首页 > 最新文献

JAMA surgery最新文献

英文 中文
A Slow March Toward Eliminating Transfusion in Uro-Oncology. 向消除泌尿肿瘤输血缓慢迈进。
IF 15.7 1区 医学 Q1 SURGERY Pub Date : 2024-10-02 DOI: 10.1001/jamasurg.2024.4203
Shawn Dason, Debasish Sundi, Akshay Sood
{"title":"A Slow March Toward Eliminating Transfusion in Uro-Oncology.","authors":"Shawn Dason, Debasish Sundi, Akshay Sood","doi":"10.1001/jamasurg.2024.4203","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4203","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361519","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}
引用次数: 0
Supporting Surgeon-Scientists to Prosper as Researchers. 支持外科医生科学家作为研究人员取得成功。
IF 15.7 1区 医学 Q1 SURGERY Pub Date : 2024-10-02 DOI: 10.1001/jamasurg.2024.2749
Jennifer E B Harman, David C Linehan, Anusha Naganathan
{"title":"Supporting Surgeon-Scientists to Prosper as Researchers.","authors":"Jennifer E B Harman, David C Linehan, Anusha Naganathan","doi":"10.1001/jamasurg.2024.2749","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.2749","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361523","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}
引用次数: 0
Strategic Changes in Organ Allocation Policy and Outcomes in Pediatric Acute Liver Failure. 小儿急性肝衰竭中器官分配政策的战略性改变与疗效。
IF 15.7 1区 医学 Q1 SURGERY Pub Date : 2024-10-02 DOI: 10.1001/jamasurg.2024.4085
Sarah Bangerth, Shrestha Vijayendra, Johanna Ascher-Bartlett, Kambiz Etasami, Rohit Kohli, Juliet Emamaullee
{"title":"Strategic Changes in Organ Allocation Policy and Outcomes in Pediatric Acute Liver Failure.","authors":"Sarah Bangerth, Shrestha Vijayendra, Johanna Ascher-Bartlett, Kambiz Etasami, Rohit Kohli, Juliet Emamaullee","doi":"10.1001/jamasurg.2024.4085","DOIUrl":"10.1001/jamasurg.2024.4085","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11447632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361522","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}
引用次数: 0
Tranexamic Acid During Radical Cystectomy: A Randomized Clinical Trial. 根治性膀胱切除术中的氨甲环酸:随机临床试验
IF 15.7 1区 医学 Q1 SURGERY Pub Date : 2024-10-02 DOI: 10.1001/jamasurg.2024.4183
Rodney H Breau, Luke T Lavallée, Ilias Cagiannos, Franco Momoli, Gregory L Bryson, Salmaan Kanji, Christopher Morash, Alexis F Turgeon, Ryan Zarychanski, Brett L Houston, Daniel I McIsaac, Ranjeeta Mallick, Greg A Knoll, Girish Kulkarni, Jonathan Izawa, Fred Saad, Wassim Kassouf, Vincent Fradet, Ricardo Rendon, Bobby Shayegan, Adrian Fairey, Darrel E Drachenberg, Dean Fergusson

Importance: Among cancer surgeries, patients requiring open radical cystectomy have the highest risk of red blood cell (RBC) transfusion. Prophylactic tranexamic acid (TXA) reduces blood loss during cardiac and orthopedic surgery, and it is possible that similar effects of TXA would be observed during radical cystectomy.

Objective: To determine whether TXA, administered before incision and for the duration of radical cystectomy, reduced the number of RBC transfusions received by patients up to 30 days after surgery.

Design, setting, and participants: The Tranexamic Acid During Cystectomy Trial (TACT) was a double-blind, placebo-controlled, randomized clinical trial with enrollment between June 2013 and January 2021. This multicenter trial was conducted in 10 academic centers. A consecutive sample of patients was eligible if the patients had a planned open radical cystectomy for the treatment of bladder cancer.

Intervention: Before incision, patients in the intervention arm received a loading dose of intravenous TXA, 10 mg/kg, followed by a maintenance infusion of 5 mg/kg per hour for the duration of the surgery. In the control arm, patients received indistinguishable matching placebo.

Main outcomes and measures: The primary outcome was receipt of RBC transfusion up to 30 days after surgery.

Results: A total of 386 patients were assessed for eligibility, and 33 did not meet eligibility. Of 353 randomized patients (median [IQR] age, 69 [62-75] years; 263 male [74.5%]), 344 were included in the intention-to-treat analysis. RBC transfusion up to 30 days occurred in 64 of 173 patients (37.0%) in the TXA group and 64 of 171 patients (37.4%) in the placebo group (relative risk, 0.99; 95% CI, 0.83-1.18). There were no differences in secondary outcomes among the TXA group vs placebo group including mean (SD) number of RBC units transfused (0.9 [1.5] U vs 1.1 [1.8] U; P = .43), estimated blood loss (927 [733] mL vs 963 [624] mL; P = .52), intraoperative transfusion (28.3% [49 of 173] vs 24.0% [41 of 171]; P = .08), or venous thromboembolic events (3.5% [6 of 173] vs 2.9% [5 of 171]; P = .57). Non-transfusion-related adverse events were similar between groups.

