Pub Date : 2026-03-18DOI: 10.1001/jamasurg.2026.0301
Mehmet Mahir Ozmen
{"title":"Refining the Role of Laparoscopic Gastrectomy for T4a Disease.","authors":"Mehmet Mahir Ozmen","doi":"10.1001/jamasurg.2026.0301","DOIUrl":"https://doi.org/10.1001/jamasurg.2026.0301","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"57 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147471445","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 : 2026-03-18DOI: 10.1001/jamasurg.2026.0304
Vo Duy Long,Tran Quang Dat,Dang Quang Thong
{"title":"Refining the Role of Laparoscopic Gastrectomy for T4a Disease-Reply.","authors":"Vo Duy Long,Tran Quang Dat,Dang Quang Thong","doi":"10.1001/jamasurg.2026.0304","DOIUrl":"https://doi.org/10.1001/jamasurg.2026.0304","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"17 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147471440","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 : 2026-03-11DOI: 10.1001/jamasurg.2026.0194
Christine E Rodhouse,Pamela C Hess,Amalia Cochran
{"title":"Surgical Patrescence-The Challenge of Becoming a Surgeon-Parent.","authors":"Christine E Rodhouse,Pamela C Hess,Amalia Cochran","doi":"10.1001/jamasurg.2026.0194","DOIUrl":"https://doi.org/10.1001/jamasurg.2026.0194","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"195 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383545","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 : 2026-03-11DOI: 10.1001/jamasurg.2026.0172
Karan R Chhabra,Emma Holler,Manish Parikh,Dana Telem,Tarik K Yuce
ImportanceIn January 2023, the US Centers for Medicare & Medicaid Services (CMS) made major changes to reimbursement policy for abdominal wall hernia repairs, including removal of postoperative global periods. Similar changes have been proposed for other common surgical procedures (eg, colectomy). The role of this policy reform in spending remains unclear.ObjectiveTo evaluate the association between the 2023 CMS ventral hernia repair reimbursement policy reform and changes in ventral hernia episode spending.Design, Setting, and ParticipantsThis retrospective cohort study used US national insurance claims data (Merative MarketScan) between January 1, 2022, and October 1, 2023. Data were analyzed from July to October 2025. Participants included commercially insured adult patients who underwent ventral or inguinal hernia repair.ExposureJanuary 2023 CMS ventral hernia repair reimbursement policy reform.Main Outcomes and MeasuresThe primary outcome was total episode spending per surgical episode, broken down into professional and facility components as well as payer and patient sources. Utilization of billable postoperative care and component separation were also evaluated. A difference-in-differences approach was used to evaluate changes in spending associated with the January 2023 policy change, with inguinal hernia repair as the unaffected comparison group.ResultsAmong 58 069 surgical episodes (34 110 ventral, 23 959 inguinal; median patient age, 52 [IQR, 43-59] years; 28% female; 90% outpatients) per-episode spending for ventral hernia decreased following policy reform by -$492 (95% CI, -$496 to -$470) (7% relative reduction) compared with inguinal hernia. Professional reimbursements decreased by -$198 (95% CI, -$200 to -$197) (20% relative reduction). Facility reimbursements increased by $84 (1.4% relative increase) in absolute terms but decreased by -$260 (95% CI, -$263 to -$239) compared with inguinal hernia (4.6% relative decrease). Patient out-of-pocket costs decreased by -$83 (95% CI, -$87 to -$82) (10% relative decrease) compared with inguinal hernia repair. Of 7561 ventral hernia repair cases (52.3%) had 1 or more related postoperative visits in the 90 days after surgery, with the mean (SD) number of visits being 1.06 (2.7). There was no significant increase in component separation procedures.Conclusions and RelevanceIn this study, following the January 2023 CMS ventral hernia repair reimbursement policy reform, episode spending decreased, with the largest component of the decrease arising from professional fees. With CMS decreasing reimbursement for numerous surgical procedures, the outcomes for surgeon practices and patient costs warrant careful consideration.
