Pub Date : 2025-12-03DOI: 10.1001/jamasurg.2025.5288
Daniel I McIsaac,Susan Lee,Dean Fergusson,Chelsia Gillis,Rachel G Khadaroo,Amanda Meliambro,John Muscedere,Antoine Eskander,Husein Moloo,Gregg Nelson,Tarit Saha,Rosaleen Chun,Pablo E Serrano,Duminda N Wijeysundera,Monica Taljaard, ,Keely Barnes,Sylvain Boet,Laura Boland,Karina Branje,Rodney Breau,Gregory L Bryson,Irfan Dhalla,Elijah Dixon,Gary Dobson,Mary Farnand,Alan Forster,Sylvain Gagne,Emily Hladkowicz,Jayna Holroyd-Leduc,Allen Huang,Joanne Hutton,Eric Jacobsohn,John Joanisse,Ana Johnson,Stephanie Johnson,Noha Khalil,Gurlie Kidd,Manoj Lalu,Luke T Lavallée,Tien Le,Max Levine,Cameron Love,Colin McCartney,Michael McMullen,Lucas Mellaci Bergamascki,Ronald Moore,Michelle Mozel,Sudhir Nagpal,Julie Nantel,Barbara Power,Celena Scheede-Bergdahl,Laura Tamblyn-Watts,Kednapa Thavorn,Daniel Trottier,Carl van Walraven,Ilun Yang
ImportanceExplanatory trials suggest that prehabilitation has efficacy in improving surgical outcomes. The effectiveness of offering home-based prehabilitation across multiple centers and for older adults with frailty remains unknown.ObjectiveTo evaluate the effectiveness of offering coach-supported, home-based prehabilitation to older surgical patients with frailty.Design, Setting, and ParticipantsThis study is a pragmatic, parallel-arm, multicenter randomized clinical trial with embedded qualitative assessment. Clinicians and assessors were fully blinded; participants were partially blinded in that the control arm received publicly available activity and nutritional guidelines. From March 2, 2020, to February 8, 2024, participants aged 60 years and older with frailty (Clinical Frailty Scale score ≥4) scheduled for elective, inpatient noncardiac surgery were recruited from surgeon's offices at 13 centers in Canada. Data analysis was completed from October 3, 2024, to December 5, 2024.InterventionAssignment to a home-based, multimodal program of exercise and personalized nutritional recommendations, remotely supported by coaches using a theory-based approach to enhance adherence.Main Outcomes and MeasuresThe coprimary outcomes were patient-reported disability 30 days after surgery using the World Health Organization Disability Assessment Schedule 2.0 and the incidence of any postoperative complication during the surgical hospitalization. Barriers to adherence were identified using the Theoretical Domains Framework. Secondary outcomes were intervention-attributable safety events, health-related quality of life, survival, falls, complication severity, activities of daily living, length of stay, discharge disposition, lower limb function, and readmission. Analysis was by mixed-effects regression, adjusting for stratification and prespecified prognostic factors.ResultsOf 992 eligible participants, 847 (85.4%) were randomized (423 to prehabilitation and 424 to usual care), and 705 participants had their planned surgery (353 in the prehabilitation group and 352 in the usual care group). A total of 452 participants (53.4%) were female, and mean (SD) participant age was 71.7 (7.1) years. A median (IQR) of 4 weeks (3-7) of prehabilitation enrollment was achieved. Preoperative safety outcomes did not differ between groups. Participants assigned to prehabilitation reported a mean (SD) postoperative disability score of 23.5 (21.8) compared to 24.7 (23.8) for usual care (adjusted mean difference, -1.4; 97.5% CI, -4.9 to 2.0; P = .36). Complications occurred in 177 participants (50.1%) assigned to prehabilitation and 168 control participants (47.7%) (adjusted odds ratio, 1.05; 97.5% CI, 0.73-1.49; P = .78). Participants completing more than 75% of prescribed exercises reported significantly lower disability scores with prehabilitation (mean difference, -4.9; 97.5% CI, -9.8 to -0.01; P = .02), but there was no significant difference in complications (odds ratio
