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In This Issue of JAMA Surgery
July 2014


JAMA Surg. 2014;149(7):625. doi:10.1001/jamasurg.2013.3489


Kim and colleagues designed a predictive model for adverse outcomes in older surgical patients. In a single-institution prospective cohort study, they performed a comprehensive geriatric assessment (CGA) of 275 elderly patients (aged ≥65 years) undergoing elective operation. A multidimensional frailty score (MFS) was established using the results of the CGA, and it was shown that the MFS is more useful than conventional methods for predicting the outcomes of geriatric patients.

Invited Commentary

Continuing Medical Education

Racial disparities in survival after trauma are well described for patients younger than 65 years. Similar information among older patients is lacking because existing trauma databases do not include important patient comorbidity information. Using a unique method for extracting trauma and comorbidity data on more than 1 million patients from the Nationwide Inpatient Sample (2003-2010), Hicks et al demonstrate that different racial disparities in survival after trauma exist between white and black patients depending on their age group. Although younger white patients have better outcomes after trauma than younger black patients, older black patients have better outcomes than older white patients.

There is growing interest in the use of health care resources by critical access hospitals (CAHs), key providers of medical care for many rural populations. Gadzinski et al used data from the Nationwide Inpatient Sample and American Hospital Association to perform a retrospective cohort study of patients undergoing common inpatient surgical procedures at CAHs or non-CAHs. They found that hospital transfers occur more often after surgical admissions at CAHs. However, the proportion of patients at CAHs using post–acute care is equal to or lower than that of patients treated in non-CAHs.

Invited Commentary

Continuing Medical Education

Brown and coauthors evaluate the effect of hospital length of stay and the occurrence of postoperative complications on total charges in patients undergoing elective pancreaticoduodenectomy. They performed a retrospective review of 89 cases identified in an institutional database of patients who underwent elective pancreaticoduodenectomy at an academic tertiary care center from December 1, 2007, through May 31, 2012, and concluded that efforts should be directed instead at reducing complications because this has a much more significant effect on financial outcomes.

Emerging data support bariatric surgery as a therapeutic strategy for management of type 2 diabetes. Halperin et al performed a 1-year pragmatic randomized trial to test the feasibility of methods to conduct a larger multisite trial to determine the long-term effect of Roux-en-Y gastric bypass surgery compared with an intensive diabetes medical and weight management program for type 2 diabetes. They found that patients in the surgical group were more likely to achieve glycemic, blood pressure, and lipid targets at 1 year.