Pub Date : 2025-02-19DOI: 10.1001/jamasurg.2024.6933
J. Juliët Vrolijk, Babette E. Becherer, Patrick Garduce, Ahmad Reza Pourghaderi, Danny A. Young-Afat, René R. J. W. van der Hulst, Gillian Farrell, Melanie Walker, Patrick Tansley, Marc A. M. Mureau, Arul Earnest, Susannah Ahern, Hinne A. Rakhorst
ImportanceDespite the widespread use of breast implants, to date, no large-scale international studies on long-term revision incidence of different implant types have been conducted.ObjectiveTo determine whether international data could be combined using a harmonized dataset to increase power and investigate clinically relevant differences in complication-related revision incidence between breast implant types.Design, Setting, and ParticipantsThis multicenter, population-based cohort study used data from the Australian Breast Device Registry and the Dutch Breast Implant Registry from 2016 to 2021. Time-to-event analysis was performed using a frailty Cox proportional hazards regression model with pooled data. The study included all permanent breast implants that were inserted for primary postmastectomy or benign breast reconstruction or cosmetic augmentation. Data were analyzed from January 1, 2016, through December 31, 2021.ExposurePermanent breast implants grouped based on implant shape, shell, and fill.Main outcomes and measuresComplication-related revision incidence between breast implant types.ResultsData exchange between registries was successful. In total, 21 115 reconstructive and 129 854 cosmetic breast implants inserted in patients with a median (IQR) age of 47 (38-55) years and 31 (25-38) years, respectively, were included. Overall complication-related revision was 6.3% for reconstructive and 1.2% for cosmetic implants. For reconstructive implants, hazard ratios (HRs) for implant types showed no significant differences compared with anatomical textured-silicone implants. For cosmetic implants, anatomical polyurethane-silicone implants showed a lower risk of revision (HR, 0.38; 95% CI, 0.22-0.64) compared with anatomical-textured-silicone implants. At 5 years, no significant differences in cumulative revision incidence were observed between implant types for either reconstructive or cosmetic implants.Conclusions and relevanceThis study showed that international datasets can be pooled to assess real-world incidence of breast implant revision, which is anticipated to generate a foundation on which future breast implant studies can be based.
{"title":"Comparing International Revision Incidence of Commonly Used Breast Implants","authors":"J. Juliët Vrolijk, Babette E. Becherer, Patrick Garduce, Ahmad Reza Pourghaderi, Danny A. Young-Afat, René R. J. W. van der Hulst, Gillian Farrell, Melanie Walker, Patrick Tansley, Marc A. M. Mureau, Arul Earnest, Susannah Ahern, Hinne A. Rakhorst","doi":"10.1001/jamasurg.2024.6933","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6933","url":null,"abstract":"ImportanceDespite the widespread use of breast implants, to date, no large-scale international studies on long-term revision incidence of different implant types have been conducted.ObjectiveTo determine whether international data could be combined using a harmonized dataset to increase power and investigate clinically relevant differences in complication-related revision incidence between breast implant types.Design, Setting, and ParticipantsThis multicenter, population-based cohort study used data from the Australian Breast Device Registry and the Dutch Breast Implant Registry from 2016 to 2021. Time-to-event analysis was performed using a frailty Cox proportional hazards regression model with pooled data. The study included all permanent breast implants that were inserted for primary postmastectomy or benign breast reconstruction or cosmetic augmentation. Data were analyzed from January 1, 2016, through December 31, 2021.ExposurePermanent breast implants grouped based on implant shape, shell, and fill.Main outcomes and measuresComplication-related revision incidence between breast implant types.ResultsData exchange between registries was successful. In total, 21 115 reconstructive and 129 854 cosmetic breast implants inserted in patients with a median (IQR) age of 47 (38-55) years and 31 (25-38) years, respectively, were included. Overall complication-related revision was 6.3% for reconstructive and 1.2% for cosmetic implants. For reconstructive implants, hazard ratios (HRs) for implant types showed no significant differences compared with anatomical textured-silicone implants. For cosmetic implants, anatomical polyurethane-silicone implants showed a lower risk of revision (HR, 0.38; 95% CI, 0.22-0.64) compared with anatomical-textured-silicone implants. At 5 years, no significant differences in cumulative revision incidence were observed between implant types for either reconstructive or cosmetic implants.Conclusions and relevanceThis study showed that international datasets can be pooled to assess real-world incidence of breast implant revision, which is anticipated to generate a foundation on which future breast implant studies can be based.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"22 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444012","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 : 2025-02-19DOI: 10.1001/jamasurg.2024.7049
James E McCarthy, Venkat K Rao
{"title":"Mobile Devices Restricted-Updating the Surgical Timeout.","authors":"James E McCarthy, Venkat K Rao","doi":"10.1001/jamasurg.2024.7049","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.7049","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449083","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 : 2025-02-19DOI: 10.1001/jamasurg.2024.4106
Arjun K. Menta, Ryan P. Lee, Mark G. Luciano
This Surgical Innovation discusses the use of sonolucent materials in cranial reconstruction to allow for ultrasonographic imaging following cranial neurosurgery.