解释性试验表明，康复治疗对改善手术结果有效。在多个中心为虚弱的老年人提供以家庭为基础的康复服务的有效性仍然未知。目的评价教练员支持的家庭康复对老年外科虚弱患者的效果。设计、环境和参与者本研究是一项实用的、平行组、多中心随机临床试验，内含定性评估。临床医生和评估人员是完全盲法的；参与者是部分盲的，因为对照组接受公开的活动和营养指南。从2020年3月2日至2024年2月8日，从加拿大13个中心的外科医生办公室招募了年龄在60岁及以上，身体虚弱（临床虚弱量表评分≥4），计划进行选择性住院非心脏手术的参与者。数据分析时间为2024年10月3日至2024年12月5日。干预：分配到一个以家庭为基础的、多模式的锻炼和个性化营养建议计划，由教练使用基于理论的方法远程支持，以提高依从性。主要结局和措施主要结局是采用世界卫生组织残疾评估表2.0评估术后30天患者报告的残疾情况，以及手术住院期间任何术后并发症的发生率。使用理论领域框架确定了坚持的障碍。次要结局是干预归因的安全事件、健康相关生活质量、生存、跌倒、并发症严重程度、日常生活活动、住院时间、出院处置、下肢功能和再入院。分析采用混合效应回归，调整分层和预先指定的预后因素。结果992名符合条件的参与者中，847人（85.4%）被随机分配（423人接受康复治疗，424人接受常规治疗），705人按计划进行了手术（康复治疗组353人，常规治疗组352人）。女性452例（53.4%），平均（SD）年龄为71.7（7.1）岁。康复前登记的中位（IQR）为4周（3-7）。术前安全性结果各组间无差异。预康复组的参与者报告的平均（SD）术后残疾评分为23.5(21.8)，而常规护理组为24.7(23.8)（调整后平均差为-1.4;97.5% CI, -4.9至2.0;P = 0.36）。术前康复组177例（50.1%）和对照组168例（47.7%）发生并发症（校正优势比1.05;97.5% CI, 0.73-1.49; P = 0.78）。完成75%以上规定运动的参与者报告，康复后的残疾评分显著降低(平均差异，-4.9;97.5% CI, -9.8至-0.01;P =。02)，但并发症发生率无显著差异（优势比1.06;97.5% CI, 0.67 ~ 1.67; P = 0.79）。坚持治疗的主要障碍是相互竞争的优先事项和动机。结论和相关性在这项随机临床试验中，在计划手术的虚弱老年人中，在手术前分配以家庭为基础的康复并没有改善术后残疾评分或减少并发症。临床试验注册号：NCT04221295。
{"title":"Home-Based Prehabilitation for Older Surgical Patients With Frailty: A Randomized Clinical Trial.","authors":"Daniel I McIsaac,Susan Lee,Dean Fergusson,Chelsia Gillis,Rachel G Khadaroo,Amanda Meliambro,John Muscedere,Antoine Eskander,Husein Moloo,Gregg Nelson,Tarit Saha,Rosaleen Chun,Pablo E Serrano,Duminda N Wijeysundera,Monica Taljaard, ,Keely Barnes,Sylvain Boet,Laura Boland,Karina Branje,Rodney Breau,Gregory L Bryson,Irfan Dhalla,Elijah Dixon,Gary Dobson,Mary Farnand,Alan Forster,Sylvain Gagne,Emily Hladkowicz,Jayna Holroyd-Leduc,Allen Huang,Joanne Hutton,Eric Jacobsohn,John Joanisse,Ana Johnson,Stephanie Johnson,Noha Khalil,Gurlie Kidd,Manoj Lalu,Luke T Lavallée,Tien Le,Max Levine,Cameron Love,Colin McCartney,Michael McMullen,Lucas Mellaci Bergamascki,Ronald Moore,Michelle Mozel,Sudhir Nagpal,Julie Nantel,Barbara Power,Celena Scheede-Bergdahl,Laura Tamblyn-Watts,Kednapa Thavorn,Daniel Trottier,Carl van Walraven,Ilun Yang","doi":"10.1001/jamasurg.2025.5288","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5288","url":null,"abstract":"ImportanceExplanatory trials suggest that prehabilitation has efficacy in improving surgical outcomes. The effectiveness of offering home-based prehabilitation across multiple centers and for older adults with frailty remains unknown.ObjectiveTo evaluate the effectiveness of offering coach-supported, home-based prehabilitation to older surgical patients with frailty.Design, Setting, and ParticipantsThis study is a pragmatic, parallel-arm, multicenter randomized clinical trial with embedded qualitative assessment. Clinicians and assessors were fully blinded; participants were partially blinded in that the control arm received publicly available activity and nutritional guidelines. From March 2, 2020, to February 8, 2024, participants aged 60 years and older with frailty (Clinical Frailty Scale score ≥4) scheduled for elective, inpatient noncardiac surgery were recruited from surgeon's offices at 13 centers in Canada. Data analysis was completed from October 3, 2024, to December 5, 2024.InterventionAssignment to a home-based, multimodal program of exercise and personalized nutritional recommendations, remotely supported by coaches using a theory-based approach to enhance adherence.Main Outcomes and MeasuresThe coprimary outcomes were patient-reported disability 30 days after surgery using the World Health Organization Disability Assessment Schedule 2.0 and the incidence of any postoperative complication during the surgical hospitalization. Barriers to adherence were identified using the Theoretical Domains Framework. Secondary outcomes were intervention-attributable safety events, health-related quality of life, survival, falls, complication severity, activities of daily living, length of stay, discharge disposition, lower limb function, and readmission. Analysis was by mixed-effects regression, adjusting for stratification and prespecified prognostic factors.ResultsOf 992 eligible participants, 847 (85.4%) were randomized (423 to prehabilitation and 424 to usual