Pub Date : 2026-02-11DOI: 10.1001/jamasurg.2025.6530
Elizabeth Y. Wang, Tariku J. Beyene, Celina M. Yong, Thomas Burdon, Yihan Lin
Importance Characterizing the quality of cardiac surgery care provided by Department of Veterans Affairs (VA) hospitals is necessary to inform patient referral and resource allocation after clinical advances and programmatic changes, such as implementation of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act. Objective To explore cardiac surgery volume, trends, and outcomes within VA hospitals. Design, Setting, and Participants This retrospective cohort study was conducted among all patients who underwent cardiac surgery at VA medical centers (VAMCs) across the US from January 1, 2005, through September 30, 2024. Patients were identified using the VA Surgical Quality Improvement Program (VASQIP) cardiac surgery database. Data analysis was conducted from November 1, 2024, through November 7, 2025. Exposure Cardiac surgery performed at VAMCs. Main Outcomes and Measures Cardiac surgery case volume and trends for all cases performed at VAMCs nationwide. Operative mortality was determined for 12 procedures indexed by the Society of Thoracic Surgeons: coronary artery bypass graft (CABG), CABG with aortic valve replacement (AVR), CABG with mitral valve (MV) replacement (MVR), CABG with MV repair, CABG with AVR and MVR or MV repair, AVR, AVR with MVR or MV repair, MVR, MV repair, tricuspid valve (TV) replacement (TVR), TV repair, and aortic aneurysm surgery. All outcomes were explored over 5-year intervals between 2005 and 2024. Adjusted mortalities were determined using the Age-Adjusted Charlson Comorbidity Index (ACCI). Results A total of 94 694 patients (mean [SD] age at procedure, 67.0 [9.1] years; 1410 [1.5%] female) at 43 VAMCs were identified, with 30 053 patients in the 2005-2009 cohort, 26 641 patients in the 2010-2014 cohort, 23 438 patients in the 2015-2019 cohort, and 14 562 patients in the 2020-2024 cohort. Age, diversity in self-reported race and ethnicity, and ACCI increased significantly over the 20-year period. Cardiac surgery volumes were highest in 2006, with a dip in volume after 2019 and subsequent stabilization. Adjusted 30-day mortalities in 2020 to 2024 were as follows: CABG, 0.8% (95% CI, 0%-99.9%); CABG with AVR, 4.3% (95% CI, 2.4%-7.5%); CABG with MVR, 3.0% (95% CI, 0.8%-10.2%); CABG with MV repair, 0% (95% CI, 0%-1.0%); CABG with AVR and MVR or MV repair, 11.8% (95% CI, 1.4%-56.4%); AVR, 1.6% (95% CI, 0.8%-3.0%); AVR with MVR or MV repair, 6.9% (95% CI, 1.7%-24.7%); MVR, 3.0% (95% CI, 1.1%-7.9%); MV repair, 0% (95% CI, 0%-100%); TVR, 0% (95% CI, 0%-100%); TV repair, 0% (95% CI, not applicable owing to no mortality across the years); and aortic aneurysm surgery, 0% (95% CI, 0%-100%). Conclusions and Relevance Cardiac surgery outcomes at VA hospitals remained consistent over time, demonstrating high-quality care, despite increasing ACCI and shifting procedural volumes.