{"title":"Sonolucent Cranioplasty for Transcranial Ultrasonographic Imaging","authors":"Arjun K. Menta, Ryan P. Lee, Mark G. Luciano","doi":"10.1001/jamasurg.2024.4106","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4106","url":null,"abstract":"This Surgical Innovation discusses the use of sonolucent materials in cranial reconstruction to allow for ultrasonographic imaging following cranial neurosurgery.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"65 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444020","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 : 2025-02-19DOI: 10.1001/jamasurg.2024.7082
Anjali A. Dixit, Brian T. Bateman, Mary T. Hawn, Michelle C. Odden, Eric C. Sun
ImportanceCase reports of postoperative diabetic ketoacidosis in patients using sodium-glucose cotransporter 2 inhibitor (SGLT2i) medications underlie guidance by the US Food and Drug Administration to withhold SGLT2i medication for at least 3 days prior to surgery. Given the potential negative consequences associated with preoperative medication withholding, a large-scale evaluation of the risk of diabetic ketoacidosis in this population is needed.ObjectiveTo estimate the association between preoperative SGLT2i medication use and postoperative diabetic ketoacidosis in a population of patients who underwent a variety of emergency surgeries. Emergency surgery was chosen given the assumption that a patient would be unable to withhold their SGLT2i medication per the current guidance.Design, Setting, and ParticipantsThis retrospective cohort study was conducted among a nationwide sample of patients aged 18 years or older with type 2 diabetes who were enrolled in commercial or Medicare fee-for-service insurance plans and who underwent 1 of 13 emergency surgeries between January 1, 2016, and December 15, 2022. Emergency surgeries were defined as those occurring on the same day or the 1 to 2 days after an emergency department claim. Data were analyzed from November 2023 through December 2024.ExposureSGLT2i medication use.Main Outcomes and MeasuresDiabetic ketoacidosis, defined by diagnosis codes, in the 0 to 14 days after surgery.ResultsAmong 34 671 patients with type 2 diabetes who underwent emergency surgery (mean [SD] age, 63.9 [14.0] years; 19 175 female [55.3%] and 15 496 male [44.7%]), the most common surgeries were laparoscopic cholecystectomy (9385 patients) and transurethral procedures (12 246 patients). There were 2607 patients (7.5%) who used SGLT2i medications and 32 064 patients (92.5%) who did not. Unadjusted incidence of diabetic ketoacidosis was 127 patients (4.9%) for those exposed to SGLT2i medications and 1115 patients (3.5%) for those unexposed. After accounting for covariates, including demographic characteristics, indicators of diabetic severity, comorbidities, and surgery type, the incidence of the outcome was 3.8% for those exposed to SGLT2i medications and 3.5% for those unexposed. The average treatment effect [ATE] was 0.2% (95% CI, −1.7% to 2.2%). Results were robust to alternate specifications (eg, intensive care unit–level care as the outcome: ATE, −1.0%; 95% CI, −2.9% to 1.1%).Conclusions and RelevanceThis study found that preoperative use of SGLT2i medications in patients undergoing emergency surgery was not associated with an increased risk for postoperative diabetic ketoacidosis compared with no use of SGLT2i medications. These findings may justify liberalizing current guidance on preoperative SGLT2i medication withholding periods.
