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In This Issue of JAMA Surgery
August 2017

Highlights

JAMA Surg. 2017;152(8):713. doi:10.1001/jamasurg.2016.3442
Research

Limited research exists detailing vena cava filter use for pulmonary embolism prophylaxis and the occurrence of pulmonary embolism in trauma over time. Cook and colleagues conducted a cohort study using 1 state and 2 national databases from 2003 to 2015. Initial increases in vena cava filter use were followed by significant decreases beginning in 2006. Rates of pulmonary embolism were unchanged.

Invited Commentary

CME

Little is known about the existence and outcomes of very low-volume vascular surgery practice of 1 or fewer procedures per year. Using state-level data from New York, Mao et al found that around half of the 318 and 512 surgeons who performed elective open aneurysm repairs and carotid endarterectomies were very low-volume surgeons. Patients undergoing surgery performed by these surgeons had worse in-hospital outcomes and increased health care resource use.

Invited Commentary

In 2011, New York mandated that surgeons advise their patients who were undergoing a mastectomy on breast reconstruction. Using state inpatient data for 42 346 women who underwent a mastectomy from 2008 to 2011, Mahmoudi et al evaluated the association of the law with the reduction in racial/ethnic disparities in immediate postmastectomy breast reconstruction. The law was associated with a reduction in white/Hispanic and white/other race disparities, but had no effect on white/African American disparities in immediate postmastectomy breast reconstruction.

Studies suggest that dexmedetomidine sedation in intensive care units is associated with reduced delirium levels; however, its intraoperative use has not been well studied. Deiner et al and the Dexlirium Writing Group performed a randomized clinical trial of 404 patients at 10 sites who were administered dexmedetomidine or a placebo while undergoing surgery. They found no difference in delirium levels between the groups.

Invited Commentary

Clinical Review & Education

The 2017 guideline is a targeted update of the 1999 Centers for Disease Control and Prevention Guideline for Prevention of Surgical Site Infections. A systematic literature review was conducted and a modified Grading of Recommendations, Assessment, Development, and Evaluation approach was used to synthesize the evidence and formulate recommendations. This guideline provides new and updated evidence–based recommendations for preventing surgical site infections.

Invited Commentary

CME

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