Pub Date : 2026-01-28DOI: 10.1001/jamasurg.2025.6255
Liane S Feldman,Franco Carli,Janius Tsang
{"title":"Expanding the Prehabilitation Team Beyond the Clinic.","authors":"Liane S Feldman,Franco Carli,Janius Tsang","doi":"10.1001/jamasurg.2025.6255","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6255","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"12 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056860","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}
ImportanceAcute appendicitis is the most common abdominal surgical emergency worldwide and a leading cause of emergency hospital admissions and operations. Despite its frequency, substantial variability persists in diagnosis and management across patient populations and health care settings.ObjectiveTo provide updated, evidence-based recommendations for the diagnosis and treatment of acute appendicitis in adults, children, pregnant women, older patients (aged ≥65 years), immunocompromised individuals, and patients with obesity (body mass index ≥30), developed by the World Society of Emergency Surgery (WSES) using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.Evidence ReviewA systematic literature search was performed in MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library to identify relevant studies published until May 2025. Eligible designs included randomized clinical trials, observational studies, systematic reviews, and meta-analyses. Risk of bias was assessed with design-appropriate tools (RoB-2, ROBINS-I, QUADAS-2). Evidence profiles and evidence-to-decision frameworks were generated for each of 19 key clinical questions. The certainty of evidence was rated as high, moderate, low, or very low. Recommendations were classified as strong or conditional (weak) according to GRADE.FindingsSix key clinical domains were addressed across 19 questions. Thirty-five recommendations were formulated. Key findings include: (1) clinical risk scores and imaging improve diagnostic accuracy and reduce negative appendectomy rates; (2) nonoperative management with antibiotics is safe and effective in selected patients with uncomplicated appendicitis, with recommendations tailored for specific populations; (3) appendectomy for uncomplicated appendicitis may be safely delayed within 24 hours without increased risk of adverse outcomes; (4) laparoscopic appendectomy remains the standard surgical approach; (5) postoperative antibiotic therapy should be limited to short courses (2-3 days) in complicated disease; and (6) follow-up strategies are essential after nonoperative management of complicated appendicitis with abscess to detect neoplasms.Conclusions and RelevanceThe 2025 WSES Jerusalem Guidelines provide updated, evidence-based recommendations for the diagnosis and treatment of acute appendicitis with the aim to standardize practice, reduce unwarranted variability, and support safe, effective, and patient-centered care across diverse populations and health care systems. Their implementation should be adapted to local resources.
急性阑尾炎是世界范围内最常见的腹部外科急症，也是急诊住院和手术的主要原因。尽管发病率很高，但在不同的患者群体和卫生保健机构中，诊断和管理仍然存在很大的差异。目的：为成人、儿童、孕妇、老年患者（≥65岁）、免疫功能低下个体和肥胖患者（体重指数≥30）急性阑尾炎的诊断和治疗提供最新的循证建议，该建议由世界急诊外科学会（WSES）采用分级建议评估、发展和评价（GRADE）方法制定。在MEDLINE、Embase、Scopus、Web of Science和Cochrane Library中进行系统的文献检索，以确定2025年5月之前发表的相关研究。符合条件的设计包括随机临床试验、观察性研究、系统评价和荟萃分析。采用设计合适的工具（rob2、robins - 1、QUADAS-2）评估偏倚风险。为19个关键临床问题中的每一个问题生成证据概要和证据到决策框架。证据的确定性分为高、中、低和极低。根据GRADE将推荐分为强推荐和有条件推荐（弱推荐）。六个关键的临床领域涉及19个问题。提出了35项建议。主要发现包括：(1)临床风险评分和影像学提高了诊断准确性，降低了阑尾切除术阴性率；(2)对于非复杂性阑尾炎患者，非手术治疗抗生素是安全有效的，可针对特定人群提出针对性的建议；(3)无并发症的阑尾炎患者可以在24小时内安全延迟阑尾切除术，而不会增加不良后果的风险；(4)腹腔镜阑尾切除术仍是标准手术方式；(5)并发症术后抗生素治疗应限于短期疗程（2-3天）；(6)复杂阑尾炎合并脓肿非手术治疗后的随访策略是发现肿瘤的关键。2025年WSES耶路撒冷指南为急性阑尾炎的诊断和治疗提供了最新的循证建议，旨在规范实践，减少不必要的可变性，并支持在不同人群和医疗保健系统中安全、有效和以患者为中心的护理。它们的执行应适应当地资源。
