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In This Issue of JAMA
February 3, 2015


JAMA. 2015;313(5):441-443. doi:10.1001/jama.2014.11553

Opinion 1 and 2; Research 1, 2, and 3; and JAMA Patient Page


In a multisite randomized clinical trial that enrolled 680 patients with severe trauma who were predicted to require massive transfusion, Holcomb and colleagues assessed the efficacy and safety of active resuscitation with plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio. The authors found no significant differences in mortality at 24 hours or at 30 days among patients receiving blood product transfusion in a 1:1:1 vs a 1:1:2 ratio.

Merkow and colleagues analyzed data from 346 hospitals (498 875 operations) participating in the American College of Surgeons National Surgical Quality Improvement Program to examine factors associated with unplanned postoperative readmissions. Among the authors’ findings was that postoperative readmissions were associated with new postdischarge complications related to the surgical procedure—for example, surgical site infections and ileus—and not exacerbations of conditions present before the index hospitalization. In an Editorial, Leape discusses strategies to reduce surgical complications.


Author Video Interview and Continuing Medical Education

Osborne and colleagues evaluated the relationship between American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) participation and surgical outcomes and Medicare expenditures in an analysis of data (2003-2012) from more than 1.2 million patients. Outcomes and expenditures were assessed before and after ACS NSQIP enrollment in 263 hospitals and were compared with outcomes and expenditures in 526 hospitals not participating in ACS NSQIP. The authors found no association between ACS NSQIP participation and improved surgical outcomes or lower Medicare payments. In an Editorial, Berwick discusses measuring outcomes to improve the quality of surgical care.

Editorial and Related Article

Author Audio Interview

Etzioni and colleagues analyzed patient data from nearly 340 000 elective surgery hospitalizations at a consortium of 113 academic hospitals to assess surgical outcomes experienced by patients treated at 44 hospitals participating in and 69 not participating in the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP). In analyses that accounted for patient risk, procedure type, and temporal trends, the authors found no association between hospital participation in ACS NSQIP and improvements in postoperative outcomes over time.

Editorial and Related Article

Clinical Review & Education

An article in JAMA Surgery reported that more than one-quarter of surgery-associated complications are diagnosed after hospital discharge and are strong predictors of hospital readmission. In this From The JAMA Network article, Dimick and Ghaferi discuss whether hospital readmission rates are a useful quality measure in surgery.

An elderly man taking warfarin for atrial fibrillation has a 4-month history of multiple dark lesions on his upper body and in his mouth and an unintentional weight loss of 15.8 kg. Physical examination reveals many slightly raised and erythematous skin lesions and 2 discrete erythematous patches on the soft palate. A skin lesion was biopsied, and results are pending. What would you do next?

In this JAMA Diagnostic Test Interpretation article, VanWagner and Green present a 57-year-old man with asymptomatic hyperbilirubinemia. The patient takes no medications and drinks one alcoholic beverage daily. His physical examination is generally unremarkable. How would you interpret the finding of hyperbilirubinemia?