Pub Date : 2026-01-28DOI: 10.1001/jamasurg.2025.6246
Hidenori Tanaka,Shravan Gowrishankar,Eben L Rosenthal
{"title":"Fluorescence-Guided Surgery-Illuminating the Limits of Cancer Therapeutics.","authors":"Hidenori Tanaka,Shravan Gowrishankar,Eben L Rosenthal","doi":"10.1001/jamasurg.2025.6246","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6246","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"77 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056873","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 : 2026-01-21DOI: 10.1001/jamasurg.2025.6155
Jordan Nantais,Refik Saskin,Andrew Calzavara,David Gomez,Nancy N Baxter
ImportanceOutcomes in emergency general surgery vary between hospitals, and models with dedicated resources and personnel have been developed with the aim of improving care. Existing literature is limited in scope and often does not involve nonoperatively treated patients, reducing generalizability.ObjectiveTo use population-level data to determine whether treatment in an emergency general surgery model is associated with clinical outcomes.Design, Setting, and ParticipantsThis was a retrospective cohort study of adults in Ontario, Canada, diagnosed with 1 of 9 emergency general surgery conditions and hospitalized between April 1, 2002, and December 31, 2019, using linked administrative data housed at ICES. Data analysis was conducted from June 24, 2024, to October 24, 2025.ExposureTreatment at a hospital with an emergency general surgery model of care in comparison with a standard surgeon on-call model.Main Outcomes and MeasuresDeath in the hospital or within 30 days of discharge was the primary outcome. Secondary outcomes included death at 90 days and complications, failure to rescue, and readmission at 30 days. Generalized estimating equations were used with a negative binomial distribution for mortality outcomes and a binomial distribution for other secondary outcomes. Clustering at the hospital level was accounted for, and effect modification according to diagnosis risk category (low, medium, or high) was evaluated.ResultsA total of 494 609 patients were included (median [IQR] age, 56 [40-72] years; 263 267 [53.2%] female), with 88 889 (18.0%) treated in an emergency general surgery model hospital. A total of 3069 patients (3.4%) in an emergency general surgery model died within 30 days, compared with 15 013 (3.7%) in a surgeon on-call model. Adjusted analyses showed an association between an emergency general surgery model and decreased adjusted relative risk (aRR) of 30-day death for patients with high-risk conditions (aRR, 0.85; 95% CI, 0.77-0.95) but not for those with low- or medium-risk conditions. Death at 90 days was likewise lower in emergency general surgery models for high-risk conditions (aRR, 0.82; 95% CI, 0.74-0.92). The odds of complications in patients with high-risk conditions showed a similar association (adjusted odds ratio, 0.68; 95% CI, 0.53-0.87), but there was no association with failure to rescue or readmission.Conclusions and RelevanceThis cohort study demonstrated that death and complications were lower for patients with high-risk conditions in an emergency general surgery model of care. These findings suggest that these patients would benefit from formal systems to prioritize management at emergency general surgery model centers but that patients with lower-risk conditions are less likely to benefit from this care.
