Pub Date : 2025-01-15DOI: 10.1001/jamasurg.2024.6041
Steven Yule, Jennifer Yule, Calum Arthur
{"title":"Turning Stress Into Success-Surgery as Professional Sport.","authors":"Steven Yule, Jennifer Yule, Calum Arthur","doi":"10.1001/jamasurg.2024.6041","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6041","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982752","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 : 2025-01-15DOI: 10.1001/jamasurg.2024.6040
Margaret E Smith, Alex B Haynes
{"title":"Effective Deimplementation of Low-Value Preoperative Testing: Choosing Wisely, From Policy to Practice.","authors":"Margaret E Smith, Alex B Haynes","doi":"10.1001/jamasurg.2024.6040","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6040","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983621","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 : 2025-01-15DOI: 10.1001/jamasurg.2024.6060
Marjorie Liggett, Hasan Alam
{"title":"Tranexamic Acid in General Surgery-Who Benefits the Most?","authors":"Marjorie Liggett, Hasan Alam","doi":"10.1001/jamasurg.2024.6060","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6060","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983646","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 : 2025-01-15DOI: 10.1001/jamasurg.2024.6048
Lily J Park, Maura Marcucci, Sandra N Ofori, Flavia K Borges, Rahima Nenshi, Charlotte Tiffanie Bendtz Kanstrup, Michael Rosen, Giovanni Landoni, Vladimir Lomivorotov, Thomas W Painter, Denis Xavier, Maria Jose Martinez-Zapata, Wojciech Szczeklik, Christian S Meyhoff, Matthew T V Chan, Marko Simunovic, Jessica Bogach, Pablo E Serrano, Kumar Balasubramanian, Margherita Cadeddu, Ilun Yang, Won Ho Kim, P J Devereaux
<p><strong>Importance: </strong>Perioperative bleeding is common in general surgery. The POISE-3 (Perioperative Ischemic Evaluation-3) trial demonstrated efficacy of prophylactic tranexamic acid (TXA) compared with placebo in preventing major bleeding without increasing vascular outcomes in noncardiac surgery.</p><p><strong>Objective: </strong>To determine the safety and efficacy of prophylactic TXA, specifically in general surgery.</p><p><strong>Design, setting, and participants: </strong>Subgroup analyses were conducted that compared randomized treatment with TXA vs placebo according to whether patients underwent general surgery or nongeneral surgery in the POISE-3 blinded, international, multicenter randomized clinical trial. Participants were 45 years or older, were undergoing noncardiac surgery, had increased cardiovascular risk, and were expected to require at least an overnight hospital admission after surgery. Among 26 581 eligible patients identified, 17 046 were excluded, resulting in 9535 patients randomized to the POISE-3 trial. Participants were enrolled from June 2018 through July 2021. The data were analyzed during December 2023.</p><p><strong>Intervention: </strong>Prophylactic, 1-g bolus of intravenous TXA or placebo at the start and end of surgery.</p><p><strong>Main outcomes and measures: </strong>The primary efficacy outcome was a composite of life-threatening bleeding, major bleeding, or bleeding into a critical organ. The primary safety outcome was a composite of myocardial injury after noncardiac surgery, nonhemorrhagic stroke, peripheral arterial thrombosis, or symptomatic proximal venous thromboembolism at 30 days. Cox proportional hazards models were conducted, incorporating tests of interaction.</p><p><strong>Results: </strong>Among 9535 POISE-3 participants, 3260 underwent a general surgery procedure. Mean age was 68.6 (SD, 9.6) years, 1740 were male (53.4%), and 1520 were female (46.6%). Among general surgery patients, 8.0% and 10.5% in the TXA and placebo groups, respectively, had the primary efficacy outcome (hazard ratio [HR], 0.74; 95% CI, 0.59-0.93; P = .01) and 11.9% and 12.5% in the TXA and placebo groups, respectively, had the primary safety outcome (HR, 0.95; 95% CI, 0.78-1.16; P = .63). There was no significant interaction by type of surgery (general surgery vs nongeneral surgery) on the primary efficacy (P for interaction = .81) and safety (P for interaction = .37) outcomes. Across subtypes of general surgery, TXA decreased the composite bleeding outcome in hepatopancreaticobiliary surgery (HR, 0.55; 95% CI, 0.34-0.91 [n = 332]) and colorectal surgery (HR, 0.67; 95% CI, 0.45-0.98 [n = 940]). There was no significant interaction across subtypes of general surgery (P for interaction = .68).</p><p><strong>Conclusions and relevance: </strong>In this study, TXA significantly reduced the risk of perioperative bleeding without increasing cardiovascular risk in patients undergoing general surgery procedures.</p><p>