{"title":"Changes in Commercial Payments Following Ventral Hernia Billing Reform.","authors":"Karan R Chhabra,Emma Holler,Manish Parikh,Dana Telem,Tarik K Yuce","doi":"10.1001/jamasurg.2026.0172","DOIUrl":"https://doi.org/10.1001/jamasurg.2026.0172","url":null,"abstract":"ImportanceIn January 2023, the US Centers for Medicare & Medicaid Services (CMS) made major changes to reimbursement policy for abdominal wall hernia repairs, including removal of postoperative global periods. Similar changes have been proposed for other common surgical procedures (eg, colectomy). The role of this policy reform in spending remains unclear.ObjectiveTo evaluate the association between the 2023 CMS ventral hernia repair reimbursement policy reform and changes in ventral hernia episode spending.Design, Setting, and ParticipantsThis retrospective cohort study used US national insurance claims data (Merative MarketScan) between January 1, 2022, and October 1, 2023. Data were analyzed from July to October 2025. Participants included commercially insured adult patients who underwent ventral or inguinal hernia repair.ExposureJanuary 2023 CMS ventral hernia repair reimbursement policy reform.Main Outcomes and MeasuresThe primary outcome was total episode spending per surgical episode, broken down into professional and facility components as well as payer and patient sources. Utilization of billable postoperative care and component separation were also evaluated. A difference-in-differences approach was used to evaluate changes in spending associated with the January 2023 policy change, with inguinal hernia repair as the unaffected comparison group.ResultsAmong 58 069 surgical episodes (34 110 ventral, 23 959 inguinal; median patient age, 52 [IQR, 43-59] years; 28% female; 90% outpatients) per-episode spending for ventral hernia decreased following policy reform by -$492 (95% CI, -$496 to -$470) (7% relative reduction) compared with inguinal hernia. Professional reimbursements decreased by -$198 (95% CI, -$200 to -$197) (20% relative reduction). Facility reimbursements increased by $84 (1.4% relative increase) in absolute terms but decreased by -$260 (95% CI, -$263 to -$239) compared with inguinal hernia (4.6% relative decrease). Patient out-of-pocket costs decreased by -$83 (95% CI, -$87 to -$82) (10% relative decrease) compared with inguinal hernia repair. Of 7561 ventral hernia repair cases (52.3%) had 1 or more related postoperative visits in the 90 days after surgery, with the mean (SD) number of visits being 1.06 (2.7). There was no significant increase in component separation procedures.Conclusions and RelevanceIn this study, following the January 2023 CMS ventral hernia repair reimbursement policy reform, episode spending decreased, with the largest component of the decrease arising from professional fees. With CMS decreasing reimbursement for numerous surgical procedures, the outcomes for surgeon practices and patient costs warrant careful consideration.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"33 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383278","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 : 2026-03-11DOI: 10.1001/jamasurg.2026.0210
Sarah J Halix,Manuel Castillo-Angeles,Atziri Rubio-Chavez,Ekaterina L Koelliker,Emma Askew,Deepanjana Das,Alessandra Mele,Eugene S Kim,Michael J Sutherland,Susan E Pories,Erika L Rangel
ImportanceObstetric complications affect many surgeons and their childbearing partners, yet workplace dynamics surrounding pregnancy remain underexplored.ObjectiveTo analyze the prevalence of obstetric complications among childbearing surgeons and childbearing partners of surgeons, identify the occupational risk factors associated with these complications, and explore the lived experiences related to obstetric complications.Design, Setting, and ParticipantsThis survey study used convergent mixed-methods analysis of data from a 2024 survey of US surgeons administered to select members of the American College of Surgeons. The survey, which was available online from March to May 2024 and included free-text responses, asked about experiences related to family building, including obstetric complications and workplace support during pregnancy.ExposuresPregnancy or parenthood.Main Outcome and MeasuresLack of workplace support (LOWS) was defined as feeling unsupported when reducing workloads during pregnancy, being discouraged from having children, being worried about childbearing-related stigma, and perceiving that childbearing conflicted with contractual obligations. Multivariable logistic regression models examined occupational factors associated with major pregnancy complications, comparing partners of nonchildbearing surgeons with childbearing surgeons and including and excluding exposures to LOWS. Qualitative thematic network analysis of free-text answers identified themes related to obstetric complications and perceptions of related workplace culture.ResultsOf 3125 respondents (9.5% response rate among 32 890 eligible surgeons), 1473 surgeon-parents were included; 949 (64.4%) were female, and 524 (35.6%) were male. Obstetric complications (eg, placental insufficiency, placenta previa, and intrauterine growth restriction) more often impacted female surgeons (295 [31.1%] female vs 120 [22.9%] males; P = .001) even after adjusting for demographics, multiple gestation, work hours, and time standing at work (odds ratio [OR], 1.34; 95% CI, 1.01-1.78). LOWS was more common among female than male surgeons (606 [64.4%] vs 167 [31.9%]; P < .001). Adjusting for LOWS eliminated the sex-based differences in obstetric complications (odds ratio, 1.19; 95% CI, 0.89-1.59). Qualitative analysis of 697 free-text responses revealed 3 major themes: (1) physical demands of surgical work negatively impact pregnancy outcomes, (2) cultural norms discourage workplace accommodations, and (3) limited parental leave policies exacerbate challenges after pregnancy complications.Conclusions and RelevancePregnancy-related LOWS is a modifiable mediator of increased obstetric risk that disproportionately affects female surgeons. Addressing flexibility stigma, improving institutional support, and implementing policies that align with contemporary family needs are essential to foster gender equity in family building among surgeons.