{"title":"Temporal Trends of Common Cardiac Surgical Procedures at Veterans Affairs Medical Centers","authors":"Elizabeth Y. Wang, Tariku J. Beyene, Celina M. Yong, Thomas Burdon, Yihan Lin","doi":"10.1001/jamasurg.2025.6530","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6530","url":null,"abstract":"Importance Characterizing the quality of cardiac surgery care provided by Department of Veterans Affairs (VA) hospitals is necessary to inform patient referral and resource allocation after clinical advances and programmatic changes, such as implementation of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act. Objective To explore cardiac surgery volume, trends, and outcomes within VA hospitals. Design, Setting, and Participants This retrospective cohort study was conducted among all patients who underwent cardiac surgery at VA medical centers (VAMCs) across the US from January 1, 2005, through September 30, 2024. Patients were identified using the VA Surgical Quality Improvement Program (VASQIP) cardiac surgery database. Data analysis was conducted from November 1, 2024, through November 7, 2025. Exposure Cardiac surgery performed at VAMCs. Main Outcomes and Measures Cardiac surgery case volume and trends for all cases performed at VAMCs nationwide. Operative mortality was determined for 12 procedures indexed by the Society of Thoracic Surgeons: coronary artery bypass graft (CABG), CABG with aortic valve replacement (AVR), CABG with mitral valve (MV) replacement (MVR), CABG with MV repair, CABG with AVR and MVR or MV repair, AVR, AVR with MVR or MV repair, MVR, MV repair, tricuspid valve (TV) replacement (TVR), TV repair, and aortic aneurysm surgery. All outcomes were explored over 5-year intervals between 2005 and 2024. Adjusted mortalities were determined using the Age-Adjusted Charlson Comorbidity Index (ACCI). Results A total of 94 694 patients (mean [SD] age at procedure, 67.0 [9.1] years; 1410 [1.5%] female) at 43 VAMCs were identified, with 30 053 patients in the 2005-2009 cohort, 26 641 patients in the 2010-2014 cohort, 23 438 patients in the 2015-2019 cohort, and 14 562 patients in the 2020-2024 cohort. Age, diversity in self-reported race and ethnicity, and ACCI increased significantly over the 20-year period. Cardiac surgery volumes were highest in 2006, with a dip in volume after 2019 and subsequent stabilization. Adjusted 30-day mortalities in 2020 to 2024 were as follows: CABG, 0.8% (95% CI, 0%-99.9%); CABG with AVR, 4.3% (95% CI, 2.4%-7.5%); CABG with MVR, 3.0% (95% CI, 0.8%-10.2%); CABG with MV repair, 0% (95% CI, 0%-1.0%); CABG with AVR and MVR or MV repair, 11.8% (95% CI, 1.4%-56.4%); AVR, 1.6% (95% CI, 0.8%-3.0%); AVR with MVR or MV repair, 6.9% (95% CI, 1.7%-24.7%); MVR, 3.0% (95% CI, 1.1%-7.9%); MV repair, 0% (95% CI, 0%-100%); TVR, 0% (95% CI, 0%-100%); TV repair, 0% (95% CI, not applicable owing to no mortality across the years); and aortic aneurysm surgery, 0% (95% CI, 0%-100%). Conclusions and Relevance Cardiac surgery outcomes at VA hospitals remained consistent over time, demonstrating high-quality care, despite increasing ACCI and shifting procedural volumes.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"6 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146152695","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 : 2026-02-11DOI: 10.1001/jamasurg.2025.6536
Kei Kobayashi, Danny Chu
{"title":"Missing the Act on the Mission of Maintaining Quality Care.","authors":"Kei Kobayashi, Danny Chu","doi":"10.1001/jamasurg.2025.6536","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6536","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":14.9,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157062","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 : 2026-02-11DOI: 10.1001/jamasurg.2025.6551
Samantha L. Savitch, Kiran H. Lagisetty, Pasithorn A. Suwanabol
Importance Anastomotic leak remains a leading cause of morbidity and mortality following colon resection. There is increasing evidence to suggest that failure to rescue (FTR), defined as death after a complication, is the culmination of a series of cascading events, which may be exacerbated by delays in diagnosis. Timely identification and management of anastomotic leaks may represent a crucial strategy for reducing FTR after colon resection. Objective To determine whether delayed diagnosis of anastomotic leak is associated with FTR following colon resection. Design, Setting, and Participants This cohort study used the Veterans Affairs Surgical Quality Improvement Program dataset from 2004 to 2023 to assess the rate of FTR after