We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
In This Issue of JAMA Surgery |

Highlights FREE

JAMA Surg. 2014;149(4):313-315. doi:10.1001/jamasurg.2013.3474.
Text Size: A A A
Published online


It is not known whether outcomes of trauma care for geriatric trauma patients are affected differently by the institutional volume of geriatric and nongeriatric cases. Matsushima and colleagues test the hypothesis that outcomes of trauma care for geriatric patients (aged >65 years) are affected differently by the volume of geriatric cases and nongeriatric cases of an institution. They showed that larger volumes of geriatric trauma patients were significantly associated with lower odds of in-hospital mortality, major complications, and failure to rescue. In contrast, larger nongeriatric trauma volumes were significantly associated with higher odds of major complications in geriatric patients.

Laparoscopic sleeve gastrectomy (LSG) is an increasingly popular bariatric surgical procedure, but there are concerns about the potential for a new or worsened case of gastroesophageal reflux disease (GERD) after LSG. DuPree et al examined preoperative and postoperative reflux symptoms among 4832 patients who underwent LSG and compared these results with those from a cohort undergoing gastric bypass (GB). The majority of patients with GERD who underwent LSG had continued or worse symptoms postoperatively, whereas most patients undergoing GB had an improvement or complete resolution of GERD.

Waits et al describe a novel approach to the quantification of postoperative mortality risk after liver transplant that they term morphometric age. By using computed tomographic scans to measure core muscle size and density, as well as aortic calcification, a composite metric of internal age was calculated. Results showed that patients who were morphometrically older than their chronologic age had a 1-year survival that was 20% lower than those patients who were morphometrically younger than their chronologic age.

Globally, Internet access is increasingly available in resource-limited settings but has not been fully utilized for medical education. Goldstein et al investigated the use of standardized online surgical curricula by surgeons and trainees in 12 low- and middle-income countries. Notably, 2 independently developed platforms were consistently well received despite regional variations in surgical practice.

Readmissions after surgery are costly and may reflect quality of care in the index hospitalization. Morris and coauthors conducted a retrospective cohort study of 59 273 major surgical procedures performed at 112 Department of Veterans hospitals to determine the timing of postoperative complications with respect to hospital discharge and the frequency of readmission stratified by predischarge and postdischarge occurrence of complications. Predischarge complications were not significantly associated with readmission, whereas postdischarge complications were strongly associated with readmission.

In this large single-center experience with central pancreatectomy for benign or low-grade pancreatic neoplasms (100 consecutive patients undergoing central pancreatectomy with pancreaticogastrostomy), Goudard and colleagues showed that central pancreatectomy, as an alternative to standard resection, effectively preserves pancreatic function in more than 90% of patients at the expense of a significant morbidity rate (72%) and a significant non-nil mortality rate (3%), underestimated by the published literature, and appears best indicated for benign or low-grade lesions in young and fit patients.

Missed doses of enoxaparin therapy occur commonly among inpatients. Louis and colleagues conducted a prospective review of 202 trauma and general surgery patients admitted to a level I trauma center that revealed interrupted enoxaparin therapy to be an independent risk factor for deep vein thrombosis (DVT) formation that can be ameliorated by physicians.

Revisional laparoscopic surgery after Roux-en-Y gastric bypass (RYGB) has been linked to substantial complications and morbidity. In a prospective, single-center, randomized, single-blinded study, Eid and coauthors investigated the safety and effectiveness of endoscopic gastric plication with the StomaphyX device vs a sham procedure for revisional surgery in RYGB patients to reduce regained weight. One year after gastric plication using the StomphyX procedure, clinically meaningful weight reduction was not achieved for at least half of treated patients.


Increased abdominal pressure may have a negative effect on intracranial pressure (ICP). Kamine et al performed a retrospective medical record review of laparoscopic ventriculoperitoneal shunt operations to determine the effect of insufflation on ICP. They found that ICP significantly increases with abdominal insufflation and correlates with laparoscopic insufflation pressure, suggesting that laparoscopy should be used cautiously in patients with a baseline elevated ICP or head trauma.





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Related Content

Customize your page view by dragging & repositioning the boxes below.