JAMA Surgery

Deiner, Stacie; Luo, Xiaodong; Lin, Hung-Mo; Sessler, Daniel I.; Saager, Leif; Sieber, Frederick E.; Lee, Hochang B.; Sano, Mary; , ; Jankowski, Christopher; Bergese, Sergio D.; Candiotti, Keith; Flaherty, Joseph H.; Arora, Harendra; Shander, Aryeh; Rock, Peter

doi: 10.1001/jamasurg.2017.1505pmid: 28593326

Key PointsQuestionDoes intraoperative dexmedetomidine reduce postoperative delirium? FindingsUnlike its use as a sedative in the intensive care unit, intraoperative dexmedetomidine did not significantly reduce the incidence of delirium over saline placebo (12.2% vs 11.4%) in this randomized clinical trial. MeaningThe administration of dexmedetomidine in the operating room does not prevent postoperative delirium, which may be due to the short-acting nature of the drug and loss of salutary effects after discontinuation of the infusion.

Berian, Julia R.; Rosenthal, Ronnie A.; Robinson, Thomas N.

doi: 10.1001/jamasurg.2017.1511pmid: 28593269

Kulaylat, Audrey S.; Kulaylat, Afif N.; Schaefer, Eric W.; Tinsley, Andrew; Williams, Emmanuelle; Koltun, Walter; Hollenbeak, Christopher S.; Messaris, Evangelos

doi: 10.1001/jamasurg.2017.1538pmid: 28614561

Key PointsQuestionAre adverse postoperative events higher among patients with ulcerative colitis who require anti–tumor necrosis factor (TNF) therapy? FindingsIn this analysis involving the insurance claims records of 2476 patients who underwent colectomy or total proctocolectomy for ulcerative colitis, preoperative anti-TNF agent use was not associated with a significant increase in postoperative complications. However, anti-TNF agent use within 90 days of surgery among patients who underwent ileal pouch-anal anastomosis was associated with higher complication rates. MeaningFor patients using anti-TNF therapy for ulcerative colitis, avoidance of ileal pouch-anal anastomosis during the initial ulcerative colitis–associated procedure may be warranted.

doi: 10.1001/jamasurg.2016.3442pmid: N/A

doi: 10.1001/jamasurg.2016.3443pmid: N/A

Sellers, Morgan M.; Niknam, Bijan A.; Kelz, Rachel R.

doi: 10.1001/jamasurg.2017.0827pmid: 28564696

This Viewpoint proposes a new framework for defining quality in surgical training that identifies potential metrics, conceptualizes their relationships, and ranks their relative importance.

Pradarelli, Jason C.; Thornton, Joseph P.; Dimick, Justin B.

doi: 10.1001/jamasurg.2017.0841pmid: 28467538

This Viewpoint will review the Taylor v Intuitive legal case and discuss its important implications for hospitals, surgical leadership, and individual surgeons.

Varghese, Thomas K.; Ghaferi, Amir A.

doi: 10.1001/jamasurg.2017.0858pmid: 28593215

This Viewpoint considers the role of measures of surgeon performance and methods for continuous improvement in patient safety efforts for surgical outcomes.

Sosa, Julie Ann; Duh, Quan-Yang; Doherty, Gerard

doi: 10.1001/jamasurg.2017.1338pmid: 28492919

This Editorial proposes possible explanations other than overdiagnosis for the increasing incidence of thyroid cancer in light of the latest USPSTF recommendation against screening for the disease.

Cook, Alan D.; Gross, Brian W.; Osler, Turner M.; Rittenhouse, Katelyn J.; Bradburn, Eric H.; Shackford, Steven R.; Rogers, Frederick B.

doi: 10.1001/jamasurg.2017.1018pmid: 28492861

Key PointsQuestionAre temporal trends in vena cava filter placement and pulmonary embolism changing over time? FindingsIn this cohort study using data from patients with traumatic injury from 3 databases, rates of vena cava filter placement showed an initial upward trend followed by a precipitous decline. Rates of pulmonary embolism demonstrated an initial increase and were followed by a reduction in the Pennsylvania Trauma Outcome Study and National Trauma Data Bank data sets, with no change in the National (Nationwide) Inpatient Sample data set. MeaningVena cava filter use is not associated with rates of pulmonary embolism.