Pub Date : 2026-02-04DOI: 10.1001/jamasurg.2025.6382
Bao Ngoc Vi Do, Jayson Willard Myers, Paras Singh Minhas
{"title":"Distance of Mass School Shootings From Trauma Centers.","authors":"Bao Ngoc Vi Do, Jayson Willard Myers, Paras Singh Minhas","doi":"10.1001/jamasurg.2025.6382","DOIUrl":"10.1001/jamasurg.2025.6382","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":14.9,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12874072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118988","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}
Pub Date : 2026-02-04DOI: 10.1001/jamasurg.2025.6415
Kelly A Boyle, David Milia, Marc de Moya
{"title":"National System Preparation in Dire Need-Call for Action.","authors":"Kelly A Boyle, David Milia, Marc de Moya","doi":"10.1001/jamasurg.2025.6415","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6415","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":14.9,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119007","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 : 2026-02-01DOI: 10.1001/jamasurg.2025.6516
{"title":"Errors in Figure 2 and the Discussion.","authors":"","doi":"10.1001/jamasurg.2025.6516","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6516","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"161 2","pages":"211"},"PeriodicalIF":14.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157045","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 : 2026-02-01DOI: 10.1001/jamasurg.2025.5366
Shawn J Rangel
{"title":"Refining CPT Codes to Reflect the Complexity of Pediatric Appendicitis.","authors":"Shawn J Rangel","doi":"10.1001/jamasurg.2025.5366","DOIUrl":"10.1001/jamasurg.2025.5366","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"207-208"},"PeriodicalIF":14.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145714378","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 : 2026-02-01DOI: 10.1001/jamasurg.2025.4199
Vincenzo Villani, Lilian S Kao, Yuman Fong
Importance: Difficult cholecystectomies are associated with a higher risk of severe bilio-vascular injuries.
Observations: Obesity, cirrhosis, high American Society of Anesthesiologists score, previous abdominal operations, and presence of acute cholecystitis or common bile duct stones are associated with difficult cholecystectomies. On imaging, thickened gallbladder wall, pericholecystic fluid, and an impacted gallstone are associated with difficult cholecystectomies. In challenging operations, the use of imaging (intraoperative cholangiography, intraoperative ultrasound, near-infrared cholangiography) is recommended. If the critical view of the hepatocystic triangle cannot be safely achieved, bailout strategies, such as tube cholecystostomy, subtotal cholecystectomy, or an anterograde approach, should be considered. Conversion to open surgery should be considered for significant bleeding, cholecystoenteric fistula, Mirizzi syndrome, or malignancy. Seeking advice or assistance from another surgeon is recommended when conditions are challenging.
Conclusions and relevance: Knowledge of perioperative and intraoperative adjuncts and alternative surgical options aid surgeons in performing difficult cholecystectomies safely.
{"title":"The Difficult Cholecystectomy.","authors":"Vincenzo Villani, Lilian S Kao, Yuman Fong","doi":"10.1001/jamasurg.2025.4199","DOIUrl":"10.1001/jamasurg.2025.4199","url":null,"abstract":"<p><strong>Importance: </strong>Difficult cholecystectomies are associated with a higher risk of severe bilio-vascular injuries.</p><p><strong>Observations: </strong>Obesity, cirrhosis, high American Society of Anesthesiologists score, previous abdominal operations, and presence of acute cholecystitis or common bile duct stones are associated with difficult cholecystectomies. On imaging, thickened gallbladder wall, pericholecystic fluid, and an impacted gallstone are associated with difficult cholecystectomies. In challenging operations, the use of imaging (intraoperative cholangiography, intraoperative ultrasound, near-infrared cholangiography) is recommended. If the critical view of the hepatocystic triangle cannot be safely achieved, bailout strategies, such as tube cholecystostomy, subtotal cholecystectomy, or an anterograde approach, should be considered. Conversion to open surgery should be considered for significant bleeding, cholecystoenteric fistula, Mirizzi syndrome, or malignancy. Seeking advice or assistance from another surgeon is recommended when conditions are challenging.