Pub Date : 2026-01-14DOI: 10.1001/jamasurg.2025.6035
Jayson S Marwaha,Daniel A Hashimoto
{"title":"Preempting the Trough of Disillusionment in Surgical AI.","authors":"Jayson S Marwaha,Daniel A Hashimoto","doi":"10.1001/jamasurg.2025.6035","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6035","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"20 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961492","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 : 2026-01-14DOI: 10.1001/jamasurg.2025.6029
Melissa Thornton,Benjamin A Y Cher,Cameron Macdonald,Jocelyn G Baker,Elisa L Marten,Don Mai,Ganesh Sankaranarayanan,Courtney J Balentine
ImportanceHaving significant gaps between the expectations and reality of artificial intelligence-based programs can be a major barrier to successful implementation. This is the first multisite implementation assessment of gaps between surgeon expectations and real-world effects of the Operating Room Black Box, a novel intervention that leverages artificial intelligence to improve surgical outcomes.ObjectiveTo identify barriers and facilitators to implementing artificial intelligence-based interventions that improve intra- and postoperative care.Design, Setting, and ParticipantsThis qualitative study was conducted at 3 large academic centers via semistructured interviews with surgeons and implementation leaders of the AI intervention to identify areas where expectations of the technology misaligned with their experiences. Thirty surgeons and 17 implementation leaders from 3 centers that implemented the AI intervention were interviewed. Data were collected and analyzed between 2021 and 2024.ExposureImplementation of the AI intervention.Main Outcomes and MeasuresThe primary outcome was areas of misalignment between participant expectations of the AI intervention technology and actual program deliverables.ResultsOf 30 surgeons and 17 implementation leaders interviewed, most surgeons (17 [57%]) were between the ages of 35 and 50 years, and implementation leaders were older, typically between 51 and 80 years old (6 [35%]). Eight surgeons (27%) and 4 implementation leaders (24%) were female. Most surgeons (17 [57%]) had neutral views of the technology, 11 (37%) expressed positive views, and 2 (7%) had negative views. Interviewees identified the following 4 major themes that highlighted misalignment between user expectations and the experience of using the technology: (1) the artificial intelligence model needed considerable additional training to be usable; (2) accessing data on surgical cases was difficult and time consuming; (3) the program showed limited ability to predict postoperative complications; and (4) the program generated few academic deliverables.Conclusions and RelevancePer the results of this multisite qualitative study, successfully implementing interventions based on artificial intelligence may require deliberate efforts to minimize gaps between what surgeons expect from the interventions and what they can deliver. Our evaluation of this study's AI intervention offers lessons for addressing this critical barrier to implementation.
{"title":"Expectations vs Reality of an Intraoperative Artificial Intelligence Intervention.","authors":"Melissa Thornton,Benjamin A Y Cher,Cameron Macdonald,Jocelyn G Baker,Elisa L Marten,Don Mai,Ganesh Sankaranarayanan,Courtney J Balentine","doi":"10.1001/jamasurg.2025.6029","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6029","url":null,"abstract":"ImportanceHaving significant gaps between the expectations and reality of artificial intelligence-based programs can be a major barrier to successful implementation. This is the first multisite implementation assessment of gaps between surgeon expectations and real-world effects of the Operating Room Black Box, a novel intervention that leverages artificial intelligence to improve surgical outcomes.ObjectiveTo identify barriers and facilitators to implementing artificial intelligence-based interventions that improve intra- and postoperative care.Design, Setting, and ParticipantsThis qualitative study was conducted at 3 large academic centers via semistructured interviews with surgeons and implementation leaders of the AI intervention to identify areas where expectations of the technology misaligned with their experiences. Thirty surgeons and 17 implementation leaders from 3 centers that implemented the AI intervention were interviewed. Data were collected and analyzed between 2021 and 2024.ExposureImplementation of the AI intervention.Main Outcomes and MeasuresThe primary outcome was areas of misalignment between participant expectations of the AI intervention technology and actual program deliverables.ResultsOf 30 surgeons and 17 implementation leaders interviewed, most surgeons (17 [57%]) were between the ages of 35 and 50 years, and implementation leaders