Conclusions and relevance: Results of this randomized clinical trial reveal that TXA did not reduce blood transfusion in patients undergoing open radical cystectomy for bladder cancer. Based on this trial, routine use of TXA during open radical cystectomy is not recommended.

Trial registration: ClinicalTrials.gov Identifier: NCT01869413.

重要性:在癌症手术中,需要进行开放性根治性膀胱切除术的患者输注红细胞(RBC)的风险最高。预防性氨甲环酸(TXA)可减少心脏和骨科手术中的失血量,在根治性膀胱切除术中也可能观察到类似的效果:目的:确定在根治性膀胱切除术切口前和手术期间使用氨甲环酸(TXA)是否能减少患者术后 30 天内输注红细胞的次数:膀胱切除术期间氨甲环酸试验(TACT)是一项双盲、安慰剂对照、随机临床试验,入组时间为2013年6月至2021年1月。这项多中心试验在 10 个学术中心进行。如果患者为治疗膀胱癌而计划进行开放性根治性膀胱切除术,则符合条件的患者均为连续样本:切口前,干预组患者接受 10 mg/kg 负荷剂量的静脉 TXA,随后在手术期间每小时输注 5 mg/kg。对照组患者接受无差别的匹配安慰剂:主要结果和测量指标:主要结果是术后 30 天内接受红细胞输注的情况:共有 386 名患者接受了资格评估,33 人不符合资格。在353名随机患者(中位数[IQR]年龄为69[62-75]岁;263名男性[74.5%])中,344名患者被纳入意向治疗分析。TXA组173例患者中有64例(37.0%)在30天内输注了红细胞,安慰剂组171例患者中有64例(37.4%)在30天内输注了红细胞(相对风险为0.99;95% CI为0.83-1.18)。TXA组与安慰剂组的次要结果无差异,包括平均(标清)输注的红细胞单位数(0.9 [1.5] U vs 1.1 [1.8] U;P = .43)、估计失血量(927 [733] mL vs 963 [624] mL;P = .52)、术中输血(28.3% [173例中的49例] vs 24.0% [171例中的41例];P = .08)或静脉血栓栓塞事件(3.5% [173例中的6例] vs 2.9% [171例中的5例];P = .57)。各组间非输血相关不良事件相似:这项随机临床试验的结果表明,TXA 并未减少膀胱癌开放根治性膀胱切除术患者的输血量。根据这项试验,不建议在开放性根治性膀胱切除术中常规使用TXA:试验注册:ClinicalTrials.gov Identifier:试验注册:ClinicalTrials.gov Identifier:NCT01869413。
{"title":"Tranexamic Acid During Radical Cystectomy: A Randomized Clinical Trial.","authors":"Rodney H Breau, Luke T Lavallée, Ilias Cagiannos, Franco Momoli, Gregory L Bryson, Salmaan Kanji, Christopher Morash, Alexis F Turgeon, Ryan Zarychanski, Brett L Houston, Daniel I McIsaac, Ranjeeta Mallick, Greg A Knoll, Girish Kulkarni, Jonathan Izawa, Fred Saad, Wassim Kassouf, Vincent Fradet, Ricardo Rendon, Bobby Shayegan, Adrian Fairey, Darrel E Drachenberg, Dean Fergusson","doi":"10.1001/jamasurg.2024.4183","DOIUrl":"10.1001/jamasurg.2024.4183","url":null,"abstract":"<p><strong>Importance: </strong>Among cancer surgeries, patients requiring open radical cystectomy have the highest risk of red blood cell (RBC) transfusion. Prophylactic tranexamic acid (TXA) reduces blood loss during cardiac and orthopedic surgery, and it is possible that similar effects of TXA would be observed during radical cystectomy.</p><p><strong>Objective: </strong>To determine whether TXA, administered before incision and for the duration of radical cystectomy, reduced the number of RBC transfusions received by patients up to 30 days after surgery.</p><p><strong>Design, setting, and participants: </strong>The Tranexamic Acid During Cystectomy Trial (TACT) was a double-blind, placebo-controlled, randomized clinical trial with enrollment between June 2013 and January 2021. This multicenter trial was conducted in 10 academic centers. A consecutive sample of patients was eligible if the patients had a planned open radical cystectomy for the treatment of bladder cancer.</p><p><strong>Intervention: </strong>Before incision, patients in the intervention arm received a loading dose of intravenous TXA, 10 mg/kg, followed by a maintenance infusion of 5 mg/kg per hour for the duration of the surgery. In the control arm, patients received indistinguishable matching placebo.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was receipt of RBC transfusion up to 30 days after surgery.</p><p><strong>Results: </strong>A total of 386 patients were assessed for eligibility, and 33 did not meet eligibility. Of 353 randomized patients (median [IQR] age, 69 [62-75] years; 263 male [74.5%]), 344 were included in the intention-to-treat analysis. RBC transfusion up to 30 days occurred in 64 of 173 patients (37.0%) in the TXA group and 64 of 171 patients (37.4%) in the placebo group (relative risk, 0.99; 95% CI, 0.83-1.18). There were no differences in secondary outcomes among the TXA group vs placebo group including mean (SD) number of RBC units transfused (0.9 [1.5] U vs 1.1 [1.8] U; P = .43), estimated blood loss (927 [733] mL vs 963 [624] mL; P = .52), intraoperative transfusion (28.3% [49 of 173] vs 24.0% [41 of 171]; P = .08), or venous thromboembolic events (3.5% [6 of 173] vs 2.9% [5 of 171]; P = .57). Non-transfusion-related adverse events were similar between groups.</p><p><strong>Conclusions and relevance: </strong>Results of this randomized clinical trial reveal that TXA did not reduce blood transfusion in patients undergoing open radical cystectomy for bladder cancer. Based on this trial, routine use of TXA during open radical cystectomy is not recommended.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT01869413.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11447623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361524","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}
引用次数: 0
Comparing Deprivation vs Vulnerability Index Performance Using Medicare Beneficiary Surgical Outcomes. 利用医疗保险受益人的手术结果,比较贫困指数与弱势指数的表现。
IF 15.7 1区 医学 Q1 SURGERY Pub Date : 2024-10-02 DOI: 10.1001/jamasurg.2024.4195
Kimberly A Rollings, Grace A Noppert, Jennifer J Griggs, Andrew M Ibrahim, Philippa J Clarke