postoperative organ space surgical site infection (OSSI) among patients who underwent colon resection at a Veteran Affairs hospital. Data were analyzed from September 1, 2024, to December 13, 2025. Exposure Colon resection. Main Outcomes and Measures FTR rate after diagnosis of OSSI. OSSI was used as a surrogate for anastomotic leak and categorized as delayed (occurring after a sepsis diagnosis) or early (before or without a sepsis diagnosis). FTR rate after delayed or early OSSI diagnosis was compared. Multivariable logistic regression was performed to identify factors associated with FTR after OSSI. Results Of 39 175 patients (37 228 males [95.0%] and 1947 females [5.0%]; mean [SD] age, 65.3 [11.1] years) included in the analysis who underwent colon resection, 219 were Asian (0.6%) individuals, 6386 were Black (16.3%) individuals, 1820 were Hispanic (4.7) individuals, 24 612 were White (62.8%) individuals, and 6138 were individuals of other or unknown race and ethnicity (15.7%). The indication for resection was colon cancer in 17 067 patients (43.6%), diverticular disease in 4678 (11.9%), inflammatory bowel disease in 658 (1.7%) and colitis, ischemia, or other indication in 16 772 (42.8%). OSSI was diagnosed in 1227 patients (3.1%); of these diagnoses, 381 (31.1%) were delayed and 846 (68.9%) were early. On multivariable analysis, those with delayed OSSI had a significantly higher mean (95% CI) number of total discrete complications compared with those with early OSSI (3.0 [2.9-3.2] vs 1.7 [1.6-1.8], <jats:italic toggle="yes">P</jats:italic> &lt; .001), higher probability of reoperation (62.1% vs 40.3%, <jats:italic toggle="yes">P</jats:italic> &lt; .001), longer mean (95% CI) length of stay (22.6 [20.4-24.8] days vs 17.6 [16.5-18.7] days, <jats:italic toggle="yes">P</jats:italic> &lt; .001), and higher probability of FTR (7.8% vs 2.2%, <jats:italic toggle="yes">P</jats:italic> &lt; .001). Probability of FTR was 6.7% higher in patients who developed sepsis (8.1%) compared with those who never developed sepsis (1.4%). Conclusions and Relevance Findings of this study suggest that FTR after OSSI, which served as a proxy for anastomotic leak, was associated with delayed diagnosis, not the lea
吻合口漏仍然是结肠切除术后发病和死亡的主要原因。越来越多的证据表明，被定义为并发症后死亡的抢救失败（FTR）是一系列连锁事件的高潮，可能因诊断延误而加剧。及时识别和处理吻合口瘘可能是减少结肠切除术后FTR的关键策略。目的探讨结肠切除术后吻合口漏的延迟诊断是否与FTR有关。本队列研究使用2004年至2023年退伍军人事务外科质量改进计划数据集，评估在退伍军人事务医院接受结肠切除术的患者术后器官间隙手术部位感染（OSSI）后FTR的发生率。数据分析时间为2024年9月1日至2025年12月13日。暴露结肠切除术。OSSI诊断后的FTR率。OSSI作为吻合口漏的替代检查，分为延迟性（脓毒症诊断后发生）和早期（脓毒症诊断前或未确诊）。比较延迟或早期OSSI诊断后的FTR率。采用多变量逻辑回归来确定与OSSI后FTR相关的因素。结果39 175例接受结肠切除术的患者（男性37 228例[95.0%]，女性1947例[5.0%]，平均[SD]年龄65.3[11.1]岁）中，219例为亚洲人（0.6%），6386例为黑人（16.3%），1820例为西班牙裔（4.7%），24 612例为白人（62.8%），6138例为其他或未知种族（15.7%）。切除的指征为结肠癌17067例（43.6%），憩室疾病4678例（11.9%），炎症性肠病658例（1.7%），结肠炎、缺血或其他指征16772例（42.8%）。1227例（3.1%）患者被诊断为OSSI；在这些诊断中，381例（31.1%）延迟诊断，846例（68.9%）早期诊断。在多变量分析中，与早期OSSI患者相比，延迟OSSI患者的总离散并发症的平均（95% CI）数明显更高（3.0 [2.9-3.2]vs 1.7[1.6-1.8]）。001)，再手术概率更高(62.1% vs 40.3%, P <；001)，平均（95% CI）住院时间更长(22.6[20.4-24.8]天vs 17.6[16.5-18.7]天，P &；001)， FTR的概率更高（7.8% vs 2.2%, P < .001）。发生败血症的患者发生FTR的概率（8.1%）比未发生败血症的患者（1.4%）高6.7%。本研究的结果表明，作为吻合口瘘的替代指标，OSSI术后FTR与延迟诊断有关，而与吻合口瘘本身无关。早期发现渗漏和避免进展为败血症可以降低FTR率。旨在早期识别和及时适当处理吻合口瘘的质量倡议可能会提高结肠切除术相关的死亡率。
{"title":"Delayed Diagnosis of Anastomotic Leak and Failure to Rescue After Colon Resection","authors":"Samantha L. Savitch, Kiran H. Lagisetty, Pasithorn A. Suwanabol","doi":"10.1001/jamasurg.2025.6551","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6551","url":null,"abstract":"Importance Anastomotic leak remains a leading cause of morbidity and mortality following colon resection. There is increasing evidence to suggest that failure to rescue (FTR), defined as death after a complication, is the culmination of a series of cascading events, which may be exacerbated by delays in diagnosis. Timely identification and management of anastomotic leaks may represent a crucial strategy for reducing FTR after colon resection. Objective To determine whether delayed diagnosis of anastomotic leak is associated with FTR following colon resection. Design, Setting, and Participants This cohort study used the Veterans Affairs Surgical Quality Improvement Program dataset from 2004 to 2023 to assess the rate of FTR after postoperative organ space surgical site infection (OSSI) among patients who underwent colon resection at a Veteran Affairs hospital. Data were analyzed from September 1, 2024, to December 13, 2025. Exposure Colon resection. Main Outcomes and Measures FTR rate after diagnosis of OSSI. OSSI was used as a surrogate for anastomotic