JAMA surgery最新文献

英文中文

Practical Guide to Clinical Big Data Sources 临床大数据源实践指南

IF 16.9 1区医学 Q1 SURGERY

JAMA surgery

Pub Date : 2025-01-08 DOI: 10.1001/jamasurg.2024.6006

Oluwadamilola M. Fayanju, Elliott R. Haut, Kamal Itani

This Guide to Statistics and Methods summarizes the limitations and considerations when using large datasets comprising patient-level data, typically abstracted from institutional electronic health records, in health services research.

本《统计和方法指南》总结了在卫生服务研究中使用包含患者级数据的大型数据集时的局限性和考虑因素，这些数据集通常是从机构电子健康记录中提取的。

引用次数: 0

Practical Guide to Patient-Generated Data Sources 患者生成数据源的实用指南

IF 16.9 1区医学 Q1 SURGERY

JAMA surgery

Pub Date : 2025-01-08 DOI: 10.1001/jamasurg.2024.6019

Ryan P. Merkow, Alex B. Haynes, Marja A. Boermeester

This Guide to Statistics and Methods provides an overview of different types of patient-generated data sources, discusses their limitations, and recommends areas for improvement prior to widespread integration.

本统计和方法指南概述了不同类型的患者生成数据源，讨论了它们的局限性，并建议在广泛整合之前需要改进的领域。

引用次数: 0

Practical Guide to Multiomics Big Data Sources 多组学大数据源实用指南

IF 16.9 1区医学 Q1 SURGERY

JAMA surgery

Pub Date : 2025-01-08 DOI: 10.1001/jamasurg.2024.6009

Leah Backhus, Shaunak Adkar, Derek Klarin

This Guide to Statistics and Methods explores the benefits for disease detection and treatment of using big data sources, such as large-scale biobanks, and discusses their implications for data management and health equity.

本《统计和方法指南》探讨了使用大型生物库等大数据源对疾病检测和治疗的好处，并讨论了它们对数据管理和卫生公平的影响。

引用次数: 0

Practical Guide to Use of Simulation and Video Data 使用模拟和视频数据的实用指南

IF 16.9 1区医学 Q1 SURGERY

JAMA surgery

Pub Date : 2025-01-08 DOI: 10.1001/jamasurg.2024.6022

Daniel A. Hashimoto, Justin B. Dimick, Carla M. Pugh

This Guide to Statistics and Methods summarizes the limitations and considerations when using simulation and intraoperative video data for surgical performance assessment.

本统计和方法指南总结了使用模拟和术中视频数据进行手术性能评估时的局限性和注意事项。

引用次数: 0

Practical Guide to Image-Based Big Data Research. 基于图像的大数据研究实用指南。

IF 15.7 1区医学 Q1 SURGERY

JAMA surgery

Pub Date : 2025-01-08 DOI: 10.1001/jamasurg.2024.6012

Elsie Gyang Ross, Shipra Arya, Marc L Melcher

引用次数: 0

Practical Guide to Administrative and Billing Big Data Sources. 管理和计费大数据源实用指南。

IF 15.7 1区医学 Q1 SURGERY

JAMA surgery

Pub Date : 2025-01-08 DOI: 10.1001/jamasurg.2024.6003

Rachel A Greenup, Danny Chu, Timothy M Pawlik

引用次数: 0

Silent Cost of Private Equity Hospitals. 私募股权医院的无声成本。

IF 15.7 1区医学 Q1 SURGERY

JAMA surgery

Pub Date : 2025-01-02 DOI: 10.1001/jamasurg.2024.5983

Aaron R Dezube, Virginia R Litle

引用次数: 0

Esophagectomy Trends and Postoperative Outcomes at Private Equity-Acquired Health Centers. 私募股权收购的医疗中心的食管切除术趋势和术后结果。

IF 15.7 1区医学 Q1 SURGERY

JAMA surgery

Pub Date : 2025-01-02 DOI: 10.1001/jamasurg.2024.5920

Jonathan E Williams, Sara L Schaefer, Ryan C Jacobs, Andrew M Ibrahim, David D Odell

Importance: Growing trends in private equity acquisition of acute care hospitals in the US have motivated investigations into quality of care delivered at these health centers. While some studies have explored comparative outcomes for high-acuity medical conditions, care trends and outcomes of complex surgical procedures, such as esophagectomy, at private equity-acquired hospitals is unknown.