{"title":"Mixed-Methods Evaluation of Surgeon Workplace Support and Obstetric Complications.","authors":"Sarah J Halix,Manuel Castillo-Angeles,Atziri Rubio-Chavez,Ekaterina L Koelliker,Emma Askew,Deepanjana Das,Alessandra Mele,Eugene S Kim,Michael J Sutherland,Susan E Pories,Erika L Rangel","doi":"10.1001/jamasurg.2026.0210","DOIUrl":"https://doi.org/10.1001/jamasurg.2026.0210","url":null,"abstract":"ImportanceObstetric complications affect many surgeons and their childbearing partners, yet workplace dynamics surrounding pregnancy remain underexplored.ObjectiveTo analyze the prevalence of obstetric complications among childbearing surgeons and childbearing partners of surgeons, identify the occupational risk factors associated with these complications, and explore the lived experiences related to obstetric complications.Design, Setting, and ParticipantsThis survey study used convergent mixed-methods analysis of data from a 2024 survey of US surgeons administered to select members of the American College of Surgeons. The survey, which was available online from March to May 2024 and included free-text responses, asked about experiences related to family building, including obstetric complications and workplace support during pregnancy.ExposuresPregnancy or parenthood.Main Outcome and MeasuresLack of workplace support (LOWS) was defined as feeling unsupported when reducing workloads during pregnancy, being discouraged from having children, being worried about childbearing-related stigma, and perceiving that childbearing conflicted with contractual obligations. Multivariable logistic regression models examined occupational factors associated with major pregnancy complications, comparing partners of nonchildbearing surgeons with childbearing surgeons and including and excluding exposures to LOWS. Qualitative thematic network analysis of free-text answers identified themes related to obstetric complications and perceptions of related workplace culture.ResultsOf 3125 respondents (9.5% response rate among 32 890 eligible surgeons), 1473 surgeon-parents were included; 949 (64.4%) were female, and 524 (35.6%) were male. Obstetric complications (eg, placental insufficiency, placenta previa, and intrauterine growth restriction) more often impacted female surgeons (295 [31.1%] female vs 120 [22.9%] males; P = .001) even after adjusting for demographics, multiple gestation, work hours, and time standing at work (odds ratio [OR], 1.34; 95% CI, 1.01-1.78). LOWS was more common among female than male surgeons (606 [64.4%] vs 167 [31.9%]; P < .001). Adjusting for LOWS eliminated the sex-based differences in obstetric complications (odds ratio, 1.19; 95% CI, 0.89-1.59). Qualitative analysis of 697 free-text responses revealed 3 major themes: (1) physical demands of surgical work negatively impact pregnancy outcomes, (2) cultural norms discourage workplace accommodations, and (3) limited parental leave policies exacerbate challenges after pregnancy complications.Conclusions and RelevancePregnancy-related LOWS is a modifiable mediator of increased obstetric risk that disproportionately affects female surgeons. Addressing flexibility stigma, improving institutional support, and implementing policies that align with contemporary family needs are essential to foster gender equity in family building among surgeons.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"131 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383279","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 : 2026-03-11DOI: 10.1001/jamasurg.2026.0195
Taylor E Wallen,John B Holcomb