were older, typically between 51 and 80 years old (6 [35%]). Eight surgeons (27%) and 4 implementation leaders (24%) were female. Most surgeons (17 [57%]) had neutral views of the technology, 11 (37%) expressed positive views, and 2 (7%) had negative views. Interviewees identified the following 4 major themes that highlighted misalignment between user expectations and the experience of using the technology: (1) the artificial intelligence model needed considerable additional training to be usable; (2) accessing data on surgical cases was difficult and time consuming; (3) the program showed limited ability to predict postoperative complications; and (4) the program generated few academic deliverables.Conclusions and RelevancePer the results of this multisite qualitative study, successfully implementing interventions based on artificial intelligence may require deliberate efforts to minimize gaps between what surgeons expect from the interventions and what they can deliver. Our evaluation of this study's AI intervention offers lessons for addressing this critical barrier to implementation.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"30 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961490","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 : 2026-01-14DOI: 10.1001/jamasurg.2025.6067
Julia H Song,Patricia L Turner,Thomas C Tsai
{"title":"Implications of Eliminating Medicare's Inpatient Only List.","authors":"Julia H Song,Patricia L Turner,Thomas C Tsai","doi":"10.1001/jamasurg.2025.6067","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6067","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"177 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961493","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 : 2026-01-07DOI: 10.1001/jamasurg.2025.5929
Cathal O'Reilly,Jennifer L McGarry,Alexandra M Zaborowski,Matthew G Davey,Denis Evoy,Jane Rothwell,Damian McCartan,Claire L Rutherford,Michael R Boland,Ruth S Prichard
ImportanceRisk-reducing bilateral mastectomy reduces the incidence of breast cancer in female carriers of the BRCA pathogenic variants, but its association with mortality remains uncertain.ObjectiveTo evaluate the association between risk-reducing bilateral mastectomy and overall and breast cancer-specific mortality in female carriers of BRCA pathogenic variants.Data SourcesPubMed, Scopus, CINAHL, Embase, and CENTRAL were searched in May 2025, with English-language restriction and no date limit. Reference lists of included studies and relevant reviews were also examined.Study SelectionEligible studies compared female carriers of BRCA1 and BRCA2 pathogenic variants who underwent risk-reducing bilateral mastectomy with those who did not and reported overall mortality or breast cancer-specific mortality. Studies including patients with a history of breast cancer were excluded.Data Extraction and SynthesisThis meta-analysis followed the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Two authors independently performed study selection, data extraction, and risk of bias assessment (using Risk of Bias in Nonrandomized Studies-of Interventions, version 2). Odds ratios (ORs) and hazard ratios (HRs) were pooled using fixed- and random-effects models according to methodological assessment.Main Outcomes and MeasuresOverall and breast cancer-specific mortality.ResultsSix observational studies met the inclusion criteria, comprising 6135 carriers of the BRCA1 or BRCA2 variant. Weighted median age at inclusion was 38.0 years, with reported age ranges spanning 15.3 to 85.3 years. Risk-reducing bilateral mastectomy was associated with lower overall mortality in both unadjusted (OR, 0.38; 95% CI, 0.27-0.55; P < .001) and adjusted (HR, 0.37; 95% CI, 0.23-0.60; P < .001) analyses. Breast cancer-specific mortality was also reduced (OR, 0.19; 95% CI, 0.08-0.47; P < .001; HR, 0.14; 95% CI, 0.04-0.49; P = .002).Conclusions and RelevanceRisk-reducing bilateral mastectomy was associated with lower overall and breast cancer-specific mortality in carriers of the BRCA variants. These findings support the role of risk-reducing bilateral mastectomy as a potentially life-extending intervention and may inform the shared decision-making discussions in these women.
降低风险的双侧乳房切除术降低了BRCA致病变异女性携带者的乳腺癌发病率，但其与死亡率的关系仍不确定。目的评估降低风险的双侧乳房切除术与BRCA致病变异女性携带者的总体死亡率和乳腺癌特异性死亡率之间的关系。数据源pubmed， Scopus， CINAHL， Embase和CENTRAL于2025年5月检索，有英文限制，无日期限制。还审查了纳入研究的参考清单和相关综述。研究选择：符合条件的研究比较了BRCA1和BRCA2致病变异的女性携带者，她们接受了降低风险的双侧乳房切除术，并报告了总死亡率或乳腺癌特异性死亡率。有乳腺癌病史的患者被排除在外。本荟萃分析遵循流行病学观察性研究荟萃分析（MOOSE）指南。两位作者独立进行了研究选择、数据提取和偏倚风险评估（使用《非随机研究干预的偏倚风险》，版本2）。根据方法学评估，采用固定效应和随机效应模型汇总优势比（ORs）和风险比（hr）。主要结局和测量：总体死亡率和乳腺癌特异性死亡率。结果6项观察性研究符合纳入标准，包括6135名BRCA1或BRCA2变异携带者。纳入时的加权中位年龄为38.0岁，报告的年龄范围为15.3至85.3岁。降低风险的双侧乳房切除术与两组患者较低的总死亡率相关(OR, 0.38; 95% CI, 0.27-0.55; P <。0.001)和调整后(HR, 0.37; 95% CI, 0.23-0.60; P <。001)分析。乳腺癌特异性死亡率也降低（OR, 0.19; 95% CI, 0.08-0.47; P < .001； HR, 0.14; 95% CI, 0.04-0.49; P = .002）。结论和相关性：降低风险的双侧乳房切除术与BRCA变异携带者较低的总体死亡率和乳腺癌特异性死亡率相关。这些发现支持降低风险的双侧乳房切除术作为一种潜在的延长生命的干预措施的作用，并可能为这些妇女的共同决策讨论提供信息。