leak and categorized as delayed (occurring after a sepsis diagnosis) or early (before or without a sepsis diagnosis). FTR rate after delayed or early OSSI diagnosis was compared. Multivariable logistic regression was performed to identify factors associated with FTR after OSSI. Results Of 39 175 patients (37 228 males [95.0%] and 1947 females [5.0%]; mean [SD] age, 65.3 [11.1] years) included in the analysis who underwent colon resection, 219 were Asian (0.6%) individuals, 6386 were Black (16.3%) individuals, 1820 were Hispanic (4.7) individuals, 24 612 were White (62.8%) individuals, and 6138 were individuals of other or unknown race and ethnicity (15.7%). The indication for resection was colon cancer in 17 067 patients (43.6%), diverticular disease in 4678 (11.9%), inflammatory bowel disease in 658 (1.7%) and colitis, ischemia, or other indication in 16 772 (42.8%). OSSI was diagnosed in 1227 patients (3.1%); of these diagnoses, 381 (31.1%) were delayed and 846 (68.9%) were early. On multivariable analysis, those with delayed OSSI had a significantly higher mean (95% CI) number of total discrete complications compared with those with early OSSI (3.0 [2.9-3.2] vs 1.7 [1.6-1.8], <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001), higher probability of reoperation (62.1% vs 40.3%, <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001), longer mean (95% CI) length of stay (22.6 [20.4-24.8] days vs 17.6 [16.5-18.7] days, <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001), and higher probability of FTR (7.8% vs 2.2%, <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001). Probability of FTR was 6.7% higher in patients who developed sepsis (8.1%) compared with those who never developed sepsis (1.4%). Conclusions and Relevance Findings of this study suggest that FTR after OSSI, which served as a proxy for anastomotic leak, was associated with delayed diagnosis, not the lea","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"48 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146152708","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 : 2026-02-04DOI: 10.1001/jamasurg.2025.6406
Pawan Acharya, Kristan Staudenmayer, Molly P. Jarman, Russell Griffin, Jeffrey D. Kerby, Zain G. Hashmi
Importance As trauma care–related demand continues to rise, the US trauma system’s current utilization and ability to accommodate surges from mass casualty events or disasters remain uncertain. Understanding existing trauma bed occupancy and reserve capacity is essential for national preparedness. Objective To assess the current occupancy and distribution of adult trauma-designated beds across US hospitals and evaluate the system’s ability to absorb a sudden and sustained surge in trauma volume. Design, Setting, and Participants This cross-sectional study analyzed 121 weeks (January 2022–April 2024) of facility-level bed availability and occupancy data from the US Department of Health and Human Services for 2027 hospitals with trauma center designation. Simulation modeling was conducted to evaluate bed capacity under various casualty influx scenarios, assuming a 10% allocation (n = 3610) of the 36 101 adult-trauma designated beds in level I/II centers nationwide. Exposures Various casualty influx scenarios. Main Outcomes and Measures Primary outcomes included mean weekly occupancy rates for adult inpatient and intensive care unit (ICU) beds by trauma center level and region, percentage of centers exceeding 80% occupancy for prolonged durations, and simulated bed deficits under sustained patient influx scenarios. Results Level I and II trauma centers consistently operated at high occupancy, exceeding 80% for inpatient beds and 75% for ICU beds across most regions. Nearly 80% of level I/II centers in the South and West exceeded 80% inpatient occupancy for 75 weeks or longer. In contrast, level III and lower-level centers showed lower occupancy but notable regional variation. Simulation modeling revealed that at sustained influx rates of 1500 to 2000 patients per day, national trauma bed deficits exceeded 20 000 beds within 45 days. Even modest influxes of 241 patients per day saturated all designated trauma beds within 90 days under dynamic length-of-stay assumptions. Conclusions and Relevance The US trauma system, particularly its tertiary centers (level I/II) are operating under sustained high occupancy with limited reserve capacity for patient surges. These findings highlight the urgent need for national trauma capacity planning, regional load-balancing mechanisms, and scalable infrastructure to enhance trauma system resilience.
