Pub Date : 2026-03-25DOI: 10.1001/jamasurg.2026.0475
Nicole M Mott, Lesly A Dossett
{"title":"Caution Before Routine Preoperative Hemoglobin A1c Testing.","authors":"Nicole M Mott, Lesly A Dossett","doi":"10.1001/jamasurg.2026.0475","DOIUrl":"https://doi.org/10.1001/jamasurg.2026.0475","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":14.9,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512140","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}
Pub Date : 2026-03-25DOI: 10.1001/jamasurg.2026.0471
Joshua B. Brown, Cherisse Berry, N. Clay Mann, Elliott R. Haut
This Viewpoint discusses challenges linking emergency medical services (EMS)–documented care with hospital outcomes and the potential of local, regional, and state trauma and EMS stakeholders to adopt and require the use of the National EMS Information System universally unique identifier to link patients’ prehospital and in-hospital trauma records at the hospital level.
{"title":"Linking EMS and Trauma Registry Data to Improve Outcomes","authors":"Joshua B. Brown, Cherisse Berry, N. Clay Mann, Elliott R. Haut","doi":"10.1001/jamasurg.2026.0471","DOIUrl":"https://doi.org/10.1001/jamasurg.2026.0471","url":null,"abstract":"This Viewpoint discusses challenges linking emergency medical services (EMS)–documented care with hospital outcomes and the potential of local, regional, and state trauma and EMS stakeholders to adopt and require the use of the National EMS Information System universally unique identifier to link patients’ prehospital and in-hospital trauma records at the hospital level.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"405 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147506742","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}
Pub Date : 2026-03-25DOI: 10.1001/jamasurg.2026.0501
Panos Kougias, Sherene E Sharath, Neal R Barshes
{"title":"A Shared Call to Action for Amputation Prevention-Beyond Benchmarks.","authors":"Panos Kougias, Sherene E Sharath, Neal R Barshes","doi":"10.1001/jamasurg.2026.0501","DOIUrl":"https://doi.org/10.1001/jamasurg.2026.0501","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":14.9,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512153","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}
Pub Date : 2026-03-25DOI: 10.1001/jamasurg.2026.0484
Michael Liu, Vishal R. Patel, Tarun Ramesh, Rishi K. Wadhera, Thomas C. Tsai
This cross-sectional study examines trends in the number of surgeons sponsored for H-1B visas in the US and various characteristics of the communities they serve.
本横断面研究考察了在美国获得H-1B签证的外科医生数量的趋势以及他们所服务的社区的各种特征。
{"title":"Surgeons Sponsored for H-1B Visas in the US","authors":"Michael Liu, Vishal R. Patel, Tarun Ramesh, Rishi K. Wadhera, Thomas C. Tsai","doi":"10.1001/jamasurg.2026.0484","DOIUrl":"https://doi.org/10.1001/jamasurg.2026.0484","url":null,"abstract":"This cross-sectional study examines trends in the number of surgeons sponsored for H-1B visas in the US and various characteristics of the communities they serve.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"405 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147506739","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}
