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In This Issue of JAMA Surgery
December 2014


JAMA Surg. 2014;149(12):1217. doi:10.1001/jamasurg.2013.3514


Little is known about the relationship between hospital care intensity and outcomes for surgical patients. Sheetz et al explored this relationship for Medicare beneficiaries using the hospital care intensity index, which is validated and publicly available through the Dartmouth Atlas of Healthcare. Although failure-to-rescue rates were lower at high–care intensity hospitals, care intensity explains a very small proportion of variation in failure-to-rescue rates across hospitals, which suggests that more aggressive care and higher resource utilization alone do not improve outcomes.

Continuing Medical Education

Malas et al compared 30-day mortality from the recent Open Vs Endovascular Repair (OVER) Veterans Affairs Cooperative trial with results obtained from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) and assessed temporal trends in perioperative mortality. They analyzed data from 21 115 patients who received elective endovascular aneurysm repair or open repair for asymptomatic infrarenal abdominal aortic aneurysms (AAA) between 2005 and 2011 in the NSQIP database. Perioperative mortality reported by the OVER trial is significantly lower than outcomes from practices outside the restriction of randomized clinical trials.

Few long-term data describe the natural history of hepatic hemangiomas. Because the rate and magnitude of normal growth is not well characterized, it is difficult to recognize lesions growing at an abnormal rate, which may require further evaluation or intervention. During a 10-year period, a total of 163 hemangiomas were identified in 123 patients. Hasan et al established quantitatively the expected growth rate of hepatic hemangiomas and defined a measure of hemangioma growth that could be used clinically to help identify hemangiomas for which growth is more than expected.

Readmission has become a major hospital quality metric, but it is unclear whether there is much difference in readmission among hospitals after appropriate risk adjustment. Lucas et al performed a hierarchical multivariable logistic regression analysis of observational data obtained from the Surveillance, Epidemiology, and End Results–Medicare linked database, a nationally representative cancer registry. They studied 44 822 patients who underwent colorectal resection for cancer at 1401 US hospitals from 1997 through 2002. Although there was marked variation in raw readmission rates, no significant variability was found in readmission rates among hospitals after adjusting for patient characteristics in a hierarchical model.

Invited Commentary

Continuing Medical Education

Arterburn et al compared the effect of laparoscopic Roux-en-Y gastric bypass (RYGB) vs gastric banding (AGB) on short- and long-term health outcomes in a retrospective cohort study of 7457 individuals 21 years or older who underwent laparoscopic bariatric surgery from 2005 through 2009, with follow-up through 2010. They found that RYGB resulted in greater weight loss than AGB but had a higher risk of short-term complications and long-term subsequent hospitalizations.

Invited Commentary