9 JAMA resources for surgeons to share with patients

Surgery is naturally a stressful experience for patients. Reliable information about when and why surgery is necessary, how to prepare for it and what to expect in terms of recovery is vital—and shouldn’t be left to Google searches. 

The JAMA Network® has published Patient Pages since 1998 to distill high-quality evidence and make it more accessible for patient education and help guide patient decisions. Patient Pages provide a basic definition of the condition or issue, along with symptoms, consequences, diagnosis, treatment and prevention. These resources, illustrated by JAMA medical illustrators, are always freely accessible online.

As part of a series of news articles curating these outstanding resources, the AMA is highlighting free, recently published Patient Page resources of highest relevance to various physician specialties. This article highlights resources relevant to surgery, including surgical treatment options for many common conditions.

AMA members can explore a range of peer-reviewed research and clinical information published by the JAMA Network, which brings JAMA® together with JAMA Network Open and 11 specialty journals. Published continuously since 1883, JAMA is one of the most widely circulated, peer-reviewed, general medical journals in the world. If you are a member or interested in becoming one, learn how to access these educational materials and innovative tools. 

1. “Acute Appendicitis”

   1. This JAMA Patient Page describes the causes, symptoms, diagnosis and treatment options for uncomplicated and complicated acute appendicitis. From the Patient Page: “Appendicitis is inflammation of the appendix, a small, tubular organ in the right lower abdomen that is attached to the large intestine.”
   2. It explains how surgery fits into treatment for acute uncomplicated appendicitis.
   3. “The most common treatment for acute uncomplicated appendicitis is laparoscopic appendectomy, which is a minimally invasive surgery performed through three small incisions to remove the entire appendix. Instead of surgery, some adults (and less commonly, children) with uncomplicated acute appendicitis may be successfully treated with a 10-day course of broad-spectrum antibiotics. In patients treated with antibiotics, rates of recurrent appendicitis within one year range from 15% to 41%. Important factors for determining the best treatment option for patients with acute uncomplicated appendicitis are presence of high-risk CT findings that make antibiotics less effective (such as presence of an appendicolith or a dilated appendix), the risk of surgery for an individual patient, and patient preference.”
   4. It also explains complicated appendicitis.
   5. “Patients with complicated appendicitis who are severely ill because of the infection (sepsis) need antibiotics and emergency surgery to remove the appendix. Those who are not acutely ill but have contained pockets of pus in the abdomen typically require intravenous antibiotics, placement of a drain into the abdomen to remove the pus, and evaluation for appendectomy six to eight weeks later.”

2. “Acute Cholecystitis”

   1. This JAMA Patient Page describes acute cholecystitis and its risk factors, diagnosis and treatment.
   2. From the Patient Page: “Acute cholecystitis is inflammation of the gallbladder.”
   3. It explains that the recommended treatment of acute cholecystitis is surgical removal of the gallbladder, or cholecystectomy.
   4. “In the U.S, standard care is laparoscopic cholecystectomy, which is minimally invasive surgery performed via three small incisions in the abdomen to remove the gallbladder. Laparoscopic cholecystectomy performed one to three days after diagnosis of acute cholecystitis is associated with fewer postoperative complications, shorter hospitalization and lower costs compared with surgery done more than three days after diagnosis. Between 2% and 15% of patients undergoing cholecystectomy require a transition from a laparoscopic approach to an ‘open’ approach, which involves a longer incision in the abdomen to remove the gallbladder safely.”

3. “Obesity in Adults”

   1. This JAMA Patient Page describes obesity in adults. From the Patient Page: “Obesity is a condition of excess body fat that affects 800 million people worldwide and approximately 42% of adults in the U.S.”
   2. It explains when surgery is used to treat obesity.
   3. “Surgery (laparoscopic gastric sleeve gastrectomy, Roux-en-Y gastric bypass) is typically reserved for people with a BMI of 40 or higher or those with weight-related health problems and a BMI of 35 or higher. These procedures result in weight loss of 25% to 30% at 12 months. People who undergo surgery for obesity may have postoperative complications (such as internal bleeding or internal hernia) and should receive supplementation with thiamine, folate, iron, copper, calcium, zinc, and vitamins A, B₁₂, D, E and K to avoid micronutrient deficiency.”

4. "Surgery for Breast Cancer Prevention”

   1. This JAMA Patient Page describes surgery for breast cancer prevention (the removal of healthy breasts to reduce risk of breast cancer), the patient population who should consider this surgery, and the alternatives to and risks of the surgery. From the Patient Page: “Surgery for breast cancer prevention is the removal of healthy breasts to reduce risk of breast cancer.
   2. “Preventive mastectomy (risk-reducing mastectomy, prophylactic mastectomy) is the surgical removal of healthy breasts in order to lower the chance of developing breast cancer. Women with a high risk of breast cancer may consider these operations to possibly avoid getting the disease. However, women who undergo these operations still have a small risk of developing breast cancer because it is impossible to completely remove all breast tissue.”