Importance: Health care researchers, professionals, payers, and policymakers are increasingly relying on publicly available composite indices of area-level socioeconomic deprivation to address health equity. Implications of index selection, however, are not well understood.

Objective: To compare the performance of 2 frequently used deprivation indices using policy-relevant outcomes among Medicare beneficiaries undergoing 3 common surgical procedures.

Design, setting, and participants: This cross-sectional study examined outcomes among Medicare beneficiaries (65 to 99 years old) undergoing 1 of 3 common surgical procedures (hip replacement, knee replacement, or coronary artery bypass grafting) between 2016 and 2019. Index discriminative performance was compared for beneficiaries residing in tracts with high- and low-deprivation levels (deciles) according to each index. Analyses were conducted between December 2022 and August 2023.

Main outcomes and measures: Tract-level deprivation was operationalized using 2020 releases of the area deprivation index (ADI) and the social vulnerability index (SVI). Binary outcomes were unplanned surgery, 30-day readmissions, and 30-day mortality. Multivariable logistic regression models, stratified by each index, accounted for beneficiary and hospital characteristics.

Results: A total of 2 433 603 Medicare beneficiaries (mean [SD] age, 73.8 [6.1] years; 1 412 968 female beneficiaries [58.1%]; 24 165 Asian [1.0%], 158 582 Black [6.5%], and 2 182 052 White [89.7%]) were included in analyses. According to both indices, beneficiaries residing in high-deprivation tracts had significantly greater adjusted odds of all outcomes for all procedures when compared with beneficiaries living in low-deprivation tracts. However, compared to ADI, SVI resulted in higher adjusted odds ratios (adjusted odds ratios, 1.17-1.31 for SVI vs 1.09-1.23 for ADI), significantly larger outcome rate differences (outcome rate difference, 0.07%-5.17% for SVI vs outcome rate difference, 0.05%-2.44% for ADI; 95% CIs excluded 0), and greater effect sizes (Cohen d, 0.076-0.546 for SVI vs 0.044-0.304 for ADI) for beneficiaries residing in high- vs low-deprivation tracts.

Conclusions and relevance: In this cross-sectional study of Medicare beneficiaries, SVI had significantly better discriminative performance-stratifying surgical outcomes over a wider range-than ADI for identifying and distinguishing between high- and low-deprivation tracts, as indexed by outcomes for common surgical procedures. Index selection requires careful consideration of index differences, index performance, and contextual factors surrounding use, especially when informing resource allocation and health care payment adjustment models to address health equity.