{"title":"Bed Capacity and Utilization at Hospitals With Trauma Centers","authors":"Pawan Acharya, Kristan Staudenmayer, Molly P. Jarman, Russell Griffin, Jeffrey D. Kerby, Zain G. Hashmi","doi":"10.1001/jamasurg.2025.6406","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6406","url":null,"abstract":"Importance As trauma care–related demand continues to rise, the US trauma system’s current utilization and ability to accommodate surges from mass casualty events or disasters remain uncertain. Understanding existing trauma bed occupancy and reserve capacity is essential for national preparedness. Objective To assess the current occupancy and distribution of adult trauma-designated beds across US hospitals and evaluate the system’s ability to absorb a sudden and sustained surge in trauma volume. Design, Setting, and Participants This cross-sectional study analyzed 121 weeks (January 2022–April 2024) of facility-level bed availability and occupancy data from the US Department of Health and Human Services for 2027 hospitals with trauma center designation. Simulation modeling was conducted to evaluate bed capacity under various casualty influx scenarios, assuming a 10% allocation (n = 3610) of the 36 101 adult-trauma designated beds in level I/II centers nationwide. Exposures Various casualty influx scenarios. Main Outcomes and Measures Primary outcomes included mean weekly occupancy rates for adult inpatient and intensive care unit (ICU) beds by trauma center level and region, percentage of centers exceeding 80% occupancy for prolonged durations, and simulated bed deficits under sustained patient influx scenarios. Results Level I and II trauma centers consistently operated at high occupancy, exceeding 80% for inpatient beds and 75% for ICU beds across most regions. Nearly 80% of level I/II centers in the South and West exceeded 80% inpatient occupancy for 75 weeks or longer. In contrast, level III and lower-level centers showed lower occupancy but notable regional variation. Simulation modeling revealed that at sustained influx rates of 1500 to 2000 patients per day, national trauma bed deficits exceeded 20 000 beds within 45 days. Even modest influxes of 241 patients per day saturated all designated trauma beds within 90 days under dynamic length-of-stay assumptions. Conclusions and Relevance The US trauma system, particularly its tertiary centers (level I/II) are operating under sustained high occupancy with limited reserve capacity for patient surges. These findings highlight the urgent need for national trauma capacity planning, regional load-balancing mechanisms, and scalable infrastructure to enhance trauma system resilience.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"301 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116165","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 : 2026-02-04DOI: 10.1001/jamasurg.2025.6386
Abdulaziz Elemosho, Odysseas P. Chatzipanagiotou, Meher Angez, Andrea Baldo, Areesh Mevawalla, Sebastian O. Ekenze, Qaidar Alizai, Timothy M. Pawlik
Importance Sleep plays a critical role in postoperative recovery, influencing immune function, pain perception, neurocognitive performance, and wound healing. Although surgical interventions are known to disrupt sleep, the extent and trajectory of these disruptions across varying procedural risks remain poorly characterized. Objective To characterize postoperative alterations in sleep stages and determine how these trajectories vary across different surgical procedures. Design, Setting, and Participants This retrospective cohort study used wearable device–derived sleep data linked to electronic health records from US participants in the prospectively maintained All of Us Research Program database. Adults undergoing surgery from January 2012 to December 2024 with 90 days or more of preoperative and 30 days or more of postoperative wearable sleep data were included. Data analyses were performed from July to November 2025. Exposure Surgical intervention stratified by procedural risk levels. Main Outcomes and Measures The primary outcome was sleep metrics, including total sleep and rapid eye movement (REM), deep, light, and wake-stage durations, compared across 9 postoperative epochs and stratified by surgical risk (low, intermediate, or high). Linear mixed-effects models were fitted for each metric with opioid exposure, dose, and patient age as covariates. Association between each sleep metric and postoperative complications was assessed using multivariate logistic regression analysis. Results A total of 634 unique surgical procedures in 512 patients were included in the analytic cohort; median (IQR) patient age at the time of surgery was 59 (46-67) years, and 558 patients (88.0%) were female. High-risk procedures were associated with significant and sustained mean (SD) reductions in REM and deep sleep through postoperative