Pub Date : 2026-03-25DOI: 10.1001/jamasurg.2026.0478
Jeroen Hermanides, Abraham H Hulst, Mark L van Zuylen
{"title":"Caution Before Routine Preoperative Hemoglobin A1c Testing.","authors":"Jeroen Hermanides, Abraham H Hulst, Mark L van Zuylen","doi":"10.1001/jamasurg.2026.0478","DOIUrl":"https://doi.org/10.1001/jamasurg.2026.0478","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":14.9,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512077","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}
Pub Date : 2026-03-25DOI: 10.1001/jamasurg.2026.0489
Aravind S. Ponukumati, Jesse A. Columbo, Robert Joseph, Scott A. Berceli, Philip P. Goodney, Louise Davies, David I. Soybel, Salvatore T. Scali, David H. Stone
Importance US veterans remain an at-risk population for limb loss, given the prevalent rates of coexisting diabetes and peripheral arterial disease (PAD). Moreover, despite the perception that a healed minor amputation might obviate the need for a future major amputation, previous work documented increased longitudinal rates of limb loss among non-veteran Medicare beneficiaries. Objective To document the corresponding incidence of major amputation among veterans after a prior minor amputation and accordingly benchmark Veterans Affairs (VA) health care delivery compared to non-VA civilian hospitals. Design, Setting, and Participants This cohort study used data from VA hospitals and identifiable linked VA-Medicare datasets using corporate data warehouse and community care data sources from January 2015 to December 2023. Of 1 451 297 veterans with information on diabetes, 64 808 had concomitant diabetes and PAD, and 62 295 of these were not receiving dialysis and were included in the study. Race and ethnicity data were derived from the electronic health record and were considered for this study to assess the association between race, ethnicity, and amputation (bearing in mind that race and ethnicity variables incompletely capture structural racism and systemic disparities in vascular disease). Race and ethnicity data are self-reported in the VA. Data were analyzed from May 2024 to January 2026. Exposure Prior minor (toe or forefoot) amputation. Main Outcome Major (below-knee or above-knee) amputation. Results Among the 62 295 veterans included, the mean (SD) age was 72.3 (10.5) years; 60 132 (96.5%) were male; and 500 (0.8%) were Asian, 512 (0.8%) American Indian or Alaska Native, 9318 (15.4%) Black, 581 (1.0%) Native Hawaiian or Other Pacific Islander, 46 540 (77.0%) White, 2198 (3.6%) more than 1 race, and 760 (1.3%) unknown or other (unspecified). A total of 2791 (4.5%) had coronary artery disease, and 8633 (13.9%) chronic kidney insufficiency. Among included veterans, 1327 (2.1%) underwent a prior minor amputation and were more likely to be male (1306/1327 [98.4%] versus 58 826/60 968 [96.5%]; <jats:italic toggle="yes">P</jats:italic> &lt; .001), to be Black (232/1290 [18.0%] versus 9086/59 119 [15.4%]; <jats:italic toggle="yes">P</jats:italic> &lt; .001) or Native American (13/1290 [1.0%] versus 499/59 119 [0.8%]; <jats:italic toggle="yes">P</jats:italic> &lt; .001), to have higher hemoglobin A <jats:sub>1c</jats:sub> (mean [SD], 7.2% [1.7] vs 6.7% [1.3]; <jats:italic toggle="yes">P</jats:italic> &lt; .001), and to have undergone a prior open (106/1327 [8.0%] vs 1381/60 968 [2.3%]; <jats:italic toggle="yes">P</jats:italic> &lt; .001) or endovascular revascularization (199/1327 [15.0%] vs 2298/60 968 [3.8%]; <jats:italic toggle="yes">P</jats:italic> &lt; .001) compared to veterans without prior minor amputation. At 5 years, 20.4% (95% CI, 17.7-23.3) of veterans not receiving dialysis with diabetes
