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In This Issue of JAMA Surgery |

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JAMA Surg. 2014;149(9):885. doi:10.1001/jamasurg.2013.3499.
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Residency attrition rates remain a great challenge for general surgery training programs. Despite the increasing acceptance of pregnancy during training, one common perception is that women who become pregnant are at increased risk of leaving surgery programs. Brown et al performed a retrospective review of 85 categorical general surgery residents in a single academic general surgery residency program over a 10-year period. Child rearing did not appear to be a risk factor for attrition in either men or women. Furthermore, child rearing did not negatively impact the quality of training based on case numbers and board pass rates.

There has been a significant shift in resuscitation practices in forward combat hospitals indicating widespread military adoption of damage control resuscitation (DCR). Langan and colleagues reviewed the Joint Theater Trauma Registry (2002-2011) of US forward combat hospitals; cohorts of patients with vital signs at presentation and subsequent in-hospital death were grouped into 2 time periods: pre-DCR (before 2006) and DCR (2006-2011). Patients who died in a hospital during the DCR period were more likely to be severely injured and have a severe brain injury, consistent with a decrease in deaths among potentially salvageable patients.

Pneumonia prevention programs have focused primarily on mechanically ventilated patients. Kazaure et al outline the results of the longest-running postoperative pneumonia prevention program for nonmechanically ventilated patients, present long-term results (2008-2012) of a standardized postoperative ward-acquired pneumonia prevention program introduced in 2007 on the surgical ward of a university-affiliated Veterans Affairs hospital, and compare their postintervention pneumonia rates with those captured in the American College of Surgeons National Surgical Quality Improvement Program. They report an overall decreased pneumonia rate of 43.6% for noncardiac patients.

In 2003, the Agency for Healthcare Research and Quality established Patient Safety Indicators (PSIs) to monitor preventable adverse events during hospitalizations. Rose et al evaluate the comparative safety of endovascular aneurysm repair (EVAR) vs open aneurysm repair (OAR) of abdominal aortic aneurysm by measuring PSIs associated with each procedure over time. These PSIs can be used to monitor the comparative safety of emerging surgical technologies. Herein, EVAR was safer than OAR. The adoption of minimally invasive technology can improve safety among surgical admissions.





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