Smoking Cessation for Preoperative Optimization.

Cigarette smoking is associated with pulmonary and cardiovascular disease and confers increased postoperative morbidity and mortality. Smoking cessation in the weeks before surgery can mitigate these risks, and surgeons should screen patients for smoking before a scheduled operation so that appropriate smoking cessation education and resources can be given. Interventions that combine nicotine replacement therapy, pharmacotherapy, and counseling are effective to achieve durable smoking cessation.

Long-term Outcomes of Perianal Fistulas in Pediatric Crohn's Disease.

Background: Approximately 30% of Crohn's disease-related perianal fistulas heal in the adult population with conventional medical and surgical interventions. This healing rate remains unknown in pediatric patients.

Objective: This study aimed to determine the healing rate of pediatric perianal Crohn's fistulas and identify factors associated with healing.

The impact of race and socioeconomic status on stage IV colorectal cancer survival.

Background: The aims of this study were to determine the impact of race and socioeconomics on survival in patients with stage IV colorectal cancer.

Methods: A prospective database of stage IV colorectal cancer patients treated at a multi-hospital health system from 2015 to 2019 was retrospectively analyzed. Univariate and multivariate survival analysis using log-rank Mantel-Cox test and Cox proportional hazard model were performed to determine the impact of race, socioeconomic factors, presentation, and treatment on overall survival.

Interactive Training Program Improves Surgeon and Pathologist Comfort Level With Total Mesorectal Excision Grading for Rectal Cancer.

Background: Total mesorectal excision for rectal cancer has been shown to decrease local recurrence and improve survival, and specimen grading is recommended as a best practice. However, specimen grading remains underutilized in the United States potentially because of the lack of surgeon and pathologist training in the technique.

Objective: This study aimed to determine whether an interactive webinar improves physician comfort with mesorectal grading.

Natural Language Processing to Estimate Clinical Competency Committee Ratings.

Objective: Residency program faculty participate in clinical competency committee (CCC) meetings, which are designed to evaluate residents' performance and aid in the development of individualized learning plans. In preparation for the CCC meetings, faculty members synthesize performance information from a variety of sources. Natural language processing (NLP), a form of artificial intelligence, might facilitate these complex holistic reviews.

Predicting postoperative opioid use with machine learning and insurance claims in opioid-naïve patients.

Background: The clinical impact of postoperative opioid use requires accurate prediction strategies to identify at-risk patients. We utilize preoperative claims data to predict postoperative opioid refill and new persistent use in opioid-naïve patients.

Methods: A retrospective study was conducted on 112,898 opioid-naïve adult postoperative patients from Optum's de-identified Clinformatics® Data Mart database.

Repair of a Crossbow Bolt Injury of the Subclavian Artery Behind the Mid-clavicle.

The management of a rare midclavicular crossbow bolt injury to the subclavian artery is discussed. Important concepts include the initial clinical diagnosis, operative planning, the surgical approach to the retro-clavicular great vessels, the technical aspects of repair, and postoperative course. A discussion of the reasoning behind an operative vs.

Association of Postoperative Opioid Prescription Size and Patient Satisfaction.

Objective: To evaluate the association between postoperative opioid prescription size and patient-reported satisfaction among surgical patients.

Summary Background Data: Opioids are overprescribed after surgery, which negatively impacts patient outcomes. The assumption that larger prescriptions increase patient satisfaction has been suggested as an important driver of excessive prescribing.

Readiness of Graduating General Surgery Residents to Perform Colorectal Procedures.

Objective: In the United States, the majority of colorectal procedures are performed primarily by nonfellowship trained general surgeons. Given that surgical technique and experience affect patient outcomes, it is important that general surgeons are well-trained to perform colorectal surgery operations. In this study, we evaluated how prepared general surgery residents were to perform colorectal procedures upon graduating residency.

Trainee Wellness and Safety in the Context of COVID-19: The Experience of One Institution.

The COVID-19 pandemic has had significant ramifications for provider well-being. During these unprecedented and challenging times, one institution's Department of Surgery put in place several important initiatives for promoting the well-being of trainees as they were redeployed to provide care to COVID-19 patients. In this article, the authors describe these initiatives, which fall into 3 broad categories: redeploying faculty and trainees, ensuring provider safety, and promoting trainee wellness.

Determinants of Value in Coronary Artery Bypass Grafting.

Background Over 180 000 coronary artery bypass grafting (CABG) procedures are performed annually, accounting for $7 to $10 billion in episode expenditures. Assessing tradeoffs between spending and quality contributing to value during 90-day episodes has not been conducted but is essential for success in bundled reimbursement models. We, therefore, identified determinants of variability in hospital 90-day episode value for CABG.

Development and characteristics of a multidisciplinary colorectal cancer clinic.

Background: Multidisciplinary cancer clinics deliver streamlined care and facilitate collaboration between specialties. We described patient volume and specialty service utilization, including surgery, of a multidisciplinary colorectal cancer clinic established at a tertiary care academic institution.

