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In This Issue of JAMA Surgery
September 2019

Highlights

JAMA Surg. 2019;154(9):789. doi:10.1001/jamasurg.2018.3833
Research

In this prospective surveillance study, Armer and colleagues examined factors associated with lymphedema, a well-known complication of breast cancer treatment, after neoadjuvant chemotherapy and axillary dissection in 486 women with node-positive breast cancer. Obesity (body mass index ≥30) was associated with lymphedema symptoms, and neoadjuvant chemotherapy lasting 144 days or longer was associated with 20% limb-volume increase. Patients with longer neoadjuvant chemotherapy duration or obesity may have higher lymphedema risk and may benefit from enhanced prospective surveillance.

Invited Commentary

The optimal use of magnetic resonance imaging-guided prostate biopsy is not yet clear. In a paired-cohort trial at University of California Los Angeles, Elkhoury and colleagues evaluated the detection rate of clinically significant prostate cancer in 300 men undergoing a first biopsy. Magnetic resonance imaging–targeted biopsy was compared against 12-core systematic biopsy, with each man serving as his own control. Results showed that prostate cancer detection is maximized when systematic and targeted biopsies are combined.

Invited Commentary

Delirium is common after cardiac surgery and may result from changes in cerebral perfusion. Brown and colleagues conducted a randomized clinical trial on 199 participants to determine whether targeting mean arterial pressure during cardiopulmonary bypass procedures using cerebral autoregulation monitoring could reduce the incidence of delirium. The results showed that postoperative delirium was less common in the intervention arm than the arm receiving usual care.

Invited Commentary

For surgical teams, reliable and optimal patient care depends on effective communication, mutual respect, and situational awareness. In this cohort study of 13 653 patients undergoing surgery by 202 surgeons at 2 geographically diverse academic medical centers, Cooper and colleagues explored whether surgeons’ unprofessional behavior increased risk for postoperative complications. Patients whose surgeons had a higher numbers of coworker reports of unprofessional behavior in the 36 months before their operations were more likely to experience medical and surgical complications.

Invited Commentary

Continuing Medical Education and Audio Author Interview

This study examined whether patients undergoing common advanced laparoscopic abdominal operations would have improved outcomes if their procedures were performed at a US hospital ranked in the top 50 for gastroenterology and gastrointestinal surgery. Gambhir and colleagues conducted a retrospective analysis of the Vizient database on 51 858 patients. Within academic centers, the top-50 hospitals performed 3-fold more laparoscopic abdominal operations annually compared with nonranked hospitals, but there was no association between hospital ranking and patient outcomes.

Invited Commentary

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