care), and 705 participants had their planned surgery (353 in the prehabilitation group and 352 in the usual care group). A total of 452 participants (53.4%) were female, and mean (SD) participant age was 71.7 (7.1) years. A median (IQR) of 4 weeks (3-7) of prehabilitation enrollment was achieved. Preoperative safety outcomes did not differ between groups. Participants assigned to prehabilitation reported a mean (SD) postoperative disability score of 23.5 (21.8) compared to 24.7 (23.8) for usual care (adjusted mean difference, -1.4; 97.5% CI, -4.9 to 2.0; P = .36). Complications occurred in 177 participants (50.1%) assigned to prehabilitation and 168 control participants (47.7%) (adjusted odds ratio, 1.05; 97.5% CI, 0.73-1.49; P = .78). Participants completing more than 75% of prescribed exercises reported significantly lower disability scores with prehabilitation (mean difference, -4.9; 97.5% CI, -9.8 to -0.01; P = .02), but there was no significant difference in complications (odds ratio","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"1 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145664096","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 : 2025-12-03DOI: 10.1001/jamasurg.2025.5282
John F. Jachimiak, Yasmin Arda, Carly C. Amon, Riley B. Brackin, Joshua S. Ng-Kamstra, John O. Hwabejire, Haytham M. A. Kaafarani, George C. Velmahos, Michael P. DeWane
Importance Unhoused individuals face significant structural barriers to postacute recovery following traumatic injury. However, national estimates of trauma readmission risk in this population remain limited. This study aimed to evaluate the association between unhoused status and 30-day hospital readmission after trauma. Objective To assess if unhoused status is linked to higher 30-day readmission rates after traumatic injury. Design, Setting, and Participants This retrospective cohort study used data from the 2017 through 2019 National Readmission Database. These data included a national, population-based sample of hospitalizations in the US. Participants included adults aged 18 years or older who were admitted for traumatic injury, identified using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes. Elective admissions, in-hospital deaths, and discharges in December were excluded, given the 30-day outcome. Unhoused status was defined using ICD-10-CM code Z59.0. A total of 2 663 876 trauma admissions were included, of whom 46 381 were unhoused (1.7%). Patients were stratified by housing status based on the ICD-10 code for homelessness. The primary outcome was 30-day all-cause readmission. Multivariable logistic regression and marginal effects models estimated adjusted odds ratios (aOR) and predicted probabilities, controlling for demographic and clinical factors. Results Unhoused patients were substantially younger (65 years, 10.4% vs 59.4%), predominantly male (77.8% vs 48.2% female), and had much higher rates of substance use disorders (alcohol, 41.3% vs 9.9%; drug, 38.4% vs 5.1%) compared with housed patients; all comparisons were statistically significant ( P < .001). The 30-day readmission rate was significantly higher among unhoused patients (19.3% vs 12.2%; P < .001), with increased adjusted odds of readmission on multivariable analysis (aOR, 1.63; 95% CI, 1.58-1.67). Against medical advice discharge carried the highest readmission risk among unhoused patients (predicted probability, 30.3%; aOR, 1.81; 95% CI, 1.67-1.96). Unhoused patients were more likely to be readmitted for new traumatic injuries (aOR, 1.48; 95% CI, 1.41-1.56), sequelae of prior trauma (aOR, 1.19; 95% CI, 1.02-1.39), and postprocedural complications (aOR, 1.26; 95% CI, 1.12-1.42). Conclusions and Relevance In this observational study, unhoused status was independently associated with significantly higher odds of 30-day readmission following trauma, often for new injury or poor healing. Improved discharge planning, continuity of care, and access to housing and postacute services are needed.
