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In This Issue of JAMA Surgery
April 2018

Highlights

JAMA Surg. 2018;153(4):297. doi:10.1001/jamasurg.2017.3663

Research

In a randomized, double-blind clinical trial of 422 patients undergoing a variety of operations, Hah et al sought to determine the association of perioperative gabapentin with remote pain and opioid cessation after discharge. They found no difference in time to pain cessation between patients receiving 72 hours of perioperative gabapentin compared with those receiving placebo. However, gabapentin had a significant effect on promoting opioid cessation after surgery.

Invited Commentary

Overlapping surgery has gained the attention of the lay press and Senate Finance Committee because of safety concerns, but data are lacking. In this retrospective cohort study of 2275 neurosurgical cases, Howard et al identified no differences in mortality, morbidity, or functional status between patients who underwent overlapping surgery vs nonoverlapping surgery. These data suggest that overlapping surgery can be safely done without risking patient safety.

Invited Commentary

Continuing Medical Education

Entrustable professional activities (EPAs) provide a framework to assess the competency of surgical residents. Wagner et al examined select EPAs with a survey tool and found that faculty physicians perceive that most residents are unable to perform complex operations independently by graduation. Faculty believe residents demonstrate better operative skill than the residents' perception of autonomy entrusted to them. The use of EPAs provides practical competency-based assessment and may facilitate earlier autonomy, improving operative training.

Continuing Medical Education

Improving value in surgery requires an accurate understanding of hospital costs. In a cross-sectional and longitudinal analysis of all California hospital financial statements, Childers and Maggard-Gibbons estimated the average cost of operating room time at $36 to $37 per minute, with minimal variation by teaching status, ownership, or setting (eg, inpatient vs ambulatory). They also describe the composition of costs, allowing identification of high-value targets.

Invited Commentary

Clinical Review & Education

The Joint Trauma System–Armed Forces Medical Examiner System Preventable Death Project aims to establish an evidence-based, military trauma–specific preventable death review process. Janak et al performed a systematic literature review of civilian and military preventable death methods, finding no accepted standard. Key components warranting future consideration are explicit preventable death definitions and criteria, medical and nonmedical evidence review processes, final determination processes, and identification of opportunities to improve the trauma care system.

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