day 7 (deep: Δ, –18.7 [48.6] minutes; <jats:italic toggle="yes">P</jats:italic> &lt; .001; REM: Δ, –12.4 [30.1] minutes; <jats:italic toggle="yes">P</jats:italic> &lt; .001), while total sleep was reduced acutely (Δ, –19.4 [145.3] minutes; <jats:italic toggle="yes">P</jats:italic> = .004). Light sleep decreased transiently; wake-stage duration increased significantly (mean [SD] Δ, +13.9 [31.8] minutes; <jats:italic toggle="yes">P</jats:italic> &lt; .001). Intermediate-risk procedures were associated with milder disruptions, primarily limited to days 0 through 3. In contrast, low-risk procedures were not associated with significant changes in any sleep metric at any postoperative epoch. Opioid exposure was associated with increased light (β, approximately +5.1 minutes; <jats:italic toggle="yes">P</jats:italic> &lt; .001) and wake-stage (+10.2 minutes; <jats:italic toggle="yes">P</jats:italic> &lt; .001) durations but suppressed deep sleep (–5.1 minutes; <jats:italic toggle="yes">P</jats:italic> &lt; .001). Age was similarly linked to greater wake-stage sleep (+0.30 minutes/y) and red
{"title":"Postoperative Sleep Dynamics Across Surgical Risk Using Wearable Device Technology","authors":"Abdulaziz Elemosho, Odysseas P. Chatzipanagiotou, Meher Angez, Andrea Baldo, Areesh Mevawalla, Sebastian O. Ekenze, Qaidar Alizai, Timothy M. Pawlik","doi":"10.1001/jamasurg.2025.6386","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6386","url":null,"abstract":"Importance Sleep plays a critical role in postoperative recovery, influencing immune function, pain perception, neurocognitive performance, and wound healing. Although surgical interventions are known to disrupt sleep, the extent and trajectory of these disruptions across varying procedural risks remain poorly characterized. Objective To characterize postoperative alterations in sleep stages and determine how these trajectories vary across different surgical procedures. Design, Setting, and Participants This retrospective cohort study used wearable device–derived sleep data linked to electronic health records from US participants in the prospectively maintained All of Us Research Program database. Adults undergoing surgery from January 2012 to December 2024 with 90 days or more of preoperative and 30 days or more of postoperative wearable sleep data were included. Data analyses were performed from July to November 2025. Exposure Surgical intervention stratified by procedural risk levels. Main Outcomes and Measures The primary outcome was sleep metrics, including total sleep and rapid eye movement (REM), deep, light, and wake-stage durations, compared across 9 postoperative epochs and stratified by surgical risk (low, intermediate, or high). Linear mixed-effects models were fitted for each metric with opioid exposure, dose, and patient age as covariates. Association between each sleep metric and postoperative complications was assessed using multivariate logistic regression analysis. Results A total of 634 unique surgical procedures in 512 patients were included in the analytic cohort; median (IQR) patient age at the time of surgery was 59 (46-67) years, and 558 patients (88.0%) were female. High-risk procedures were associated with significant and sustained mean (SD) reductions in REM and deep sleep through postoperative day 7 (deep: Δ, –18.7 [48.6] minutes; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001; REM: Δ, –12.4 [30.1] minutes; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001), while total sleep was reduced acutely (Δ, –19.4 [145.3] minutes; <jats:italic toggle=\"yes\">P</jats:italic> = .004). Light sleep decreased transiently; wake-stage duration increased significantly (mean [SD] Δ, +13.9 [31.8] minutes; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001). Intermediate-risk procedures were associated with milder disruptions, primarily limited to days 0 through 3. In contrast, low-risk procedures were not associated with significant changes in any sleep metric at any postoperative epoch. Opioid exposure was associated with increased light (β, approximately +5.1 minutes; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001) and wake-stage (+10.2 minutes; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001) durations but suppressed deep sleep (–5.1 minutes; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001). Age was similarly linked to greater wake-stage sleep (+0.30 minutes/y) and red","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"9 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116135","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 : 2026-02-04DOI: 10.1001/jamasurg.2025.6382
Bao Ngoc Vi Do, Jayson Willard Myers, Paras Singh Minhas
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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}
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