{"title":"Diagnosis and Treatment of Acute Appendicitis: 2025 Edition of the World Society of Emergency Surgery Jerusalem Guidelines.","authors":"Mauro Podda,Marco Ceresoli,Belinda De Simone,Paola Fugazzola,Francesco Pata,Andrea Balla,Chiara Gerardi,Eleonora Allocati,Paulina Salminen,Raul Coimbra,Michael Kelly,Marja Boermeester,Helmut Segovia Lohse,Edward Tan,Adolfo Pisanu,Fikri Abu-Zidan,David Flum,Boris Sakakushev,Luca Ansaloni,Carlos Augusto Gomes,David Talan,Giovanni Domenico Tebala,Vishal Shelat,Cino Bendinelli,Zsolt Balogh,Panu Mentula,Isidoro Di Carlo,Yoram Kluger,Matti Tolonen,Henna Sammalkorpi,Dimitrios Damaskos,Walter Biffl,Baohong Yang,Ville Sallinen,Justin Davies,Carlo Vallicelli,Francesco Amico,Goran Augustin,Eugenio Cucinotta,Andrey Litvin,Andrew Kirkpatrick,Nicola de'Angelis,Dieter Weber,Ari Leppaniemi,Matthew Lee,Luis Felipe Cabrera Vargas,Massimo Sartelli,Federico Coccolini,Salomone Di Saverio,Fausto Catena","doi":"10.1001/jamasurg.2025.6218","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6218","url":null,"abstract":"ImportanceAcute appendicitis is the most common abdominal surgical emergency worldwide and a leading cause of emergency hospital admissions and operations. Despite its frequency, substantial variability persists in diagnosis and management across patient populations and health care settings.ObjectiveTo provide updated, evidence-based recommendations for the diagnosis and treatment of acute appendicitis in adults, children, pregnant women, older patients (aged ≥65 years), immunocompromised individuals, and patients with obesity (body mass index ≥30), developed by the World Society of Emergency Surgery (WSES) using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.Evidence ReviewA systematic literature search was performed in MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library to identify relevant studies published until May 2025. Eligible designs included randomized clinical trials, observational studies, systematic reviews, and meta-analyses. Risk of bias was assessed with design-appropriate tools (RoB-2, ROBINS-I, QUADAS-2). Evidence profiles and evidence-to-decision frameworks were generated for each of 19 key clinical questions. The certainty of evidence was rated as high, moderate, low, or very low. Recommendations were classified as strong or conditional (weak) according to GRADE.FindingsSix key clinical domains were addressed across 19 questions. Thirty-five recommendations were formulated. Key findings include: (1) clinical risk scores and imaging improve diagnostic accuracy and reduce negative appendectomy rates; (2) nonoperative management with antibiotics is safe and effective in selected patients with uncomplicated appendicitis, with recommendations tailored for specific populations; (3) appendectomy for uncomplicated appendicitis may be safely delayed within 24 hours without increased risk of adverse outcomes; (4) laparoscopic appendectomy remains the standard surgical approach; (5) postoperative antibiotic therapy should be limited to short courses (2-3 days) in complicated disease; and (6) follow-up strategies are essential after nonoperative management of complicated appendicitis with abscess to detect neoplasms.Conclusions and RelevanceThe 2025 WSES Jerusalem Guidelines provide updated, evidence-based recommendations for the diagnosis and treatment of acute appendicitis with the aim to standardize practice, reduce unwarranted variability, and support safe, effective, and patient-centered care across diverse populations and health care systems. Their implementation should be adapted to local resources.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"64 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056867","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}
ImportanceModerate to severe postoperative nausea and vomiting (PONV) significantly impedes recovery and is inadequately managed by current pharmacotherapy.ObjectiveTo evaluate the clinical efficacy of a novel wearable transcutaneous electrical acupoint stimulation (TEAS) device targeting the PC6 (Neiguan) acupoint in managing moderate to severe PONV.Design, Setting, and ParticipantsThis randomized, double-dummy, patient-blinded and observer-blinded, parallel-group, and active-controlled clinical trial was conducted at 4 hospitals in Shanghai and Tianjin, China, from May 2024 through May 2025. Eligible participants were female patients aged 25 to 55 years scheduled for thyroidectomy or anterior cervical surgery undergoing general anesthesia who developed moderate to severe PONV (numerical rating score [NRS] ≥4). These data were analyzed during June 2025.InterventionsParticipants were randomized 1:1 to receive either active TEAS via the EmeTerm wristband applied for 2 hours with a saline placebo injection or an identical inactive TEAS device (model stimulator) with intravenous metoclopramide, 10 mg. Participants not achieving symptom relief (NRS ≥4) at 2 hours underwent rerandomization to cross-intervention.Main outcome and measureThe primary outcome was the 