{"title":"From Balanced Blood Products to Personalized Medicine in Acute Resuscitation of Trauma Patients.","authors":"Taylor E Wallen,John B Holcomb","doi":"10.1001/jamasurg.2026.0195","DOIUrl":"https://doi.org/10.1001/jamasurg.2026.0195","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"1 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383464","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 : 2026-03-11DOI: 10.1001/jamasurg.2026.0157
Tobias Carling,Karan Patel,Constantine A Stratakis,Fabio R Faucz
{"title":"Tailored Vein Sampling and Surgery in Primary Aldosteronism.","authors":"Tobias Carling,Karan Patel,Constantine A Stratakis,Fabio R Faucz","doi":"10.1001/jamasurg.2026.0157","DOIUrl":"https://doi.org/10.1001/jamasurg.2026.0157","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"29 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383280","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 : 2026-03-11DOI: 10.1001/jamasurg.2026.0197
Wesam Ibrahim,Kenneth Meza Monge,Johannes Menzel,Luis Morales Ojeda,Michael Dalton,Daniel Alejandro Fuenmayor Lozada,Andrea Vidal-Gallardo,Angelica Maria Fonseca Niño,Lorenzo E Aragón Conrado,Michael W Cripps,Juan-Pablo Idrovo
ImportanceHemorrhage remains the leading preventable cause of trauma-related death. The effectiveness of whole-blood vs component therapy remains uncertain, particularly given heterogeneous patient populations and resuscitation protocols.ObjectiveTo determine whether whole-blood transfusion is associated with reduced mortality compared with component therapy in adult trauma patients, with prespecified analysis by civilian vs military settings.Evidence ReviewIn this updated systematic review and meta-analysis, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and CINAHL were searched from January 1, 2006, through June 30, 2025. Two reviewers independently screened 6888 records and extracted data. Randomized clinical trials and observational studies comparing whole-blood vs component therapy in adults (aged ≥16 years) with traumatic hemorrhage were included. The Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool was used to assess the risk of bias in observational studies, while the Cochrane Risk of Bias 2 (RoB 2) tool was applied for randomized clinical trials. Random-effects meta-analysis used restricted maximum likelihood with Hartung-Knapp adjustment.FindingsForty studies (2 randomized clinical trials, 38 cohort studies; n = 49 776) were included. Whole-blood transfusion, compared with component therapy, was associated with reduced 24-hour mortality (odds ratio [OR], 0.76; 95% CI, 0.60-0.95; τ2 = 0.27; I2 = 87%; 95% prediction interval [PI], 0.30-1.89). In civilians (24 studies; n = 39 028), mortality reduction was significant (OR, 0.73; 95% CI, 0.57-0.93; τ2 = 0.27; I2 = 89%; 95% PI, 0.28-1.91), corresponding to an absolute risk reduction of 4.6 percentage points (95% CI, 1.4-8.6 percentage points) based on median control mortality of 20% (range, 15%-25%). No benefit was observed in military settings (5 studies; n = 2171; OR, 0.99; 95% CI, 0.58-1.70). Civilians also showed reduced 30-day mortality (OR, 0.76; 95% CI, 0.60-0.98) and transfusion requirements (mean difference, -2.66 units; 95% CI, -3.96 to -1.35 units).Conclusions and RelevanceIn this updated systematic review and meta-analysis, whole-blood transfusion was associated with reduced mortality in civilian but not military adult trauma patients, although the wide 95% PIs suggest substantial heterogeneity, indicating that benefits may vary considerably across settings. These findings support selective whole-blood transfusion protocol implementation in civilian centers while highlighting the need for refined patient selection criteria.