{"title":"Preoperative SGLT2 Inhibitor Use and Postoperative Diabetic Ketoacidosis","authors":"Anjali A. Dixit, Brian T. Bateman, Mary T. Hawn, Michelle C. Odden, Eric C. Sun","doi":"10.1001/jamasurg.2024.7082","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.7082","url":null,"abstract":"ImportanceCase reports of postoperative diabetic ketoacidosis in patients using sodium-glucose cotransporter 2 inhibitor (SGLT2i) medications underlie guidance by the US Food and Drug Administration to withhold SGLT2i medication for at least 3 days prior to surgery. Given the potential negative consequences associated with preoperative medication withholding, a large-scale evaluation of the risk of diabetic ketoacidosis in this population is needed.ObjectiveTo estimate the association between preoperative SGLT2i medication use and postoperative diabetic ketoacidosis in a population of patients who underwent a variety of emergency surgeries. Emergency surgery was chosen given the assumption that a patient would be unable to withhold their SGLT2i medication per the current guidance.Design, Setting, and ParticipantsThis retrospective cohort study was conducted among a nationwide sample of patients aged 18 years or older with type 2 diabetes who were enrolled in commercial or Medicare fee-for-service insurance plans and who underwent 1 of 13 emergency surgeries between January 1, 2016, and December 15, 2022. Emergency surgeries were defined as those occurring on the same day or the 1 to 2 days after an emergency department claim. Data were analyzed from November 2023 through December 2024.ExposureSGLT2i medication use.Main Outcomes and MeasuresDiabetic ketoacidosis, defined by diagnosis codes, in the 0 to 14 days after surgery.ResultsAmong 34 671 patients with type 2 diabetes who underwent emergency surgery (mean [SD] age, 63.9 [14.0] years; 19 175 female [55.3%] and 15 496 male [44.7%]), the most common surgeries were laparoscopic cholecystectomy (9385 patients) and transurethral procedures (12 246 patients). There were 2607 patients (7.5%) who used SGLT2i medications and 32 064 patients (92.5%) who did not. Unadjusted incidence of diabetic ketoacidosis was 127 patients (4.9%) for those exposed to SGLT2i medications and 1115 patients (3.5%) for those unexposed. After accounting for covariates, including demographic characteristics, indicators of diabetic severity, comorbidities, and surgery type, the incidence of the outcome was 3.8% for those exposed to SGLT2i medications and 3.5% for those unexposed. The average treatment effect [ATE] was 0.2% (95% CI, −1.7% to 2.2%). Results were robust to alternate specifications (eg, intensive care unit–level care as the outcome: ATE, −1.0%; 95% CI, −2.9% to 1.1%).Conclusions and RelevanceThis study found that preoperative use of SGLT2i medications in patients undergoing emergency surgery was not associated with an increased risk for postoperative diabetic ketoacidosis compared with no use of SGLT2i medications. These findings may justify liberalizing current guidance on preoperative SGLT2i medication withholding periods.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"13 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444021","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 : 2025-02-19DOI: 10.1001/jamasurg.2024.7066
Derek Y F So, George A Wells, Marie Lordkipanidzé, Aun Yeong Chong, Marc Ruel, Louis P Perrault, Michel R Le May, Louise Sun, Diem Tran, Marino Labinaz, Christopher Glover, Juan Russo, Mélanie Welman, Vincent Chan, Lily Chen, Jordan Bernick, Fraser Rubens, Jean-Francois Tanguay
Importance: Perioperative bleeding is a major concern in patients receiving ticagrelor for acute coronary syndromes (ACS) when coronary artery bypass graft (CABG) surgery is required.
