Pub Date : 2024-09-11DOI: 10.1001/jamasurg.2024.3372
Kathryn M. Stadeli, Farah B. Mohamed, Lauren L. Agoubi, Abdifatah Dahiye, Elina Serrano, Maymuna Haji-Eda, Monica S. Vavilala
This survey study evaluates a program for increasing bystander bleeding control skills, improving self-efficacy for bleeding control, and building trust between community participants and first responders in a Somali community in the US affected by firearm-related deaths.
{"title":"Teaching Bleeding Control and Building Trust With a Community Affected by Firearm Injuries","authors":"Kathryn M. Stadeli, Farah B. Mohamed, Lauren L. Agoubi, Abdifatah Dahiye, Elina Serrano, Maymuna Haji-Eda, Monica S. Vavilala","doi":"10.1001/jamasurg.2024.3372","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.3372","url":null,"abstract":"This survey study evaluates a program for increasing bystander bleeding control skills, improving self-efficacy for bleeding control, and building trust between community participants and first responders in a Somali community in the US affected by firearm-related deaths.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":16.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170819","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 : 2024-09-11DOI: 10.1001/jamasurg.2024.3365
James McDermott, Lillian S. Kao, Jessica A. Keeley, Areg Grigorian, Angela Neville, Christian de Virgilio
ImportanceNecrotizing soft tissue infections (NSTIs) are severe life- and limb-threatening infections with high rates of morbidity and mortality. Unfortunately, there has been minimal improvement in outcomes over time.ObservationsNSTIs are characterized by their heterogeneity in microbiology, risk factors, and anatomical involvement. They often present with nonspecific symptoms, leading to a high rate of delayed diagnosis. Laboratory values and imaging help increase suspicion for NSTI, though ultimately, the diagnosis is clinical. Surgical exploration is warranted when there is high suspicion for NSTI, even if the diagnosis is uncertain. Thus, it is acceptable to have a certain rate of negative exploration. Immediate empirical broad-spectrum antibiotics, further tailored based on tissue culture results, are essential and should be continued at least until surgical debridement is complete and the patient shows signs of clinical improvement. Additional research is needed to determine optimal antibiotic duration. Early surgical debridement is crucial for improved outcomes and should be performed as soon as possible, ideally within 6 hours of presentation. Subsequent debridements should be performed every 12 to 24 hours until the patient is showing signs of clinical improvement and there is no additional necrotic tissue within the wound. There are insufficient data to support the routine use of adjunct treatments such as hyperbaric oxygen therapy and intravenous immunoglobulin. However, clinicians should be aware of multiple ongoing efforts to develop more robust diagnostic and treatment strategies.Conclusions and RelevanceGiven the poor outcomes associated with NSTIs, a review of clinically relevant evidence and guidelines is warranted. This review discusses diagnostic and treatment approaches to NSTI while highlighting future directions and promising developments in NSTI management.
