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In This Issue of JAMA Surgery
March 2018

Highlights

JAMA Surg. 2018;153(3):197. doi:10.1001/jamasurg.2017.3657
Research

Predicting surgical risk is difficult, and patient counseling depends on accurate assessment of postoperative risk. In this study of 152 surgical and medical residents, Healy and coauthors demonstrated that residents did not differ significantly in their prediction of postoperative complications. However, both groups similarly overestimated risk when compared with risk-adjusted models from the American College of Surgeons National Surgical Quality Improvement Program.

Invited Commentary

Author Audio Interview

Can a surgeon’s competency be quantified? Using a sensorized bipolar forceps, the SmartForceps, in operations on 26 patients with various neurosurgical conditions, this study established a catalog of tool-tissue interaction forces in novice, intermediate, and experienced surgeons. Through force analysis, a metric distinguishing surgeon skill level was discovered. In an evolving competency-based surgical education paradigm, this metric could enhance surgeon training and performance.

Clinical experience suggests worse outcomes occur in redo carotid endarterectomy compared with primary carotid endarterectomy, but objective quantification has yet to be determined. In a retrospective analysis of a prospective cohort of patients maintained in the Vascular Quality Initiative database, Arhuidese and coauthors reviewed data on 64 118 carotid endarterectomy procedures. Redo procedures were found to have a 2.8-fold increased risk of perioperative stroke in asymptomatic patients compared with the perioperative stroke risk in patients receiving primary procedures.

Invited Commentary

Helicopter transport is a common but expensive resource with little evidence to guide triage decisions between helicopter and ground transport. Brown et al performed a cost-effectiveness analysis to compare the Air Medical Prehospital Triage score with current practice as triage strategies. The incremental cost-effectiveness ratio for current practice was $255 333 per quality-adjusted life-year. Sensitivity analyses favored use of the Air Medical Prehospital Triage score.

Invited Commentary

Continuing Medical Education

The majority of quality improvement efforts fail because of the absence of efforts to address nuances of implementation. Enhanced recovery pathways have proven to be an effective approach to improving perioperative care, but effective implementation is essential to success. Through a systematic review, Stone et al identified facilitators of and barriers to enhanced recovery implementation that should be considered in perioperative care.

Continuing Medical Education

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