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In This Issue of JAMA Surgery
January 2014


JAMA Surg. 2014;149(1):2-3. doi:10.1001/jamasurg.2013.3459

Although lower extremity revascularization is effective in preventing amputation, the relationship between spending on vascular care and regional amputation rates remains unclear. Using 18 463 Medicare patients with severe peripheral arterial disease, Goodney and coauthors examined the relationship between spending on vascular care and regional amputation risk. Although revascularization was associated with higher spending (R = 0.38), higher spending was not associated with lower regional amputation rates (R = 0.10).

Continuing Medical Education

Previous studies have described the prevalence and mortality of venous thromboembolism following oncologic surgery, but they were limited by small sample size and homogenous populations from single-institution series. Trinh and colleagues performed a population-level assessment of the likelihood of venous thromboembolism following major cancer surgery for 8 solid cancers. They demonstrated that the prevalence of venous thromboembolism events following major cancer surgery has increased over time; however, venous thromboembolism-associated mortality has decreased.

Continuing Medical Education

A comparison of how different health care systems affect pediatric surgical outcomes has never been performed. In this study, Cheong and Emil use national databases from the United States and Canada to compare outcomes of the most common pediatric acute surgical disease, appendicitis. Overall, the Canadian perforation rate fell in the middle between privately insured and publicly insured or noninsured US patients. Age and US insurance status were the most important determinants of outcome differences between the 2 cohorts.

Gastroesophageal reflux disease (GERD) is a common diagnosis in infants and young children, but the prevalence of physiologic regurgitation in this population makes diagnosis and treatment challenging, and the influence of patient age on surgical management is not known. McAteer and colleagues evaluated 9 years of data from a national registry of children's hospitals to determine the association between patient age and the likelihood of undergoing an antireflux procedure among hospitalized children with a diagnosis of GERD. They showed that the hazard of progression to an antireflux procedure is significantly higher among children 6 months of age or younger than among older children after adjusting for patient demographics and other indications for operative management.

Invited Commentary

The use of technically variant segmental grafts allows for living donors or split/reduced-size grafts from deceased donors to increase the donor pool. Rodriguez-Davalos and colleagues retrospectively analyzed 218 consecutive liver transplant patients from August 2007 to August 2012; 69 of these patients received segmental grafts with minimal vascular complications and outcomes equivalent to patients who underwent transplantation with whole liver grafts.

Salim and colleagues sought to determine whether outreach interventions targeting Hispanic Americans improve organ donation outcomes. They conducted a prospective before-after study of 4 southern California neighborhoods with a high percentage of Hispanic American residents and established that focused donor outreach significantly improved intent to donate.

Liver grafts procured after circulatory death have been used to address the acute shortage of organs and to decrease the waiting list mortality rate for adults; however, the use of grafts from donation after circulatory death (DCD) for children remains controversial, and outcome data are limited. Hong and colleagues report a 20-year, case-matched retrospective outcomes analysis of orthotopic liver transplantation in children using grafts from DCD vs donation after brain death. Their study showed excellent long-term outcomes with liver transplantation in children using DCD organs.

Older patients have a more difficult time recovering from acute traumatic injury than do younger patients. Tillou and colleagues implemented a routine geriatric consultation for all elderly trauma patients admitted to an academic tertiary care level 1 trauma center and then followed up with these patients for 1 year to determine their postinjury functional status. They found that the functional recovery of patients after implementation of the new program was better than that of a control group of patients admitted prior to implementation of the new program.

Invited Commentary

Author Video Interview