{"title":"Necrotizing Soft Tissue Infections","authors":"James McDermott, Lillian S. Kao, Jessica A. Keeley, Areg Grigorian, Angela Neville, Christian de Virgilio","doi":"10.1001/jamasurg.2024.3365","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.3365","url":null,"abstract":"ImportanceNecrotizing soft tissue infections (NSTIs) are severe life- and limb-threatening infections with high rates of morbidity and mortality. Unfortunately, there has been minimal improvement in outcomes over time.ObservationsNSTIs are characterized by their heterogeneity in microbiology, risk factors, and anatomical involvement. They often present with nonspecific symptoms, leading to a high rate of delayed diagnosis. Laboratory values and imaging help increase suspicion for NSTI, though ultimately, the diagnosis is clinical. Surgical exploration is warranted when there is high suspicion for NSTI, even if the diagnosis is uncertain. Thus, it is acceptable to have a certain rate of negative exploration. Immediate empirical broad-spectrum antibiotics, further tailored based on tissue culture results, are essential and should be continued at least until surgical debridement is complete and the patient shows signs of clinical improvement. Additional research is needed to determine optimal antibiotic duration. Early surgical debridement is crucial for improved outcomes and should be performed as soon as possible, ideally within 6 hours of presentation. Subsequent debridements should be performed every 12 to 24 hours until the patient is showing signs of clinical improvement and there is no additional necrotic tissue within the wound. There are insufficient data to support the routine use of adjunct treatments such as hyperbaric oxygen therapy and intravenous immunoglobulin. However, clinicians should be aware of multiple ongoing efforts to develop more robust diagnostic and treatment strategies.Conclusions and RelevanceGiven the poor outcomes associated with NSTIs, a review of clinically relevant evidence and guidelines is warranted. This review discusses diagnostic and treatment approaches to NSTI while highlighting future directions and promising developments in NSTI management.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":16.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170817","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 : 2024-09-11DOI: 10.1001/jamasurg.2024.3581
Karen Trang, Hannah C. Decker, Andrew Gonzalez, Logan Pierce, Amy M. Shui, Genevieve B. Melton-Meaux, Elizabeth C. Wick
ImportanceMany health systems use electronic consent (eConsent) for surgery, but few have used surgical consent functionality in the patient portal (PP). Incorporating the PP into the consent process could potentially improve efficiency by letting patients independently review and sign their eConsent before the day of surgery.ObjectiveTo evaluate the association of eConsent delivery via the PP with operational efficiency and patient engagement.Design, Setting, and ParticipantsThis mixed-methods study consisted of a retrospective quantitative analysis (February 8 to August 8, 2023) and a qualitative analysis of semistructured patient interviews (December 1, 2023, to January 31, 2024) of adult surgical patients in a health system that implemented surgical eConsent. Statistical analysis was performed between September 1, 2023, and June 6, 2024.Main Outcomes and MeasuresPatient demographics, efficiency metrics (first-start case delays), and PP access logs were analyzed from electronic health records. Qualitative outcomes included thematic analysis from semistructured patient interviews.ResultsIn the PP-eligible cohort of 7672 unique patients, 8478 surgical eConsents were generated (median [IQR] age, 58 [43-70] years; 4611 [54.4%] women), of which 5318 (62.7%) were signed on hospital iPads and 3160 (37.3%) through the PP. For all adult patients who signed an eConsent using the PP, patients waited a median (IQR) of 105 (17-528) minutes to view their eConsent after it was electronically pushed to their PP. eConsents signed on the same day of surgery were associated with more first-start delays (odds ratio, 1.59; 95% CI, 1.37-1.83; P < .001). Themes that emerged from patient interviews included having a favorable experience with the PP, openness to eConsent, skimming the consent form, and the importance of the discussion with the surgeon.Conclusions and RelevanceThese findings suggest that eConsent incorporating PP functionality may reduce surgical delays and staff burden by allowing patients to review and sign before the day of surgery. Most patients spent minimal time engaging with their consent form, emphasizing the importance of surgeon-patient trust and an informed consent discussion. Additional studies are needed to understand patient perceptions of eConsent, PP, and barriers to increased uptake.
