnout in general surgery residents, providing important insights into strategies to measure physician burnout. The study offers multiple strengths: a large and representative sample (N  = 6956), an excellent survey response rate (85.6%), the use of a validated gold standard measure of burnout, and exploration of prevalence based on inconsistencies in the literature. The authors have asserted that the Maslach Burnout Inventory is scored and interpreted inconsistently in the lit erature regarding the time fr...
Source: JAMA Surgery - September 9, 2020 Category: Sports Medicine Source Type: research

Access and Care Disparities in Ambulatory Surgery Centers
Janeway et al are to be congratulated on their work, which analyzed the association of socioeconomic status with ambulatory surgery center (ASC) access and outcomes in Florida and New York. The study used 3 years of data (2011-2013) from the Healthcare Cost and Utilization Project of the Agency for Health Research and Quality. The State Ambulatory Surgery and Services Databases comprise a subset of the data, which include ambulatory surgery discharge records from both hospital-affiliated and freestanding ASCs. Florida and New York were chosen for comparison based on their high volumes of ambulatory procedures and the consi...
Source: JAMA Surgery - September 9, 2020 Category: Sports Medicine Source Type: research

Preoperative Metformin Exposure and Postoperative Outcomes in Adults With Type 2 Diabetes
To the Editor We read with great interest the article titled “Association Between Preoperative Metformin Exposure and Postoperative Outcomes in Adults With Type 2 Diabetes.” This retrospective study shows an association between metformin prescriptions provided to individuals with type 2 diabetes before a major surgical procedure and reduced risk-adjusted mortality and readmission after the operation. In general, it is a well-designed study; however, we would like to address some questions concerning the content of this article. (Source: JAMA Surgery)
Source: JAMA Surgery - September 9, 2020 Category: Sports Medicine Source Type: research

Preoperative Metformin Exposure and Postoperative Outcomes in Adults With Type 2 Diabetes
To the Editor We read with great interest the article by Reitz et al published in JAMA Surgery. The study concluded that there is an association between metformin prescriptions provided to individuals with type 2 diabetes before a major surgical procedure and reduced risk-adjusted mortality and readmission after the operation. Although it sounds scientific, there are some problems that deserve our attention. (Source: JAMA Surgery)
Source: JAMA Surgery - September 9, 2020 Category: Sports Medicine Source Type: research

Association of Race, Insurance, and Income With Location of Ambulatory Surgery in 2 US States
This cohort study uses data from the State Ambulatory Surgery and Services Databases to examine the association of race, health insurance status, and household income with the location in which ambulatory surgery is performed among patients in New York and Florida between 2011 and 2013. (Source: JAMA Surgery)
Source: JAMA Surgery - September 9, 2020 Category: Sports Medicine Source Type: research

Evaluating the Association of Multiple Burnout Definitions and Thresholds With Prevalence and Outcomes
This cross-sectional national survey of general surgery residents assesses the prevalence of burnout using a range of definitions and thresholds and associates the resulting estimates with suicidal thoughts and thoughts of attrition among general surgery residents. (Source: JAMA Surgery)
Source: JAMA Surgery - September 9, 2020 Category: Sports Medicine Source Type: research

Video-Based Feedback for the Improvement of Surgical Technique
This article describes Video-Based Feedback for the Improvement of Surgical Technique, a video-centered approach to coaching practicing surgeons. (Source: JAMA Surgery)
Source: JAMA Surgery - September 9, 2020 Category: Sports Medicine Source Type: research

Female Surgical Trainees and Departmental Awards
For surgical trainees, the content of a curriculum vitae may enable or prevent them from pursuing their ultimate goals. The provision of awards within an individual department is not a private matter and is deserving of scrutiny. In this issue of JAMA Surgery, Kuo and colleagues highlight that although the gap between male and female awardees appears to be decreasing over time, factors such as implicit bias and culturally ingrained ideas about gender groups may prevent female trainees from achieving parity in award receipt. (Source: JAMA Surgery)
Source: JAMA Surgery - September 2, 2020 Category: Sports Medicine Source Type: research

Gender Disparity in Awards in General Surgery Residency Programs
This survey study assesses the presence of gender disparity in award winners in general surgery residency programs. (Source: JAMA Surgery)
Source: JAMA Surgery - September 2, 2020 Category: Sports Medicine Source Type: research

USMLE Step 1 Scoring System Change to Pass/Fail —An Opportunity for Change
This Viewpoint presents an opinion generally in support of the change in the USMLE Step 1 scoring system to pass/fail, with some reservations also expressed. (Source: JAMA Surgery)
Source: JAMA Surgery - September 2, 2020 Category: Sports Medicine Source Type: research

USLME Step 1 Scoring System Change to Pass/Fail —Perspective of a Clerkship Director
This Viewpoint offers a clerkship director ’s perspective on the United States Medical Licensing Examination (USMLE) Step 1 change from score-based results to pass/fail. (Source: JAMA Surgery)
Source: JAMA Surgery - September 2, 2020 Category: Sports Medicine Source Type: research

USMLE Step 1 Scoring System Change to Pass/Fail —Perspective of a Program Director
This article describes how the changes in USMLE Step 1 scoring to pass/fail may affect international medical graduates. (Source: JAMA Surgery)
Source: JAMA Surgery - September 2, 2020 Category: Sports Medicine Source Type: research

USMLE Step 1 Scoring System Change to Pass/Fail —Implications for International Medical Graduates
This Viewpoint offers international medical graduates ’ perspective on the United States Medical Licensing Examination (USMLE) Step 1 change from score-based results to pass/fail. (Source: JAMA Surgery)
Source: JAMA Surgery - September 2, 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 - September 1, 2020 Category: Surgery Source Type: research

JAMA Surgery
Mission Statement: To promote the art and science of surgery by publishing relevant peer-reviewed research to assist the surgeon in optimizing patient care. JAMA Surgery will also serve as a forum for the discussion of issues pertinent to surgery, such as the education and training of the surgical workforce, quality improvement, and the ethics and economics of health care delivery. (Source: JAMA Surgery)
Source: JAMA Surgery - September 1, 2020 Category: Surgery 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 - September 1, 2020 Category: Surgery 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 - September 1, 2020 Category: Surgery Source Type: research