2-hour PONV remission rate following initial intervention defined as a significant relief in symptoms (NRS ≤3).ResultsA total of 310 patients were screened for eligibility and 232 (74.8%) were randomized into either TEAS group (n = 116) or control group (n = 116). All participants completed the trial and a per-protocol analysis was conducted. Among 232 total patients, mean (SD) age was 43.5 (5.1) years and 100% were female. The TEAS group demonstrated a significantly higher 2-hour remission rate (77.6%; 95% CI, 69.2%-84.2% vs 55.2%; 95% CI, 46.1%-63.9%; P < .001) and a lower 24-hour relapse rate (12.2%; 95% CI, 7.0%-20.6% vs 56.3%; 95% CI, 44.1%-67.7%; P < .001) compared with controls. No adverse events were reported.Conclusion and relevanceIn this study, wearable TEAS significantly outperformed metoclopramide for moderate to severe PONV, representing an effective nonpharmacological alternative that enhances postanesthesia recovery.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2400084329.
中度至重度术后恶心和呕吐（PONV）严重阻碍恢复，目前的药物治疗无法充分控制。目的评价一种新型可穿戴经皮穴位电刺激装置（TEAS）治疗中重度PONV的临床疗效。设计、环境和参与者这项随机、双虚拟、患者盲和观察者盲、平行组和主动对照的临床试验于2024年5月至2025年5月在中国上海和天津的4家医院进行。符合条件的参与者是年龄在25 - 55岁的女性患者，她们计划接受甲状腺切除术或颈椎前路手术，接受全身麻醉，并出现中度至重度PONV（数值评分[NRS]≥4）。这些数据是在2025年6月进行分析的。干预措施：参与者按1:1随机分配，通过EmeTerm腕带接受活性tea，并注射生理盐水安慰剂2小时，或接受相同的非活性tea装置（模型刺激器），静脉注射甲氧氯普胺，10mg。在2小时未达到症状缓解（NRS≥4）的参与者被重新随机分配到交叉干预。主要结局和测量主要结局是初始干预后2小时PONV缓解率，定义为症状显著缓解（NRS≤3）。结果共筛选合格患者310例，其中232例（74.8%）随机分为TEAS组（n = 116）和对照组（n = 116）。所有参与者都完成了试验，并进行了每个方案的分析。232例患者中，平均（SD）年龄为43.5（5.1）岁，100%为女性。tea组2小时缓解率显著高于对照组(77.6%;95% CI, 69.2%-84.2% vs 55.2%; 95% CI, 46.1%-63.9%; P <。24小时复发率较低（12.2%;95% CI, 7.0%-20.6% vs 56.3%; 95% CI, 44.1%-67.7%; P < 0.001）。001)。无不良事件报告。结论和相关性在本研究中，可穿戴式tea治疗中度至重度PONV的效果明显优于甲氧氯普胺，是一种有效的非药物替代方法，可增强麻醉后恢复。中国临床试验注册号：ChiCTR2400084329。
{"title":"Transcutaneous Electrical Acupoint Stimulation vs Metoclopramide for Moderate to Severe Postoperative Nausea and Vomiting: A Randomized Clinical Trial.","authors":"Dong-Yu Zheng,Peng Ding,Ming Gong,Hong-Wei Zhu,Hui-Jing Shi,Guang-Li Ren,Ling-Yan Jin,Yong-Qiang Wang,Hong-Bin Yuan,Yong-Hua Li","doi":"10.1001/jamasurg.2025.6394","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6394","url":null,"abstract":"ImportanceModerate to severe postoperative nausea and vomiting (PONV) significantly impedes recovery and is inadequately managed by current pharmacotherapy.ObjectiveTo evaluate the clinical efficacy of a novel wearable transcutaneous electrical acupoint stimulation (TEAS) device targeting the PC6 (Neiguan) acupoint in managing moderate to severe PONV.Design, Setting, and ParticipantsThis randomized, double-dummy, patient-blinded and observer-blinded, parallel-group, and active-controlled clinical trial was conducted at 4 hospitals in Shanghai and Tianjin, China, from May 2024 through May 2025. Eligible participants were female patients aged 25 to 55 years scheduled for thyroidectomy or anterior cervical surgery undergoing general anesthesia who developed moderate to severe PONV (numerical rating score [NRS] ≥4). These data were analyzed during June 2025.InterventionsParticipants were randomized 1:1 to receive either active TEAS via the EmeTerm wristband applied for 2 hours with a saline placebo injection or an identical inactive TEAS device (model stimulator) with intravenous metoclopramide, 10 mg. Participants not achieving symptom relief (NRS ≥4) at 2 hours underwent rerandomization to cross-intervention.Main outcome and measureThe primary outcome was the 2-hour PONV remission rate following initial intervention defined as a significant relief in symptoms (NRS ≤3).ResultsA total of 310 patients were screened for eligibility and 232 (74.8%) were randomized into either TEAS group (n = 116) or control group (n = 116). All participants completed the trial and a per-protocol analysis was conducted. Among 232 total patients, mean (SD) age was 43.5 (5.1) years and 100% were female. The TEAS group demonstrated a significantly higher 2-hour remission rate (77.6%; 95% CI, 69.2%-84.2% vs 55.2%; 95% CI, 46.1%-63.9%; P < .001) and a lower 24-hour relapse rate (12.2%; 95% CI, 7.0%-20.6% vs 56.3%; 95% CI, 44.1%-67.7%; P < .001) compared with controls. No adverse events were reported.Conclusion and relevanceIn this study, wearable TEAS significantly outperformed metoclopramide for moderate to severe PONV, representing an effective nonpharmacological alternative that enhances postanesthesia recovery.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2400084329.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"33 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-28DOI: 10.1001/jamasurg.2025.6583