{"title":"Electronic Surgical Consent Delivery Via Patient Portal to Improve Perioperative Efficiency","authors":"Karen Trang, Hannah C. Decker, Andrew Gonzalez, Logan Pierce, Amy M. Shui, Genevieve B. Melton-Meaux, Elizabeth C. Wick","doi":"10.1001/jamasurg.2024.3581","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.3581","url":null,"abstract":"ImportanceMany health systems use electronic consent (eConsent) for surgery, but few have used surgical consent functionality in the patient portal (PP). Incorporating the PP into the consent process could potentially improve efficiency by letting patients independently review and sign their eConsent before the day of surgery.ObjectiveTo evaluate the association of eConsent delivery via the PP with operational efficiency and patient engagement.Design, Setting, and ParticipantsThis mixed-methods study consisted of a retrospective quantitative analysis (February 8 to August 8, 2023) and a qualitative analysis of semistructured patient interviews (December 1, 2023, to January 31, 2024) of adult surgical patients in a health system that implemented surgical eConsent. Statistical analysis was performed between September 1, 2023, and June 6, 2024.Main Outcomes and MeasuresPatient demographics, efficiency metrics (first-start case delays), and PP access logs were analyzed from electronic health records. Qualitative outcomes included thematic analysis from semistructured patient interviews.ResultsIn the PP-eligible cohort of 7672 unique patients, 8478 surgical eConsents were generated (median [IQR] age, 58 [43-70] years; 4611 [54.4%] women), of which 5318 (62.7%) were signed on hospital iPads and 3160 (37.3%) through the PP. For all adult patients who signed an eConsent using the PP, patients waited a median (IQR) of 105 (17-528) minutes to view their eConsent after it was electronically pushed to their PP. eConsents signed on the same day of surgery were associated with more first-start delays (odds ratio, 1.59; 95% CI, 1.37-1.83; <jats:italic>P</jats:italic> &amp;lt; .001). Themes that emerged from patient interviews included having a favorable experience with the PP, openness to eConsent, skimming the consent form, and the importance of the discussion with the surgeon.Conclusions and RelevanceThese findings suggest that eConsent incorporating PP functionality may reduce surgical delays and staff burden by allowing patients to review and sign before the day of surgery. Most patients spent minimal time engaging with their consent form, emphasizing the importance of surgeon-patient trust and an informed consent discussion. Additional studies are needed to understand patient perceptions of eConsent, PP, and barriers to increased uptake.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":16.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170856","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 : 2024-09-11DOI: 10.1001/jamasurg.2024.2753
Lois K. Lee, Danielle Laraque-Arena, Eric W. Fleegler
This Viewpoint presents an updated scientific approach applied to the foundational framework of the Haddon Matrix for injury prevention to reduce firearm injuries and deaths to children and youth.
{"title":"The Updated Haddon Matrix for Pediatric Firearm Injuries","authors":"Lois K. Lee, Danielle Laraque-Arena, Eric W. Fleegler","doi":"10.1001/jamasurg.2024.2753","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.2753","url":null,"abstract":"This Viewpoint presents an updated scientific approach applied to the foundational framework of the Haddon Matrix for injury prevention to reduce firearm injuries and deaths to children and youth.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":16.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170848","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 : 2024-09-11DOI: 10.1001/jamasurg.2024.3571
Niccolò Stomeo,Arosh S Perera Molligoda Arachchige
{"title":"Pain Management Details for Serratus Anterior Plane Blocks in Early Rib Fracture.","authors":"Niccolò Stomeo,Arosh S Perera Molligoda Arachchige","doi":"10.1001/jamasurg.2024.3571","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.3571","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":16.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170814","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 : 2024-09-11DOI: 10.1001/jamasurg.2024.3588
