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In This Issue of JAMA Surgery |

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JAMA Surg. 2016;151(1):1. doi:10.1001/jamasurg.2015.2892.
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Holihan et al determine the interobserver reliability of computed tomographic (CT) scans for detecting a ventral hernia recurrence among surgeons and radiologists. Nine independent and blinded reviewers evaluated the CT scans of 100 patients and reported the presence or absence of a ventral hernia. Owing to the high interobserver variability, CT scans were not associated with reliable diagnosing in ventral hernia recurrence.

The term golden hour was coined to encourage urgency of trauma care. In 2009, Secretary of Defense Robert M. Gates mandated prehospital helicopter transport of critically injured combat casualties in 60 minutes or less. Kotwal and colleagues compare morbidity and mortality outcomes for casualties before vs after the mandate and for those who underwent prehospital helicopter transport in 60 minutes or less vs more than 60 minutes. For the total casualty population (N = 21 089), Kotwal and colleagues found that the percentage killed in action and the case fatality rate were higher before vs after the mandate, while the percentage died of wounds remained unchanged.

General surgery residents are evaluated objectively via the American Board of Surgery In-Training Examination (ABSITE) and subjectively via institution-specific evaluations. It is unclear whether these measures form a reasonable assessment of performance. Ray et al sought to determine whether favorable evaluations correlate with ABSITE performance. A cross-sectional analysis of 150 ABSITE scores and 1131 evaluations showed that favorable evaluations do not correlate with ABSITE scores, nor do they predict passing.

The prognostic role of the extent of lymphadenectomy during surgery for esophageal cancer is uncertain and requires clarification. Lagergen et al conducted a cohort study of 606 patients who underwent esophagectomy for cancer at St Thomas’ Hospital in London, England, to clarify whether the number of removed lymph nodes influences mortality following surgery. Cox regression analysis with adjustment for confounders was performed. This study indicated that the extent of lymphadenectomy during surgery for esophageal cancer might not influence 5-year all-cause or disease-specific survival.

The Model for End-Stage Liver Disease (MELD) score is predictive of trauma outcomes. To determine whether a decrease in MELD score is associated with improved mortality in critically ill trauma patients, Peetz and colleagues performed a retrospective registry study of 525 critically ill trauma patients with chronic liver disease at 2 level I trauma centers in Boston, Massachusetts. They found that a decrease in MELD score within 72 hours of intensive care unit admission was associated with improved mortality.





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