重要性:医疗保健研究人员、专业人士、付款人和政策制定者越来越依赖于公开的地区级社会经济贫困综合指数来解决健康公平问题。然而,人们对指数选择的影响还不甚了解:目的:在接受 3 种常见外科手术的医疗保险受益人中,使用与政策相关的结果,比较 2 种常用贫困指数的表现:这项横断面研究调查了 2016 年至 2019 年期间接受 3 种常见外科手术(髋关节置换术、膝关节置换术或冠状动脉旁路移植术)中一种手术的医疗保险受益人(65 岁至 99 岁)的治疗效果。根据每个指数,比较了居住在高贫困水平和低贫困水平(十分位数)地区的受益人的指数判别性能。分析在 2022 年 12 月至 2023 年 8 月期间进行:采用 2020 年发布的地区贫困指数 (ADI) 和社会脆弱性指数 (SVI) 来计算地区贫困程度。二元结果为非计划手术、30 天再入院和 30 天死亡率。多变量逻辑回归模型根据每个指数进行分层,并考虑受益人和医院的特征:共有 2 433 603 名医疗保险受益人(平均 [SD] 年龄 73.8 [6.1] 岁;1 412 968 名女性受益人 [58.1%];24 165 名亚裔 [1.0%]、158 582 名黑人 [6.5%] 和 2 182 052 名白人 [89.7%])被纳入分析。根据这两项指数,与居住在低贫困地区的受益人相比,居住在高贫困地区的受益人在所有程序中出现所有结果的调整后几率明显更高。然而,与 ADI 相比,SVI 的调整后几率更高(SVI 的调整后几率为 1.17-1.31 vs ADI 的调整后几率为 1.09-1.23),结果率差异更大(SVI 的结果率差异为 0.07%-5.17%;95% CIs 不包括 0),居住在高贫困区与低贫困区的受益人的效应大小更大(Cohen d,SVI 为 0.076-0.546 vs ADI 为 0.044-0.304):在这项针对医疗保险受益人的横断面研究中,在识别和区分高贫困区和低贫困区方面,SVI 的判别性能--在更大范围内对手术结果进行分级--明显优于 ADI(以常见手术的结果为指标)。指数的选择需要仔细考虑指数的差异、指数的性能以及使用的环境因素,尤其是在为资源分配和医疗支付调整模型提供信息以解决健康公平问题时。
{"title":"Comparing Deprivation vs Vulnerability Index Performance Using Medicare Beneficiary Surgical Outcomes.","authors":"Kimberly A Rollings, Grace A Noppert, Jennifer J Griggs, Andrew M Ibrahim, Philippa J Clarke","doi":"10.1001/jamasurg.2024.4195","DOIUrl":"10.1001/jamasurg.2024.4195","url":null,"abstract":"<p><strong>Importance: </strong>Health care researchers, professionals, payers, and policymakers are increasingly relying on publicly available composite indices of area-level socioeconomic deprivation to address health equity. Implications of index selection, however, are not well understood.</p><p><strong>Objective: </strong>To compare the performance of 2 frequently used deprivation indices using policy-relevant outcomes among Medicare beneficiaries undergoing 3 common surgical procedures.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study examined outcomes among Medicare beneficiaries (65 to 99 years old) undergoing 1 of 3 common surgical procedures (hip replacement, knee replacement, or coronary artery bypass grafting) between 2016 and 2019. Index discriminative performance was compared for beneficiaries residing in tracts with high- and low-deprivation levels (deciles) according to each index. Analyses were conducted between December 2022 and August 2023.</p><p><strong>Main outcomes and measures: </strong>Tract-level deprivation was operationalized using 2020 releases of the area deprivation index (ADI) and the social vulnerability index (SVI). Binary outcomes were unplanned surgery, 30-day readmissions, and 30-day mortality. Multivariable logistic regression models, stratified by each index, accounted for beneficiary and hospital characteristics.</p><p><strong>Results: </strong>A total of 2 433 603 Medicare beneficiaries (mean [SD] age, 73.8 [6.1] years; 1 412 968 female beneficiaries [58.1%]; 24 165 Asian [1.0%], 158 582 Black [6.5%], and 2 182 052 White [89.7%]) were included in analyses. According to both indices, beneficiaries residing in high-deprivation tracts had significantly greater adjusted odds of all outcomes for all procedures when compared with beneficiaries living in low-deprivation tracts. However, compared to ADI, SVI resulted in higher adjusted odds ratios (adjusted odds ratios, 1.17-1.31 for SVI vs 1.09-1.23 for ADI), significantly larger outcome rate differences (outcome rate difference, 0.07%-5.17% for SVI vs outcome rate difference, 0.05%-2.44% for ADI; 95% CIs excluded 0), and greater effect sizes (Cohen d, 0.076-0.546 for SVI vs 0.044-0.304 for ADI) for beneficiaries residing in high- vs low-deprivation tracts.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study of Medicare beneficiaries, SVI had significantly better discriminative performance-stratifying surgical outcomes over a wider range-than ADI for identifying and distinguishing between high- and low-deprivation tracts, as indexed by outcomes for common surgical procedures. Index selection requires careful consideration of index differences, index performance, and contextual factors surrounding use, especially when informing resource allocation and health care payment adjustment models to address health equity.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11447624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361521","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}
引用次数: 0
Choosing the Right Neighborhood Deprivation Index. 选择正确的邻里贫困指数。
IF 15.7 1区 医学 Q1 SURGERY Pub Date : 2024-10-02 DOI: 10.1001/jamasurg.2024.4204
Michael A Jacobs, Susanne Schmidt, Daniel E Hall
{"title":"Choosing the Right Neighborhood Deprivation Index.","authors":"Michael A Jacobs, Susanne Schmidt, Daniel E Hall","doi":"10.1001/jamasurg.2024.4204","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4204","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361520","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}
引用次数: 0
A Calculator Approach to Select Neoadjuvant Therapy in Pancreatic Cancer. 选择胰腺癌新辅助疗法的计算器方法
IF 15.7 1区 医学 Q1 SURGERY Pub Date : 2024-10-01 DOI: 10.1001/jamasurg.2024.2486
Ville Sallinen, Arto Kokkola, Pauli Puolakkainen
{"title":"A Calculator Approach to Select Neoadjuvant Therapy in Pancreatic Cancer.","authors":"Ville Sallinen, Arto Kokkola, Pauli Puolakkainen","doi":"10.1001/jamasurg.2024.2486","DOIUrl":"10.1001/jamasurg.2024.2486","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751683","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}
引用次数: 0
Social Determinants of Health and Surgical Desirability of Outcome Ranking in Older Veterans. 老年退伍军人健康的社会决定因素和结果排名的手术可取性。
IF 15.7 1区 医学 Q1 SURGERY Pub Date : 2024-10-01 DOI: 10.1001/jamasurg.2024.2489
Michael A Jacobs, Yubo Gao, Susanne Schmidt, Paula K Shireman, Michael Mader, Carly A Duncan, Leslie R M Hausmann, Karyn B Stitzenberg, Lillian S Kao, Mary Vaughan Sarrazin, Daniel E Hall