{"title":"Error in Study Name.","authors":"","doi":"10.1001/jamasurg.2025.6583","DOIUrl":"10.1001/jamasurg.2025.6583","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":14.9,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146063615","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 : 2026-01-28DOI: 10.1001/jamasurg.2025.6214
Mercy Mitei,Agneta Odera,Elizabeth A Stuebing,Britney L Grayson,Keir Thelander,Kathryn M Chu,Robert K Parker,Jane Kayle Lee
{"title":"Perceptions of Gender Discrimination Among Surgical Trainees in Africa.","authors":"Mercy Mitei,Agneta Odera,Elizabeth A Stuebing,Britney L Grayson,Keir Thelander,Kathryn M Chu,Robert K Parker,Jane Kayle Lee","doi":"10.1001/jamasurg.2025.6214","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6214","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"41 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-28DOI: 10.1001/jamasurg.2025.6246
Hidenori Tanaka,Shravan Gowrishankar,Eben L Rosenthal
{"title":"Fluorescence-Guided Surgery-Illuminating the Limits of Cancer Therapeutics.","authors":"Hidenori Tanaka,Shravan Gowrishankar,Eben L Rosenthal","doi":"10.1001/jamasurg.2025.6246","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6246","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"77 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21DOI: 10.1001/jamasurg.2025.6155
Jordan Nantais,Refik Saskin,Andrew Calzavara,David Gomez,Nancy N Baxter
ImportanceOutcomes in emergency general surgery vary between hospitals, and models with dedicated resources and personnel have been developed with the aim of improving care. Existing literature is limited in scope and often does not involve nonoperatively treated patients, reducing generalizability.ObjectiveTo use population-level data to determine whether treatment in an emergency general surgery model is associated with clinical outcomes.Design, Setting, and ParticipantsThis was a retrospective cohort study of adults in Ontario, Canada, diagnosed with 1 of 9 emergency general surgery conditions and hospitalized between April 1, 2002, and December 31, 2019, using linked administrative data housed at ICES. Data analysis was conducted from June 24, 2024, to October 24, 2025.ExposureTreatment at a hospital with an emergency general surgery model of care in comparison with a standard surgeon on-call model.Main Outcomes and MeasuresDeath in the hospital or within 30 days of discharge was the primary outcome. Secondary outcomes included death at 90 days and complications, failure to rescue, and readmission at 30 days. Generalized estimating equations were used with a negative binomial distribution for mortality outcomes and a binomial distribution for other secondary outcomes. Clustering at the hospital level was accounted for, and effect modification according to diagnosis risk category (low, medium, or high) was evaluated.ResultsA total of 494 609 patients were included (median [IQR] age, 56 [40-72] years; 263 267 [53.2%] female), with 88 889 (18.0%) treated in an emergency general surgery model hospital. A total of 3069 patients (3.4%) in an emergency general surgery model died within 30 days, compared with 15 013 (3.7%) in a surgeon on-call model. Adjusted analyses showed an association between an emergency general surgery model and decreased adjusted relative risk (aRR) of 30-day death for patients with high-risk conditions (aRR, 0.85; 95% CI, 0.77-0.95) but not for those with low- or medium-risk conditions. Death at 90 days was likewise lower in emergency general surgery models for high-risk conditions (aRR, 0.82; 95% CI, 0.74-0.92). The odds of complications in patients with high-risk conditions showed a similar association (adjusted odds ratio, 0.68; 95% CI, 0.53-0.87), but there was no association with failure to rescue or readmission.Conclusions and RelevanceThis cohort study demonstrated that death and complications were lower for patients with high-risk conditions in an emergency general surgery model of care. These findings suggest that these patients would benefit from formal systems to prioritize management at emergency general surgery model centers but that patients with lower-risk conditions are less likely to benefit from this care.
