March 1, 2016 Issue of JAMA Surgery

This Viewpoint discusses specialty fellowships within general surgery and emphasizes the importance of striking a balance between specialty fellowships and residential training.

Hepatopancreatobiliary Surgery Fellowships: How Many Do We Need?

Rebecca M. Minter, MD

Abstract Full Text

JAMA Surg. 2016;151(3):213-214. doi:10.1001/jamasurg.2015.4601

This Viewpoint discusses the growing number of hepatopancreatobilary surgery fellowships and emphasizes the need for standardization of training requirements.

A Strategy to Reduce General Surgery Resident Attrition: A Resident鈥檚 Perspective

Molly A. Wasserman, MD

Abstract Full Text

JAMA Surg. 2016;151(3):215-216. doi:10.1001/jamasurg.2015.4607

This Viewpoint proposes a strategy to reduce general surgery resident attrition, focusing on the creation of formal mentorship programs.

Original Investigation

Evaluation of the Perceived Association Between Resident Turnover and the Outcomes of Patients Who Undergo Emergency General Surgery: Questioning the July Phenomenon

Adil A. Shah, MD; Cheryl K. Zogg, MSPH, MHS; Stephanie L. Nitzschke, MD; et al.

Abstract Full Text

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JAMA Surg. 2016;151(3):217-224. doi:10.1001/jamasurg.2015.3940

This study reports on whether an association between the influx of new residents at the beginning of the academic year and outcomes exists among a nationally representative sample of patients who underwent emergency general surgery.

Invited Commentary
Debunking the July Phenomenon: Are We Asking the Right Questions?
Elizabeth A. Bailey, MD, MEd; Karole Collier, BA; Rachel R. Kelz, MD, MSCE

JAMA Surg

Self-harm Emergencies After Bariatric Surgery: A Population-Based Cohort Study

Junaid A. Bhatti, MBBS, MSc, PhD; Avery B. Nathens, MD, PhD, FRCSC; Deva Thiruchelvam, MSc; et al.

Abstract Full Text

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JAMA Surg. 2016;151(3):226-232. doi:10.1001/jamasurg.2015.3414

This population-based, longitudinal cohort study of patients undergoing bariatric surgery reported an increased risk of self-harm emergencies after bariatric surgery.

Invited Commentary
Bariatric Surgery鈥擬ore Than Just an Operation
Amir A. Ghaferi, MD, MS; Carol Lindsay-Westphal, PhD

JAMA Surg

Association Between Clinically Staged Node-Negative Esophageal Adenocarcinoma and Overall Survival Benefit From Neoadjuvant Chemoradiation

Emmanuel Gabriel, MD, PhD; Kristopher Attwood, PhD; William Du, MD; et al.

Abstract Full Text

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JAMA Surg. 2016;151(3):234-245. doi:10.1001/jamasurg.2015.4068

This study reports that patients with node-positive esophageal adenocarcinoma benefit significantly from neoadjuvant chemoradiation, while patients with node-negative tumors do not gain significant overall survival as compared with surgery alone.

Invited Commentary
Preoperative Chemoradiation in an Era of Suboptimal Clinical Staging
Wayne L. Hofstetter, MD

JAMA Surg

Use of Protamine for Anticoagulation During Carotid Endarterectomy: A Meta-analysis

Karina A. Newhall, MD; Elizabeth C. Saunders, BA; Robin J. Larson, MD, MPH; et al.

Abstract Full Text

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JAMA Surg. 2016;151(3):247-255. doi:10.1001/jamasurg.2015.3592

This meta-analysis reviews the evidence for and against protamine use, both in its association with increased thrombotic complications and with decreased bleeding, in patients undergoing carotid endarterectomy.

Invited Commentary
The Benefit of Heparin Reversal With Protamine During Carotid Endarterectomy
Claudio Baracchini, MD; Enzo Ballotta, MD

JAMA Surg

Self-reported Determinants of Access to Surgical Care in 3 Developing Countries

Joseph D. Forrester, MD, MSc; Jared A. Forrester, MD; Thaim B. Kamara, MD; et al.

Abstract Full Text

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JAMA Surg. 2016;151(3):257-263. doi:10.1001/jamasurg.2015.3431

This cross-sectional, cluster-based population survey reports on the self-reported determinants of access to surgical care in Sierra Leone, Rwanda, and Nepal using the validated Surgeons OverSeas Assessment of Surgical Need tool.

Invited Commentary
Access to Surgical Care in Developing Countries
Tarik Sammour, PhD; Andrew G. Hill, MBChB, MD, EdD(Thesis), FRACS

JAMA Surg

Association of VA Surgeons

Association Between MC-2 Peptide and Hepatic Perfusion and Liver Injury Following Resuscitated Hemorrhagic Shock

Paul J. Matheson, PhD; Rafael Fernandez-Botran, PhD; Jason W. Smith, MD, PhD; et al.

Abstract Full Text

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JAMA Surg. 2016;151(3):265-272. doi:10.1001/jamasurg.2015.4050

This laboratory study examines the MC-2 peptide鈥檚 association with reduced liver injury following rescuscitated hemorrhagic shock in rats.

Invited Commentary

Debunking the July Phenomenon: Are We Asking the Right Questions?