Brett L. Ecker, Kenneth Seier, Austin M. Eckhoff, Gabriella N. Tortorello, Peter J. Allen, Vinod P. Balachandran, Nicola Blackburn, Michael I. D’Angelica, Ronald P. DeMatteo, Daniel G. Blazer, Jeffrey A. Drebin, William E. Fisher, Danielle Fortuna, Anthony J. Gill, Marie-Claude Gingras, T. Peter Kingham, Major K. Lee, Michael E. Lidsky, Daniel P. Nussbaum, Michael J. Overman, Jaswinder S. Samra, Ronglai Shen, Carlie S. Sigel, Kevin C. Soares, Charles M. Vollmer, Alice C. Wei, Sabino Zani, Robert E. Roses, Mithat Gonen, William R. Jarnagin
ImportanceAmpullary adenocarcinoma (AA) is characterized by clinical and genomic heterogeneity. A previously developed genomic classifier defined biologically distinct phenotypes with greater accuracy than standard histologic classification. External validation is needed before routine clinical use.ObjectiveTo test external validity of the prognostic value of the hidden genome classifier of AA.Design, Setting, and ParticipantsThis retrospective cohort study took place at 6 international academic institutions. Consecutive patients (n = 192) who underwent curative-intent resection of histologically confirmed AA were included. The data were analyzed from January 2005 through July 2020.ExposuresThe multilevel meta-feature regression model previously trained on a prospectively sequenced cohort of 3411 patients (1001 pancreatic adenocarcinoma, 165 distal bile duct adenocarcinoma, and 2245 colorectal adenocarcinoma) was applied to AA sequencing data to quantify the relative proportions of parental cell of origin.Main Outcome and MeasuresGenomic classification was correlated with immunohistologic subtype (intestinal [INT] or pancreatobiliary [PB]) and with overall survival (OS), using the log-rank test and Cox proportional hazard models.ResultsAmong 192 patients with AA (median age, 69.0 [IQR, 60.0-74.0] years and 134 were male [64%]), concordance between immunohistologic and genomic subtypes was 55%. Most INT subtype tumors were categorized into the colorectal genomic subtype (43 of 57 [72.9%]). Of the 114 PB subtype tumors, 29 had a pancreatic genomic profile (25.4%) and 24 had a distal bile duct genomic profile (21.1%). Whereas the standard immunohistologic subtypes were not associated with survival (log rank P = .26), predicted genomic probabilities were correlated with survival probability. Genomic scores with higher colorectal probability were associated with higher survival probability; higher pancreatic and distal bile duct probabilities were associated with lower survival probability.Conclusions and RelevanceThe AA genomic classifier is reproducible with available molecular testing in a diverse international cohort of patients and improves stratification of the divergent clinical outcomes beyond standard immunohistologic classification. These data provide a molecular classification that may be incorporated into clinical trials for prospective validation.
重要性瘤腺癌（AA）具有临床和基因组异质性。与标准组织学分类相比，以前开发的基因组分类器能更准确地定义不同的生物表型。这项回顾性队列研究在 6 家国际学术机构进行。研究对象包括接受组织学确诊 AA 治疗性切除术的连续患者（n = 192）。暴露将之前在3411例患者（1001例胰腺腺癌、165例远端胆管腺癌和2245例结直肠腺癌）的前瞻性测序队列中训练的多层次元特征回归模型应用于AA测序数据，以量化亲源细胞的相对比例。结果在192例AA患者中（中位年龄69.0 [IQR，60.0-74.0]岁，男性134例[64%]），免疫组织学亚型与基因组亚型的一致性为55%。大多数 INT 亚型肿瘤被归入结直肠基因组亚型（57 例中有 43 例 [72.9%]）。在 114 个 PB 亚型肿瘤中，29 个具有胰腺基因组特征（25.4%），24 个具有远端胆管基因组特征（21.1%）。虽然标准免疫组织学亚型与生存率无关（对数秩 P = .26），但预测的基因组概率与生存概率相关。结直肠概率较高的基因组评分与较高的生存概率相关；胰腺和远端胆管概率较高的基因组评分与较低的生存概率相关。这些数据提供了一种可纳入临床试验进行前瞻性验证的分子分类方法。
{"title":"Genome-Derived Ampullary Adenocarcinoma Classifier and Postresection Prognostication","authors":"Brett L. Ecker, Kenneth Seier, Austin M. Eckhoff, Gabriella N. Tortorello, Peter J. Allen, Vinod P. Balachandran, Nicola Blackburn, Michael I. D’Angelica, Ronald P. DeMatteo, Daniel G. Blazer, Jeffrey A. Drebin, William E. Fisher, Danielle Fortuna, Anthony J. Gill, Marie-Claude Gingras, T. Peter Kingham, Major K. Lee, Michael E. Lidsky, Daniel P. Nussbaum, Michael J. Overman, Jaswinder S. Samra, Ronglai Shen, Carlie S. Sigel, Kevin C. Soares, Charles M. Vollmer, Alice C. Wei, Sabino Zani, Robert E. Roses, Mithat Gonen, William R. Jarnagin","doi":"10.1001/jamasurg.2024.3588","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.3588","url":null,"abstract":"ImportanceAmpullary