"It Gives Me Peace of Mind So I Can Focus on Healing": Views on Advance Care Planning for Older Surgical Patients.

The period of time before an elective operation may be an opportune time to engage older adults in advance care planning (ACP). Past interventions have not been readily incorporated into surgical workflows leaving a need for ACP tools that are generalizable, easy to implement, and effective. This is a qualitative study.

Advanced Care Planning Content Encoding with Natural Language Processing.

While advanced care planning (ACP) is an essential practice for ensuring patient-centered care, its adoption remains poor and the completeness of its documentation variable. Natural language processing (NLP) approaches hold promise for supporting ACP, including its use for decision support to improve ACP gaps at the point of care. ACP themes were annotated on palliative care notes across four annotators (Fleiss kappa = 0.

"It's Incapacitated Me in so Many Ways": Older Adults' Lived Experience With Postoperative Symptoms at Home After Major Elective Surgery.

Objective: This qualitative study aimed to explore the challenges faced by older adults regarding the postoperative symptom experience after major elective surgery.

Background: Although extensively studied in oncology settings, the impact of postoperative symptom burden remains largely underexplored in elective major surgery among older adults.

Methods: We employed convenience sampling to recruit adults aged 65 years or above undergoing major elective surgery at the University of California, San Francisco.

Large Language Model-Based Chatbot vs Surgeon-Generated Informed Consent Documentation for Common Procedures.

Importance: Informed consent is a critical component of patient care before invasive procedures, yet it is frequently inadequate. Electronic consent forms have the potential to facilitate patient comprehension if they provide information that is readable, accurate, and complete; it is not known if large language model (LLM)-based chatbots may improve informed consent documentation by generating accurate and complete information that is easily understood by patients.

Objective: To compare the readability, accuracy, and completeness of LLM-based chatbot- vs surgeon-generated information on the risks, benefits, and alternatives (RBAs) of common surgical procedures.

Quality Improvement Initiative Implementation at the Unit or Hospital Level.

Quality improvement efforts take considerable commitment, including mentorship, training, and resources. Leveraging an established framework, such as that outlined by the American College of Surgeons, to design, implement, and analyze quality improvement projects offers the best chance for success. Herein, we illustrate the application of this framework to a gap in advance care planning for surgical patients.

Disparities in advance care planning rates persist among emergency general surgery patients: Current state and recommendations for improvement.

Background: Unanticipated changes in health status and worsening of chronic conditions often prompt the need to consider emergency general surgery (EGS). Although discussions about goals of care may promote goal-concordant care and reduce patient and caregiver depression and anxiety, these conversations, as well as standardized documentation, remain infrequent for EGS patients.

Methods: We conducted a retrospective cohort study using electronic health record data from patients admitted to an EGS service at a tertiary academic center to determine the prevalence of clinically meaningful advance care planning (ACP) documentation (conversations and legal ACP forms) during the EGS hospitalization.

Experiences with targeting inpatient advance care planning for emergency general surgery patients: A resident-led quality improvement project.

Background: For patients who may permanently or temporarily lose their ability to communicate preferences, advance care planning is a critical mechanism to guide medical decision-making but is currently underused among surgical patients.

Methods: A resident-led quality improvement project, including education and performance measurement, was conducted on an emergency general surgery service to increase the completion of inpatient advance care planning notes using a specialized template in the electronic health record. Advance care planning documentation was defined as either preadmission advance care planning documentation (eg, advance directive) or inpatient advance care planning (use of the electronic health record template).

High risk of complications after a "low risk" procedure: A national study of nursing home residents and older adults undergoing haemorrhoid surgery.

Aim: To evaluate 30-day complications and 1-year mortality for older adults undergoing haemorrhoid surgery.

Method: This retrospective cohort study evaluated older adults (age 66+) undergoing haemorrhoid surgery using Medicare claims and the minimum data set (MDS). Long-stay nursing home residents were identified, and propensity score matched to community-dwelling older adults.

Missed Opportunities and Health Disparities for Advance Care Planning Before Elective Surgery in Older Adults.

Importance: Advance care planning (ACP) prepares patients and caregivers for medical decision-making, yet it is underused in the perioperative surgical setting, particularly among older adults undergoing high-risk procedures who are at risk for postoperative complications. It is unknown what patient factors are associated with perioperative ACP documentation among older surgical patients.

Objective: To assess ACP documentation among high-risk patients 65 years and older undergoing elective surgery.

Robotic repair of perineal hernias: a video vignette and review of the literature.

Background: Perineal hernias can be secondarily acquired following abdominoperineal resection of the rectum. While transabdominal minimally invasive techniques have traditionally used laparoscopy, there are few studies published on the robotic platform, which has been gaining popularity for other types of hernia repairs. We review the existing literature, share a video vignette, and provide practical tips for surgeons interested in adopting this approach.

"I Wish Someone had Asked Me Earlier"-Perspectives on Advance Care Planning in Surgery.

Recent controversy has called into question the meaning and clinical utility of Advance Care Planning (ACP), however data have consistently shown potential benefit to patients and their surrogate decision makers. We present the concept of surgery-specific advance care planning and a structured, scalable approach to integrating it into clinical practice.

Characteristics and Procedures Among Adults Discharged to Hospice After Gastrointestinal Tract Surgery in California.

Importance: Hospice care is associated with improved quality of life and goal-concordant care. Limited data suggest that provision of hospice services after surgery is suboptimal; however, literature in this domain is in its nascency, leaving gaps in our understanding of patients who enroll in hospice after surgery.

Objective: To characterize the transition to hospice after gastrointestinal tract surgery and identify areas that warrant further attention and intervention.

Public Opinions About Surgery in Older Adults: A Thematic Analysis.

Objective: To examine public opinions of surgery in older adults.

Background: Increasing numbers of older adults are undergoing surgery. National healthcare organizations recognize the increased risks of postoperative complications and mortality in the older surgical population and have made efforts to improve the care of older adults undergoing surgery through hospital-level programs.

Mental health, preoperative disability, and postoperative outcomes in patients undergoing shoulder arthroplasty.

Background: Mental health conditions are associated with poor outcomes in patients with chronic disease as well as various orthopedic conditions. The purpose of this study was to describe the relationship between mental health, preoperative disability, and postoperative outcomes in patients undergoing shoulder arthroplasty.

Methods: Data, including mental health diagnoses, were prospectively collected from patients undergoing total shoulder arthroplasty or reverse total shoulder arthroplasty from 2009 to 2015 at a single academic institution.

Factors associated with oncology patients' involvement in shared decision making during chemotherapy.

Objective: Oncology patients are increasingly encouraged to play an active role in treatment decision making. While previous studies have evaluated relationships between demographic characteristics and decision-making roles, less is known about the association of symptoms and psychological adjustment characteristics (eg, coping styles and personality traits) and decision-making roles.

Methods: As part of a larger study of symptom clusters, patients (n = 765) receiving chemotherapy for breast, gastrointestinal, gynecological, or lung cancer provided information on demographic, clinical, symptom, and psychological adjustment characteristics.