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}
Pub Date : 2025-11-26DOI: 10.1001/jamasurg.2025.5176
Ashley Y Williams,Joshua L J Jones,Daphney R Portis
{"title":"Zeroing in on Firearm Injury Prevention Efforts-Practice and Policy.","authors":"Ashley Y Williams,Joshua L J Jones,Daphney R Portis","doi":"10.1001/jamasurg.2025.5176","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5176","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"193 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599654","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.2025.5168
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.
{"title":"Neighborhood Deprivation, State Laws, and Firearm Injury in the US.","authors":"Ann M Polcari,Anthony D Douglas,Justin S Hatchimonji,Diane N Haddad,Tanya L Zakrison,Selwyn O Rogers,Andrew J Benjamin","doi":"10.1001/jamasurg.2025.5168","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5168","url":null,"abstract":"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.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"19 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599657","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 : 2025-11-19DOI: 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.
{"title":"Financial Hardship After Surgical Procedures","authors":"Alexandra Hernandez, Nina M. Clark, Jamie Olapo, Charles Liu, Rhea Udyavar, Jonathan G. Sham, Ali Rowhani-Rahbar, Joseph L. Dieleman, John W. Scott","doi":"10.1001/jamasurg.2025.5055","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5055","url":null,"abstract":"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.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"101 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145545425","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 : 2025-11-19DOI: 10.1001/jamasurg.2025.5074
Hannah Bae,Kurt R Sweat,Marc L Melcher,Itai Ashlagi
{"title":"Organ Procurement Following the Centers for Medicare and Medicaid Services Performance Evaluations.","authors":"Hannah Bae,Kurt R Sweat,Marc L Melcher,Itai Ashlagi","doi":"10.1001/jamasurg.2025.5074","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5074","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"7 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145545136","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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