{"title":"A Population-Level Evaluation of Emergency General Surgery Models of Care and Clinical Outcomes.","authors":"Jordan Nantais,Refik Saskin,Andrew Calzavara,David Gomez,Nancy N Baxter","doi":"10.1001/jamasurg.2025.6155","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6155","url":null,"abstract":"ImportanceOutcomes in emergency general surgery vary between hospitals, and models with dedicated resources and personnel have been developed with the aim of improving care. Existing literature is limited in scope and often does not involve nonoperatively treated patients, reducing generalizability.ObjectiveTo use population-level data to determine whether treatment in an emergency general surgery model is associated with clinical outcomes.Design, Setting, and ParticipantsThis was a retrospective cohort study of adults in Ontario, Canada, diagnosed with 1 of 9 emergency general surgery conditions and hospitalized between April 1, 2002, and December 31, 2019, using linked administrative data housed at ICES. Data analysis was conducted from June 24, 2024, to October 24, 2025.ExposureTreatment at a hospital with an emergency general surgery model of care in comparison with a standard surgeon on-call model.Main Outcomes and MeasuresDeath in the hospital or within 30 days of discharge was the primary outcome. Secondary outcomes included death at 90 days and complications, failure to rescue, and readmission at 30 days. Generalized estimating equations were used with a negative binomial distribution for mortality outcomes and a binomial distribution for other secondary outcomes. Clustering at the hospital level was accounted for, and effect modification according to diagnosis risk category (low, medium, or high) was evaluated.ResultsA total of 494 609 patients were included (median [IQR] age, 56 [40-72] years; 263 267 [53.2%] female), with 88 889 (18.0%) treated in an emergency general surgery model hospital. A total of 3069 patients (3.4%) in an emergency general surgery model died within 30 days, compared with 15 013 (3.7%) in a surgeon on-call model. Adjusted analyses showed an association between an emergency general surgery model and decreased adjusted relative risk (aRR) of 30-day death for patients with high-risk conditions (aRR, 0.85; 95% CI, 0.77-0.95) but not for those with low- or medium-risk conditions. Death at 90 days was likewise lower in emergency general surgery models for high-risk conditions (aRR, 0.82; 95% CI, 0.74-0.92). The odds of complications in patients with high-risk conditions showed a similar association (adjusted odds ratio, 0.68; 95% CI, 0.53-0.87), but there was no association with failure to rescue or readmission.Conclusions and RelevanceThis cohort study demonstrated that death and complications were lower for patients with high-risk conditions in an emergency general surgery model of care. These findings suggest that these patients would benefit from formal systems to prioritize management at emergency general surgery model centers but that patients with lower-risk conditions are less likely to benefit from this care.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"2 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005278","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 : 2026-01-21DOI: 10.1001/jamasurg.2025.6171
Rohun Bhagat,Laura Young,Eugene H Blackstone,Faisal G Bakaeen
{"title":"Internal Mammary Artery Grafting-A Therapy Like No Other.","authors":"Rohun Bhagat,Laura Young,Eugene H Blackstone,Faisal G Bakaeen","doi":"10.1001/jamasurg.2025.6171","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6171","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"231 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005277","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 : 2026-01-21DOI: 10.1001/jamasurg.2025.5890
Adom Bondzi-Simpson,Vaibhav Gupta,Tiago Ribeiro,Michael Ko,Steven H Lin,Natalie G Coburn,Julie Hallet,Biniam Kidane
ImportanceThe Surgery as Needed for Oesophageal Cancer (SANO) trial introduced active surveillance as a noninferior alternative to esophagectomy for patients with esophageal cancer who achieve a clinical complete response (cCR) after neoadjuvant chemoradiation (nCRT). However, concerns remain about recurrence risk, long-term survival, and quality-of-life trade-offs with organ-preserving strategies.ObjectiveTo evaluate the long-term comparative effectiveness of active surveillance vs standard esophagectomy in patients with cCR following nCRT for locally advanced esophageal cancer, using updated data from the SANO trial.Design, Setting, and ParticipantsThis decision analytical model used Markov modeling and probabilities and utility inputs derived from the SANO trial and existing literature. The base case was a 60-year-old male with good functional status and cT3N1M0 esophageal cancer achieving cCR after nCRT.ExposuresStandard routine esophagectomy vs active surveillance after neoadjuvant chemoradiation.Main Outcomes and MeasuresThe primary outcome was quality-adjusted life-years (QALYs); the secondary outcome was life-years. Additional model scenarios explored (1) quality-of-life impacts of esophagectomy modeled as a time-varying covariate and (2) 2-year outcomes to align with the SANO trial time horizon. Sensitivity analyses evaluated recurrence probabilities and surgery-related quality-of-life trade-offs.ResultsAt 5 years, standard surgery yielded greater QALYs (1.74 vs 1.34; incremental gain of 0.40 QALYs or ~4.8 months in perfect health) and life-years (3.11 vs 2.41; incremental gain of 0.70 life-years or ~8.4 months) compared with active surveillance. However, at a 2-year horizon, active surveillance was preferred for QALYs (incremental gain of ~15 days), consistent with the SANO trial. Sensitivity analyses revealed the model favored active surveillance when the recurrence probability was less than 43%, the likelihood of local/resectable recurrence was greater than 94%, or the negative quality-of-life impact of esophagectomy was substantial. Modeling esophagectomy's quality-of-life impact as time limited further strengthened surgery's long-term QALY benefit.Conclusions and RelevanceThis study found that while active surveillance offers short-term quality-of-life benefits and may be appropriate in select patients, particularly those at low recurrence risk or with high surgical risk, esophagectomy remains the preferred strategy for maximizing long-term survival and QALYs. These findings support a nuanced, individualized approach to post-nCRT management, balancing organ preservation with long-term oncologic outcomes.