Importance: Evaluating how social determinants of health (SDOH) influence veteran outcomes is crucial, particularly for quality improvement.

Objective: To measure associations between SDOH, care fragmentation, and surgical outcomes using a Desirability of Outcome Ranking (DOOR).

Design, setting, and participants: This was a cohort study of US veterans using data from the Veterans Affairs (VA) Surgical Quality Improvement Program (VASQIP; 2013-2019) limited to patients aged 65 years or older with inpatient stays between 2 and 30 days, merged with multiple data sources, including Medicare. Race and ethnicity data were retrieved from VASQIP, Medicare and Medicaid beneficiary summary files, the Veterans Health Administration Corporate Data Warehouse, and the United States Veterans Eligibility Trends and Statistics file. Data were analyzed between September 2023 and February 2024.

Exposure: Living in a highly deprived neighborhood (Area Deprivation Index >85), race and ethnicity used as a social construct, rurality, and care fragmentation (percentage of non-VA care days).

Main outcomes and measures: DOOR is a composite, patient-centered ranking of 26 outcomes ranging from no complication (1, best) to 90-day mortality or near-death complications (6, worst). A series of proportional odds regressions was used to assess the impact of SDOH and care fragmentation adjusted for clinical risk factors, including presentation acuity (presenting with preoperative acute serious conditions and urgent or emergent surgical procedures).

Results: The cohort had 93 644 patients (mean [SD] age, 72.3 [6.2] years; 91 443 [97.6%] male; 74 624 [79.7%] White). Veterans who identified as Black (adjusted odds ratio [aOR], 1.06; 95% CI, 1.02-1.10; P = .048) vs White and veterans with higher care fragmentation (per 20% increase in VA care days relative to all care days: aOR, 1.01; 95% CI, 1.01-1.02; P < .001) were associated with worse (higher) DOOR scores until adjusting for presentation acuity. Living in rural geographic areas was associated with better DOOR scores than living in urban areas (aOR, 0.93; 95% CI, 0.91-0.96; P < .001), and rurality was associated with lower presentation acuity (preoperative acute serious conditions: aOR, 0.88; 95% CI, 0.81-0.95; P = .001). Presentation acuity was higher in veterans identifying as Black, living in deprived neighborhoods, and with increased care fragmentation.

Conclusions and relevance: Veterans identifying as Black and veterans with greater proportions of non-VA care had worse surgical outcomes. VA programs should direct resources to reduce presentation acuity among Black veterans, incentivize veterans to receive care within the VA where possible, and better coordinate veterans' treatment and records between care sources.

