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In This Issue of JAMA Surgery |

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JAMA Surg. 2015;150(1):3. doi:10.1001/jamasurg.2014.2483.
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Breast conservation surgery (BCS) is recommended for most women with early-stage breast cancer but is often not performed. Kummerow et al performed a retrospective cohort study of temporal trends in performance of mastectomy for early-stage breast cancer. In the past decade, there have been marked trends toward higher proportions of BCS-eligible patients undergoing mastectomy, breast reconstruction, and bilateral mastectomy. The greatest increases are seen in women with node-negative and in situ disease.

The overall incidence of colorectal cancer (CRC) has been decreasing since 1998, but there has been an apparent increase in the incidence of CRC in young adults. Bailey and colleagues performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results CRC registry (N = 393 241). Based on current trends, in 2030, the incidence rates for colon and rectal cancers will increase by 90.0% and 124.2%, respectively, for patients 20 to 34 years and by 27.7% and 46.0%, respectively, for patients 35 to 49 years.

Risk adjustment is an important component of quality assessment in surgical health care. However, data collection places an additional burden on physicians. There is also concern that outcomes can be gamed depending on the information recorded for each patient. Anderson and Chang include data from a total of 745 053 patients from the National Surgical Quality Improvement Program database from 2005 to 2010. When comparing models that included all preoperative variables with models that only included objective variables, they found that there was no difference in discrimination, suggesting that a rigorous risk-adjusted surgical quality assessment can be performed solely with objective variables.

Because of the high mortality rate after rupture of small abdominal aortic aneurysms (AAAs), surveillance is recommended to detect aneurysm expansion; however, the effects of clinical risk factors on long-term patterns of AAA expansion are poorly characterized. Bhak et al identify significant clinical risk factors associated with the AAA expansion rate for both constant and accelerated expansion trajectories. Smoking cessation and control of diastolic blood pressure are direct actions that should be taken to reduce the rate of AAA expansion.

Surgical site infection (SSI) has emerged as the leading publicly reported surgical outcome and is tied to payment determinations. Many hospitals monitor SSIs using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), in addition to mandatory participation (for most states) in the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN), which has resulted in duplication of effort and incongruent data. Ju et al compared the collection methods and colon SSI rates for the NHSN at each hospital with those of the ACS NSQIP.





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