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In This Issue of JAMA Surgery |

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JAMA Surg. 2016;151(5):401. doi:10.1001/jamasurg.2015.2916.
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RESEARCH

Nonoperative management may be a reasonable treatment alternative for uncomplicated appendicitis. Minneci and colleagues enrolled 102 children with uncomplicated appendicitis in a single-center cohort study in which 37 families chose nonoperative management and 65 chose surgery. After 1 year, they found that children managed nonoperatively compared with the surgery group had fewer disability days and lower appendicitis-related health care costs.

Risk estimates of 30-day mortality and actual mortality events in the Veterans Health Administration were evaluated by Smith et al at multiple time points from 25 to 365 days. They found that risk estimate groups were predictive of postoperative events for the study period overall and by surgical specialty. Evidence for delays in patient care to meet a 30-day metric was not identified.

Management of the primary tumor site in patients with metastatic breast cancer remains controversial. Thomas and colleagues conducted a population-based retrospective cohort study of 21 372 patients with newly diagnosed stage IV breast cancer. They found that initial surgery to the primary tumor was strongly associated with survival, especially prolonged survival of at least 10 years.

The association between kidney disease and long-term cardiovascular mortality after vascular surgery is unknown. In a single-center cohort of 3646 vascular patients by Huber et al, cardiovascular mortality was modeled with kidney disease as the main covariate. They found that acute kidney injury is common after vascular surgery and is associated with a risk for long-term cardiovascular mortality comparable to that seen with chronic kidney disease.

CLINICAL REVIEW & EDUCATION

Median arcuate ligament syndrome is a rare disease and a diagnosis of exclusion. Therefore, a diagnostic workup can be challenging. Kim et al explored the current literature and patient outcomes to present a comprehensive algorithm to diagnose the disease and treat the patients.

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