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In This Issue of JAMA Surgery
February 2014

Highlights

JAMA Surg. 2014;149(2):105. doi:10.1001/jamasurg.2013.3464
Research

Recent evidence suggests that vitamin D status may be a modifiable risk factor for nosocomial infections. Quraishi and coauthors performed a retrospective analysis of 770 patients who underwent Roux-en-Y gastric bypass surgery from a single teaching hospital in Boston, Massachusetts, between 2007 and 2011, to determine whether preoperative 25-hydroxyvitamin D levels are associated with the risk of hospital-acquired infections. In this cohort of patients, a significant inverse association was observed between preoperative vitamin D status and the risk of postoperative infections.

Reducing mortality after major postoperative complications (failure to rescue [FTR]) may hold the potential to significantly decrease overall hospital mortality. Gonzalez and colleagues used national Medicare data to examine rates of mortality, complications, and FTR at high- and low-volume hospitals. Compared with low-volume hospitals, high-volume institutions have similar rates of complications but dramatically lower rates of FTR and postoperative mortality.

Invited Commentary

The expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) guides breast cancer management but is not included in the TNM staging system. Bagaria and colleagues examine the effect of the triple-negative phenotype (defined by the absence of ER, PR, and HER2) on TNM staging for 1842 patients with breast cancer and show that the inclusion of a recognized and easily reproducible examination of ER, PR, and HER2 expression improves the prognostic accuracy of TNM staging for breast cancer.

The use of epidural analgesia in laparoscopic colorectal surgery has demonstrated superiority over conventional analgesia in controlling pain; however, controversy exists regarding its cost-effectiveness and its effect on postoperative outcomes. In a retrospective review of a large nationwide database, Habibi and coauthors found that while epidural analgesia appears to be safe, it comes with higher hospital charges, longer hospital stay, and a higher incidence of urinary tract infections.

Continuing Medical Education

The goal of this study was to determine whether providing hospitals with benchmarking information on their trauma mortality outcomes leads to improved outcomes. Glance and colleagues report the impact of providing confidential performance reports in a cohort of 326 206 trauma patients admitted to 44 hospitals, controlling for injury severity, patient case mix, hospital effects, and preexisting time trends. Nonpublic reporting of hospital risk-adjusted mortality rates did not lead to improved trauma mortality outcomes.

Invited Commentary

There is significant variation in the duration of chemotherapy administered to patients with locally advanced pancreatic cancer prior to surgical resection. Kadera and colleagues retrospectively reviewed 49 consecutive patients at a single institution with American Joint Committee on Cancer stage III pancreatic ductal adenocarcinoma who underwent a surgical resection during the period from 1992 to 2011. A longer duration of chemotherapy was associated with lymph node negativity and outstanding overall survival. The prognostic biomarkers of SMAD4, perineural invasion, and histopathologic response were also associated with survival and could be used to determine which patients are more likely to benefit from additional adjuvant therapy.

Invited Commentary

Hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CRS) in the treatment of metastatic and primary peritoneal cancer are associated with high morbidity and mortality. In a retrospective review, Jafari and colleagues demonstrated that the overall mortality and morbidity rates associated with HIPEC-CRS are acceptable.

Invited Commentary

Juo and colleagues performed a propensity score–matched analysis between robotic, laparoscopic, and open colectomy using data from the US Nationwide Inpatient Sample database from 2008 to 2010. Although robotic colectomy is shown to be equivalent to laparoscopic colectomy in most clinical outcomes, laparoscopic colectomy is shown to be associated with both favorable clinical outcomes and lower cost compared with open colectomy.

Invited Commentary

Continuing Medical Education

It is not known whether sentinel lymph node biopsy (SLNB) rates for breast cancer differ by surgeon expertise. In a population-based prospective cohort of 1703 elderly breast cancer survivors, Yen and coauthors found that women treated by surgeons with more experience with and focus on breast cancer (eg, those with a higher percentage and volume of breast cancer cases) were more likely to undergo SLNB.

Invited Commentary

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