adenocarcinoma (AA) is characterized by clinical and genomic heterogeneity. A previously developed genomic classifier defined biologically distinct phenotypes with greater accuracy than standard histologic classification. External validation is needed before routine clinical use.ObjectiveTo test external validity of the prognostic value of the hidden genome classifier of AA.Design, Setting, and ParticipantsThis retrospective cohort study took place at 6 international academic institutions. Consecutive patients (n = 192) who underwent curative-intent resection of histologically confirmed AA were included. The data were analyzed from January 2005 through July 2020.ExposuresThe multilevel meta-feature regression model previously trained on a prospectively sequenced cohort of 3411 patients (1001 pancreatic adenocarcinoma, 165 distal bile duct adenocarcinoma, and 2245 colorectal adenocarcinoma) was applied to AA sequencing data to quantify the relative proportions of parental cell of origin.Main Outcome and MeasuresGenomic classification was correlated with immunohistologic subtype (intestinal [INT] or pancreatobiliary [PB]) and with overall survival (OS), using the log-rank test and Cox proportional hazard models.ResultsAmong 192 patients with AA (median age, 69.0 [IQR, 60.0-74.0] years and 134 were male [64%]), concordance between immunohistologic and genomic subtypes was 55%. Most INT subtype tumors were categorized into the colorectal genomic subtype (43 of 57 [72.9%]). Of the 114 PB subtype tumors, 29 had a pancreatic genomic profile (25.4%) and 24 had a distal bile duct genomic profile (21.1%). Whereas the standard immunohistologic subtypes were not associated with survival (log rank <jats:italic>P</jats:italic> = .26), predicted genomic probabilities were correlated with survival probability. Genomic scores with higher colorectal probability were associated with higher survival probability; higher pancreatic and distal bile duct probabilities were associated with lower survival probability.Conclusions and RelevanceThe AA genomic classifier is reproducible with available molecular testing in a diverse international cohort of patients and improves stratification of the divergent clinical outcomes beyond standard immunohistologic classification. These data provide a molecular classification that may be incorporated into clinical trials for prospective validation.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":16.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170846","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 : 2024-09-04DOI: 10.1001/jamasurg.2024.3509
Lia D Delaney, Adam Furst, Heather Day, Katherine Arnow, Robin M Cisco, Electron Kebebew, Maria E Montez-Rath, Manjula Kurella Tamura, Carolyn D Seib
Importance: Primary hyperparathyroidism (PHPT) is a common endocrine disorder associated with neuropsychiatric symptoms. Although parathyroidectomy has been associated with improvement of preexisting depression among adults with PHPT, the effect of parathyroidectomy on the development of new depression is unknown.
Objective: To determine the effect of early parathyroidectomy on the incidence of new depression among adults with PHPT compared with nonoperative management.
Design, setting, and participants: Analyzed data included observational national Veterans Affairs data from adults with a new diagnosis of PHPT from 2000 through 2019 using target trial emulation with cloning, a biostatistical method that uses observational data to emulate a randomized clinical trial. New depression rates were compared between those treated with early parathyroidectomy vs nonoperative management using an extended Cox model with time-varying inverse probability censoring weighting, adjusted for patient demographics, comorbidities, and depression risk factors. Eligible adults with a new biochemical diagnosis of PHPT, excluding those with past depression diagnoses, residing in an assisted living/nursing facility, or with Charlson Comorbidity Index score higher than 4 were included. These data were analyzed January 4, 2023, through June 15, 2023.
Exposure: Early parathyroidectomy (within 1 year of PHPT diagnosis) vs nonoperative management.