重要性:评估健康的社会决定因素(SDOH)如何影响退伍军人的治疗效果至关重要,尤其是在提高质量方面:使用结果可取性排名(DOOR)来衡量 SDOH、护理分散性和手术结果之间的关联:这是一项针对美国退伍军人的队列研究,使用的数据来自退伍军人事务局(VA)外科质量改进计划(VASQIP;2013-2019 年),仅限于年龄在 65 岁或以上、住院时间在 2 到 30 天之间的患者,并与包括医疗保险在内的多种数据源进行了合并。种族和民族数据取自 VASQIP、医疗保险和医疗补助受益人汇总文件、退伍军人健康管理局企业数据仓库以及美国退伍军人资格趋势和统计文件。数据分析时间为 2023 年 9 月至 2024 年 2 月:主要结果和测量指标:DOOR是一个以患者为中心的综合排名,包含26项结果,从无并发症(1,最佳)到90天死亡率或濒死并发症(6,最差)。采用一系列比例几率回归评估SDOH和护理分散的影响,并对临床风险因素进行调整,包括就诊急症(术前出现急性重症和紧急或急诊外科手术):队列中有 93 644 名患者(平均 [SD] 年龄 72.3 [6.2] 岁;91 443 [97.6%] 男性;74 624 [79.7%] 白人)。黑人退伍军人(调整后的几率比 [aOR],1.06;95% CI,1.02-1.10;P = .048)与白人退伍军人以及护理分散程度较高的退伍军人(退伍军人护理天数相对于所有护理天数每增加 20%:aOR,1.01;95% CI,1.01-1.02;P 结论及相关性:黑人退伍军人和接受非退伍军人护理比例较高的退伍军人的手术效果较差。退伍军人事务部的计划应将资源用于减少黑人退伍军人的急诊,鼓励退伍军人尽可能在退伍军人事务部内接受治疗,并更好地协调退伍军人的治疗和记录。
{"title":"Social Determinants of Health and Surgical Desirability of Outcome Ranking in Older Veterans.","authors":"Michael A Jacobs, Yubo Gao, Susanne Schmidt, Paula K Shireman, Michael Mader, Carly A Duncan, Leslie R M Hausmann, Karyn B Stitzenberg, Lillian S Kao, Mary Vaughan Sarrazin, Daniel E Hall","doi":"10.1001/jamasurg.2024.2489","DOIUrl":"10.1001/jamasurg.2024.2489","url":null,"abstract":"<p><strong>Importance: </strong>Evaluating how social determinants of health (SDOH) influence veteran outcomes is crucial, particularly for quality improvement.</p><p><strong>Objective: </strong>To measure associations between SDOH, care fragmentation, and surgical outcomes using a Desirability of Outcome Ranking (DOOR).</p><p><strong>Design, setting, and participants: </strong>This was a cohort study of US veterans using data from the Veterans Affairs (VA) Surgical Quality Improvement Program (VASQIP; 2013-2019) limited to patients aged 65 years or older with inpatient stays between 2 and 30 days, merged with multiple data sources, including Medicare. Race and ethnicity data were retrieved from VASQIP, Medicare and Medicaid beneficiary summary files, the Veterans Health Administration Corporate Data Warehouse, and the United States Veterans Eligibility Trends and Statistics file. Data were analyzed between September 2023 and February 2024.</p><p><strong>Exposure: </strong>Living in a highly deprived neighborhood (Area Deprivation Index >85), race and ethnicity used as a social construct, rurality, and care fragmentation (percentage of non-VA care days).</p><p><strong>Main outcomes and measures: </strong>DOOR is a composite, patient-centered ranking of 26 outcomes ranging from no complication (1, best) to 90-day mortality or near-death complications (6, worst). A series of proportional odds regressions was used to assess the impact of SDOH and care fragmentation adjusted for clinical risk factors, including presentation acuity (presenting with preoperative acute serious conditions and urgent or emergent surgical procedures).</p><p><strong>Results: </strong>The cohort had 93 644 patients (mean [SD] age, 72.3 [6.2] years; 91 443 [97.6%] male; 74 624 [79.7%] White). Veterans who identified as Black (adjusted odds ratio [aOR], 1.06; 95% CI, 1.02-1.10; P = .048) vs White and veterans with higher care fragmentation (per 20% increase in VA care days relative to all care days: aOR, 1.01; 95% CI, 1.01-1.02; P < .001) were associated with worse (higher) DOOR scores until adjusting for presentation acuity. Living in rural geographic areas was associated with better DOOR scores than living in urban areas (aOR, 0.93; 95% CI, 0.91-0.96; P < .001), and rurality was associated with lower presentation acuity (preoperative acute serious conditions: aOR, 0.88; 95% CI, 0.81-0.95; P = .001). Presentation acuity was higher in veterans identifying as Black, living in deprived neighborhoods, and with increased care fragmentation.</p><p><strong>Conclusions and relevance: </strong>Veterans identifying as Black and veterans with greater proportions of non-VA care had worse surgical outcomes. VA programs should direct resources to reduce presentation acuity among Black veterans, incentivize veterans to receive care within the VA where possible, and better coordinate veterans' treatment and records between care sources.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11292565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141855480","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}
引用次数: 0
Intraoperative Oxygen Treatment, Oxidative Stress, and Organ Injury Following Cardiac Surgery: A Randomized Clinical Trial. 术中氧气治疗、氧化应激和心脏手术后的器官损伤:随机临床试验
IF 15.7 1区 医学 Q1 SURGERY Pub Date : 2024-10-01 DOI: 10.1001/jamasurg.2024.2906
Marcos G Lopez, Matthew S Shotwell, Cassandra Hennessy, Mias Pretorius, David R McIlroy, Melissa J Kimlinger, Eric H Mace, Tarek Absi, Ashish S Shah, Nancy J Brown, Frederic T Billings

Importance: Liberal oxygen (hyperoxia) is commonly administered to patients during surgery, and oxygenation is known to impact mechanisms of perioperative organ injury.