Objective: To evaluate whether early CABG surgery at 2 to 3 days after ticagrelor cessation is noninferior to waiting 5 to 7 days.
Design, setting, and participants: RAPID CABG was a noninferiority, open-label randomized trial with 6 months of follow-up. Participants were patients with ACS who had received ticagrelor and required CABG. Patients were enrolled in tertiary centers in Canada between January 2016 and March 2021. Data were analyzed from March 2021 to December 2023.
Intervention: Early or delayed CABG.
Main outcomes and measures: The primary outcome was based on noninferiority comparison of class 3 or 4 universal definition of perioperative bleeding (UDPB). Noninferiority was prespecified as 8% between groups. Twelve-hour chest tube drainage was reported as a noninferiority comparison. Other bleeding, ischemic, and length-of-stay outcomes were assessed for superiority.
Results: Among 143 randomized patients, the median (IQR) age was 65 (58-72) years; there were 117 male patients (82%) and 26 female (18%). Of these, 123 patients (86.0%) underwent surgery in the allocated time frame (per protocol). The median (IQR) time to surgery was 3 (2-3) days in the early group and 6 (5-7) days in the delayed group (P < .001). In a per-protocol analysis, severe or massive UDPB occurred in 3 of 65 early-group patients (4.6%) and 3 of 58 patients (5.2%) in the delayed group (between-group difference, -0.6%; 95% CI, -8.3% to 7.1%; P = .03 for noninferiority). Median (IQR) chest tube drainage was 470 (330-650) mL vs 495 (380-610) mL (between-group difference -25 mL; 95% CI, -111.25 to 35; P = .01 for noninferiority). Median (IQR) hospital stay was 9 (7-13) days and 12 (10-15) days for the early and delayed groups (P < .001).
Conclusion and relevance: This study found that an early surgical strategy, 2 to 3 days after ticagrelor cessation, was noninferior in incurring perioperative bleeding. The data support a reduction in the delay between ticagrelor cessation and CABG surgery and may decrease hospital length of stay.
{"title":"Early vs Delayed Bypass Surgery in Patients With Acute Coronary Syndrome Receiving Ticagrelor: The RAPID CABG Randomized Open-Label Noninferiority Trial.","authors":"Derek Y F So, George A Wells, Marie Lordkipanidzé, Aun Yeong Chong, Marc Ruel, Louis P Perrault, Michel R Le May, Louise Sun, Diem Tran, Marino Labinaz, Christopher Glover, Juan Russo, Mélanie Welman, Vincent Chan, Lily Chen, Jordan Bernick, Fraser Rubens, Jean-Francois Tanguay","doi":"10.1001/jamasurg.2024.7066","DOIUrl":"10.1001/jamasurg.2024.7066","url":null,"abstract":"<p><strong>Importance: </strong>Perioperative bleeding is a major concern in patients receiving ticagrelor for acute coronary syndromes (ACS) when coronary artery bypass graft (CABG) surgery is required.</p><p><strong>Objective: </strong>To evaluate whether early CABG surgery at 2 to 3 days after ticagrelor cessation is noninferior to waiting 5 to 7 days.</p><p><strong>Design, setting, and participants: </strong>RAPID CABG was a noninferiority, open-label randomized trial with 6 months of follow-up. Participants were patients with ACS who had received ticagrelor and required CABG. Patients were enrolled in tertiary centers in Canada between January 2016 and March 2021. Data were analyzed from March 2021 to December 2023.</p><p><strong>Intervention: </strong>Early or delayed CABG.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was based on noninferiority comparison of class 3 or 4 universal definition of perioperative bleeding (UDPB). Noninferiority was prespecified as 8% between groups. Twelve-hour chest tube drainage was reported as a noninferiority comparison. Other bleeding, ischemic, and length-of-stay outcomes were assessed for superiority.</p><p><strong>Results: </strong>Among 143 randomized patients, the median (IQR) age was 65 (58-72) years; there were 117 male patients (82%) and 26 female (18%). Of these, 123 patients (86.0%) underwent surgery in the allocated time frame (per protocol). The median (IQR) time to surgery was 3 (2-3) days in the early group and 6 (5-7) days in the delayed group (P < .001). In a per-protocol analysis, severe or massive UDPB occurred in 3 of 65 early-group patients (4.6%) and 3 of 58 patients (5.2%) in the delayed group (between-group difference, -0.6%; 95% CI, -8.3% to 7.1%; P = .03 for noninferiority). Median (IQR) chest tube drainage was 470 (330-650) mL vs 495 (380-610) mL (between-group difference -25 mL; 95% CI, -111.25 to 35; P = .01 for noninferiority). Median (IQR) hospital stay was 9 (7-13) days and 12 (10-15) days for the early and delayed groups (P < .001).