{"title":"Safety and Efficacy of Tranexamic Acid in General Surgery.","authors":"Lily J Park, Maura Marcucci, Sandra N Ofori, Flavia K Borges, Rahima Nenshi, Charlotte Tiffanie Bendtz Kanstrup, Michael Rosen, Giovanni Landoni, Vladimir Lomivorotov, Thomas W Painter, Denis Xavier, Maria Jose Martinez-Zapata, Wojciech Szczeklik, Christian S Meyhoff, Matthew T V Chan, Marko Simunovic, Jessica Bogach, Pablo E Serrano, Kumar Balasubramanian, Margherita Cadeddu, Ilun Yang, Won Ho Kim, P J Devereaux","doi":"10.1001/jamasurg.2024.6048","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6048","url":null,"abstract":"<p><strong>Importance: </strong>Perioperative bleeding is common in general surgery. The POISE-3 (Perioperative Ischemic Evaluation-3) trial demonstrated efficacy of prophylactic tranexamic acid (TXA) compared with placebo in preventing major bleeding without increasing vascular outcomes in noncardiac surgery.</p><p><strong>Objective: </strong>To determine the safety and efficacy of prophylactic TXA, specifically in general surgery.</p><p><strong>Design, setting, and participants: </strong>Subgroup analyses were conducted that compared randomized treatment with TXA vs placebo according to whether patients underwent general surgery or nongeneral surgery in the POISE-3 blinded, international, multicenter randomized clinical trial. Participants were 45 years or older, were undergoing noncardiac surgery, had increased cardiovascular risk, and were expected to require at least an overnight hospital admission after surgery. Among 26 581 eligible patients identified, 17 046 were excluded, resulting in 9535 patients randomized to the POISE-3 trial. Participants were enrolled from June 2018 through July 2021. The data were analyzed during December 2023.</p><p><strong>Intervention: </strong>Prophylactic, 1-g bolus of intravenous TXA or placebo at the start and end of surgery.</p><p><strong>Main outcomes and measures: </strong>The primary efficacy outcome was a composite of life-threatening bleeding, major bleeding, or bleeding into a critical organ. The primary safety outcome was a composite of myocardial injury after noncardiac surgery, nonhemorrhagic stroke, peripheral arterial thrombosis, or symptomatic proximal venous thromboembolism at 30 days. Cox proportional hazards models were conducted, incorporating tests of interaction.</p><p><strong>Results: </strong>Among 9535 POISE-3 participants, 3260 underwent a general surgery procedure. Mean age was 68.6 (SD, 9.6) years, 1740 were male (53.4%), and 1520 were female (46.6%). Among general surgery patients, 8.0% and 10.5% in the TXA and placebo groups, respectively, had the primary efficacy outcome (hazard ratio [HR], 0.74; 95% CI, 0.59-0.93; P = .01) and 11.9% and 12.5% in the TXA and placebo groups, respectively, had the primary safety outcome (HR, 0.95; 95% CI, 0.78-1.16; P = .63). There was no significant interaction by type of surgery (general surgery vs nongeneral surgery) on the primary efficacy (P for interaction = .81) and safety (P for interaction = .37) outcomes. Across subtypes of general surgery, TXA decreased the composite bleeding outcome in hepatopancreaticobiliary surgery (HR, 0.55; 95% CI, 0.34-0.91 [n = 332]) and colorectal surgery (HR, 0.67; 95% CI, 0.45-0.98 [n = 940]). There was no significant interaction across subtypes of general surgery (P for interaction = .68).</p><p><strong>Conclusions and relevance: </strong>In this study, TXA significantly reduced the risk of perioperative bleeding without increasing cardiovascular risk in patients undergoing general surgery procedures.</p><p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983575","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 : 2025-01-15DOI: 10.1001/jamasurg.2024.6063
Alexis G Antunez, Ruby J Kazemi, Caroline Richburg, Cecilia Pesavento, Andrew Vastardis, Erin Kim, Abigail L Kappelman, Devak Nanua, Hiba Pediyakkal, Faelan Jacobson-Davies, Shawna N Smith, James Henderson, Valerie Gavrila, Anthony Cuttitta, Hari Nathan, Lesly A Dossett
Importance: Routine preoperative blood tests and electrocardiograms before low-risk surgery do not prevent adverse events or change management but waste resources and can cause patient harm. Given this, multispecialty organizations recommend against routine testing before low-risk surgery.
