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Error in Title. 标题错误。
IF 14.9 1区 医学 Q1 SURGERY Pub Date : 2025-12-01 DOI: 10.1001/jamasurg.2025.4596
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引用次数: 0
Smoking and Failure to Rescue From Pulmonary Complications After Lung Resection. 吸烟与肺切除术后肺部并发症抢救失败。
IF 16.9 1区 医学 Q1 SURGERY Pub Date : 2025-11-26 DOI: 10.1001/jamasurg.2025.5128
Samantha L Savitch,Tyler M Bauer,Nicole M Mott,Jonathan E Williams,Pasithorn A Suwanabol,Kiran H Lagisetty
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引用次数: 0
Data and the Art of Surgical Preference Card Maintenance. 手术偏好卡维护的数据与艺术。
IF 16.9 1区 医学 Q1 SURGERY Pub Date : 2025-11-26 DOI: 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.
重要性外科医生对使用手术偏好卡的每个病例所要求的大量差异和过剩的供应代表了通过优化降低成本的机会。目的根据外科病历记录的历史用药情况,优选优选卡。设计、环境和参与者本质量改进研究于2019年1月1日至2023年12月31日在一个大型、三级、多医院的学术卫生系统中进行。它包括泌尿科、结肠直肠和外科肿瘤服务。这些数据从2024年1月到2024年8月进行了分析。根据2019年1月1日至2023年12月31日期间的过去病例数据,对每个手术收据项目进行单独的线性时间序列普通最小二乘回归模型拟合,以估计该项目的最佳数量。通过优化现有手术偏好卡上列出的项目,为每个手术创建新的偏好卡,并创建新的偏好卡,将现有偏好卡按手术分层,整理项目级估计后,构建最优手术偏好卡并进行比较。主要结果和措施优化前后卡片上的唯一和总项目数量在3个级别上进行计算。现有优先卡中的基线浪费估计为当前手术优先卡上所有项目的总成本与与病例相关的手术收据总成本之间的差额,即2024年1月1日至2024年5月31日所有符合条件的病例的平均值。基线浪费也与估计浪费进行比较,在3个级别中使用优化的手术偏好卡。结果共评估了1298张偏好卡和432个程序,占偏好卡-程序组合的3088个独特组合。目前的手术偏好卡每例未使用物品的平均(SD)成本为1294.41美元(2307.17美元),在研究的所有病例中总计为3美元 716 251.11。3种优化策略均降低了未使用物品的成本,减少了术中负担。未使用物品的成本相对降低幅度最大的是结肠直肠手术,节省了488美元 774.88,减少了55.8%。使用回归模型优化手术偏好卡具有减少手术浪费的潜力,在手术水平分层后优化现有卡可以最大限度地减少浪费。
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引用次数: 0
Safeguarding Laparoscopic Training in the Robotic Era. 保障机器人时代的腹腔镜训练。
IF 16.9 1区 医学 Q1 SURGERY Pub Date : 2025-11-26 DOI: 10.1001/jamasurg.2025.5162
George Ferzli,Yannis Karamitas,Damien Lazar
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引用次数: 0
Preference Card Optimization-Promise and Practical Considerations. 偏好卡优化-承诺和实际考虑。
IF 16.9 1区 医学 Q1 SURGERY Pub Date : 2025-11-26 DOI: 10.1001/jamasurg.2025.5167
Oliver Aalami
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引用次数: 0
Zeroing in on Firearm Injury Prevention Efforts-Practice and Policy. 聚焦于枪支伤害预防工作——实践和政策。
IF 16.9 1区 医学 Q1 SURGERY Pub Date : 2025-11-26 DOI: 10.1001/jamasurg.2025.5176
Ashley Y Williams,Joshua L J Jones,Daphney R Portis
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引用次数: 0
Neighborhood Deprivation, State Laws, and Firearm Injury in the US. 美国的邻里剥夺、州法律和枪支伤害。
IF 16.9 1区 医学 Q1 SURGERY Pub Date : 2025-11-26 DOI: 10.1001/jamasurg.2025.5168
Ann M Polcari,Anthony D Douglas,Justin S Hatchimonji,Diane N Haddad,Tanya L Zakrison,Selwyn O Rogers,Andrew J Benjamin
ImportanceFirearm injury remains a pressing public health crisis in the US, yet the relative influence of neighborhood deprivation and state firearm laws is not well understood.ObjectiveTo assess the associations of neighborhood deprivation, state firearm law strength, and urbanicity with firearm injury rates across the US.Design, Setting, and ParticipantsThis was a population-based cross-sectional study conducted at the Census block group level across the entire US from January 2018 through December 2022. Gun Violence Archive data were used to identify and include fatal and nonfatal firearm injuries in individuals of all ages. Suicide-related firearm injuries were excluded. Data were analyzed from March to June 2025.ExposureNeighborhood deprivation measured by the 2020 Area Deprivation Index at the census block group level, state firearm law strength determined by the 2020 Giffords Law Center Annual Gun Law Scorecard, and urbanicity (urban, mixed, and rural categories) based on 2020 Census Bureau urban-rural