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In This Issue of JAMA Surgery |

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JAMA Surg. 2015;150(12):1105. doi:10.1001/jamasurg.2014.2538.
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Under bundled payments programs, health care providers, such as hospitals and physicians, will need a better understanding of episode costs to identify areas to target improvements in quality and cost-efficiency. In a retrospective cohort study of 24 647 Medicare patients undergoing bariatric procedures, Grenda and colleagues examined variations in episode costs. They found that variations in hospital episode payments exist, with payments for index hospitalization accounting for the greatest variation.

The interrelationship between delirium and other major postoperative complications has not been well examined. In a prospective cohort study of 566 older patients, Gleason and colleagues measured delirium with the Confusion Assessment Method and a validated medical record review method. They found that delirium occurs more frequently and has a greater effect at the population level than other major complications.

Long-term outcomes of open and endovascular (EVAR) repairs of abdominal aortic aneurysms (AAAs) have not been studied on a population level outside of a controlled trial setting. In an analysis of a statewide inpatient database, Chang et al found that EVAR repair was associated with improved 30-day clinical outcomes and survival until 3 years postoperatively. After 3 years, EVAR repair was associated with higher mortality; however, these mortality differences did not reach statistical significance over the entire study period. Reintervention and late AAA rupture rates are higher after EVAR repair.

Synthetic mesh slings are the most common surgical treatment for female stress urinary incontinence (SUI). However, the US Food and Drug Administration has released warnings that question the safety of vaginal mesh. Welk et al used administration data to perform a retrospective cohort study of 59 887 adult women undergoing an incident procedure for SUI with synthetic mesh in Ontario, Canada. The 10-year cumulative incidence of secondary surgery for mesh revision or erosion was 1 in 30 women, with patients of high-volume surgeons significantly less likely to experience this outcome.

Domestic violence (DV) is an extremely underreported crime and a growing social problem in the United States. Joseph et al performed a 6-year analysis of the National Trauma Data Bank to unveil the trends and prevalence of DV among trauma patients. A total of 16 575 patients who experienced DV were included. The overall reported prevalence of DV among trauma patients was 5.7 cases per 1000 trauma center discharges. Over the years, the reported prevalence of DV has been increasing among children and adults, and continues to remain high among female trauma patients.





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