</p><p><strong>Conclusion and relevance: </strong>This study found that an early surgical strategy, 2 to 3 days after ticagrelor cessation, was noninferior in incurring perioperative bleeding. The data support a reduction in the delay between ticagrelor cessation and CABG surgery and may decrease hospital length of stay.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT02668562.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449081","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 : 2025-02-12DOI: 10.1001/jamasurg.2024.6912
Neha G Gaddam, Bayley E Clarke, Cheryl B Iglesia
{"title":"Rediscovering the Clitoris-Sexual Function After Transvaginal Surgery.","authors":"Neha G Gaddam, Bayley E Clarke, Cheryl B Iglesia","doi":"10.1001/jamasurg.2024.6912","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6912","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399255","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 : 2025-02-12DOI: 10.1001/jamasurg.2024.6580
Lisa M. McElroy, Caroline P. Thirukumaran, Catherine G. Velopulos
This Viewpoint advocates for the inclusion of social determinants of health and health-related social needs data into the electronic health record as a measure for improving provision of equitable surgical care.
{"title":"Quantifying Social Vulnerability and Its Impact on Health Care Delivery, Payment, and Performance","authors":"Lisa M. McElroy, Caroline P. Thirukumaran, Catherine G. Velopulos","doi":"10.1001/jamasurg.2024.6580","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6580","url":null,"abstract":"This Viewpoint advocates for the inclusion of social determinants of health and health-related social needs data into the electronic health record as a measure for improving provision of equitable surgical care.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"43 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143393117","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 : 2025-02-12DOI: 10.1001/jamasurg.2024.6922
Shaniel T Bowen, Pamela A Moalli, Rebecca G Rogers, Marlene M Corton, Uduak U Andy, Charles R Rardin, Michael E Hahn, Alison C Weidner, David R Ellington, Donna Mazloomdoost, Amaanti Sridhar, Marie G Gantz
<p><strong>Importance: </strong>Transvaginal surgery is commonly performed to treat pelvic organ prolapse. Little research focuses on how sexual function relates to clitoral anatomy after vaginal surgery despite the clitoris' role in the sexual response.</p><p><strong>Objective: </strong>To determine how postoperative sexual function after vaginal surgery is associated with clitoral features (size, position, shape).</p><p><strong>Design, setting, and participants: </strong>This was a cross-sectional ancillary study of magnetic resonance imaging (MRI) data from the Defining Mechanisms of Anterior Vaginal Wall Descent (DEMAND) study. The setting comprised 8 clinical sites in the US Pelvic Floor Disorders Network and included the MRI data of 88 women with uterovaginal prolapse previously randomized to either vaginal mesh hysteropexy or vaginal hysterectomy with uterosacral ligament suspension between 2013 and 2015. Data were analyzed between September 2021 and June 2023.</p><p><strong>Exposures: </strong>Participants underwent postoperative pelvic MRI at 30 to 42 months (or earlier if reoperation was desired) between June 2014 and May 2018. Sexual activity and function at baseline (preoperatively) and 24- to 48-month follow-up (postoperatively) were assessed using the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, International Urogynecological Association Revised (PISQ-IR). Clitoral features were derived from postoperative MRI-based 3-dimensional models.</p><p><strong>Main outcomes and measures: </strong>Correlations between (1) PISQ-IR mean, subscale, and item scores and (2) clitoral size, position, and shape (principal component scores).