Methods: We conducted a retrospective observational cohort study of adult patients with colorectal adenocarcinoma from 2012 to 2017.

Assessment of a quality improvement intervention to decrease opioid prescribing in a regional health system.

Background: Opioids are prescribed in excess after surgery. We leveraged our continuous quality improvement infrastructure to implement opioid prescribing guidelines and subsequently evaluate changes in postoperative opioid prescribing, consumption and patient satisfaction/pain in a statewide regional health system.

Methods: We collected data regarding postoperative prescription size, opioid consumption and patient-reported outcomes from February 2017 to May 2019, from a 70-hospital surgical collaborative.

Building, scaling, and sustaining a learning health system for surgical quality improvement: A toolkit.

This article describes how to start, replicate, scale, and sustain a learning health system for quality improvement, based on the experience of the Michigan Surgical Quality Collaborative (MSQC). The key components to operationalize a successful collaborative improvement infrastructure and the features of a learning health system are explained. This information is designed to guide others who desire to implement quality improvement interventions across a regional network of hospitals using a collaborative approach.

Post-discharge Opioid Consumption After Minimally Invasive and Open Colectomy: Does Operative Approach Matter?

Objective: To determine if patients consume less opioid after minimally invasive colectomy compared to open colectomy.

Background: Opioids are overprescribed after surgery, and surgeons are under increasing pressure to reduce postoperative opioid prescribing. In colorectal surgery, minimally invasive approaches are partly justified by reduced inpatient opioid use, but there are no studies comparing post-discharge opioid consumption between minimally invasive and open colectomy.

The Association Between Preoperative Opioid Exposure and Prolonged Postoperative Use.

Objective: To determine the effect of nonchronic, periodic preoperative opioid use on prolonged opioid fills after surgery.

Background: Nonchronic, periodic opioid use is common, but its effect on prolonged postoperative opioid fills is not well understood. We hypothesize greater periodic opioid use before surgery is correlated with persistent postoperative use.

Functional and Cognitive Decline Among Older Adults After High-risk Surgery.

Objective: The aim of this study was to determine whether older adults are at higher risk of lasting functional and cognitive decline after surgery, and the impact of decline on survival and healthcare use.

Summary Background Data: Patient-centered outcomes after surgery are poorly characterized.

Methods: Using data from the Health and Retirement Study linked with Medicare, we matched older adults (≥65 years) who underwent one of 163 high-risk elective operations (ie, inpatient mortality of ≥1%) with nonsurgical controls between 1992 and 2012.

Preoperative Opioid Use and Readmissions Following Surgery.

Objective: To assess the association between preoperative opioid exposure and readmissions following common surgery.

Summary Background Data: Preoperative opioid use is common, but its effect on opioid-related, pain-related, respiratory-related, and all-cause readmissions following surgery is unknown.

Methods: We analyzed claims data from a 20% national Medicare sample of patients ages ≥ 65 with Medicare Part D claims undergoing surgery between January 1, 2009 and November 30, 2016.

Youth Perspectives of Prescription Pain Medication in the Opioid Crisis.

Objective: To characterize current youth perspectives of prescription pain medication.

Study Design: In total, 1047 youths aged 14-24 years were recruited by targeted social media advertisements to match national demographic benchmarks. Youths were queried by open-ended text message prompts about exposure and access to prescription pain medication, perceived safety of prescribed and nonprescribed medication, and associations with the word "opioid.

Characteristics of Patients Seeking Second Opinions at a Multidisciplinary Colorectal Cancer Clinic.

Background: Patients seeking second opinions are a challenge for the colorectal cancer provider because of complexity, failed therapeutic relationship with another provider, need for reassurance, and desire for exploration of treatment options.

Objective: The purpose of this study was to describe the patient and treatment characteristics of patients seeking initial and second opinions in colorectal cancer care at a multidisciplinary colorectal cancer clinic.

Design: This was a retrospective cohort study.

Variation in colectomy rates for benign polyp and colorectal cancer.

Background: Removal of pre-cancerous polyps on screening colonoscopy is a mainstay of colorectal cancer (CRC) prevention. Complex polyps may require surgical removal with colectomy, an operation with a 17% morbidity and 1.5% mortality rate.

Health Care Spending and New Persistent Opioid Use After Surgery.

Objective: We sought to describe the differences in health care spending and utilization among patients who develop persistent postoperative opioid use.

Summary Of Background Data: Although persistent opioid use following surgery has garnered concern, its impact on health care costs and utilization remains unknown.

Methods: We examined insurance claims among 133,439 opioid-naive adults undergoing surgery.

Medical Student Consulting: Providing Students Leadership and Business Opportunities While Positively Impacting the Community.

Introduction: Medical schools are increasingly attempting to prepare future physicians for diverse new leadership roles in the health care system. Many schools have implemented didactic leadership curricula, with varying levels of structure and success. Project-based learning via completion of real-world projects using a team-based approach remains an underutilized approach to developing student leadership skills.