食管癌按需手术（SANO）试验将主动监测作为食管癌患者在新辅助放化疗（nCRT）后达到临床完全缓解（cCR）的非次优选择。然而，对器官保存策略的复发风险、长期生存和生活质量权衡的担忧仍然存在。目的利用SANO试验的最新数据，评估主动监测与标准食管切除术对局部晚期食管癌nCRT后cCR患者的长期比较效果。设计、设置和参与者这个决策分析模型使用了马尔可夫模型以及从SANO试验和现有文献中获得的概率和效用输入。基本病例为60岁男性，功能状态良好，cT3N1M0食管癌在nCRT后达到cCR。标准常规食管切除术与新辅助放化疗后的主动监测。主要结局和测量：主要结局为质量调整生命年（QALYs）；次要结果是生命年。其他模型场景探讨了(1)食管切除术作为时变协变量建模的生活质量影响和(2)与SANO试验时间范围一致的2年结果。敏感性分析评估了复发概率和手术相关的生活质量权衡。结果5年后，与主动监测相比，标准手术获得更高的QALYs （1.74 vs 1.34；完全健康时增加0.40 QALYs或约4.8个月）和生命年（3.11 vs 2.41；增加0.70生命年或约8.4个月）。然而，与SANO试验一致，在2年的期限内，主动监测是QALYs（增量增益约15天）的首选。敏感性分析显示，当复发概率小于43%，局部/可切除复发的可能性大于94%，或食管切除术对生活质量的负面影响很大时，该模型更倾向于主动监测。模拟食管切除术在时间限制下对生活质量的影响，进一步加强了手术的长期质量效益。结论和相关性本研究发现，虽然主动监测可以提供短期的生活质量益处，并且可能适用于特定的患者，特别是那些复发风险低或手术风险高的患者，但食管切除术仍然是最大化长期生存率和QALYs的首选策略。这些发现支持一种微妙的、个性化的ncrt后管理方法，平衡器官保存与长期肿瘤预后。
{"title":"Esophagectomy vs Active Surveillance in Clinical Complete Responders After Neoadjuvant Chemoradiation.","authors":"Adom Bondzi-Simpson,Vaibhav Gupta,Tiago Ribeiro,Michael Ko,Steven H Lin,Natalie G Coburn,Julie Hallet,Biniam Kidane","doi":"10.1001/jamasurg.2025.5890","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5890","url":null,"abstract":"ImportanceThe Surgery as Needed for Oesophageal Cancer (SANO) trial introduced active surveillance as a noninferior alternative to esophagectomy for patients with esophageal cancer who achieve a clinical complete response (cCR) after neoadjuvant chemoradiation (nCRT). However, concerns remain about recurrence risk, long-term survival, and quality-of-life trade-offs with organ-preserving strategies.ObjectiveTo evaluate the long-term comparative effectiveness of active surveillance vs standard esophagectomy in patients with cCR following nCRT for locally advanced esophageal cancer, using updated data from the SANO trial.Design, Setting, and ParticipantsThis decision analytical model used Markov modeling and probabilities and utility inputs derived from the SANO trial and existing literature. The base case was a 60-year-old male with good functional status and cT3N1M0 esophageal cancer achieving cCR after nCRT.ExposuresStandard routine esophagectomy vs active surveillance after neoadjuvant chemoradiation.Main Outcomes and MeasuresThe primary outcome was quality-adjusted life-years (QALYs); the secondary outcome was life-years. Additional model scenarios explored (1) quality-of-life impacts of esophagectomy modeled as a time-varying covariate and (2) 2-year outcomes to align with the SANO trial time horizon. Sensitivity analyses evaluated recurrence probabilities and surgery-related quality-of-life trade-offs.ResultsAt 5 years, standard surgery yielded greater QALYs (1.74 vs 1.34; incremental gain of 0.40 QALYs or ~4.8 months in perfect health) and life-years (3.11 vs 2.41; incremental gain of 0.70 life-years or ~8.4 months) compared with active surveillance. However, at a 2-year horizon, active surveillance was preferred for QALYs (incremental gain of ~15 days), consistent with the SANO trial. Sensitivity analyses revealed the model favored active surveillance when the recurrence probability was less than 43%, the likelihood of local/resectable recurrence was greater than 94%, or the negative quality-of-life impact of esophagectomy was substantial. Modeling esophagectomy's quality-of-life impact as time limited further strengthened surgery's long-term QALY benefit.Conclusions and RelevanceThis study found that while active surveillance offers short-term quality-of-life benefits and may be appropriate in select patients, particularly those at low recurrence risk or with high surgical risk, esophagectomy remains the preferred strategy for maximizing long-term survival and QALYs. These findings support a nuanced, individualized approach to post-nCRT management, balancing organ preservation with long-term oncologic outcomes.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"11 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005275","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 : 2026-01-21DOI: 10.1001/jamasurg.2025.6145
Forrest Bohler,Aaquib Noorani,Jesse C Selber,Karam Hadid,Angelis Lau,George A Flores,Sergey G Toshinskiy,Kongkrit Chaiyasate