{"title":"Risk-Reducing Bilateral Mastectomy and Mortality in Carriers of BRCA1 and BRCA2 Variants: A Systematic Review and Meta-Analysis.","authors":"Cathal O'Reilly,Jennifer L McGarry,Alexandra M Zaborowski,Matthew G Davey,Denis Evoy,Jane Rothwell,Damian McCartan,Claire L Rutherford,Michael R Boland,Ruth S Prichard","doi":"10.1001/jamasurg.2025.5929","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5929","url":null,"abstract":"ImportanceRisk-reducing bilateral mastectomy reduces the incidence of breast cancer in female carriers of the BRCA pathogenic variants, but its association with mortality remains uncertain.ObjectiveTo evaluate the association between risk-reducing bilateral mastectomy and overall and breast cancer-specific mortality in female carriers of BRCA pathogenic variants.Data SourcesPubMed, Scopus, CINAHL, Embase, and CENTRAL were searched in May 2025, with English-language restriction and no date limit. Reference lists of included studies and relevant reviews were also examined.Study SelectionEligible studies compared female carriers of BRCA1 and BRCA2 pathogenic variants who underwent risk-reducing bilateral mastectomy with those who did not and reported overall mortality or breast cancer-specific mortality. Studies including patients with a history of breast cancer were excluded.Data Extraction and SynthesisThis meta-analysis followed the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Two authors independently performed study selection, data extraction, and risk of bias assessment (using Risk of Bias in Nonrandomized Studies-of Interventions, version 2). Odds ratios (ORs) and hazard ratios (HRs) were pooled using fixed- and random-effects models according to methodological assessment.Main Outcomes and MeasuresOverall and breast cancer-specific mortality.ResultsSix observational studies met the inclusion criteria, comprising 6135 carriers of the BRCA1 or BRCA2 variant. Weighted median age at inclusion was 38.0 years, with reported age ranges spanning 15.3 to 85.3 years. Risk-reducing bilateral mastectomy was associated with lower overall mortality in both unadjusted (OR, 0.38; 95% CI, 0.27-0.55; P < .001) and adjusted (HR, 0.37; 95% CI, 0.23-0.60; P < .001) analyses. Breast cancer-specific mortality was also reduced (OR, 0.19; 95% CI, 0.08-0.47; P < .001; HR, 0.14; 95% CI, 0.04-0.49; P = .002).Conclusions and RelevanceRisk-reducing bilateral mastectomy was associated with lower overall and breast cancer-specific mortality in carriers of the BRCA variants. These findings support the role of risk-reducing bilateral mastectomy as a potentially life-extending intervention and may inform the shared decision-making discussions in these women.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"391 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907801","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 : 2026-01-07DOI: 10.1001/jamasurg.2025.5847
Anai N Kothari
{"title":"Suitability of Large Language Models and Predicting Case Duration-Reply.","authors":"Anai N Kothari","doi":"10.1001/jamasurg.2025.5847","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5847","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"82 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907803","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 : 2026-01-07DOI: 10.1001/jamasurg.2025.5844
Jordan Prosky,Judy Wawira Gichoya
{"title":"Suitability of Large Language Models and Predicting Case Duration.","authors":"Jordan Prosky,Judy Wawira Gichoya","doi":"10.1001/jamasurg.2025.5844","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5844","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"39 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907798","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 : 2026-01-01DOI: 10.1001/jamasurg.2025.4916
Kaelyn C Cummins, Allan Tsung
{"title":"Total Pancreatectomy-Still a Last-Resort Procedure.","authors":"Kaelyn C Cummins, Allan Tsung","doi":"10.1001/jamasurg.2025.4916","DOIUrl":"10.1001/jamasurg.2025.4916","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"58"},"PeriodicalIF":14.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495553","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 : 2026-01-01DOI: 10.1001/jamasurg.2025.5416
{"title":"Change to Open Access.","authors":"","doi":"10.1001/jamasurg.2025.5416","DOIUrl":"10.1001/jamasurg.2025.5416","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"104"},"PeriodicalIF":14.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12631564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145549136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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