5. “What Is Aortic Stenosis?”

   1. This JAMA Patient Page describes aortic stenosis and its symptoms, diagnosis and treatment options. From the Patient Page: “Aortic stenosis is a narrowing of the aortic valve of the heart, making it more difficult for the heart to pump blood into the aorta.” It describes treatment of aortic stenosis.
   2. “There are no medications that prevent or cure aortic stenosis. For mild or moderate aortic stenosis that is not causing symptoms, no treatment is necessary, but patients should have a regular checkup with their doctor. If the aortic valve is severely narrowed or the narrowing is causing symptoms, the valve may need to be replaced.”
   3. It also explains the three approaches to aortic valve replacement: transcatheter aortic valve replacement, bioprosthetic valve replacement and mechanical valve replacement.

6. "What Is Endometriosis?”

   1. This JAMA Patient Page describes endometriosis, including its signs and symptoms, diagnosis, and treatment. From the Patient Page: “Endometriosis is a chronic inflammatory disease in which cells similar to those lining the uterus are present outside of the uterus.”
   2. It explains how surgery fits into endometriosis treatment.
   3. “Surgery is an option for patients whose endometriosis symptoms do not improve with drug therapy, for those who cannot take hormone medications, and for large ovarian endometriosis cysts or deep lesions causing severe symptoms (such as blood in the urine or stool). Surgeons typically remove endometriosis tissue in a minimally invasive procedure. Patients with persistent severe symptoms despite hormone treatment and surgery and who do not desire future pregnancy may consider removal of the uterus (hysterectomy) and any remaining endometriosis lesions. If possible, the ovaries should be preserved in women undergoing hysterectomy before menopause.”

7. “What Is Knee Osteoarthritis?”

    

   1. This JAMA Patient Page describes knee osteoarthritis and its symptoms, diagnosis and treatments. From the Patient Page: “Knee osteoarthritis is a common cause of knee pain and disability among adults.”
   2. It describes how surgery is used for knee osteoarthritis.
   3. “Total knee replacement surgery may be considered for patients with advanced knee osteoarthritis on x-ray and persistent symptoms despite six months of behavioral and medical treatments. Although many patients have substantially decreased pain in the first 12 months after total knee replacement, 10% to 34% report long-term pain between three months and five years afterward.”

8. “What Is Uterine Prolapse?”

   1. This JAMA Patient Page describes uterine prolapse and its risk factors, symptoms and treatment options. From the Patient Page: “Uterine prolapse occurs when the uterus drops into the vagina.” It summarizes the three surgical treatment options:
   2. "Uterosacral ligament suspension involves surgery to attach uterosacral ligaments to the top of the vagina to restore support for the uterus.”
   3. “Sacrospinous ligament suspension involves surgical attachment of the cervix or top of the vagina to one or both of the sacrospinous pelvic ligaments to keep the uterus in place.”
   4. “Colpocleisis involves surgery to shorten and narrow the vagina so that the uterus cannot drop into the vaginal canal. This procedure is the most effective treatment for uterine prolapse but does not allow for future vaginal sexual intercourse.”

9. “What Is Prostate Cancer?”

   1. This JAMA Patient Page describes prostate cancer and its risk factors, symptoms and treatment options. From the Patient Page: “Prostate cancer is a common malignancy in older men.”
   2. It describes how surgery fits into prostate cancer treatment, including in stage 4.
   3. “Patients with prostate cancer that has spread to nearby lymph nodes may receive radiation therapy or surgery to remove the prostate. In addition, these patients receive treatment to decrease testosterone levels through either hormone therapy or surgical removal of the testicles. For men with prostate cancer and distant metastases, such as in the bones, first-line treatment is hormone therapy alone or in combination, and some patients also receive chemotherapy.”

In addition to the Patient Page feature, here are other ways physicians can leverage resources from the JAMA Network to help them in their clinical practice:

• Take CME courses and earn AMA PRA Category 1 Credit™.
• Fulfill maintenance of licensure (MOL) and CME requirements on JN Learning™, the home for all JAMA Network CME.
• Read concise summaries of clinical guidelines and recommendations in a format designed for today’s busy physicians.

The subscription cost of JAMA is included with your AMA membership, plus unlimited digital access to all JAMA Network journals, including JAMA Surgery and these other journals: JAMA Cardiology, JAMA Dermatology, JAMA Internal Medicine, JAMA Network Open, JAMA Neurology, JAMA Oncology, Ophthalmology, JAMA Otolaryngology–Head and Neck Surgery, JAMA Pediatrics and JAMA Psychiatry.

The journals include many helpful features for students, residents and fellows, including full-text PDFs, clinical challenges, archived editions, audio and video author interviews where authors give their perspectives on a study’s objectives, findings and implications.