Objective: To determine whether a multicomponent deimplementation strategy (the intervention) would reduce low-value preoperative testing before low-risk general surgery operations.
Design, setting, and participants: This study had a pre-post quality improvement interventional design using interrupted time series and difference-in-difference analytic approaches. The setting was a single academic, quaternary referral hospital with 2 freestanding ambulatory surgery centers and a central preoperative clinic. Included in the study were adult patients undergoing nonurgent outpatient inguinal hernia repairs, lumpectomy, or laparoscopic cholecystectomy between June 2022 and August 2023. Eligible clinicians included those treating at least 1 patient during both the preintervention and postintervention periods.
Interventions: All clinicians were exposed to the multicomponent deimplementation intervention, and their testing practices were compared before and after the intervention. The strategy components were evidenced-based decisional support, multidisciplinary stakeholder engagement, educational sessions, and consensus building with surgeons and physician assistants staffing a preoperative clinic.
Main outcomes and measures: The primary end point of the trial was the rate of unnecessary preoperative tests across each trial period.
Results: A total of 1143 patients (mean [SD] age, 58.7 [15.5] years; 643 female [56.3%]) underwent 261 operations (23%) in the preintervention period, 510 (45%) in the intervention period, and 372 (33%) in the postintervention period. Unnecessary testing rates decreased over each period (intervention testing rate, -16%; 95% CI, -4% to -27%; P = .01; postintervention testing rate, -27%; 95% CI, -17% to -38%; P = .003) and within each test category. The decrease in overall testing was not observed at other hospitals in the state on adjusted difference-in-difference analysis.
Conclusions and relevance: In this quality improvement study, a multicomponent deimplementation strategy was associated with a reduction in unnecessary preoperative testing before low-risk general surgery operations. The resulting changes in testing practice patterns were not associated with temporal trends within or outside the study hospital. Results suggest that this intervention was effective, applicable to common general surgery operations, and adaptable for expansion into appropriate clinical settings.