鉴于并发糖尿病和外周动脉疾病（PAD）的普遍发生率，美国退伍军人仍然是肢体丧失的高危人群。此外，尽管人们认为小截肢愈合可能会避免未来的大截肢，但之前的研究表明，非退伍军人医疗保险受益人的肢体丧失纵向率增加。目的了解退伍军人小截肢术后大截肢的发生率，并比较退伍军人事务部（VA）与非VA民用医院的医疗服务水平。设计、环境和参与者本队列研究使用了2015年1月至2023年12月期间来自VA医院的数据和可识别的VA- medicare数据集，这些数据集使用了企业数据仓库和社区护理数据源。在1451 297名有糖尿病信息的退伍军人中，64 808人同时患有糖尿病和PAD，其中62 295人未接受透析治疗，并纳入研究。种族和民族数据来源于电子健康记录，本研究考虑了这些数据，以评估种族、民族和截肢之间的关系（考虑到种族和民族变量不能完全反映结构性种族主义和血管疾病的系统性差异）。种族和民族数据在退伍军人中是自我报告的。数据分析时间为2024年5月至2026年1月。先前有轻微（脚趾或前足）截肢。主要结果：膝下或膝上截肢。结果纳入的62 295名退伍军人平均（SD）年龄为72.3（10.5）岁；男性60132例（96.5%）；500人（0.8%）为亚洲人，512人（0.8%）为美洲印第安人或阿拉斯加原住民，9318人（15.4%）为黑人，581人（1.0%）为夏威夷原住民或其他太平洋岛民，46440人（77.0%）为白人，2198人（3.6%）超过一个种族，760人（1.3%）为未知或其他（未指定）。冠心病2791例（4.5%），慢性肾功能不全8633例（13.9%）。在纳入的退伍军人中，1327人（2.1%）之前经历过轻微截肢，男性更有可能（1306/1327[98.4%]对58826 / 60968 [96.5%]）；P <；001)，黑人(232/1290 [18.0%]vs 9086/ 59119 [15.4%]; P <；001)或印第安人(13/1290 [1.0%]vs 499/ 59119 [0.8%]; P <；0.001)，血红蛋白a1c升高(平均[SD]， 7.2% [1.7] vs 6.7% [1.3]; P <；001)，并且经历了先前的开放(106/1327 [8.0%]vs 1381/ 60968 [2.3%]; P <；。001)或血管内血运重建术(199/1327 [15.0%]vs 2298/ 60968 [3.8%]; P <；001)与之前没有轻微截肢的退伍军人相比。在5年时，20.4% （95% CI, 17.7-23.3）未接受透析的糖尿病和PAD患者（先前有轻微截肢）接受了严重截肢。在接受轻微截肢的退伍军人中，662名退伍军人（49.9%）至少有一次足部就诊，699名退伍军人（52.7%）接受了血红蛋白a1c检测，而医疗保险受益人分别为146 273/202 304（72.3%）和106 054/202 304（52.4%）。结论和相关性在这项队列研究中，大约1 / 5的伴有糖尿病和PAD的退伍军人先前进行过任何轻微截肢，后来又进行了一次大截肢。这些结果与先前发表的具有类似风险特征的非退伍军人医疗保险受益人的结果相当。这些发现表明，与非VA医院相比，VA医疗保健系统在这一高危患者群体中可以实现相当的肢体挽救结果。
{"title":"Veterans Hospitals vs Non-Veterans Centers in the Prevention of Limb Loss","authors":"Aravind S. Ponukumati, Jesse A. Columbo, Robert Joseph, Scott A. Berceli, Philip P. Goodney, Louise Davies, David I. Soybel, Salvatore T. Scali, David H. Stone","doi":"10.1001/jamasurg.2026.0489","DOIUrl":"https://doi.org/10.1001/jamasurg.2026.0489","url":null,"abstract":"Importance US veterans remain an at-risk population for limb loss, given the prevalent rates of coexisting diabetes and peripheral arterial disease (PAD). Moreover, despite the perception that a healed minor amputation might obviate the need for a future major amputation, previous work documented increased longitudinal rates of limb loss among non-veteran Medicare beneficiaries. Objective To document the corresponding incidence of major amputation among veterans after a prior minor amputation and accordingly benchmark Veterans Affairs (VA) health care delivery compared to non-VA civilian hospitals. Design, Setting, and Participants This cohort study used data from VA hospitals and identifiable linked VA-Medicare datasets using corporate data warehouse and community care data sources from January 2015 to December 2023. Of 1 451 297 veterans with information on diabetes, 64 808 had concomitant diabetes and PAD, and 62 295 of these were not receiving dialysis and were included in the study. Race and ethnicity data were derived from the