{"title":"Whole-Blood vs Component Therapy in Adult Trauma: An Updated Systematic Review and Meta-Analysis.","authors":"Wesam Ibrahim,Kenneth Meza Monge,Johannes Menzel,Luis Morales Ojeda,Michael Dalton,Daniel Alejandro Fuenmayor Lozada,Andrea Vidal-Gallardo,Angelica Maria Fonseca Niño,Lorenzo E Aragón Conrado,Michael W Cripps,Juan-Pablo Idrovo","doi":"10.1001/jamasurg.2026.0197","DOIUrl":"https://doi.org/10.1001/jamasurg.2026.0197","url":null,"abstract":"ImportanceHemorrhage remains the leading preventable cause of trauma-related death. The effectiveness of whole-blood vs component therapy remains uncertain, particularly given heterogeneous patient populations and resuscitation protocols.ObjectiveTo determine whether whole-blood transfusion is associated with reduced mortality compared with component therapy in adult trauma patients, with prespecified analysis by civilian vs military settings.Evidence ReviewIn this updated systematic review and meta-analysis, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and CINAHL were searched from January 1, 2006, through June 30, 2025. Two reviewers independently screened 6888 records and extracted data. Randomized clinical trials and observational studies comparing whole-blood vs component therapy in adults (aged ≥16 years) with traumatic hemorrhage were included. The Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool was used to assess the risk of bias in observational studies, while the Cochrane Risk of Bias 2 (RoB 2) tool was applied for randomized clinical trials. Random-effects meta-analysis used restricted maximum likelihood with Hartung-Knapp adjustment.FindingsForty studies (2 randomized clinical trials, 38 cohort studies; n = 49 776) were included. Whole-blood transfusion, compared with component therapy, was associated with reduced 24-hour mortality (odds ratio [OR], 0.76; 95% CI, 0.60-0.95; τ2 = 0.27; I2 = 87%; 95% prediction interval [PI], 0.30-1.89). In civilians (24 studies; n = 39 028), mortality reduction was significant (OR, 0.73; 95% CI, 0.57-0.93; τ2 = 0.27; I2 = 89%; 95% PI, 0.28-1.91), corresponding to an absolute risk reduction of 4.6 percentage points (95% CI, 1.4-8.6 percentage points) based on median control mortality of 20% (range, 15%-25%). No benefit was observed in military settings (5 studies; n = 2171; OR, 0.99; 95% CI, 0.58-1.70). Civilians also showed reduced 30-day mortality (OR, 0.76; 95% CI, 0.60-0.98) and transfusion requirements (mean difference, -2.66 units; 95% CI, -3.96 to -1.35 units).Conclusions and RelevanceIn this updated systematic review and meta-analysis, whole-blood transfusion was associated with reduced mortality in civilian but not military adult trauma patients, although the wide 95% PIs suggest substantial heterogeneity, indicating that benefits may vary considerably across settings. These findings support selective whole-blood transfusion protocol implementation in civilian centers while highlighting the need for refined patient selection criteria.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"54 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383281","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 : 2026-03-04DOI: 10.1001/jamasurg.2026.0057
Julien T Hohenleitner,Rohin Gawdi,Oliver J Standring,Steven M Cohen,Daniel A King,Gerardo Vitiello,Sepideh Gholami,Danielle K DePeralta,Matthew J Weiss
ImportancePancreatic cancer is among the deadliest malignancies, with 5-year survival estimated at 13%. Medicaid expansion offers the opportunity to assess whether broader insurance eligibility improves outcomes.ObjectiveTo evaluate whether state-level Medicaid expansion was associated with reduced mortality and increased surgical resection among adults with pancreatic cancer and whether effects varied across demographic and socioeconomic subgroups.Design, Setting, and ParticipantsThis was an observational cohort study using generalized difference-in-differences Cox and logistic regression models. Data were drawn from the Surveillance, Epidemiology, and End Results (SEER) Research Plus database (2006-2019). Included were patients from a population-based registry including 12 US states with variable Medicaid expansion timelines. Patients were aged 20 to 64 years with pancreatic cancer, excluding those 65 years or older. Patients were categorized by state Medicaid expansion status as follows: nonexpansion, early (expansion in 2011), on time (expansion in 2014), and late (expansion in 2017). Groups were propensity score matched for demographic and clinical covariates. Data were analyzed between May and July 2025.ExposureResidence in a state with Medicaid expansion, classified by timing. Residents of nonexpansion states served as controls in all analyses.Main Outcomes and MeasuresThe primary outcome was 2-year all-cause mortality. The secondary outcome was rate of surgical resection.ResultsA total of 51 707 patients were included in this analysis; patients were categorized by state Medicaid expansion status as follows: 8758 nonexpansion, 32 818 early, 