Main outcome: New depression, including among subgroups according to patient age (65 years or older; younger than 65 years) and baseline serum calcium (11.3 mg/dL or higher; less than 11.3 mg/dL).
Results: The study team identified 40 231 adults with PHPT and no history of depression of whom 35896 were male (89%) and the mean (SD) age was 67 (11.3) years. A total of 3294 patients underwent early parathyroidectomy (8.2%). The weighted cumulative incidence of depression was 11% at 5 years and 18% at 10 years among patients who underwent parathyroidectomy, compared with 9% and 18%, respectively, among nonoperative patients. Those treated with early parathyroidectomy experienced no difference in the adjusted rate of new depression compared with nonoperative management (hazard ratio, 1.05; 95% CI, 0.94-1.17). There was also no estimated effect of early parathyroidectomy on new depression in subgroup analyses based on patient age or serum calcium.
Conclusions: In this study, there was no difference in the incidence of new depression among adults with PHPT treated with early parathyroidectomy vs nonoperative management, which is relevant to preoperative discussions about the benefits and risks of operative treatment.
{"title":"Parathyroidectomy and the Development of New Depression Among Adults With Primary Hyperparathyroidism.","authors":"Lia D Delaney, Adam Furst, Heather Day, Katherine Arnow, Robin M Cisco, Electron Kebebew, Maria E Montez-Rath, Manjula Kurella Tamura, Carolyn D Seib","doi":"10.1001/jamasurg.2024.3509","DOIUrl":"10.1001/jamasurg.2024.3509","url":null,"abstract":"<p><strong>Importance: </strong>Primary hyperparathyroidism (PHPT) is a common endocrine disorder associated with neuropsychiatric symptoms. Although parathyroidectomy has been associated with improvement of preexisting depression among adults with PHPT, the effect of parathyroidectomy on the development of new depression is unknown.</p><p><strong>Objective: </strong>To determine the effect of early parathyroidectomy on the incidence of new depression among adults with PHPT compared with nonoperative management.</p><p><strong>Design, setting, and participants: </strong>Analyzed data included observational national Veterans Affairs data from adults with a new diagnosis of PHPT from 2000 through 2019 using target trial emulation with cloning, a biostatistical method that uses observational data to emulate a randomized clinical trial. New depression rates were compared between those treated with early parathyroidectomy vs nonoperative management using an extended Cox model with time-varying inverse probability censoring weighting, adjusted for patient demographics, comorbidities, and depression risk factors. Eligible adults with a new biochemical diagnosis of PHPT, excluding those with past depression diagnoses, residing in an assisted living/nursing facility, or with Charlson Comorbidity Index score higher than 4 were included. These data were analyzed January 4, 2023, through June 15, 2023.</p><p><strong>Exposure: </strong>Early parathyroidectomy (within 1 year of PHPT diagnosis) vs nonoperative management.</p><p><strong>Main outcome: </strong>New depression, including among subgroups according to patient age (65 years or older; younger than 65 years) and baseline serum calcium (11.3 mg/dL or higher; less than 11.3 mg/dL).</p><p><strong>Results: </strong>The study team identified 40 231 adults with PHPT and no history of depression of whom 35896 were male (89%) and the mean (SD) age was 67 (11.3) years. A total of 3294 patients underwent early parathyroidectomy (8.2%). The weighted cumulative incidence of depression was 11% at 5 years and 18% at 10 years among patients who underwent parathyroidectomy, compared with 9% and 18%, respectively, among nonoperative patients. Those treated with early parathyroidectomy experienced no difference in the adjusted rate of new depression compared with nonoperative management (hazard ratio, 1.05; 95% CI, 0.94-1.17). There was also no estimated effect of early parathyroidectomy on new depression in subgroup analyses based on patient age or serum calcium.</p><p><strong>Conclusions: </strong>In this study, there was no difference in the incidence of new depression among adults with PHPT treated with early parathyroidectomy vs nonoperative management, which is relevant to preoperative discussions about the benefits and risks of operative treatment.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125735","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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