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 Showing 101-120 of 128 Articles
Original Investigation 
Howard Nelson-Williams, MD, MPH; Faiz Gani, MBBS; Arman Kilic, MD; Gaya Spolverato, MD; Yuhree Kim, MD, MPH; Doris Wagner, MD; Neda Amini, MD; Aslam Ejaz, MD, MPH; Timothy M. Pawlik, MD, MPH, PhD
Includes: Supplemental Content

Importance  In an era of accountable care, understanding variation in health care costs is critical to reducing health care spending.

Objective  To identify factors associated with increased hospital costs and quantify variations in costs among individual hospitals in patients undergoing liver and pancreatic surgery in the ...

Invited Commentary: Does Decreasing Variability Affect Quality?; David M. Mahvi, MD
Original Investigation 
Neha Bansal, MD; Kristina D. Simmons, PhD; Andrew J. Epstein, PhD, MPP; Jon B. Morris, MD; Rachel R. Kelz, MD, MSCE
Includes: Supplemental Content

Importance  To evaluate and financially reward general surgery residency programs based on performance, performance must first be defined and measureable.

Objective  To assess general surgery residency program performance using the objective clinical outcomes of patients operated on by program graduates.

Design, Setting, and Participants  A ...

Invited Commentary: Making a Difference in Surgery Residency Programs; John L. Tarpley, MD, FWACS; Walter E. Smalley Jr, MD, MPH
Invited Commentary 
John L. Tarpley, MD, FWACS; Walter E. Smalley Jr, MD, MPH
Invited Commentary 
David M. Mahvi, MD

The cost of health care in the United States has been the topic of countless studies during the last several decades. Many remedies have been proposed and implemented, but cost continues to rise. One puzzling aspect of cost has been the variability of cost for the same disease ...

Research Letter 
Mark D. Neuman, MD, MSc; Rachel M. Werner, MD, PhD

Using the University of Michigan Health and Retirement Study, this study reports on the association between marital status and postoperative function.

Research Letter 
Sarah E. Sasor, MD; Naveed N. Nosrati, MD; Terrence Katona, DO; William A. Wooden, MD; Adam Cohen, MD; Imtiaz A. Munshi, MD; Sunil S. Tholpady, MD, PhD

This study reports whether clearance of nonmelanoma skin cancer in excisional specimens can be predicted based on the appearance of a lesion after biopsy and on the demographic characteristics of the patient.

Comment & Response 
Jamie S. Ullman, MD; Shelly D. Timmons, MD, PhD; Alex B. Valadka, MD

To the Editor We read with interest the study by Joseph et al.1 Their Brain Injury Guidelines (BIG) protocol is a local hospital protocol that endeavors to define criteria for the imaging, admission, and management of patients with traumatic brain injury (TBI). The BIG protocol was devised ...

Comment & Response 
Bellal Joseph, MD; Viraj Pandit, MD; Hassan Aziz, MD

In Reply We would like to thank Ullman et al for their insightful comments and discussion. First, we would like to reiterate the fact the Brain Injury Guidelines (BIG) were developed and implemented at our center in coordination with our neurosurgical colleagues. There have been multiple collaborative studies ...

Original Investigation 
Sherif Y. Shalaby, MD; Trenton R. Foster, MD; Michael R. Hall, MD; Kirstyn E. Brownson, MD; Penny Vasilas, RN; Daniel G. Federman, MD; Hamid R. Mojibian, MD; Alan Dardik, MD, PhD
Includes: Supplemental Content

Importance  Abdominal aortic aneurysms are associated with chronic inflammation within the aortic wall, and previous studies have suggested that chronic inflammation may be a consequence of a dysregulated and persistent autoimmune response. Persistent aortic remodeling after aneurysm repair could place the patient at risk for endoleak or ...

Invited Commentary: Inflammation, Endoleaks, and Aortic Remodeling; Michael Sobel, MD; Gale L. Tang, MD
Original Investigation 
Karina A. Newhall, MD; Elizabeth C. Saunders, BA; Robin J. Larson, MD, MPH; David H. Stone, MD; Philip P. Goodney, MD, MS
Includes: Supplemental Content

Importance  Protamine sulfate can be administered at the conclusion of carotid endarterectomy (CEA) to reverse the anticoagulant effects of heparin and to limit the risk for postoperative bleeding. Protamine use remains controversial owing to concern for increased thrombotic complications with its use.

Objective  To review the ...