electronic health record and were considered for this study to assess the association between race, ethnicity, and amputation (bearing in mind that race and ethnicity variables incompletely capture structural racism and systemic disparities in vascular disease). Race and ethnicity data are self-reported in the VA. Data were analyzed from May 2024 to January 2026. Exposure Prior minor (toe or forefoot) amputation. Main Outcome Major (below-knee or above-knee) amputation. Results Among the 62 295 veterans included, the mean (SD) age was 72.3 (10.5) years; 60 132 (96.5%) were male; and 500 (0.8%) were Asian, 512 (0.8%) American Indian or Alaska Native, 9318 (15.4%) Black, 581 (1.0%) Native Hawaiian or Other Pacific Islander, 46 540 (77.0%) White, 2198 (3.6%) more than 1 race, and 760 (1.3%) unknown or other (unspecified). A total of 2791 (4.5%) had coronary artery disease, and 8633 (13.9%) chronic kidney insufficiency. Among included veterans, 1327 (2.1%) underwent a prior minor amputation and were more likely to be male (1306/1327 [98.4%] versus 58 826/60 968 [96.5%]; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001), to be Black (232/1290 [18.0%] versus 9086/59 119 [15.4%]; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001) or Native American (13/1290 [1.0%] versus 499/59 119 [0.8%]; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001), to have higher hemoglobin A <jats:sub>1c</jats:sub> (mean [SD], 7.2% [1.7] vs 6.7% [1.3]; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001), and to have undergone a prior open (106/1327 [8.0%] vs 1381/60 968 [2.3%]; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001) or endovascular revascularization (199/1327 [15.0%] vs 2298/60 968 [3.8%]; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001) compared to veterans without prior minor amputation. At 5 years, 20.4% (95% CI, 17.7-23.3) of veterans not receiving dialysis with diabetes ","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"2 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147506741","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}
Pub Date : 2026-03-25DOI: 10.1001/jamasurg.2026.0510
Maxine Germes, Maxime K. Collard, Sophie Laroche, Mathilde Wagner, Pénélope Raimbert, Jérémie H. Lefèvre, Yann Parc, Thibault Voron
Importance Antibiotic-only management (AOM) for uncomplicated acute appendicitis is increasingly adopted, raising concern about missed appendiceal neoplasms. Objective To assess the prevalence, histologic spectrum, and predictors of incidental appendiceal tumors after appendectomy for acute appendicitis. Design, Setting, and Participants This single-center retrospective cohort study was conducted from January 1, 2013, to December 31, 2021, at the tertiary surgical emergency center at Saint-Antoine Hospital in Paris, France. All consecutive adult patients undergoing appendectomy for acute appendicitis were eligible for inclusion. Data were analyzed in June 2025. Exposure Standard surgical management with appendectomy (no AOM); preoperative clinical variables, laboratory values, and imaging findings were assessed as potential predictors of appendiceal tumors. Main Outcome and Measures Prevalence and histopathological classification