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In This Issue of JAMA Surgery
December 2013

Highlights

JAMA Surg. 2013;148(12):1081-1083. doi:10.1001/jamasurg.2013.2208
Research

Transcatheter aortic valve replacement (TAVR) is approved for patients for whom traditional AVR poses high or prohibitive risk. Omer and colleagues evaluated the early results of one the first Veteran Affairs (VA) TAVR programs, in which19 transfemoral TAVRs were performed. There was no operative (30-day) mortality and a low incidence of major morbidity. Thus, TAVR can be performed safely and with good outcomes at a VA facility with adequate expertise and resources.

Invited Commentary

Whether hospital and surgeon volumes have an association with readmission among patients undergoing pancreatoduodenectomy is not known. Using the Surveillance, Epidemiology, and End Results (SEER)–Medicare data, Hyder and colleagues examined in-hospital morbidity, mortality, and procedure volumes relative to 30-day readmission. Nearly 1 in 5 patients were readmitted following pancreatoduodenectomy. Although differences in readmission were attributable to differences among hospitals, the largest share of variation was found at the patient level.

Invited Commentary

Continuing Medical Education

To determine whether the administration of chemotherapy mitigates tumor growth after portal vein embolization (PVE) that is performed before major hepatectomy for metastatic colorectal cancer, Fischer et al performed a retrospective analysis of 64 consecutive PVEs performed in patients with metastatic colorectal cancer. Two hundred eight tumors were measured in these 64 patients. It was found that chemotherapy does not retard growth of the liver after PVE and may prevent cancer progression.

Data examining mortality in patients eligible for bariatric surgery are limited. Padwal and colleagues studied 15 394 surgery-eligible individuals and derived a simple clinical prediction rule based on age, diabetes mellitus, smoking, and male sex that can be used to predict the risk of 10-year all-cause mortality. Body mass index was notably absent as an important mortality predictor, which led the authors to question the current practice of primarily basing surgical eligibility on this anthropometric index.

Racial disparities in receipt of minimally invasive surgery (MIS) persist in the United States; however, little is known as to how expanding insurance coverage influences disparities in surgical care. Loehrer and colleagues performed a cohort study of 167 560 nonelderly adults undergoing surgery in Massachusetts and 6 control states between 2001 and 2009. The 2006 Massachusetts health care reform was associated with increased receipt of MIS by nonwhite patients and elimination of racial disparities in Massachusetts, while disparities persisted in control states.

To identify the age at which the risk of venous thromboembolism (VTE) after trauma increases from the low rate seen in children toward the higher rate seen in adults, Van Arendonk and colleagues examined VTE risk among trauma patients 21 years of age or younger in the National Trauma Data Bank (2008-2010). While controlling for other known VTE risk factors, they found that the risk of VTE varied considerably across patient age and increased dramatically at age 16 years, after a smaller increase at age 13 years.

Invited Commentary

Continuing Medical Education

Optimally forecasting surgical risk for older adults requires quantifying geriatric syndromes, such as a history of falls, in addition to the traditional preoperative assessment of chronic disease burden. Jones and coauthors included patients 65 years and older undergoing colorectal or cardiac operations and data on related postoperative outcomes to a history of prior falls. A history of 1 or more falls in the 6 months prior to an operation was associated with an increased risk of postoperative complications, need for discharge to an institutional care facility, and need for 30-day readmission.

Invited Commentary

Author Audio Interview

Uncertainty exists about the influence of advanced age on the outcomes of carotid revascularization. Antoniou and colleagues conducted a systematic literature review to identify articles comparing outcomes of carotid endarterectomy (CEA) or carotid stenting (CAS) in a study population comprising 587 886 patients. Carotid stenting was found to be associated with increased risk of stroke in the elderly compared with their young counterparts; CEA was associated with similar neurologic outcomes in elderly and young patients, at the expense of increased peri-interventional mortality.

Invited Commentary

Zenoni and coauthors review the current data available regarding the use of minimally invasive techniques for patients requiring resection of the head of the pancreas. A retrospective review of all published studies in the English literature describing minimally invasive pancreaticoduodenectomy was performed. The reported advantages of minimally invasive pancreaticoduodenectomy include better visualization, faster recovery time, and decreased length of hospital stay. In cases of robotic approaches, some of the proposed advantages include increased dexterity and a superior ergonomic position for the operating surgeon. It remains to be determined, however, if the benefits of this technique outweigh the longer operative times and higher costs associated with this approach.

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