Objective: To evaluate the effect of intraoperative hyperoxia compared to maintaining normoxia on oxidative stress, kidney injury, and other organ dysfunctions after cardiac surgery.

Design, setting, and participants: This was a participant- and assessor-blinded, randomized clinical trial conducted from April 2016 to October 2020 with 1 year of follow-up at a single tertiary care medical center. Adult patients (>18 years) presenting for elective open cardiac surgery without preoperative oxygen requirement, acute coronary syndrome, carotid stenosis, or dialysis were included. Of 3919 patients assessed, 2501 were considered eligible and 213 provided consent. Of these, 12 were excluded prior to randomization and 1 following randomization whose surgery was cancelled, leaving 100 participants in each group.

Interventions: Participants were randomly assigned to hyperoxia (1.00 fraction of inspired oxygen [FiO2]) or normoxia (minimum FiO2 to maintain oxygen saturation 95%-97%) throughout surgery.

Main outcomes and measures: Participants were assessed for oxidative stress by measuring F2-isoprostanes and isofurans, for acute kidney injury (AKI), and for delirium, myocardial injury, atrial fibrillation, and additional secondary outcomes. Participants were monitored for 1 year following surgery.

Results: Two hundred participants were studied (median [IQR] age, 66 [59-72] years; 140 male and 60 female; 82 [41.0%] with diabetes). F2-isoprostanes and isofurans (primary mechanistic end point) increased on average throughout surgery, from a median (IQR) of 73.3 (53.1-101.1) pg/mL at baseline to a peak of 85.5 (64.0-109.8) pg/mL at admission to the intensive care unit and were 9.2 pg/mL (95% CI, 1.0-17.4; P = .03) higher during surgery in patients assigned to hyperoxia. Median (IQR) change in serum creatinine (primary clinical end point) from baseline to postoperative day 2 was 0.01 mg/dL (-0.12 to 0.19) in participants assigned hyperoxia and -0.01 mg/dL (-0.16 to 0.19) in those assigned normoxia (median difference, 0.03; 95% CI, -0.04 to 0.10; P = .45). AKI occurred in 21 participants (21%) in each group. Intraoperative oxygen treatment did not affect additional acute organ injuries, safety events, or kidney, neuropsychological, and functional outcomes at 1 year.

Conclusions: Among adults receiving cardiac surgery, intraoperative hyperoxia increased intraoperative oxidative stress compared to normoxia but did not affect kidney injury or additional measurements of organ injury including delirium, myocardial injury, and atrial fibrillation.

Trial registration: ClinicalTrials.gov Identifier: NCT02361944.