Objective: To compare structural characteristics and postoperative outcomes following esophagectomy between private equity-acquired and nonacquired health centers.

Design, setting, and participants: This retrospective cohort study included Medicare beneficiaries aged 65 to 99 years who underwent elective esophagectomy at US health centers between January 1, 2016, and December 31, 2020. Health centers were designated as private equity acquired using the Agency for Healthcare Research and Quality Compendium of US Health Systems. Data were analyzed between October 15, 2023, and March 30, 2024.

Exposure: Patient cohorts were created based on whether they received care at private equity-acquired or nonacquired health centers.

Main outcomes and measures: The main outcome was 30-day postoperative complications, mortality, failure to rescue, and readmission using summary statistics and multivariable logistic regression.

Results: A total of 9462 patients (mean [SD] age, 72.9 [5.6] years; 6970 male [73.7%]) underwent esophagectomy during the study period, with 517 (5.5%) receiving care at private equity-acquired institutions. Annual procedure volume was lower at private equity-acquired hospitals vs nonacquired hospitals (median, 2 [IQR, 1-4] vs 7 [IQR, 3-15] procedures per year). Compared with patients treated at nonacquired hospitals, patients treated at private equity-acquired hospitals had significantly higher 30-day mortality (8.1% [95% CI, 5.8%-10.3%] vs 4.9% [95% CI, 4.5%-5.3%]; odds ratio [OR], 1.82 [95% CI, 1.25-2.64]; P = .002), any complications (36.6% [95% CI, 32.9%-40.3%] vs 30.1% [95% CI, 29.2%-30.9%]; OR, 1.46 [95% CI, 1.18-1.80]), serious complications (17.5% [95% CI, 14.5%-20.6%] vs 14.3% [95% CI, 13.7%-15.0%]; OR, 1.34 [95% CI, 1.03-1.77]; P = .03), and failure to rescue (5.9% [95% CI, 3.9%-7.9%] vs 3.4% [95% CI, 3.1%-3.8%]; OR, 1.86 [95% CI, 1.22-2.84]; P = .004).

Conclusions and relevance: These findings suggest that patients who undergo esophagectomy at private equity-acquired hospitals may be at risk for worse outcomes. Further understanding of the drivers of these outcomes is needed to improve performance and inform policy pertaining to care allocation for select surgical conditions.

重要性：在美国，私募股权收购急症护理医院的趋势日益增长，这促使人们对这些医疗中心提供的护理质量进行调查。虽然一些研究探讨了高敏度医疗条件的比较结果，但在私募股权收购的医院中，复杂外科手术（如食管切除术）的护理趋势和结果尚不清楚。目的：比较私募股权收购和非收购医疗中心食管切除术的结构特征和术后结果。设计、环境和参与者：这项回顾性队列研究纳入了2016年1月1日至2020年12月31日期间在美国卫生中心接受选择性食管切除术的65至99岁的医疗保险受益人。医疗中心被指定为私募股权收购，使用美国医疗保健系统研究和质量纲要机构。数据分析时间为2023年10月15日至2024年3月30日。暴露：根据患者是否在私募股权收购的或非收购的医疗中心接受治疗来创建患者队列。主要结局和指标：采用汇总统计和多变量logistic回归，主要结局为术后30天并发症、死亡率、抢救失败和再入院。结果：共9462例患者(平均[SD]年龄72.9[5.6]岁；6970名男性（73.7%）在研究期间接受了食管切除术，其中517名（5.5%）在私募股权收购的机构接受治疗。私募股权收购的医院的年手术量低于非收购的医院（中位数为每年2例[IQR， 1-4]对7例[IQR， 3-15]例）。与在非收购医院接受治疗的患者相比，在私募股权收购的医院接受治疗的患者30天死亡率显著更高(8.1% [95% CI, 5.8%-10.3%] vs 4.9% [95% CI, 4.5%-5.3%]；优势比[OR]， 1.82 [95% CI, 1.25-2.64]；P = .002),任何并发症(36.6%(95%可信区间,32.9% - -40.3%)和30.1%(95%可信区间,29.2% - -30.9%);或者,1.46(95%可信区间,1.18 - -1.80)),严重的并发症(17.5%(95%可信区间,14.5% - -20.6%)和14.3%(95%可信区间,13.7% - -15.0%);Or为1.34 [95% ci, 1.03-1.77]；P = 03),未能拯救(5.9%(95%可信区间,3.9% - -7.9%)和3.4%(95%可信区间,3.1% - -3.8%);Or为1.86 [95% ci, 1.22-2.84]；p = .004)。结论和相关性：这些发现表明，在私募股权收购的医院接受食管切除术的患者可能面临预后较差的风险。需要进一步了解这些结果的驱动因素，以提高性能，并为选择手术条件的护理分配提供政策信息。

