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In This Issue of JAMA Surgery
October 2017


JAMA Surg. 2017;152(10):901. doi:10.1001/jamasurg.2016.3452


The significance of early tumor cell dissemination in colon cancer is unclear. In this prospective study of 122 patients with nonmetastasized colon cancer, Weixler et al investigated the correlation of tumor cell dissemination with bone marrow and sentinel lymph nodes. They found that tumor cell dissemination and bone marrow and sentinel lymph nodes are independent events that are associated with a worse prognosis.

The ongoing opioid epidemic necessitates the exploration of opioid prescription practices for trauma patients to formulate evidence-based prescription guidelines. In this population-based analysis of 33 762 patients who experienced trauma, Chaudhary et al examined the incidence and predictors of opioid prescription at discharge. The incidence of opioid prescription closely matched that of moderate to severe pain among patients with a traumatic injury, signifying appropriate prescription practices.

Invited Commentary


The effect of Medicaid expansion on length of stay following trauma under the Affordable Care Act remains vague. Holzmacher and colleagues performed a cohort analysis of 2314 patients who were admitted to a level 1 trauma center from 3 states and stratified into groups by the degree to which each state expanded Medicaid eligibility. Length of stay following trauma was reduced in states that had expanded their Medicaid eligibility criteria.

With the current opioid epidemic, there is increased interest in providing alternative treatments for postoperative pain. Tedesco and colleagues examined the effectiveness of nonpharmaceutical pain management therapies following a total knee arthroplasty in a systematic review and meta-analysis. A total of 2391 patients from 39 randomized clinical trials were included. They found that electrotherapy and acupuncture provided reduced and delayed opioid consumption.

Clinical Review & Education

In 2015, 23% of practicing physicians were 65 years or older. As physicians age, their variation in cognitive skills increases—some physicians retain their abilities but others experience problems. Many safety-conscious industries mandate age-based performance testing, but medicine does not. The authors argue that the medical profession should take more active steps to assess the performance of physicians as they age.