ImportanceAs part of an effort to boost physician supply and opportunity, several US states have recently enacted laws permitting internationally trained physicians to practice without completing an Accreditation Council for Graduate Medical Education-accredited residency or fellowship, representing a major departure from long-standing licensure norms. Little is known about how the public perceives these laws, particularly in surgical fields in which technical competency and patient trust are paramount.ObjectiveTo assess public perceptions of state laws permitting internationally trained surgeons to practice in the US without US-based residency training.Design, Setting, and ParticipantsThis cross-sectional study involving perspectives of US adults on state licensure of internationally trained surgeons to address surgical workforce shortages was conducted in July 2025 using an online crowdsourcing platform (Amazon Mechanical Turk; Amazon Mechanical Turk, Inc). A 21-item survey was administered through Qualtrics (Qualtrics, LLC). Quality control included definitional understanding, attention checks, and time-based screening.Main Outcomes and MeasuresPrimary outcomes included support for licensure laws for internationally trained surgeons, ethical concerns regarding international brain drain, perceived training equivalence, personal comfort with internationally trained surgeon care, hospital trust, and preferences for regulatory oversight. Subgroup analyses were performed by sex and self-defined political views using χ2 testing.ResultsOf 1270 initial responses, 1066 (83.9%) passed quality criteria and were analyzed. Among 1066 respondents (634 male [59.5%], median [IQR] age 33 [29-35] years), 906 (85.0%) supported state licensure laws for internationally trained surgeons. Most respondents (991; 93.0%) believed such laws would improve access and 856 (80.3%) felt diversity would improve, yet 755 (70.8%) expressed ethical concerns about international brain drain. Regarding training, a majority of respondents (787; 73.8%) did not view international training as equivalent to US training, and 831 (78.0%) reported they would be less likely to select an internationally trained surgeon for surgery. Regarding informed consent, nearly all respondents (1005; 94.3%) supported mandatory disclosure of training background. Males (575 of 634 [90.7%], P < .001) and conservatives (512 of 569 [89.9%], P < .001) were significantly more supportive of the laws, whereas liberals were more likely to express ethical concern (248 of 301 [82.4%], P < .001) and discomfort with internationally trained surgeon care (257 of 301 [85.3%], P = .02). The majority of respondents (817 [76.6%]) supported restricting internationally trained surgeon practice to underserved areas.Conclusions and RelevanceFindings of this study suggest that the US public generally supports licensure laws for internationally trained surgeons but with important caveats, including geographic restriction of prac
{"title":"Public Views on State Licensure of Internationally Trained Surgeons Without US Residency.","authors":"Forrest Bohler,Aaquib Noorani,Jesse C Selber,Karam Hadid,Angelis Lau,George A Flores,Sergey G Toshinskiy,Kongkrit Chaiyasate","doi":"10.1001/jamasurg.2025.6145","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6145","url":null,"abstract":"ImportanceAs part of an effort to boost physician supply and opportunity, several US states have recently enacted laws permitting internationally trained physicians to practice without completing an Accreditation Council for Graduate Medical Education-accredited residency or fellowship, representing a major departure from long-standing licensure norms. Little is known about how the public perceives these laws, particularly in surgical fields in which technical competency and patient trust are paramount.ObjectiveTo assess public perceptions of state laws permitting internationally trained surgeons to practice in the US without US-based residency training.Design, Setting, and ParticipantsThis cross-sectional study involving perspectives of US adults on state licensure of internationally trained surgeons to address surgical workforce shortages was conducted in July 2025 using an online crowdsourcing platform (Amazon Mechanical Turk; Amazon Mechanical Turk, Inc). A 21-item survey was administered through Qualtrics (Qualtrics, LLC). Quality control included definitional understanding, attention checks, and time-based screening.Main Outcomes and MeasuresPrimary outcomes included support for licensure laws