Journal of the American College of Surgeons
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Centralization for complex cancer surgery may not always be feasible owing to socioeconomic disparities, geographic constraints, or patient preference. The present study investigates how the combined volume of complex cancer operations impacts postoperative outcomes at hospitals that are low-volume for a specific high-risk cancer operation. ⋯ Patients who underwent complex operations at MVH had similar postoperative outcomes to those at HVH. MVH provide a model for the centralization of complex cancer surgery for patients who do not receive their care at HVH.
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State regulations have decreased prescribed opioids with more than 25% of patients abstaining from opioids. Despite this, 2 distinct populations of patients exist who consume "high" or "low" amounts of opioids. The aim of this study was to identify factors associated with postoperative opioid use after common surgical procedures and develop an opioid risk score. ⋯ Preoperative patient characteristics associated with high opioid use postoperatively were identified and an opioid risk score was derived. Identification of patients with a higher need for opioids presents an opportunity for improved preoperative interventions, the use of nonopioid analgesic therapies, and alternative therapies.
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Artificial intelligence (AI) methods and AI-enabled metrics hold tremendous potential to advance surgical education. Our objective was to generate consensus guidance on specific needs for AI methods and AI-enabled metrics for surgical education. ⋯ The Delphi panel consensus provides a specific, bold, and forward-looking roadmap for AI methods and AI-enabled metrics for surgical education.
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Postpartum depression has well-established long-term adverse effects on maternal and infant health. Surgeons with rigorous operative schedules are at higher risk of obstetric complications, but they rarely reduce their workload during pregnancy. We evaluated whether lack of workplace support for work reductions during difficult pregnancies or after neonatal complications is associated with surgeon postpartum depression. ⋯ Lack of workplace support for surgeons with obstetric or neonatal health concerns is associated with a higher risk of postpartum depression. Institutional policies must address the needs of surgeons facing difficult pregnancies to improve mental health outcomes and promote career longevity.
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Does Adding a Measure of Social Vulnerability to a Surgical Risk Calculator Improve Its Performance?
Emerging literature suggests that measures of social vulnerability should be incorporated into surgical risk calculators. The Social Vulnerability Index (SVI) is a measure designed by the CDC that encompasses 15 socioeconomic and demographic variables at the census tract level. We examined whether adding the SVI into a parsimonious surgical risk calculator would improve model performance. ⋯ The eight-variable SURPAS prediction model was not significantly improved by adding the SVI, showing that this parsimonious tool functions well without including a measure of social vulnerability.