{"title":"A Population-Level Evaluation of Emergency General Surgery Models of Care and Clinical Outcomes.","authors":"Jordan Nantais,Refik Saskin,Andrew Calzavara,David Gomez,Nancy N Baxter","doi":"10.1001/jamasurg.2025.6155","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6155","url":null,"abstract":"ImportanceOutcomes in emergency general surgery vary between hospitals, and models with dedicated resources and personnel have been developed with the aim of improving care. Existing literature is limited in scope and often does not involve nonoperatively treated patients, reducing generalizability.ObjectiveTo use population-level data to determine whether treatment in an emergency general surgery model is associated with clinical outcomes.Design, Setting, and ParticipantsThis was a retrospective cohort study of adults in Ontario, Canada, diagnosed with 1 of 9 emergency general surgery conditions and hospitalized between April 1, 2002, and December 31, 2019, using linked administrative data housed at ICES. Data analysis was conducted from June 24, 2024, to October 24, 2025.ExposureTreatment at a hospital with an emergency general surgery model of care in comparison with a standard surgeon on-call model.Main Outcomes and MeasuresDeath in the hospital or within 30 days of discharge was the primary outcome. Secondary outcomes included death at 90 days and complications, failure to rescue, and readmission at 30 days. Generalized estimating equations were used with a negative binomial distribution for mortality outcomes and a binomial distribution for other secondary outcomes. Clustering at the hospital level was accounted for, and effect modification according to diagnosis risk category (low, medium, or high) was evaluated.ResultsA total of 494 609 patients were included (median [IQR] age, 56 [40-72] years; 263 267 [53.2%] female), with 88 889 (18.0%) treated in an emergency general surgery model hospital. A total of 3069 patients (3.4%) in an emergency general surgery model died within 30 days, compared with 15 013 (3.7%) in a surgeon on-call model. Adjusted analyses showed an association between an emergency general surgery model and decreased adjusted relative risk (aRR) of 30-day death for patients with high-risk conditions (aRR, 0.85; 95% CI, 0.77-0.95) but not for those with low- or medium-risk conditions. Death at 90 days was likewise lower in emergency general surgery models for high-risk conditions (aRR, 0.82; 95% CI, 0.74-0.92). The odds of complications in patients with high-risk conditions showed a similar association (adjusted odds ratio, 0.68; 95% CI, 0.53-0.87), but there was no association with failure to rescue or readmission.Conclusions and RelevanceThis cohort study demonstrated that death and complications were lower for patients with high-risk conditions in an emergency general surgery model of care. These findings suggest that these patients would benefit from formal systems to prioritize management at emergency general surgery model centers but that patients with lower-risk conditions are less likely to benefit from this care.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"2 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21DOI: 10.1001/jamasurg.2025.6171
Rohun Bhagat,Laura Young,Eugene H Blackstone,Faisal G Bakaeen
{"title":"Internal Mammary Artery Grafting-A Therapy Like No Other.","authors":"Rohun Bhagat,Laura Young,Eugene H Blackstone,Faisal G Bakaeen","doi":"10.1001/jamasurg.2025.6171","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6171","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"231 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005277","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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