Invited Commentary: Heparin Reversal With Protamine During Carotid Endarterectomy; Claudio Baracchini, MD; Enzo Ballotta, MD
Original Investigation 
Barclay T. Stewart, MD, MScPH; Robert Quansah, MD, PhD; Adam Gyedu, MD, MPH; Godfred Boakye, BSc; Francis Abantanga, MD; James Ankomah, MBChB, MPH; Peter Donkor, MDSc; Charles Mock, MD, PhD

Importance  Trauma care capacity assessments in developing countries have generated evidence to support advocacy, detailed baseline capabilities, and informed targeted interventions. However, serial assessments to determine the effect of capacity improvements or changes over time have rarely been performed.

Objective  To compare the availability of trauma ...

Invited Commentary: Assessing Trauma Care Capacity in Low- and Middle-Income Countries; Grace Hsiung, MD; Colin Gause, MD; Fizan Abdullah, MD, PhD
Invited Commentary 
Michael Sobel, MD; Gale L. Tang, MD

Shalaby and colleagues1 have taken a fresh look at inflammation and aortic aneurysms by examining the continued remodeling of the residual aneurysmal sac after endovascular repair of infrarenal aortic aneurysms (endovascular aneurysm repair [EVAR]). Two long-term pitfalls for EVAR are endoleaks and continued expansion of the residual ...

Invited Commentary 
Claudio Baracchini, MD; Enzo Ballotta, MD

Protamine sulfate is a strong alkaline polypeptide used mainly to reverse the anticoagulant effects of heparin. When injected intravenously, the alkaline protamine combines with the acidic heparin to form a neutral salt, thereby annulling heparin’s anticoagulating properties. The controversy over heparin reversal with protamine during carotid endarterectomy (CEA) ...

Invited Commentary 
Grace Hsiung, MD; Colin Gause, MD; Fizan Abdullah, MD, PhD

We commend Stewart et al1 on their article regarding their longitudinal capacity assessment of the progress in trauma service availability during the last decade in Ghana and their recognition of the need for expanding the evidence base for trauma care capacity in low- and middle-income countries. The ...

Comment & Response 
Victor O. Popoola, MBBS, MPH, ScM; Brandyn D. Lau, MPH, CPH; Elliott R. Haut, MD, PhD

To the Editor We were interested to read the recent study by the Colorectal Writing Group for the Surgical Care and Outcomes Assessment Program–Comparative Effectiveness Research Translation Network (SCOAP-CERTAIN) Collaborative1 published in JAMA Surgery. However, we have concerns that the methodologic flaws in the study may ...

Comment & Response 
Scott R. Steele, MD; Vlad V. Simianu, MD, MPH; David R. Flum, MD, MPH

In Reply We appreciate the letter by Popoola and colleagues regarding their concerns over our recent study.1 They justly point out that one of the limitations of large databases such as the Surgical Care and Outcomes Assessment Program is their inability to distinguish the underlying cause of ...

Original Investigation 
Richard S. Hoehn, MD; Koffi Wima, MS; Matthew A. Vestal, MHA; Drew J. Weilage, MHA; Dennis J. Hanseman, PhD; Daniel E. Abbott, MD; Shimul A. Shah, MD, MHCM
Includes: Supplemental Content

Importance  Safety-net hospitals provide broad services for a vulnerable population of patients and are financially at risk owing to impending reimbursement penalties and policy changes.

Objective  To determine the effect of patient and hospital factors on surgical outcomes and cost at safety-net hospitals.

Design, Setting, and ...

Invited Commentary: The Uninsured and Underserved and the Hospitals That Care for Them; Larry R. Kaiser, MD; Verdi J. DiSesa, MD, MBA; Henry A. Pitt, MD
Original Investigation 
Ida J. Hatoum, ScD; Robin Blackstone, MD; Tina D. Hunter, PhD; Diane M. Francis, MPH; Michael Steinbuch, PhD; Jason L. Harris, PhD; Lee M. Kaplan, MD, PhD
Includes: Supplemental Content

Importance  Little is known about comorbidity remission after bariatric surgery during typical clinical care across diverse and geographically distributed populations.

Objective  To estimate the improvement in obesity-related comorbidities after bariatric surgery and to identify clinical factors associated with these responses using a large representative population of ...

Invited Commentary: Predicting Comorbidity Remission Following Bariatric Surgery; Scott Kahan, MD, MPH
Invited Commentary 
Larry R. Kaiser, MD; Verdi J. DiSesa, MD, MBA; Henry A. Pitt, MD

It has been said if you want to control health care costs, solve poverty. The pervasive effect of poverty stymies efforts to improve health and is associated with more illness, poorer outcomes, and a resultant significant increase in cost expended to care for this population. In this issue ...

Perhaps the most reliable expectation of obesity treatment is variability. We see vast heterogeneity in treatment response to bariatric surgery, pharmacotherapy, behavioral therapy, medically and self-directed weight loss, and other modalities, each ranging from near-miraculous benefits to null, or even negative, effects. For example, weight loss from bariatric ...

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