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In This Issue of JAMA Surgery
November 2019


JAMA Surg. 2019;154(11):985. doi:10.1001/jamasurg.2018.3845


Severe hemorrhagic shock is associated with a state of vasopressin deficiency and an increased need for blood products. In a single-center randomized clinical trial, Sims and colleagues investigated the outcomes of low-dose vasopressin on blood product use in 100 adult trauma patients who were in hemorrhagic shock. Vasopressin supplementation decreased blood product use by 1.4 L in the initial 48 hours of care without increasing complications.

Invited Commentary

Continuing Medical Education

Author Audio Interview

Female surgeons earn less than male surgeons and hold fewer leadership positions. In a survey of general surgery resident physicians, Gray and colleagues found no sex difference in future career goals, such as desire to hold leadership positions, expected hours of work, or projected retirement age; however, women anticipated earning roughly $30 000 less per year and had a more negative view of salary negotiation. These findings may aid in identifying strategies to help narrow the sex-associated inequities in surgery careers.

The patterns of disease recurrence after resection of pancreatic ductal adenocarcinoma remain unclear. In this secondary analysis of a randomized clinical trial, Jones and colleagues investigated patterns of recurrence after adjuvant chemotherapy and their association with survival. Adjuvant gemcitabine plus capecitabine was associated with reduced rate of local recurrence and improved overall survival compared with gemcitabine monotherapy. Pancreatic cancer behaves as a systemic disease, requiring effective systemic therapy after resection.

Invited Commentary

Studies have shown that surgeons overprescribe opioids, although guidelines for appropriate opioid prescribing are available. Concern about patient-reported satisfaction ratings of their surgeon may be a barrier to surgeons adopting guideline-directed prescribing practices. Louie and colleagues found that surgeons could greatly decrease the proportion of patients receiving opioids and the number of pills prescribed with no change in satisfaction ratings.

Continuing Medical Education

Clinical Review and Education

Robotic surgery has been increasingly used in a variety of surgical procedures. Marshall and Wee review the current status of adoption of the robotic instrument as it applies to general thoracic surgery, including the current status in the United States, the outlook for the future, and opportunities and challenges for the incorporation of this tool into general thoracic surgical procedures.