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引用次数: 0

De-Escalation of Nodal Surgery in Clinically Node-Positive Breast Cancer. 临床淋巴结阳性乳腺癌的淋巴结手术降级。

IF 15.7 1区医学 Q1 SURGERY

JAMA surgery

Pub Date : 2025-01-02 DOI: 10.1001/jamasurg.2024.5913

Neslihan Cabioglu, Havva Belma Koçer, Hasan Karanlik, Mehmet Ali Gülçelik, Abdullah Igci, Mahmut Müslümanoglu, Cihan Uras, Baris Mantoglu, Didem Can Trabulus, Giray Akgül, Mustafa Tükenmez, Kazim Senol, Enver Özkurt, Ebru Sen, Güldeniz Karadeniz Çakmak, Süleyman Bademler, Selman Emiroglu, Nilüfer Yildirim, Halil Kara, Ahmet Dag, Ece Dilege, Ayse Altinok, Gül Basaran, Ecenur Varol, Ümit Ugurlu, Yasemin Bölükbasi, Yeliz Emine Ersoy, Baha Zengel, Niyazi Karaman, Serdar Özbas, Leyla Zer, Halime Gül Kiliç, Orhan Agcaoglu, Gürhan Sakman, Zafer Utkan, Aykut Soyder, Alper Akcan, Sefa Ergün, Ravza Yilmaz, Adnan Aydiner, Atilla Soran, Kamuran Ibis, Vahit Özmen

Importance: Increasing evidence supports the oncologic safety of de-escalating axillary surgery for patients with breast cancer after neoadjuvant chemotherapy (NAC).Objective: To evaluate the oncologic outcomes of de-escalating axillary surgery among patients with clinically node (cN)-positive breast cancer and patients whose disease became cN negative after NAC (ycN negative).Design, setting, and participants: In the NEOSENTITURK MF-1803 prospective cohort registry trial, patients from 37 centers with cT1-4N1-3M0 disease treated with sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD) alone or with ypN-negative or ypN-positive disease after NAC were recruited between February 15, 2019, and January 1, 2023, and evaluated.Exposure: Treatment with SLNB or TAD after NAC.Main outcomes and measures: The primary aim of the study was axillary, locoregional, or distant recurrence rates; disease-free survival; and disease-specific survival. Number of axillary lymph nodes removed was also evaluated.Results: A total of 976 patients (median age, 46 years [range, 21-80 years]) with cT1-4N1-3M0 disease underwent SLNB (n = 620) or TAD alone (n = 356). Most of the cohort had a mapping procedure with blue dye alone (645 [66.1%]) with (n = 177) or without (n = 468) TAD. Overall, no difference was found between patients treated with TAD and patients treated with SLNB in the median number of total lymph nodes removed (TAD, 4 [3-6] vs SLNB, 4 [3-6]; P = .09). Among patients with ypN-positive disease, those who underwent TAD were more likely to have a lower median lymph node ratio (TAD, 0.28 [IQR, 0.20-0.40] vs SLNB, 0.33 [IQR, 0.20-0.50]; P = .03). At a median follow-up of 39 months (IQR, 29-48 months), no significant difference was found in the rates of ipsilateral axillary recurrence (0.3% [1 of 356] vs 0.3% [2 of 620]; P ≥ .99) or locoregional recurrence (0.6% [2 of 356] vs 1.1% [7 of 620]; P = .50) between the TAD and SLNB groups, with an overall locoregional recurrence rate of 0.9% (9 of 976). The initial clinical tumor stage, pathologic complete response, and use of blue dye alone as a mapping procedure were not associated with the outcome. Even though patients with TAD demonstrated an increased disease-free survival rate compared with the SLNB group, this difference did not reach statistical significance (94.9% vs 92.6%; P = .07). Factors associated with decreased 5-year disease-specific survival were cN2-3 axillary stage (cN1, 98.7% vs cN2-3, 96.8%; P = .03) and nonluminal type tumor pathologic characteristics (luminal, 98.9% vs nonluminal, 96.9%; P = .007).Conclusions and relevance: The short-term results suggest very low rates of axillary and locoregional recurrence in a select group of patients with cN-negative disease after NAC treated with TAD alone or SLNB alone followed b