classifications. A spatial lag variable for neighboring state firearm law strength was also included.Main Outcomes and MeasuresFirearm injury rates per 1000 population in a Census block group was evaluated using negative binomial regression to estimate incident rate ratios (IRR). Spatial autocorrelation was assessed using bivariate Moran I statistics.ResultsAcross 233 386 Census block groups, 206 082 shooting incidents were analyzed (81 241 fatalities and 176 179 nonfatal injuries). On multivariable analysis, each decile increase in Area Deprivation Index (ADI) was associated with a 25% increase in firearm injury rates (IRR, 1.25; 95% CI, 1.25-1.26; P < .001) while incremental strengthening of state firearm law grade was associated with a 5% decrease (IRR, 0.95; 95% CI, 0.95-0.96; P < .001). Neighboring state law strength had a weaker association (IRR, 0.99; 95% CI, 0.99-1.00; P < .001). Compared to urban block groups, mixed (IRR, 0.39; 95% CI, 0.37-0.41) and rural (IRR, 0.22; 95% CI, 0.22-0.23) block groups had significantly lower rates (P < .001 for both). Bivariate global Moran I confirmed positive spatial autocorrelation between ADI and shooting incidents (I, 0.76; P < .001).Conclusions and RelevanceIn this national cross-sectional study, neighborhood deprivation demonstrated a substantially stronger statistical association with firearm injury rates than did state firearm law strength. While firearm legislation is crucial, strategies that prioritize investment in socially and economically deprived communities, especially in urban settings, may yield more meaningful reductions in firearm injuries overall.
枪支伤害在美国仍然是一个紧迫的公共卫生危机,然而邻里剥夺和州枪支法律的相对影响还没有得到很好的理解。目的评估美国社区剥夺、州枪支法律力度和城市化与枪支伤害率的关系。设计、环境和参与者这是一项基于人口的横断面研究,从2018年1月到2022年12月,在整个美国的人口普查组水平上进行。枪支暴力档案数据被用来识别并包括所有年龄段的人的致命和非致命枪支伤害。与自杀有关的火器伤害被排除在外。数据分析时间为2025年3月至6月。通过2020年人口普查街区水平的区域剥夺指数衡量的邻里剥夺,由2020年吉福兹法律中心年度枪支法律记分卡确定的州枪支法律力度,以及基于2020年人口普查局城乡分类的城市化(城市,混合和农村类别)。邻州枪支法律强度的空间滞后变量也包括在内。主要结果和测量方法使用负二项回归来估计事故率比(IRR),评估人口普查街区组中每1000人的枪支伤害率。使用双变量Moran I统计量评估空间自相关性。结果在233个 386个人口普查街区组中,分析了206 082起枪击事件(81 241人死亡,176 179人非致命伤害)。在多变量分析中,区域剥夺指数(ADI)每增加十分位数与枪支伤害率增加25%相关(IRR, 1.25; 95% CI, 1.25-1.26; P <。而逐步加强国家枪支法律等级与5%的下降相关(IRR, 0.95; 95% CI, 0.95-0.96; P < .001)。邻州法律强度的相关性较弱(IRR, 0.99; 95% CI, 0.99-1.00; P < 0.001)。与城市街区组相比,混合街区组(IRR, 0.39; 95% CI, 0.37-0.41)和农村街区组(IRR, 0.22; 95% CI, 0.22-0.23)的发病率显著低于城市街区组(P < 0.05)。两者都是001)。双变量全球Moran I证实了ADI与枪击事件之间的正空间自相关(I, 0.76; P < 0.001)。结论和相关性在这项全国性的横断面研究中,社区剥夺与枪支伤害率的统计关联比州枪支法律强度的统计关联更强。虽然枪支立法至关重要,但优先投资于社会和经济贫困社区的战略,特别是在城市环境中,可能会在总体上更有意义地减少枪支伤害。
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引用次数: 0
A Sentinel Increase in Mortality Following Nontraumatic Major Lower Extremity Amputation. 非创伤性下肢大截肢术后死亡率的前哨增高。
IF 16.9 1区 医学 Q1 SURGERY Pub Date : 2025-11-19 DOI: 10.1001/jamasurg.2025.5070
Claire Ferguson,Danylo Orlov,Dewi Sihaloho,Steven Medvedovsky,Sherene E Sharath,Panos Kougias
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引用次数: 0
Financial Hardship After Surgical Procedures 手术后的经济困难
IF 16.9 1区 医学 Q1 SURGERY Pub Date : 2025-11-19 DOI: 10.1001/jamasurg.2025.5055
Alexandra Hernandez, Nina M. Clark, Jamie Olapo, Charles Liu, Rhea Udyavar, Jonathan G. Sham, Ali Rowhani-Rahbar, Joseph L. Dieleman, John W. Scott
