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In This Issue of JAMA Surgery |

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JAMA Surg. 2015;150(6):497. doi:10.1001/jamasurg.2014.2508.
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Postoperative readmissions are common and affect hospital reimbursement. Tevis et al developed a predictive nomogram in 2799 patients at a single institution using the American College of Surgeons National Surgical Quality Improvement Program database. The nomogram was prospectively validated in 255 patients and was found to accurately predict readmission within 30 days of hospital discharge after surgery.

Surveillance modalities for individuals at risk for pancreatic cancer have not yet been defined. In a prospective observational study of 40 patients with a genetic risk for developing pancreatic cancer at Karolinska University Hospital in Stockholm, Sweden, Del Chiaro et al found a neoplastic pancreatic lesion in 16 patients (5 of whom underwent surgery) using a magnetic resonance imaging–based surveillance program. Although the follow-up period of approximately 1 year was relatively short, the surveillance program seems to be effective.

Venous thromboembolism (VTE) surveillance practices in hospitals have been reported to explain the variation in VTE rates in hospitals. Using Surgical Quality Improvement Program data, Holcomb et al examined the relationship between inpatient surveillance testing for VTE and postdischarge VTE rates among 25 975 patients at 79 Veterans Affairs facilities who underwent surgery between 2005 and 2009. They found that hospitals with higher inpatient VTE rates have higher postdischarge VTE rates, which suggests that surveillance may be influenced by higher observed rates and not surveillance practices alone.

Arteriovenous fistulas (AVFs) have been shown to reduce hospitalization rates and improve quality of life and survivability. In a retrospective analysis of data from the US Renal Data System, Zarkowsky and colleagues assessed national trends in initial hemodialysis access with respect to race/ethnicity among patients with end-stage renal disease. They found that black and Hispanic patients tend to initiate dialysis with an AVF less frequently than white patients despite being younger and having fewer comorbidities. These disparities persisted independent of factors that drive health access for fistula placement, such as medical insurance status and nephrology care.

Conditional survival (CS) takes into account the years that a patient has already survived and may be a more relevant metric of anticipated survival. Spolverato et al examined 535 patients who underwent resection of intrahepatic cholangiocarcinoma (ICC) and defined the CS of these patients. Conditional survival exceeded actuarial survival for all high-risk subgroups and may provide critical quantitative information about the changing probability of survival over time among patients with ICC.





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