</p><p><strong>Results: </strong>A total of 82 women (median [range] age, 65 [47-79] years) were analyzed (41 received hysteropexy and 41 received hysterectomy). Postoperatively, 37 were sexually active (SA), and 45 were not SA (NSA). Among SA women, better overall postoperative sexual function (higher PISQ-IR summary score) correlated with a larger clitoral glans width (Spearman ρ = 0.37; 95% CI, 0.05-0.62; P = .03) and thickness (Spearman ρ = 0.38; 95% CI, 0.06-0.63; P = .02). Among NSA women, sexual inactivity related to postoperative dyspareunia correlated with a more lateral clitoral position (Spearman ρ = 0.45; 95% CI, 0.18-0.66; P = .002), and sexual inactivity related to incontinence/prolapse correlated with a more posterior clitoral position (Spearman ρ = -0.36; 95% CI, -0.60 to -0.07; P = .02) (farther from the pubic symphysis). Shape analysis demonstrated that poorer postoperative sexual function outcomes in SA women and sexual inactivity in NSA women correlated with a more posteriorly positioned glans, anteriorly oriented clitoral body, medially positioned crura, and lateral vestibular bulbs.</p><p><strong>Conclusions and relevance: </strong>Results of this cross-sectional study suggest that postoperative sexual function after vaginal surgery was associated with clitoral glans size, position,
{"title":"Postoperative Sexual Function After Vaginal Surgery and Clitoral Size, Position, and Shape.","authors":"Shaniel T Bowen, Pamela A Moalli, Rebecca G Rogers, Marlene M Corton, Uduak U Andy, Charles R Rardin, Michael E Hahn, Alison C Weidner, David R Ellington, Donna Mazloomdoost, Amaanti Sridhar, Marie G Gantz","doi":"10.1001/jamasurg.2024.6922","DOIUrl":"10.1001/jamasurg.2024.6922","url":null,"abstract":"<p><strong>Importance: </strong>Transvaginal surgery is commonly performed to treat pelvic organ prolapse. Little research focuses on how sexual function relates to clitoral anatomy after vaginal surgery despite the clitoris' role in the sexual response.</p><p><strong>Objective: </strong>To determine how postoperative sexual function after vaginal surgery is associated with clitoral features (size, position, shape).</p><p><strong>Design, setting, and participants: </strong>This was a cross-sectional ancillary study of magnetic resonance imaging (MRI) data from the Defining Mechanisms of Anterior Vaginal Wall Descent (DEMAND) study. The setting comprised 8 clinical sites in the US Pelvic Floor Disorders Network and included the MRI data of 88 women with uterovaginal prolapse previously randomized to either vaginal mesh hysteropexy or vaginal hysterectomy with uterosacral ligament suspension between 2013 and 2015. Data were analyzed between September 2021 and June 2023.</p><p><strong>Exposures: </strong>Participants underwent postoperative pelvic MRI at 30 to 42 months (or earlier if reoperation was desired) between June 2014 and May 2018. Sexual activity and function at baseline (preoperatively) and 24- to 48-month follow-up (postoperatively) were assessed using the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, International Urogynecological Association Revised (PISQ-IR). Clitoral features were derived from postoperative MRI-based 3-dimensional models.</p><p><strong>Main outcomes and measures: </strong>Correlations between (1) PISQ-IR mean, subscale, and item scores and (2) clitoral size, position, and shape (principal component scores).</p><p><strong>Results: </strong>A total of 82 women (median [range] age, 65 [47-79] years) were analyzed (41 received hysteropexy and 41 received hysterectomy). Postoperatively, 37 were sexually active (SA), and 45 were not SA (NSA). Among SA women, better overall postoperative sexual function (higher PISQ-IR summary score) correlated with a larger clitoral glans width (Spearman ρ = 0.37; 95% CI, 0.05-0.62; P = .03) and thickness (Spearman ρ = 0.38; 95% CI, 0.06-0.63; P = .02). Among NSA women, sexual inactivity related to postoperative dyspareunia correlated with a more lateral clitoral position (Spearman ρ = 0.45; 95% CI, 0.18-0.66; P = .002), and sexual inactivity related to incontinence/prolapse correlated with a more posterior clitoral position (Spearman ρ = -0.36; 95% CI, -0.60 to -0.07; P = .02) (farther from the pubic symphysis). Shape analysis demonstrated that poorer postoperative sexual function outcomes in SA women and sexual inactivity in NSA women correlated with a more posteriorly positioned glans, anteriorly oriented clitoral body, medially positioned crura, and lateral vestibular bulbs.