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In This Issue of JAMA Surgery
January 2017

Highlights

Author Affiliations
 

Copyright 2017 American Medical Association. All Rights Reserved.

JAMA Surg. 2017;152(1):1. doi:10.1001/jamasurg.2016.3407
Research

There is sparse recent data on rural trauma care and how processes and outcomes compare with urban settings. Using a prospective cohort of 67 047 injured patients served by 44 emergency medical services (EMS) agencies and 27 hospitals in 7 counties, Newgard et al sought to compare rural vs urban processes of care and outcomes following trauma. Most high-risk trauma patients injured in rural areas were cared for outside of major trauma centers, and rural trauma deaths tended to occur early.

CME and Author Audio Interview

Pancreatic mucinous cystic neoplasms (MCNs) harbor malignant potential, and current guidelines recommend resection. However, data are limited on preoperative risk factors for malignancy occurring in the setting of an MCN. The associations of preoperative factors with malignancy were assessed by Postlewait et al for 349 patients who underwent MCN resection at 8 centers (2000-2014). Independent risk factors for malignancy in resected pancreatic MCNs include male sex, pancreatic head/neck location, larger MCN, solid component/mural nodule, and duct dilation.

Invited Commentary

CME

To date, no previous studies have tested whether the mechanism of injury influences the risk of venous thromboembolism (VTE). The data in the study by Karcutskie et al show that transfusion status, neurologic status, and pelvic fracture independently predict VTE after blunt trauma and that vascular injury, severe abdominal injury, and younger age independently predict VTE after penetrating trauma.

Invited Commentary

CME

There are an increasing number of veterans in the United States, and the current delay and wait times prevent Veterans Affairs (VA) institutions from fully meeting the needs of current and former service members. Valsangkar et al identify whether lean processes can be used to improve wait times for surgical procedures in VA hospitals. They found that wait times decreased nearly 3-fold, operative volume and the number of outpatient evaluations increased, and the number of no-shows decreased.

Invited Commentary

Sustainable programs are essential to improve surgical care in underserved communities worldwide. In this prospective observational study by Wagner et al, general surgeons in 5 countries were trained using a competency-based paradigm to become regional trainers in tension-free hernioplasty. Training programs were successful at all sites with low rates of complications, and certified participants became regional trainers, who then conducted further training series.

Invited Commentary

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