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In This Issue of JAMA Surgery
March 2017

Highlights

JAMA Surg. 2017;152(3):217. doi:10.1001/jamasurg.2016.3417

Research

Eravacycline is a novel, fully synthetic fluorocycline antibiotic of the tetracycline class with in vitro activity against clinically important gram-negative, gram-positive aerobic, and facultative bacteria. Solomkin et al evaluated the efficacy and safety of eravacycline compared with ertapenem in adult hospitalized patients with complicated intra-abdominal infections (cIAIs). Overall, eravacycline demonstrated noninferiority to ertapenem for the treatment of patients with cIAI.

CME

Mesh, a synthetic graft, has been used in pelvic organ prolapse (POP) repair and stress urinary incontinence (SUI) to augment and strengthen weakened tissue. Polypropylene mesh has come under scrutiny by the US Food and Drug Administration. Chughtai et al examined the rates of mesh complications and invasive reintervention after the placement of vaginal mesh for POP repair or SUI surgery. They found that the combined use of POP mesh and SUI mesh sling was associated with the highest erosion and repeated intervention risk, while mesh sling alone had the lowest erosion and repeated intervention risk.

Invited Commentary

Attrition of residents from general surgery training programs is relatively high; however, there are wide discrepancies in the prevalence and causes of attrition reported among surgical residents in previous studies. Khoushhal et al summarize the estimate of attrition prevalence among general surgery residents. They found that general surgery programs have relatively high attrition, with female residents more likely to leave their training programs than male residents, and that residents most often relocate or switch to another specialty after the first postgraduate year owing to lifestyle-related issues.

Invited Commentary

CME and Author Audio Interview

Contralateral prophylactic mastectomy (CPM) use is increasing among women with unilateral breast cancer, but little is known about treatment decision making or physician interactions in diverse patient populations. Jagsi et al evaluated patient motivations, knowledge, and decisions, as well as the impact of surgeon recommendations, in a large, diverse sample of patients who underwent recent treatment for breast cancer. They found that many patients consider CPM, but knowledge about the procedure is low and discussions with surgeons appear to be incomplete. Its use is substantial among patients without clinical indications but is low when patients report that their surgeon recommended against it.

Invited Commentary

Clinical Review & Education

Enhanced Recovery After Surgery (ERAS) is an evidence-based care improvement process for surgical patients. This review by Ljungqvist et al discusses the development of the ERAS protocol as well as the improvements in clinical outcomes and cost savings that have resulted from its implementation.

CME

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