for internationally trained surgeons, ethical concerns regarding international brain drain, perceived training equivalence, personal comfort with internationally trained surgeon care, hospital trust, and preferences for regulatory oversight. Subgroup analyses were performed by sex and self-defined political views using χ2 testing.ResultsOf 1270 initial responses, 1066 (83.9%) passed quality criteria and were analyzed. Among 1066 respondents (634 male [59.5%], median [IQR] age 33 [29-35] years), 906 (85.0%) supported state licensure laws for internationally trained surgeons. Most respondents (991; 93.0%) believed such laws would improve access and 856 (80.3%) felt diversity would improve, yet 755 (70.8%) expressed ethical concerns about international brain drain. Regarding training, a majority of respondents (787; 73.8%) did not view international training as equivalent to US training, and 831 (78.0%) reported they would be less likely to select an internationally trained surgeon for surgery. Regarding informed consent, nearly all respondents (1005; 94.3%) supported mandatory disclosure of training background. Males (575 of 634 [90.7%], P < .001) and conservatives (512 of 569 [89.9%], P < .001) were significantly more supportive of the laws, whereas liberals were more likely to express ethical concern (248 of 301 [82.4%], P < .001) and discomfort with internationally trained surgeon care (257 of 301 [85.3%], P = .02). The majority of respondents (817 [76.6%]) supported restricting internationally trained surgeon practice to underserved areas.Conclusions and RelevanceFindings of this study suggest that the US public generally supports licensure laws for internationally trained surgeons but with important caveats, including geographic restriction of prac","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"87 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005276","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 : 2026-01-21DOI: 10.1001/jamasurg.2025.6152
Kamal M F Itani,Marco G Patti
{"title":"A Window on the Public's Perception of Internationally Trained Surgeons.","authors":"Kamal M F Itani,Marco G Patti","doi":"10.1001/jamasurg.2025.6152","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6152","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"16 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005279","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 : 2026-01-14DOI: 10.1001/jamasurg.2025.6035
Jayson S Marwaha,Daniel A Hashimoto
{"title":"Preempting the Trough of Disillusionment in Surgical AI.","authors":"Jayson S Marwaha,Daniel A Hashimoto","doi":"10.1001/jamasurg.2025.6035","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6035","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"20 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961492","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 : 2026-01-14DOI: 10.1001/jamasurg.2025.6029
Melissa Thornton,Benjamin A Y Cher,Cameron Macdonald,Jocelyn G Baker,Elisa L Marten,Don Mai,Ganesh Sankaranarayanan,Courtney J Balentine
ImportanceHaving significant gaps between the expectations and reality of artificial intelligence-based programs can be a major barrier to successful implementation. This is the first multisite implementation assessment of gaps between surgeon expectations and real-world effects of the Operating Room Black Box, a novel intervention that leverages artificial intelligence to improve surgical outcomes.ObjectiveTo identify barriers and facilitators to implementing artificial intelligence-based interventions that improve intra- and postoperative care.Design, Setting, and ParticipantsThis qualitative study was conducted at 3 large academic centers via semistructured interviews with surgeons and implementation leaders of the AI intervention to identify areas where expectations of the technology misaligned with their experiences. Thirty surgeons and 17 implementation leaders from 3 centers that implemented the AI intervention were interviewed. Data were collected and analyzed between 2021 and 2024.ExposureImplementation of the AI intervention.Main Outcomes and MeasuresThe primary outcome was areas of misalignment between participant expectations of the AI intervention technology and actual program deliverables.ResultsOf 30 surgeons and 17 implementation leaders interviewed, most