</p><p><strong>Conclusions and relevance: </strong>Knowledge of perioperative and intraoperative adjuncts and alternative surgical options aid surgeons in performing difficult cholecystectomies safely.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"189-196"},"PeriodicalIF":14.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292121","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 : 2026-02-01DOI: 10.1001/jamasurg.2025.5507
Thomas S Helling
{"title":"General Surgeons and Tranexamic Acid.","authors":"Thomas S Helling","doi":"10.1001/jamasurg.2025.5507","DOIUrl":"10.1001/jamasurg.2025.5507","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"188"},"PeriodicalIF":14.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774602","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}
ImportanceFrailty is associated with functional decline and increased postoperative morbidity. Prehabilitation may complement Enhanced Recovery After Surgery (ERAS) care to improve patient outcomes.ObjectiveTo evaluate the effect of a multimodal prehabilitation program on functional capacity and clinical outcomes in older patients with frailty undergoing radical gastrectomy.Design, Setting, and ParticipantsThis randomized clinical trial was conducted at 15 centers in China. Participants aged 65 to 85 years with frailty (Geriatric 8 screening tool score ≤14) scheduled for elective gastrectomy or neoadjuvant chemotherapy prior to elective gastrectomy were randomized 1:1 to ERAS care either with or without prehabilitation. Recruitment for the study began in September 2022 and was completed in April 2024; data analysis was completed from September 2024 to April 2025.InterventionsThe prehabilitation group (PG) underwent multimodal prehabilitation for at least 2 weeks in combination with ERAS care, while the standard ERAS group (SG) followed a well-defined ERAS pathway.Main Outcomes and MeasuresThe primary outcome was the proportion of patients with postoperative complications within 30 days after surgery. Secondary outcomes included functional capacity, surgical resilience, and other short-term postoperative outcomes.ResultsA total of 368 participants were randomized to either the PG or SG group. In the modified intention-to-treat population of 347 participants (PG: n = 169; SG: n = 178), overall compliance with prehabilitation was 93.75%; median (IQR) participant age was 70 (68-73) years, and 95 participants (27.4%) were female. The rate of complications was lower in PG compared to SG (17.2% vs 28.7%; P = .01). In particular, significant benefits were observed in minor complications (PG: 18 of 169 patients [10.7%]; SG: 36 of 178 patients [20.2%]; P = .01) and medical complications (PG: 14 of 169 patients [8.3%]; SG: 30 of 178 patients [16.9%]; P = .02). The PG showed increased functional capacity before surgery compared to baseline (mean [SD] 6-minute walk test change, +24 [12.5] m; P < .001). Four weeks after surgery, the mean walking distance of the PG remained above baseline levels. Moreover, secondary parameters, such as chronic low-grade inflammation, preoperative physical quality of life, length of intensive care unit stay, mechanical ventilation time, and length of hospital stay, generally favored prehabilitation compared with standard ERAS care.Conclusions and RelevancePer the results of this randomized clinical trial, a multimodal prehabilitation program may enhance physiological reserve, reduce morbidity, and promote surgical resilience in older patients with frailty undergoing radical gastrectomy.Trial RegistrationClinicalTrials.gov Identifier: NCT05352802.
