A JAMA THEME ISSUE
Edited by John L. Zeller, MD, PhD, and Phil B. Fontanarosa, MD, MBA
In a multicenter randomized trial, Lederle and colleagues compared short-term outcomes following endovascular vs open repair of abdominal aortic aneurysm. The authors found that perioperative mortality (30 days or inpatient) was lower among patients who underwent endovascular repair. However, at a 2-year follow-up, there were no significant differences in mortality, major morbidity, procedure failure, secondary therapeutic procedures, health-related quality of life, or erectile function by surgical approach.
Some data suggest that a higher perioperative inspiratory oxygen fraction is associated with a reduced risk of surgical site infections. Meyhoff and colleagues Article randomly assigned 1400 patients who were undergoing acute or elective laparotomy to receive either 80% or 30% oxygen during and for 2 hours after surgery and found no difference in the risk of surgical site infection. In an editorial, Hunt and Hopf Article discuss the evidence that links the use of high inspiratory oxygen to the prevention of surgical site infections.
Among women with stage 0 through II breast cancer, Morrow and colleagues assessed the rate of initial mastectomy, the perceived reason for its use, and the rate of mastectomy after breast-conserving surgery. The authors report that breast-conserving surgery was recommended and attempted as initial therapy in the majority (75.4%) of women. Surgeon recommendation, patient preference, and failure of breast-conserving surgery all contributed to the mastectomy rate.
Use of minimally invasive radical prostatectomy has increased in recent years despite limited data on outcomes compared with patients who had the conventional open retropubic approach. In a population-based observational cohort, Hu and colleagues found that compared with open retropubic radical prostatectomy, patients who underwent the minimally invasive procedure had significantly shorter lengths of stay, fewer respiratory and miscellaneous surgical complications, and strictures with similar rates of use of additional cancer therapies. Minimally invasive radical prostatectomy was associated with more genitourinary complications, erectile dysfunction, and incontinence.
In a retrospective cohort study, Rothschild and colleagues examined the relationship between attending surgeons' and obstetrician/gynecologists' nighttime work hours and rates of complications in procedures performed the following day. The authors found that overall complication rates the day after overnight work were not significantly greater than complication rates associated with procedures of the same type performed on days not following overnight procedures. Overnight sleep opportunities of 6 hours or less were associated with higher rates of surgical (but not labor and delivery) complications the next day.
In an analysis of 1985-2005 Medicare claims data, Brauer and colleagues examined trends in hip fracture incidence and mortality. The authors report that hip fracture rates and subsequent mortality declined and patient comorbidities increased during the study period.
“Breast cancer: The pink disease; a woman's problem; a girlie, nonmasculine thing.” From “Oh, to Live in an Age When Men Had Breasts . . . ”
Organizations are seeking innovative ways to boost the evidence base for surgery, for which use of randomized clinical trials to test new surgical interventions has proven challenging.
Beyond outcomes: the appropriateness of surgical care
Preoperative functional status assessment of older adults
Multihospital collaborative for surgical quality
Musculoskeletal conditions: clinical and workforce needs
Zeller and Fontanarosa discuss important issues confronting surgical practice, including shared accountability, appropriateness, and quality.
How would you care for a 66-year-old man with an abdominal aortic aneurysm? Go to www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is November 8.
For your patients: Information about lung complications after surgery.
This Week in JAMA . JAMA. 2009;302(14):1501. doi:10.1001/jama.2009.1475