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In This Issue of JAMA Surgery
May 2014


JAMA Surg. 2014;149(5):409. doi:10.1001/jamasurg.2013.3479


The best surgical approach to repair primary ventral hernias remains unclear. Nguyen and colleagues performed a systematic review and meta-analysis of all comparative studies evaluating mesh vs suture repair of primary ventral hernias. Mesh repair of primary ventral hernias is associated with fewer hernia recurrences but a slightly increased rate of seroma and surgical site infection. Further prospective, randomized trials are needed to identify the best technique in patients.

Continuing Medical Education

The goal of this study was to determine the factors associated with the decision to admit rather than transfer severely injured patients who are initially seen at non–trauma center emergency departments (EDs). Delgado and colleagues analyzed 4513 major trauma encounters in 636 non–trauma center EDs. Patients with insurance, those with severe abdominal injuries, and those with initial care in higher-volume, urban teaching hospitals had a significantly increased risk of being hospitalized in a non–trauma center rather than transferred to a trauma center.

Invited Commentary

Hospital readmissions are an indicator of suboptimal care and have been targeted by the Centers for Medicare & Medicaid Services to reduce health care cost and improve quality. Using American College of Surgeons National Surgical Quality Improvement Program (NSQIP) data, Glance and colleagues performed a retrospective cohort study of 142 232 patients who underwent noncardiac surgery. They found that the risk of postoperative complications was a strong predictor of hospital readmission. Prospective identification of high-risk patients, using the NSQIP complication risk index, may allow hospitals to reduce unplanned rehospitalization.

Invited Commentary

There are no readily available endovascular devices in the United States to treat high-risk patients with symptomatic complex aortic aneurysms. Pisimisis et al describe a successful treatment of a ruptured juxtarenal aortic aneurysm using a surgeon-modified fenestrated endovascular graft for a high–surgical risk patient with limited surgical options.

Invited Commentary

Lamore and colleagues evaluated the variability of perioperative glucocorticoid dosing among patients with inflammatory bowel disease (IBD) undergoing major abdominal surgery. A retrospective study of 49 patients with IBD undergoing colorectal surgery at a single institution between July 2010 and August 2011 was performed. Administration of high-dose perioperative glucocorticoids is a common practice, but physician prescribing habits were highly variable. Many of the patients with IBD had a very low clinical risk of postoperative adrenal crisis.

Invited Commentary