6605 on time, and 3522 late. Among 51 703 patients (age range, 20-64 years; 29 212 male [56.5%]) diagnosed with malignant-coded pancreatic cancer, Medicaid expansion was associated with reduced 2-year mortality in early (hazard ratio [HR], 0.91; 95% CI, 0.86-0.96), on-time (HR, 0.91; 95% CI, 0.84-0.98), and late (HR, 0.94; 95% CI, 0.89-0.99) expansion states. Decreased associated mortality generally emerged after 3 years' postimplementation. Expansion narrowed geographic disparity in survival for patients in midsized (HR, 0.94; 95% CI, 0.88-1.00; P = .04) and small (HR, 0.88; 95% CI, 0.79-0.98; P = .02) metropolitan counties but did not improve income-related disparity. Patients with stage II to III disease had an associated decrease in mortality compared with stage IV (stage II: HR, 0.91; 95% CI, 0.86-0.97; P = .002; stage III: HR, 0.81; 95% CI, 0.76-0.87; P < .001). Expansion was also associated with a 19% relative increase in the odds of surgical resection (odds ratio, 1.19; 95% CI, 1.10-1.30).Conclusions and RelevanceResults of this cohort study reveal that Medicaid expansion was associated with improved survival and surgical access for patients with pancreatic cancer, although improvements were delayed and uneven. Persistent income-related disparities highlight the need for additional policies to a
{"title":"Medicaid Expansion Timing and Pancreatic Cancer Resection Rates and Survival.","authors":"Julien T Hohenleitner,Rohin Gawdi,Oliver J Standring,Steven M Cohen,Daniel A King,Gerardo Vitiello,Sepideh Gholami,Danielle K DePeralta,Matthew J Weiss","doi":"10.1001/jamasurg.2026.0057","DOIUrl":"https://doi.org/10.1001/jamasurg.2026.0057","url":null,"abstract":"ImportancePancreatic cancer is among the deadliest malignancies, with 5-year survival estimated at 13%. Medicaid expansion offers the opportunity to assess whether broader insurance eligibility improves outcomes.ObjectiveTo evaluate whether state-level Medicaid expansion was associated with reduced mortality and increased surgical resection among adults with pancreatic cancer and whether effects varied across demographic and socioeconomic subgroups.Design, Setting, and ParticipantsThis was an observational cohort study using generalized difference-in-differences Cox and logistic regression models. Data were drawn from the Surveillance, Epidemiology, and End Results (SEER) Research Plus database (2006-2019). Included were patients from a population-based registry including 12 US states with variable Medicaid expansion timelines. Patients were aged 20 to 64 years with pancreatic cancer, excluding those 65 years or older. Patients were categorized by state Medicaid expansion status as follows: nonexpansion, early (expansion in 2011), on time (expansion in 2014), and late (expansion in 2017). Groups were propensity score matched for demographic and clinical covariates. Data were analyzed between May and July 2025.ExposureResidence in a state with Medicaid expansion, classified by timing. Residents of nonexpansion states served as controls in all analyses.Main Outcomes and MeasuresThe primary outcome was 2-year all-cause mortality. The secondary outcome was rate of surgical resection.ResultsA total of 51 707 patients were included in this analysis; patients were categorized by state Medicaid expansion status as follows: 8758 nonexpansion, 32 818 early, 6605 on time, and 3522 late. Among 51 703 patients (age range, 20-64 years; 29 212 male [56.5%]) diagnosed with malignant-coded pancreatic cancer, Medicaid expansion was associated with reduced 2-year mortality in early (hazard ratio [HR], 0.91; 95% CI, 0.86-0.96), on-time (HR, 0.91; 95% CI, 0.84-0.98), and late (HR, 0.94; 95% CI, 0.89-0.99) expansion states. Decreased associated mortality generally emerged after 3 years' postimplementation. Expansion narrowed geographic disparity in survival for patients in midsized (HR, 0.94; 95% CI, 0.88-1.00; P = .04) and small (HR, 0.88; 95% CI, 0.79-0.98; P = .02) metropolitan counties but did not improve income-related disparity. Patients with stage II to III disease had an associated decrease in mortality compared with stage IV (stage II: HR, 0.91; 95% CI, 0.86-0.97; P = .002; stage III: HR, 0.81; 95% CI, 0.76-0.87; P < .001). Expansion was also associated with a 19% relative increase in the odds of surgical resection (odds ratio, 1.19; 95% CI, 1.10-1.30).Conclusions and RelevanceResults of this cohort study reveal that Medicaid expansion was associated with improved survival and surgical access for patients with pancreatic cancer, although improvements were delayed and uneven. Persistent income-related disparities highlight the need for additional policies to a","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"42 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350719","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 : 2026-03-04DOI: 10.1001/jamasurg.2026.0049
Stefanie C Rohde,Grace F Chao,Mahmoud Abdel-Rasoul,Mohamed I Elsaid,Patrick J Sweigert
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