surgeons (17 [57%]) were between the ages of 35 and 50 years, and implementation leaders were older, typically between 51 and 80 years old (6 [35%]). Eight surgeons (27%) and 4 implementation leaders (24%) were female. Most surgeons (17 [57%]) had neutral views of the technology, 11 (37%) expressed positive views, and 2 (7%) had negative views. Interviewees identified the following 4 major themes that highlighted misalignment between user expectations and the experience of using the technology: (1) the artificial intelligence model needed considerable additional training to be usable; (2) accessing data on surgical cases was difficult and time consuming; (3) the program showed limited ability to predict postoperative complications; and (4) the program generated few academic deliverables.Conclusions and RelevancePer the results of this multisite qualitative study, successfully implementing interventions based on artificial intelligence may require deliberate efforts to minimize gaps between what surgeons expect from the interventions and what they can deliver. Our evaluation of this study's AI intervention offers lessons for addressing this critical barrier to implementation.
{"title":"Expectations vs Reality of an Intraoperative Artificial Intelligence Intervention.","authors":"Melissa Thornton,Benjamin A Y Cher,Cameron Macdonald,Jocelyn G Baker,Elisa L Marten,Don Mai,Ganesh Sankaranarayanan,Courtney J Balentine","doi":"10.1001/jamasurg.2025.6029","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6029","url":null,"abstract":"ImportanceHaving significant gaps between the expectations and reality of artificial intelligence-based programs can be a major barrier to successful implementation. This is the first multisite implementation assessment of gaps between surgeon expectations and real-world effects of the Operating Room Black Box, a novel intervention that leverages artificial intelligence to improve surgical outcomes.ObjectiveTo identify barriers and facilitators to implementing artificial intelligence-based interventions that improve intra- and postoperative care.Design, Setting, and ParticipantsThis qualitative study was conducted at 3 large academic centers via semistructured interviews with surgeons and implementation leaders of the AI intervention to identify areas where expectations of the technology misaligned with their experiences. Thirty surgeons and 17 implementation leaders from 3 centers that implemented the AI intervention were interviewed. Data were collected and analyzed between 2021 and 2024.ExposureImplementation of the AI intervention.Main Outcomes and MeasuresThe primary outcome was areas of misalignment between participant expectations of the AI intervention technology and actual program deliverables.ResultsOf 30 surgeons and 17 implementation leaders interviewed, most surgeons (17 [57%]) were between the ages of 35 and 50 years, and implementation leaders were older, typically between 51 and 80 years old (6 [35%]). Eight surgeons (27%) and 4 implementation leaders (24%) were female. Most surgeons (17 [57%]) had neutral views of the technology, 11 (37%) expressed positive views, and 2 (7%) had negative views. Interviewees identified the following 4 major themes that highlighted misalignment between user expectations and the experience of using the technology: (1) the artificial intelligence model needed considerable additional training to be usable; (2) accessing data on surgical cases was difficult and time consuming; (3) the program showed limited ability to predict postoperative complications; and (4) the program generated few academic deliverables.Conclusions and RelevancePer the results of this multisite qualitative study, successfully implementing interventions based on artificial intelligence may require deliberate efforts to minimize gaps between what surgeons expect from the interventions and what they can deliver. Our evaluation of this study's AI intervention offers lessons for addressing this critical barrier to implementation.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"30 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961490","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 : 2026-01-14DOI: 10.1001/jamasurg.2025.6067
Julia H Song,Patricia L Turner,Thomas C Tsai
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