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In This Issue of JAMA Surgery
November 2017

Highlights

JAMA Surg. 2017;152(11):993. doi:10.1001/jamasurg.2016.3457
Research

Recent evidence suggests that patients experience inferior outcomes at safety-net hospitals; however, little is known regarding the outcomes of common surgical procedures. Using state-level data from California, Won et al found that safety-net hospitals treated a disproportionate amount of patients with advanced appendicitis and performed fewer laparoscopic appendectomies. Nonetheless, safety-net hospitals achieved good patient outcomes with similar costs.

CME

Overtreatment in the surgical intensive care unit (ICU) has not been well described. In this prospective observational study, Dhillon and colleagues sought to identify sources of avoidable surgical ICU days and to determine strategies to minimize these days. They found that nearly one-fourth of surgical ICU days could be potentially avoidable and targeted interventions that could reduce inappropriate surgical ICU use.

Achieving a body mass index (calculated as weight in kilograms divided by height in meters squared) of less than 30 after bariatric surgery is an important health improvement goal. In this retrospective study that included 27 320 patients, the significant predictors for achieving this target body mass index were identified using logistic regression. Optimal results were achieved among patients who underwent bariatric surgery when their body mass index was less than 40.

Invited Commentary

To examine the temporal trend of myocardial infarction after infrainguinal bypass and open aortic surgeries, Juo et al conducted a retrospective cohort study using National Surgery Quality Improvement Program database cases from 2005 to 2014. Despite recent advances in patient selection and perioperative care, no significant changes in cardiac outcomes have been observed following these high-risk procedures over the past decade.

CME

Clinical Review & Education

Surgeons commonly prescribe opioid analgesics for acute pain after surgery, although little is known regarding how commonly those opioids go unused. In a systematic review of 6 studies and 810 patients, Bicket et al found that most patients reported having unused opioids following a diverse group of surgeries. Because rates of safe storage and disposal were low, postoperative prescriptions likely serve as an important source for opioid misuse.

CME

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