重要性：越来越多的证据支持乳腺癌患者在新辅助化疗（NAC）后进行降级腋窝手术的肿瘤学安全性。目的：评价临床淋巴结（cN）阳性乳腺癌患者和NAC （ycN阴性）后变为cN阴性的患者行腋窝降压手术的肿瘤预后。设计、环境和参与者：在NEOSENTITURK MF-1803前瞻性队列注册试验中，在2019年2月15日至2023年1月1日期间招募了来自37个中心的cT1-4N1-3M0疾病患者，这些患者单独接受前哨淋巴结活检（SLNB）或靶向腋窝清扫（TAD）治疗，或患有NAC后的ypn阴性或ypn阳性疾病，并进行了评估。暴露：NAC后用SLNB或TAD治疗。主要结果和测量：研究的主要目的是腋窝、局部或远处的复发率；无病生存;以及疾病特异性生存。同时评估腋窝淋巴结切除的数量。结果：共有976例cT1-4N1-3M0患者（中位年龄46岁[范围21-80岁]）行SLNB （n = 620）或单独行TAD （n = 356）。大多数队列进行了单独使用蓝色染料（645例[66.1%]）（n = 177）或不使用TAD （n = 468）的制图程序。总体而言，接受TAD治疗的患者和接受SLNB治疗的患者在总淋巴结切除的中位数上没有差异(TAD, 4 [3-6] vs SLNB, 4 [3-6]；p = .09)。在ypn阳性疾病患者中，接受TAD的患者更可能有较低的中位淋巴结比(TAD, 0.28 [IQR, 0.20-0.40] vs SLNB, 0.33 [IQR, 0.20-0.50]；p = .03)。中位随访39个月（IQR， 29-48个月），发现同侧腋窝复发率无显著差异(0.3%[356例中1例]vs 0.3%[620例中2例]；P≥0.99)或局部复发(0.6%[356例中2例]vs 1.1%[620例中7例]；P = 0.50)，总局部复发率为0.9%（976例中9例）。最初的临床肿瘤分期，病理完全缓解，以及单独使用蓝色染料作为绘图程序与结果无关。尽管与SLNB组相比，TAD患者的无病生存率增加，但这种差异没有达到统计学意义(94.9% vs 92.6%；p = .07)。与5年疾病特异性生存率降低相关的因素为：cN2-3腋窝期(cN1, 98.7% vs cN2-3, 96.8%；P = .03)和非腔型肿瘤病理特征(腔型，98.9% vs非腔型，96.9%；p = .007)。结论和相关性：短期结果表明，无论SLNB技术或淋巴结病理如何，在一组选择的cn阴性疾病患者中，单独使用TAD或单独使用SLNB治疗NAC后，局部淋巴结照射的腋窝和局部复发率非常低。与SLNB相比，TAD是否具有明显的生存优势还有待于更长的随访研究。

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引用次数: 0

Increasing Enrollment of Women in Surgical Clinical Trials. 越来越多的女性参加外科临床试验。

IF 15.7 1区医学 Q1 SURGERY

JAMA surgery

Pub Date : 2025-01-02 DOI: 10.1001/jamasurg.2024.5213

Judith C Lin, Linda M Harris, Melina R Kibbe

引用次数: 0

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