{"title":"Multicomponent Deimplementation Strategy to Reduce Low-Value Preoperative Testing.","authors":"Alexis G Antunez, Ruby J Kazemi, Caroline Richburg, Cecilia Pesavento, Andrew Vastardis, Erin Kim, Abigail L Kappelman, Devak Nanua, Hiba Pediyakkal, Faelan Jacobson-Davies, Shawna N Smith, James Henderson, Valerie Gavrila, Anthony Cuttitta, Hari Nathan, Lesly A Dossett","doi":"10.1001/jamasurg.2024.6063","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6063","url":null,"abstract":"<p><strong>Importance: </strong>Routine preoperative blood tests and electrocardiograms before low-risk surgery do not prevent adverse events or change management but waste resources and can cause patient harm. Given this, multispecialty organizations recommend against routine testing before low-risk surgery.</p><p><strong>Objective: </strong>To determine whether a multicomponent deimplementation strategy (the intervention) would reduce low-value preoperative testing before low-risk general surgery operations.</p><p><strong>Design, setting, and participants: </strong>This study had a pre-post quality improvement interventional design using interrupted time series and difference-in-difference analytic approaches. The setting was a single academic, quaternary referral hospital with 2 freestanding ambulatory surgery centers and a central preoperative clinic. Included in the study were adult patients undergoing nonurgent outpatient inguinal hernia repairs, lumpectomy, or laparoscopic cholecystectomy between June 2022 and August 2023. Eligible clinicians included those treating at least 1 patient during both the preintervention and postintervention periods.</p><p><strong>Interventions: </strong>All clinicians were exposed to the multicomponent deimplementation intervention, and their testing practices were compared before and after the intervention. The strategy components were evidenced-based decisional support, multidisciplinary stakeholder engagement, educational sessions, and consensus building with surgeons and physician assistants staffing a preoperative clinic.</p><p><strong>Main outcomes and measures: </strong>The primary end point of the trial was the rate of unnecessary preoperative tests across each trial period.</p><p><strong>Results: </strong>A total of 1143 patients (mean [SD] age, 58.7 [15.5] years; 643 female [56.3%]) underwent 261 operations (23%) in the preintervention period, 510 (45%) in the intervention period, and 372 (33%) in the postintervention period. Unnecessary testing rates decreased over each period (intervention testing rate, -16%; 95% CI, -4% to -27%; P = .01; postintervention testing rate, -27%; 95% CI, -17% to -38%; P = .003) and within each test category. The decrease in overall testing was not observed at other hospitals in the state on adjusted difference-in-difference analysis.</p><p><strong>Conclusions and relevance: </strong>In this quality improvement study, a multicomponent deimplementation strategy was associated with a reduction in unnecessary preoperative testing before low-risk general surgery operations. The resulting changes in testing practice patterns were not associated with temporal trends within or outside the study hospital. Results suggest that this intervention was effective, applicable to common general surgery operations, and adaptable for expansion into appropriate clinical settings.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983626","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 : 2025-01-08DOI: 10.1001/jamasurg.2024.6028
Anai N. Kothari, Amy H. Kaji, Genevieve B. Melton
This Guide to Statistics and Methods discusses approaches to incorporating artificial intelligence (AI)–enabled analytics when working with big data and outlines AI-related considerations for data management and health equity.
{"title":"Practical Guide to the Use of AI-Enabled Analytics in Research","authors":"Anai N. Kothari, Amy H. Kaji, Genevieve B. Melton","doi":"10.1001/jamasurg.2024.6028","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6028","url":null,"abstract":"This Guide to Statistics and Methods discusses approaches to incorporating artificial intelligence (AI)–enabled analytics when working with big data and outlines AI-related considerations for data management and health equity.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"6 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936212","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 : 2025-01-08DOI: 10.1001/jamasurg.2024.6025
Tyler J. Loftus, Adil Haider, Gilbert R. Upchurch
This Guide to Statistics and Methods provides an overview of the limitations and opportunities in applying large language models in such tasks as extracting surgical risk factors from clinical notes, learning from text inputs for decision support, and serving as educational tools.
{"title":"Practical Guide to Artificial Intelligence, Chatbots, and Large Language Models in Conducting and Reporting Research","authors":"Tyler J. Loftus, Adil Haider, Gilbert R. Upchurch","doi":"10.1001/jamasurg.2024.6025","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6025","url":null,"abstract":"This Guide to Statistics and Methods provides an overview of the limitations and opportunities in applying large language models in such tasks as extracting surgical risk factors from clinical notes, learning from text inputs for decision support, and serving as educational tools.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"28 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936294","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 : 2025-01-08DOI: 10.1001/jamasurg.2024.6000
Shipra Arya, Lesly A Dossett, Melina R Kibbe
{"title":"Best Practices for Big Data Sources and Methods in Surgery.","authors":"Shipra Arya, Lesly A Dossett, Melina R Kibbe","doi":"10.1001/jamasurg.2024.6000","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6000","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949202","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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