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In This Issue of JAMA Surgery
August 2014


JAMA Surg. 2014;149(8):753. doi:10.1001/jamasurg.2013.3494

Policy makers have developed an all-cause hospital readmissions measure that uses administrative claims data to evaluate hospital performance. To determine this measure’s accuracy, Sacks and coauthors retrospectively reviewed 315 consecutive readmissions at a large academic medical center. They identified significant limitations in the readmission measure’s ability to exclude planned readmissions and to capture the clinical reason for readmission. Readmissions for reasons unrelated to the original hospital stay were also noted to be frequent.

Invited Commentary

Continuing Medical Education

Nationally, the number of cases of traumatic injury to elderly patients is increasing. Recent work has shown frailty as a tool to define the gap that exists between physiological and chronological age. Joseph et al investigated the use of the Frailty Index for geriatric patients after traumatic injury. Notably, the Frailty Index was superior to age and an independent predictor for the development of in-hospital complications and adverse discharge disposition.

Invited Commentary

Adjustable gastric bands are widely used because of low postoperative morbidity, but their long-term results are poor, often leading to revisional surgery. Thereaux et al assess the safety of revisional procedures by comparing the 30-day outcomes of primary gastric bypass vs revisions following failed adjustable gastric banding. They found that the 30-day major adverse outcome rates were similar for primary gastric bypass and for procedures following failed adjustable gastric banding. Long-term comparative studies are required to better understand the quadratic relationship between body mass index and early postoperative outcomes.

Invited Commentary

Ingalls and coauthors identify differences in mortality for soldiers undergoing early and rapid evacuation from the combat theater and evaluate the capabilities of the Critical Care Air Transport Team and Joint Theater Trauma Registry databases to provide adequate data to support future initiatives for improvement of performance. They found that rapid movement of critically injured casualties within hours of wounding appears to be effective, with a minimal mortality incurred during movement and overall 30-day mortality. They also found no association between the duration of time from wounding to arrival at Landstuhl Regional Medical Center with respect to mortality.

Invited Commentary

The degree to which extended length of stay represents complications, patient illness, or inefficient practice style is unclear. Krell and colleagues analyzed data from the 2009 American College of Surgeons National Surgical Quality Improvement Program. Study participants were 22 664 adults undergoing colorectal resections in 199 hospitals. Much of the variation in hospitals’ risk-adjusted extended length of stay rates is not attributable to patient illness or complications and therefore most likely represents differences in practice style.