重要性:在手术过程中,通常会为患者提供自由氧(高氧),而氧合对围术期器官损伤机制的影响是众所周知的:评估术中高氧与维持常氧相比对心脏手术后氧化应激、肾损伤和其他器官功能障碍的影响:这是一项由参与者和评估者双盲的随机临床试验,于 2016 年 4 月至 2020 年 10 月在一家三级医疗中心进行,随访 1 年。纳入的患者均为择期接受开胸心脏手术的成年患者(18 岁以上),术前不需供氧、无急性冠脉综合征、颈动脉狭窄或透析。在接受评估的 3919 名患者中,2501 人被认为符合条件,213 人表示同意。其中,12人在随机分配前被排除,1人在随机分配后因手术取消而被排除,因此每组各有100名参与者:在整个手术过程中,参与者被随机分配到高氧(1.00 的吸入氧分数 [FiO2])或常氧(维持血氧饱和度 95%-97% 的最低 FiO2)组:通过测量 F2-异前列腺素和异呋喃对参与者进行氧化应激评估、急性肾损伤(AKI)评估、谵妄、心肌损伤、心房颤动和其他次要结果评估。参与者在术后接受了为期一年的监测:研究对象共 200 人(中位数[IQR]年龄为 66 [59-72] 岁;男性 140 人,女性 60 人;82 [41.0%] 人患有糖尿病)。F2-异前列腺素和异呋喃(主要机理终点)在整个手术过程中平均增加,从基线时的中位数(IQR)73.3 (53.1-101.1) pg/mL增加到重症监护室入院时的峰值85.5 (64.0-109.8) pg/mL,在手术过程中,被分配到高氧状态的患者的F2-异前列腺素和异呋喃含量高出9.2 pg/mL(95% CI,1.0-17.4;P = .03)。从基线到术后第2天,接受高氧治疗的患者血清肌酐(主要临床终点)的中位数(IQR)变化为0.01 mg/dL (-0.12 to 0.19),接受常氧治疗的患者为-0.01 mg/dL (-0.16 to 0.19)(中位数差异为0.03;95% CI,-0.04 to 0.10;P = .45)。各组中均有 21 名参与者(21%)发生了 AKI。术中氧疗不会影响其他急性器官损伤、安全事件或肾脏、神经心理和功能1年后的预后:结论:在接受心脏手术的成人中,术中高氧比常氧增加了术中氧化应激,但不影响肾损伤或其他器官损伤的测量,包括谵妄、心肌损伤和心房颤动:试验注册:ClinicalTrials.gov Identifier:试验注册:ClinicalTrials.gov Identifier:NCT02361944。
{"title":"Intraoperative Oxygen Treatment, Oxidative Stress, and Organ Injury Following Cardiac Surgery: A Randomized Clinical Trial.","authors":"Marcos G Lopez, Matthew S Shotwell, Cassandra Hennessy, Mias Pretorius, David R McIlroy, Melissa J Kimlinger, Eric H Mace, Tarek Absi, Ashish S Shah, Nancy J Brown, Frederic T Billings","doi":"10.1001/jamasurg.2024.2906","DOIUrl":"10.1001/jamasurg.2024.2906","url":null,"abstract":"<p><strong>Importance: </strong>Liberal oxygen (hyperoxia) is commonly administered to patients during surgery, and oxygenation is known to impact mechanisms of perioperative organ injury.</p><p><strong>Objective: </strong>To evaluate the effect of intraoperative hyperoxia compared to maintaining normoxia on oxidative stress, kidney injury, and other organ dysfunctions after cardiac surgery.</p><p><strong>Design, setting, and participants: </strong>This was a participant- and assessor-blinded, randomized clinical trial conducted from April 2016 to October 2020 with 1 year of follow-up at a single tertiary care medical center. Adult patients (>18 years) presenting for elective open cardiac surgery without preoperative oxygen requirement, acute coronary syndrome, carotid stenosis, or dialysis were included. Of 3919 patients assessed, 2501 were considered eligible and 213 provided consent. Of these, 12 were excluded prior to randomization and 1 following randomization whose surgery was cancelled, leaving 100 participants in each group.</p><p><strong>Interventions: </strong>Participants were randomly assigned to hyperoxia (1.00 fraction of inspired oxygen [FiO2]) or normoxia (minimum FiO2 to maintain oxygen saturation 95%-97%) throughout surgery.</p><p><strong>Main outcomes and measures: </strong>Participants were assessed for oxidative stress by measuring F2-isoprostanes and isofurans, for acute kidney injury (AKI), and for delirium, myocardial injury, atrial fibrillation, and additional secondary outcomes. Participants were monitored for 1 year following surgery.</p><p><strong>Results: </strong>Two hundred participants were studied (median [IQR] age, 66 [59-72] years; 140 male and 60 female; 82 [41.0%] with diabetes). F2-isoprostanes and isofurans (primary mechanistic end point) increased on average throughout surgery, from a median (IQR) of 73.3 (53.1-101.1) pg/mL at baseline to a peak of 85.5 (64.0-109.8) pg/mL at admission to the intensive care unit and were 9.2 pg/mL (95% CI, 1.0-17.4; P = .03) higher during surgery in patients assigned to hyperoxia. Median (IQR) change in serum creatinine (primary clinical end point) from baseline to postoperative day 2 was 0.01 mg/dL (-0.12 to 0.19) in participants assigned hyperoxia and -0.01 mg/dL (-0.16 to 0.19) in those assigned normoxia (median difference, 0.03; 95% CI, -0.04 to 0.10; P = .45). AKI occurred in 21 participants (21%) in each group. Intraoperative oxygen treatment did not affect additional acute organ injuries, safety events, or kidney, neuropsychological, and functional outcomes at 1 year.</p><p><strong>Conclusions: </strong>Among adults receiving cardiac surgery, intraoperative hyperoxia increased intraoperative oxidative stress compared to normoxia but did not affect kidney injury or additional measurements of organ injury including delirium, myocardial injury, and atrial fibrillation.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT02361944.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11307166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897380","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}
引用次数: 0
Social Work's Role in Bridging Breast Cancer Care Gaps-Reply. 社会工作在缩小乳腺癌护理差距中的作用--回复。
IF 15.7 1区 医学 Q1 SURGERY Pub Date : 2024-10-01 DOI: 10.1001/jamasurg.2024.2931
Andrea V Barrio, Monica Morrow, Babak J Mehrara
{"title":"Social Work's Role in Bridging Breast Cancer Care Gaps-Reply.","authors":"Andrea V Barrio, Monica Morrow, Babak J Mehrara","doi":"10.1001/jamasurg.2024.2931","DOIUrl":"10.1001/jamasurg.2024.2931","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897385","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}
引用次数: 0
期刊
JAMA surgery
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1