Elizabeth A. Bailey, MD, MEd; Karole Collier, BA; Rachel R. Kelz, MD, MSCE

Abstract Full Text

JAMA Surg. 2016;151(3):224-225. doi:10.1001/jamasurg.2015.3947

Bariatric Surgery鈥擬ore Than Just an Operation

Amir A. Ghaferi, MD, MS; Carol Lindsay-Westphal, PhD

Abstract Full Text

JAMA Surg. 2016;151(3):232-233. doi:10.1001/jamasurg.2015.3396

Preoperative Chemoradiation in an Era of Suboptimal Clinical Staging

Wayne L. Hofstetter, MD

Abstract Full Text

JAMA Surg. 2016;151(3):245-246. doi:10.1001/jamasurg.2015.4047

The Benefit of Heparin Reversal With Protamine During Carotid Endarterectomy

Claudio Baracchini, MD; Enzo Ballotta, MD

Abstract Full Text

JAMA Surg. 2016;151(3):255-256. doi:10.1001/jamasurg.2015.3615

Access to Surgical Care in Developing Countries

Tarik Sammour, PhD; Andrew G. Hill, MBChB, MD, EdD(Thesis), FRACS

Abstract Full Text

JAMA Surg. 2016;151(3):263-264. doi:10.1001/jamasurg.2015.3434

Editor's Note

FIRST Trial鈥擠ecision to Publish a Description of the Study

Julie Ann Sosa, MD; Howard Bauchner, MD

Abstract Full Text

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JAMA Surg. 2016;151(3):281. doi:10.1001/jamasurg.2015.5442

Special Communication

Development of the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial Protocol: A National Cluster-Randomized Trial of Resident Duty Hour Policies

Karl Y. Bilimoria, MD, MS; Jeanette W. Chung, PhD; Larry V. Hedges, PhD; et al.

Abstract Full Text

JAMA Surg. 2016;151(3):273-281. doi:10.1001/jamasurg.2015.4990

This article discusses the design and rationale for the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) randomized trial, which will evaluate whether changing surgical resident duty hour policies to permit greater flexibility in work hours will affect patient postoperative outcomes, resident education, and resident well-being.

Editor's Note
FIRST Trial鈥擠ecision to Publish a Description of the Study
Julie Ann Sosa, MD; Howard Bauchner, MD

JAMA Surg

Surgical Innovation

Video-Based Surgical Coaching: An Emerging Approach to Performance Improvement

Caprice C. Greenberg, MD, MPH; Janet Dombrowski, BSN, MHSA; Justin B. Dimick, MD, MPH

Abstract Full Text

JAMA Surg. 2016;151(3):282-283. doi:10.1001/jamasurg.2015.4442

This article discusses the potential of video-based peer coaching to improve the quality and safety of surgical care.

JAMA Surgery Clinical Challenge

Painful Right Inguinal Swelling

Florian Fanget, MD; Eddy Cotte, MD, PhD; Kayvan Mohkam, MD

Abstract Full Text

JAMA Surg. 2016;151(3):285-286. doi:10.1001/jamasurg.2015.2766

A 69-year-old man presented to the emergency department with a 5-day history of painful irreducible right inguinal swelling, a normal white blood cell count, and a hypodense mass on computed tomographic imaging. What is your diagnosis?

Postprandial Abdominal Pain

Dustin Y. Yoon, MD; Albert A. Nemcek, MD; Melina R. Kibbe, MD

Abstract Full Text

JAMA Surg. 2016;151(3):287-288. doi:10.1001/jamasurg.2015.4715

An active man in his early 80s presented to the hospital with a 6-month history of cramping epigastric abdominal pain that occurred 30 minutes after eating solid food and was associated with nausea and vomiting. His medical history was significant for atrial fibrillation and a history of an open abdominal aortic aneurysm repair. What is your diagnosis?

Research Letter

Association of VA Surgeons

Predicting the Presence of Nonmelanoma Skin Cancers After Biopsy: A Method to Reduce Unnecessary Surgical Procedures

Sarah E. Sasor, MD; Naveed N. Nosrati, MD; Terrence Katona, DO; et al.

Abstract Full Text

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JAMA Surg. 2016;151(3):289-290. doi:10.1001/jamasurg.2015.3243

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.

A Novel Method of Neuromonitoring in Thyroidectomy and Parathyroidectomy Using Transcutaneous Intraoperative Vagal Stimulation

Insoo Suh, MD; Charles Yingling, PhD; Gregory W. Randolph, MD; et al.

Abstract Full Text

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JAMA Surg. 2016;151(3):290-292. doi:10.1001/jamasurg.2015.3249

This study reports on a novel method of transcutaneous intraoperative vagal stimulation in the upper neck that is less invasive and is feasible in thyroidectomy and parathyroidectomy.

Femoral Hernias in Patients Undergoing Total Extraperitoneal Laparoscopic Hernia Repair: Including Routine Evaluation of the Femoral Canal in Approaches to Inguinal Hernia Repair

Paul Waltz, MD; Jason Luciano, MD, MBA; Andrew Peitzman, MD; et al.

Abstract Full Text

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JAMA Surg. 2016;151(3):292-293. doi:10.1001/jamasurg.2015.3402

This study reports on the incidence of femoral hernia in patients who preoperatively received a diagnosis of inguinal hernia before undergoing total extraperitoneal laparoscopic hernia repair, with particular attention to cases of reoperation.

Comment & Response