of incidental appendiceal neoplasms identified after appendectomy for acute appendicitis and preoperative clinical and radiologic factors associated with aggressive tumors. Results Among the cohort, median (IQR) age was 32 years (25-43), and 999 patients (44%) were female. Among 2293 appendectomies, 37 (1.6%) had malignant or premalignant lesions and 8 (0.3%) had benign nondysplastic lesions. Neuroendocrine tumors (NETs) (n = 22) predominated; all were grade 1 (G1) and smaller than 2 cm, with 19 (86%) measuring 1 cm or less without recurrence after 34 months of follow-up. Other lesions included low-grade appendiceal mucinous neoplasms (n = 5), metastatic tumors (n = 3), goblet cell carcinomas (n = 2), mucinous adenocarcinoma (n = 1), and low-grade dysplastic polyps (n = 4). Compared with nonneoplastic appendicitis, aggressive tumors (putting aside G1 NETs &lt;2 cm and low-grade dysplasia) occurred more often in older patients (median [IQR] age, no malignant lesions: 32 years [25.0-43.0] vs malignant lesions: 45.0 years [37.8-57.2]; <jats:italic toggle="yes">P</jats:italic> = .03), with longer median symptom duration (no malignant lesions: 2 days vs malignant lesions: 1 day; <jats:italic toggle="yes">P</jats:italic> &lt; .001), larger median (IQR) appendiceal diameter (no malignant lesions: 11.0 mm [9.0-13.0] vs malignant lesions: 18.0 mm [14.0-25.5]; <jats:italic toggle="yes">P</jats:italic> &lt; .001), and radiologic suspicion of complicated appendicitis (no malignant lesions: 287 of 2234 [13%] vs malignant lesions: 6 of 11 [55%]; <jats:italic toggle="yes">P</jats:italic> = .001). In dedicated univariate analysis, NETs could not be distinguished from nonneoplastic appendicitis by any clinical or radiological variables tested. Using eligibility criteria for AOM derived from the univariate analysis (abdominal pain duration &lt;14 days; age &lt;60 years; and on imaging: uncomplicated appendicitis, appendiceal diameter &lt;15 mm, and absence of suspicious appendiceal, peritone
重要性：对于无并发症的急性阑尾炎，越来越多地采用单纯抗生素治疗（AOM），这引起了人们对阑尾肿瘤遗漏的关注。目的探讨急性阑尾炎术后阑尾偶发肿瘤的发生率、组织学特征及预测因素。设计、环境和参与者本单中心回顾性队列研究于2013年1月1日至2021年12月31日在法国巴黎圣安东尼医院三级外科急诊中心进行。所有连续接受急性阑尾炎阑尾切除术的成年患者均符合纳入条件。数据分析时间为2025年6月。阑尾切除术的标准手术处理（无AOM）；术前临床变量、实验室值和影像学结果被评估为阑尾肿瘤的潜在预测因素。急性阑尾炎阑尾切除术后偶发阑尾肿瘤的患病率和组织病理学分类以及术前与侵袭性肿瘤相关的临床和放射学因素。结果队列中，中位（IQR）年龄为32岁（25-43岁），女性999例（44%）。在2293例阑尾切除术中，37例（1.6%）有恶性或癌前病变，8例（0.3%）有良性非发育不良病变。神经内分泌肿瘤（NETs） （n = 22）为主；所有患者均为1级（G1），小于2cm，其中19例（86%）小于1cm，随访34个月后无复发。其他病变包括低级别阑尾黏液性肿瘤（n = 5）、转移性肿瘤（n = 3）、杯状细胞癌（n = 2）、黏液性腺癌（n = 1）和低级别发育不良息肉（n = 4）。与非肿瘤性阑尾炎相比，侵袭性肿瘤（姑且不考虑G1 NETs和低度发育不良）多发于老年患者（中位年龄，无恶性病变：32岁[25.0-43.0]vs恶性病变：45.0岁[37.8-57.2];P = 0.03），中位症状持续时间更长（无恶性病变：2天vs恶性病变：1天；P <）。001)，阑尾直径中位数（IQR）较大(无恶性病变：11.0 mm [9.0-13.0] vs恶性病变：18.0 mm [14.0-25.5]; P <；影像学怀疑并发阑尾炎（2234例中无恶性病变：287例[13%]vs 11例恶性病变：6例[55%]；P = .001）。在专门的单变量分析中，net不能通过任何临床或放射学变量来区分非肿瘤性阑尾炎。根据单变量分析得出的AOM的资格标准（腹痛持续时间14天；年龄60岁；影像学：无并发症的阑尾炎，阑尾直径15mm，无可疑的阑尾、腹膜、肝脏或骨骼病变），没有一个侵袭性肿瘤患者符合所有这些标准。然而，22例小G1 NETs中有17例（77%）和4例低级别发育不良息肉中有1例（25%）符合这些标准。通过对所有这些选择标准进行分组，74%的队列符合潜在AOM的资格标准；在无并发症阑尾炎亚组中，85%符合条件。结论及相关性在本单中心队列研究中，偶发阑尾肿瘤多为小而低级别的NETs；侵袭性恶性肿瘤是罕见的，发生在可识别的高危人群中。应用集合的术前选择标准可靠地排除了侵袭性肿瘤患者，从而在严格选择的个体中支持AOM的肿瘤安全性。
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