Importance Affordable access to surgical procedures remains elusive for many in the US. However, the financial hardship attributable to surgical procedures is not well understood at the national level. Objective To evaluate the association between surgical procedures and financial hardship among working-aged adults in the US, compare changes in financial hardship after elective vs emergency surgery, and examine variation by payer and income. Design, Setting, and Participants This retrospective cohort study of the Medical Expenditure Panel Survey (MEPS) included respondents from 2014 to 2021. The MEPS is a nationally representative survey of noninstitutionalized US civilians. All adults aged 18 to 64 years old who reported undergoing a surgical procedure were matched to a cohort of nonsurgical control patients using coarsened exact matching on age, sex, race, ethnicity, income, payer, census region, comorbidities, and year. These data were analyzed from January 2025 to August 2025. Exposures The primary exposure was surgical procedure(s) within the last 12 months; secondary exposure was emergency vs elective surgical procedures. Main Outcomes and Measures The primary outcome of interest was financial hardship, defined as problems paying medical bills or delaying needed care due to cost. Secondary outcome was family out-of-pocket (OOP) spending. Results The weighted sample included 40 million working-aged (18-64 years) adults (62% female and 38% male) who underwent surgical procedures. Overall, 37.9% of surgical patients experienced financial hardship in the year after surgery. On difference-in-differences analysis, surgical procedures were associated with a 5.4–percentage point increase (95% CI, 1.8-9.0) in financial hardship, a 16% relative increase. Uninsured patients had a 23.7–percentage point increase (95% CI, 5.1-42.2), privately insured patients had an 8.4–percentage point increase (95% CI, 3.6-13.1), and those with Medicaid had no significant change. OOP spending increased by $708 (95% CI, $576-$839) after operations, with the highest increases among emergency surgeries and non-Medicaid insurance type. Conclusions and Relevance Surgical procedures were associated with substantial financial hardship for working-aged adults in the US, especially after emergency surgery and among the uninsured and privately insured. The finding that Medicaid enrollees were protected against increases in financial hardship after surgical procedures suggests that policies that restrict Medicaid eligibility may increase financial hardship among working-aged surgical patients, unless other changes are made to improve financial risk protection.
对于许多美国人来说,负担得起的外科手术仍然是难以捉摸的。然而,在国家一级对外科手术造成的经济困难并没有很好地了解。目的评估美国工作年龄成人手术与经济困难之间的关系,比较选择性手术与急诊手术后经济困难的变化,并检查付款人和收入的变化。这项医疗支出小组调查(MEPS)的回顾性队列研究包括2014年至2021年的受访者。MEPS是一项针对非收容美国平民的全国代表性调查。在年龄、性别、种族、民族、收入、付款人、人口普查地区、合并症和年份等方面,对所有报告接受手术治疗的18至64岁的成年人与一组非手术对照患者进行粗精确匹配。这些数据是从2025年1月到2025年8月进行分析的。主要暴露为过去12个月内的外科手术;第二次暴露是急诊手术与选择性手术。主要结果和测量主要结果是经济困难,定义为支付医疗账单的问题或因费用而延误所需的护理。次要指标是家庭自费支出(OOP)。结果加权样本包括4000万接受过外科手术的工作年龄(18-64岁)成年人(女性62%,男性38%)。总体而言,37.9%的手术患者在术后一年经历了经济困难。在差异分析中,外科手术与经济困难增加5.4个百分点(95% CI, 1.8-9.0)相关,相对增加16%。没有保险的患者增加了23.7个百分点(95% CI, 5.1-42.2),私人保险的患者增加了8.4个百分点(95% CI, 3.6-13.1),有医疗补助的患者没有显著变化。手术后OOP支出增加了708美元(95% CI, 576- 839美元),其中紧急手术和非医疗补助保险类型的增幅最大。在美国,对于工作年龄的成年人来说,外科手术与严重的经济困难有关,特别是在急诊手术后以及在没有保险和私人保险的人群中。这项研究发现,医疗补助计划的参保者在手术后的经济困难中受到了保护,这表明限制医疗补助计划资格的政策可能会增加工作年龄外科患者的经济困难,除非做出其他改变来改善财务风险保护。
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引用次数: 0
Organ Procurement Following the Centers for Medicare and Medicaid Services Performance Evaluations. 器官采购遵循医疗保险和医疗补助服务绩效评估中心。
IF 16.9 1区 医学 Q1 SURGERY Pub Date : 2025-11-19 DOI: 10.1001/jamasurg.2025.5074
Hannah Bae,Kurt R Sweat,Marc L Melcher,Itai Ashlagi
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引用次数: 0
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JAMA surgery
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