</p><p><strong>Conclusions and relevance: </strong>Results of this cross-sectional study suggest that postoperative sexual function after vaginal surgery was associated with clitoral glans size, position,","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399254","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 : 2025-02-12DOI: 10.1001/jamasurg.2024.6724
Seyed A. Arshad, Patrick Murphy, Jon C. Gould
ImportancePerforated peptic ulcer disease (PUD) affects 4 million people annually worldwide, with a lifetime prevalence of 5% to 10%. Of those affected, 5% will progress to the point of perforation. Despite advances in the understanding and treatment, perforated PUD continues to have a high rate of morbidity (50%) and mortality (30%). This review summarizes the current evidence on management of perforated PUD, including management of failed repairs.ObservationsApproaches for repair include primary closure and omental patch closure. Omental patch may be most useful in large perforations with friable tissue. Minimally invasive surgery is the preferred approach in perforated PUD, with improved outcomes compared with open techniques. Leak from the ulcer after repair is seen in approximately 12% to 17% of cases. Approaches to releak include expectant management, radiologic and/or endoscopic intervention, and repeat surgery. Morbidity and mortality after releak are especially high, and complete healing of the leak may take time.Conclusions and RelevanceDespite advances in medical management and surgical techniques, perforated PUD continues to have a relatively high rate of morbidity and mortality. Minimally invasive surgery is the current preferred treatment approach.
{"title":"Management of Perforated Peptic Ulcer","authors":"Seyed A. Arshad, Patrick Murphy, Jon C. Gould","doi":"10.1001/jamasurg.2024.6724","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6724","url":null,"abstract":"ImportancePerforated peptic ulcer disease (PUD) affects 4 million people annually worldwide, with a lifetime prevalence of 5% to 10%. Of those affected, 5% will progress to the point of perforation. Despite advances in the understanding and treatment, perforated PUD continues to have a high rate of morbidity (50%) and mortality (30%). This review summarizes the current evidence on management of perforated PUD, including management of failed repairs.ObservationsApproaches for repair include primary closure and omental patch closure. Omental patch may be most useful in large perforations with friable tissue. Minimally invasive surgery is the preferred approach in perforated PUD, with improved outcomes compared with open techniques. Leak from the ulcer after repair is seen in approximately 12% to 17% of cases. Approaches to releak include expectant management, radiologic and/or endoscopic intervention, and repeat surgery. Morbidity and mortality after releak are especially high, and complete healing of the leak may take time.Conclusions and RelevanceDespite advances in medical management and surgical techniques, perforated PUD continues to have a relatively high rate of morbidity and mortality. Minimally invasive surgery is the current preferred treatment approach.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"56 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143393118","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 : 2025-02-05DOI: 10.1001/jamasurg.2024.6817
Traci L Hedrick, Christopher A Campbell
{"title":"The Morbidity of a Perineal Wound.","authors":"Traci L Hedrick, Christopher A Campbell","doi":"10.1001/jamasurg.2024.6817","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.6817","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188710","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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