{"title":"The Experience of Readmission After Trauma Among the Unhoused","authors":"John F. Jachimiak, Yasmin Arda, Carly C. Amon, Riley B. Brackin, Joshua S. Ng-Kamstra, John O. Hwabejire, Haytham M. A. Kaafarani, George C. Velmahos, Michael P. DeWane","doi":"10.1001/jamasurg.2025.5282","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5282","url":null,"abstract":"Importance Unhoused individuals face significant structural barriers to postacute recovery following traumatic injury. However, national estimates of trauma readmission risk in this population remain limited. This study aimed to evaluate the association between unhoused status and 30-day hospital readmission after trauma. Objective To assess if unhoused status is linked to higher 30-day readmission rates after traumatic injury. Design, Setting, and Participants This retrospective cohort study used data from the 2017 through 2019 National Readmission Database. These data included a national, population-based sample of hospitalizations in the US. Participants included adults aged 18 years or older who were admitted for traumatic injury, identified using <jats:italic toggle=\"yes\">International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)</jats:italic> diagnosis codes. Elective admissions, in-hospital deaths, and discharges in December were excluded, given the 30-day outcome. Unhoused status was defined using <jats:italic toggle=\"yes\">ICD-10-CM</jats:italic> code Z59.0. A total of 2 663 876 trauma admissions were included, of whom 46 381 were unhoused (1.7%). Patients were stratified by housing status based on the <jats:italic toggle=\"yes\">ICD-10</jats:italic> code for homelessness. The primary outcome was 30-day all-cause readmission. Multivariable logistic regression and marginal effects models estimated adjusted odds ratios (aOR) and predicted probabilities, controlling for demographic and clinical factors. Results Unhoused patients were substantially younger (65 years, 10.4% vs 59.4%), predominantly male (77.8% vs 48.2% female), and had much higher rates of substance use disorders (alcohol, 41.3% vs 9.9%; drug, 38.4% vs 5.1%) compared with housed patients; all comparisons were statistically significant ( <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001). The 30-day readmission rate was significantly higher among unhoused patients (19.3% vs 12.2%; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001), with increased adjusted odds of readmission on multivariable analysis (aOR, 1.63; 95% CI, 1.58-1.67). Against medical advice discharge carried the highest readmission risk among unhoused patients (predicted probability, 30.3%; aOR, 1.81; 95% CI, 1.67-1.96). Unhoused patients were more likely to be readmitted for new traumatic injuries (aOR, 1.48; 95% CI, 1.41-1.56), sequelae of prior trauma (aOR, 1.19; 95% CI, 1.02-1.39), and postprocedural complications (aOR, 1.26; 95% CI, 1.12-1.42). Conclusions and Relevance In this observational study, unhoused status was independently associated with significantly higher odds of 30-day readmission following trauma, often for new injury or poor healing. Improved discharge planning, continuity of care, and access to housing and postacute services are needed.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"28 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658248","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 : 2025-12-03DOI: 10.1001/jamasurg.2025.5275
Joanelle A Bailey,Nina E Glass,Cherisse Berry
{"title":"Housing as a Health Intervention-Structural Vulnerability in Trauma.","authors":"Joanelle A Bailey,Nina E Glass,Cherisse Berry","doi":"10.1001/jamasurg.2025.5275","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5275","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"113 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145664094","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 : 2025-11-26DOI: 10.1001/jamasurg.2025.5128
Samantha L Savitch,Tyler M Bauer,Nicole M Mott,Jonathan E Williams,Pasithorn A Suwanabol,Kiran H Lagisetty
{"title":"Smoking and Failure to Rescue From Pulmonary Complications After Lung Resection.","authors":"Samantha L Savitch,Tyler M Bauer,Nicole M Mott,Jonathan E Williams,Pasithorn A Suwanabol,Kiran H Lagisetty","doi":"10.1001/jamasurg.2025.5128","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5128","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"98 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599951","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 : 2025-11-26DOI: 10.1001/jamasurg.2025.5179
Sean Perez,Adir Mancebo,Patricia Lopez,Leslie Joe,Paul Benavidez,Zhihan Li,Mehri Sadri,Eduardo Spiegel-Pinzon,Ryan Lopez,Bryan Clary,Christopher A Longhurst,Kristin Mekeel,Karandeep Singh