虚弱与功能下降和术后发病率增加有关。预康复可以补充术后增强恢复（ERAS）护理，以改善患者的预后。目的评价多模式康复方案对行根治性胃切除术的老年虚弱患者功能能力和临床预后的影响。设计、环境和参与者本随机临床试验在中国的15个中心进行。年龄在65 ~ 85岁之间，体弱者（Geriatric 8筛查工具评分≤14）计划择期胃切除术或择期胃切除术前新辅助化疗的参与者按1:1的比例随机分配到有或没有预适应的ERAS治疗组。该研究的招募于2022年9月开始，并于2024年4月完成；数据分析于2024年9月至2025年4月完成。干预措施：预康复组（PG）在ERAS护理的同时进行至少2周的多模式预康复，而标准ERAS组（SG）则遵循明确的ERAS途径。主要结局和措施主要结局是术后30天内出现术后并发症的患者比例。次要结局包括功能能力、手术恢复力和其他短期术后结局。结果共有368名参与者被随机分为PG组和SG组。在347名受试者（PG: n = 169; SG: n = 178）的改良意向治疗人群中，总体康复依从性为93.75%；参与者年龄中位数（IQR）为70（68-73）岁，95名参与者（27.4%）为女性。PG组并发症发生率低于SG组（17.2% vs 28.7%; P = 0.01）。特别是，在轻微并发症方面观察到显著的益处(PG: 169例患者中有18例[10.7%]；SG: 178例患者中有36例[20.2%];P =。01)和医学并发症（169例患者中PG: 14例[8.3%]；178例患者中SG: 30例[16.9%];P = 0.02）。与基线相比，PG术前功能能力增加（平均[SD] 6分钟步行测试变化，+24 [12.5]m; P < .001）。术后4周，PG的平均步行距离仍高于基线水平。此外，次要参数，如慢性低度炎症、术前身体生活质量、重症监护病房住院时间、机械通气时间和住院时间，与标准ERAS护理相比，普遍倾向于康复治疗。结论和相关性根据这项随机临床试验的结果，多模式的康复计划可以增强接受根治性胃切除术的老年虚弱患者的生理储备，降低发病率，并提高手术恢复能力。临床试验注册号：NCT05352802。
{"title":"Supervised Multimodal Prehabilitation and Clinical Outcomes in Older Patients With Frailty and Gastric Cancer: The GISSG+2201 Randomized Clinical Trial.","authors":"Yuqi Sun,Yulong Tian,Shougen Cao,Leping Li,Wenbin Yu,Yinlu Ding,Xixun Wang,Ying Kong,Xinjian Wang,Hao Wang,Xizeng Hui,Jianjun Qu,Hongbo Wang,Quanhong Duan,Daogui Yang,Huanhu Zhang,Shaofei Zhou,Xiaodong Liu,Zequn Li,Qi Liu,Yanbing Zhou","doi":"10.1001/jamasurg.2025.6256","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6256","url":null,"abstract":"ImportanceFrailty is associated with functional decline and increased postoperative morbidity. Prehabilitation may complement Enhanced Recovery After Surgery (ERAS) care to improve patient outcomes.ObjectiveTo evaluate the effect of a multimodal prehabilitation program on functional capacity and clinical outcomes in older patients with frailty undergoing radical gastrectomy.Design, Setting, and ParticipantsThis randomized clinical trial was conducted at 15 centers in China. Participants aged 65 to 85 years with frailty (Geriatric 8 screening tool score ≤14) scheduled for elective gastrectomy or neoadjuvant chemotherapy prior to elective gastrectomy were randomized 1:1 to ERAS care either with or without prehabilitation. Recruitment for the study began in September 2022 and was completed in April 2024; data analysis was completed from September 2024 to April 2025.InterventionsThe prehabilitation group (PG) underwent multimodal prehabilitation for at least 2 weeks in combination with ERAS care, while the standard ERAS group (SG) followed a well-defined ERAS pathway.Main Outcomes and MeasuresThe primary outcome was the proportion of patients with postoperative complications within 30 days after surgery. Secondary outcomes included functional capacity, surgical resilience, and other short-term postoperative outcomes.ResultsA total of 368 participants were randomized to either the PG or SG group. In the modified intention-to-treat population of 347 participants (PG: n = 169; SG: n = 178), overall compliance with prehabilitation was 93.75%; median (IQR) participant age was 70 (68-73) years, and 95 participants (27.4%) were female. The rate of complications was lower in PG compared to SG (17.2% vs 28.7%; P = .01). In particular, significant benefits were observed in minor complications (PG: 18 of 169 patients [10.7%]; SG: 36 of 178 patients [20.2%]; P = .01) and medical complications (PG: 14 of 169 patients [8.3%]; SG: 30 of 178 patients [16.9%]; P = .02). The PG showed increased functional capacity before surgery compared to baseline (mean [SD] 6-minute walk test change, +24 [12.5] m; P < .001). Four weeks after surgery, the mean walking distance of the PG remained above baseline levels. Moreover, secondary parameters, such as chronic low-grade inflammation, preoperative physical quality of life, length of intensive care unit stay, mechanical ventilation time, and length of hospital stay, generally favored prehabilitation compared with standard ERAS care.Conclusions and RelevancePer the results of this randomized clinical trial, a multimodal prehabilitation program may enhance physiological reserve, reduce morbidity, and promote surgical resilience in older patients with frailty undergoing radical gastrectomy.Trial RegistrationClinicalTrials.gov Identifier: NCT05352802.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"87 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056868","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}
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