ImportanceThe substantial variation and excess of supplies requested by surgeons for each case using surgical preference cards represents an opportunity for cost reduction through optimization.ObjectiveTo optimize preference cards based on historical supply use captured through surgical receipts.Design, Setting, and ParticipantsThis quality improvement study took place in a large, tertiary, multi-hospital academic health system from January 1, 2019, through December 31, 2023. It included urology, colorectal, and surgical oncology services. These data were analyzed from January 2024 to August 2024.ExposuresSeparate linear time-series ordinary least squares regression models were fit for each surgical receipt item to estimate the optimal number of that item based on data from past cases between January 1, 2019, and December 31, 2023. Optimal surgical preference cards were constructed and compared after collating item-level estimates by optimizing items listed on existing surgical preference cards, creating new preference cards for each procedure, and creating new preference cards that stratify existing preference cards by procedure.Main outcome and measuresThe number of unique and total items on the cards before and after optimization were calculated at the 3 levels. Baseline waste was estimated in existing preference cards as the difference between the total cost of all items on the current surgical preference card and total cost of the surgical receipt associated with the case, averaged across all eligible cases from January 1, 2024, to May 31, 2024. Baseline waste was also compared against the estimated waste, using the optimized surgical preference card at each of the 3 levels.ResultsA total of 1298 preference cards and 432 procedures were evaluated, accounting for 3088 unique preference card-procedure combinations. The current surgical preference cards incurred a mean (SD) cost per case of unused items of $1294.41 ($2307.17), amounting to $3 716 251.11 across all cases in the study. All 3 optimization strategies reduced the cost of unused items and produced less intraoperative burden. The greatest relative reduction in the cost of unused items was seen in colorectal surgery, where cost savings of $488 774.88 reflected a 55.8% reduction.Conclusions and RelevanceOptimization of surgical preference cards with regression models has the potential to reduce surgical waste, with the greatest reduction in waste seen with optimizing existing cards after stratifying at the procedure level.
{"title":"Data and the Art of Surgical Preference Card Maintenance.","authors":"Sean Perez,Adir Mancebo,Patricia Lopez,Leslie Joe,Paul Benavidez,Zhihan Li,Mehri Sadri,Eduardo Spiegel-Pinzon,Ryan Lopez,Bryan Clary,Christopher A Longhurst,Kristin Mekeel,Karandeep Singh","doi":"10.1001/jamasurg.2025.5179","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5179","url":null,"abstract":"ImportanceThe substantial variation and excess of supplies requested by surgeons for each case using surgical preference cards represents an opportunity for cost reduction through optimization.ObjectiveTo optimize preference cards based on historical supply use captured through surgical receipts.Design, Setting, and ParticipantsThis quality improvement study took place in a large, tertiary, multi-hospital academic health system from January 1, 2019, through December 31, 2023. It included urology, colorectal, and surgical oncology services. These data were analyzed from January 2024 to August 2024.ExposuresSeparate linear time-series ordinary least squares regression models were fit for each surgical receipt item to estimate the optimal number of that item based on data from past cases between January 1, 2019, and December 31, 2023. Optimal surgical preference cards were constructed and compared after collating item-level estimates by optimizing items listed on existing surgical preference cards, creating new preference cards for each procedure, and creating new preference cards that stratify existing preference cards by procedure.Main outcome and measuresThe number of unique and total items on the cards before and after optimization were calculated at the 3 levels. Baseline waste was estimated in existing preference cards as the difference between the total cost of all items on the current surgical preference card and total cost of the surgical receipt associated with the case, averaged across all eligible cases from January 1, 2024, to May 31, 2024. Baseline waste was also compared against the estimated waste, using the optimized surgical preference card at each of the 3 levels.ResultsA total of 1298 preference cards and 432 procedures were evaluated, accounting for 3088 unique preference card-procedure combinations. The current surgical preference cards incurred a mean (SD) cost per case of unused items of $1294.41 ($2307.17), amounting to $3 716 251.11 across all cases in the study. All 3 optimization strategies reduced the cost of unused items and produced less intraoperative burden. The greatest relative reduction in the cost of unused items was seen in colorectal surgery, where cost savings of $488 774.88 reflected a 55.8% reduction.Conclusions and RelevanceOptimization of surgical preference cards with regression models has the potential to reduce surgical waste, with the greatest reduction in waste seen with optimizing existing cards after stratifying at the procedure level.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"6 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599656","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 : 2025-11-26DOI: 10.1001/jamasurg.2025.5162
George Ferzli,Yannis Karamitas,Damien Lazar
{"title":"Safeguarding Laparoscopic Training in the Robotic Era.","authors":"George Ferzli,Yannis Karamitas,Damien Lazar","doi":"10.1001/jamasurg.2025.5162","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5162","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"97 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599697","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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