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Tag: American College of Surgeons (ACS)

  • Dr. Jonathan Woodson Is Fourth Recipient of American College of Surgeons Distinguished Lifetime Military Contribution Award

    Dr. Jonathan Woodson Is Fourth Recipient of American College of Surgeons Distinguished Lifetime Military Contribution Award

    Newswise — Boston (October 23, 2023): Retired USAR Major General Jonathan Woodson, MD, MSS, FACS, MG, MC, renowned for his significant contributions to both military and civilian surgical care, was honored with the American College of Surgeons (ACS) Distinguished Lifetime Military Contribution Award during the ACS Clinical Congress 2023 in Boston, Massachusetts. Established by the Board of Regents in 2018, the award is selectively conferred based on merit, rather than annually. 

    Dr. Woodson is a quadruple-board-certified surgeon whose career has intertwined military service, surgical practice, and leadership in education. After earning his medical degree from New York University School of Medicine in New York City, Dr. Woodson completed residency training in internal medicine and general and vascular surgery at Massachusetts General Hospital and Harvard Medical School in Boston. He also completed fellowships in general, vascular, and critical care surgery at Waltham Weston Hospital & Medical Center in Massachusetts and Massachusetts General Hospital. 

    Dr. Woodson attained board certification in internal medicine, general surgery, surgical critical care, and vascular surgery. In addition, he completed a fellowship at the Health Services Research Institute of the Association of American Medical Colleges in Washington, D.C., and later, a master’s degree in strategic studies from the U.S. Army War College in Carlisle, Pennsylvania.  

    His career achievements also include several years as the Lars Anderson Professor in Management and Professor of the Practice at Boston University Questrom School of Business, with joint appointments as professor of surgery at the school of medicine and professor of health law, policy, and management at the school of public health. At Boston University, he also established and led the Institute for Health System Innovation and Policy.   

    At present, Dr. Woodson is the president of the Uniformed Services University (USU) of the Health Sciences in Bethesda, Maryland, where he leads the F. Edward Hébert School of Medicine and its associated graduate programs in the biomedical sciences, public health, nursing, dentistry, and allied health. Prior to assuming this role in 2022, Dr. Woodson was appointed as a member of the USU Board of Regents in 2016 and served as its chair from 2019 to 2021.   

    Dr. Woodson’s military achievements span several countries. He joined the military in 1986 as a Captain and served for 36 years, retiring as a Major General of the U.S. Army Reserve and Commander of the U.S. Army Reserve Medical Command of Pinellas Park, Florida, in 2022.   

    During his military career, Dr. Woodson was deployed to Saudi Arabia for Operation Desert Storm, to Afghanistan during Operation Enduring Freedom, and to Iraq during Operation Iraqi Freedom, as well as to Kosovo. Additionally, in 2010, President Barack Obama appointed Dr. Woodson the Assistant Secretary of Defense for Health Affairs and Director of the Tricare Management Activity in the U.S. Department of Defense, a role he held until 2016.  

    Notably, Dr. Woodson is the second winner of the Distinguished Lifetime Military Contribution Award who responded to the terrorist attacks of September 11, 2001. The 2021 winner, Lieutenant General (Retired) Paul K. Carlton, MD, FACS, was present in the Pentagon in Washington, D.C., at the time of the airplane crash and helped rescue three colleagues from the burning building immediately afterward. Dr. Woodson’s contribution to the rescue operation was at the World Trade Center in New York City, where he responded as a senior medical officer with the U.S. National Disaster Medical System.  

    In nomination materials for the Distinguished Lifetime Military Contribution Award, Board of Regents member Anton N. Sidawy, MD, MPH, FACS, wrote, “Jonathan is the ultimate officer, gentleman, and scholar. He is highly respected, transparent, and extremely thoughtful.”  

    When asked about the award, Dr. Woodson responded with a modesty that reflected Dr. Sidawy’s description. He said, “To think that the College would honor me with a lifetime achievement award is unexpected, and I’m very humbled by it and very honored.” 

    The Distinguished Lifetime Military Contribution Award was established by the ACS Board of Regents’ Honors Committee in 2018 to recognize a physician’s distinguished contributions to the advancement of military surgery. Recipients for this Award must be a physician with a demonstrated commitment to the advancement of military surgical care but are not required to be in active medical practice. 

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    About the American College of Surgeons 
    The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has approximately 90,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the American College of Surgeons. 

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  • American College of Surgeons Releases Online Version of Disaster Management and Emergency Preparedness Course

    American College of Surgeons Releases Online Version of Disaster Management and Emergency Preparedness Course

    Newswise — CHICAGO (October 17, 2023): In a world where unexpected emergencies and natural disasters are ever-present, preparedness is paramount. The American College of Surgeons (ACS) recently released the online version of its Disaster Management and Emergency Preparedness (eDMEP) course, making this important content accessible to a wider audience. 

    The eDMEP course provides physicians with essential knowledge and best practices for responding to mass casualty incidents. The course focuses on the hospital response to disaster. The overall goal is to motivate action and stimulate critical thinking to be ready for, respond to, and recover from disasters. Featuring diverse scenarios ranging from earthquakes to complex terrorist attacks, this comprehensive course ensures that learners are well-equipped to manage unforeseen emergencies. 

    What sets eDMEP apart is its innovative interactive approach. Each scenario immerses the learner into the crucial role of a trauma surgeon or triage officer responding to a specific disaster. The interactive scenarios help learners hone their triage skills in a virtual setting, preparing them for real-life situations. Furthermore, each scenario is tailored to the respective disaster, ensuring that casualties and injuries accurately reflect the conditions and unique needs of that event. 

    “Just like trauma, disaster management is a team endeavor. It requires ‘all hands-on deck,’ from the managers to the cleaning crews and from the trauma surgeons to the internists. This course not only provides information to all members of the disaster management team, it takes them by the hand and walks them through all the steps of disaster preparation, response, and recovery. The eDMEP case scenarios take online surgical education to the next level, providing opportunities to make decisions about patient care in realistic mass casualty situations by incorporating elements of game theory,” said Jeannette M. Capella, MD, MEd, FACS, Education Program Chair, ACS Disaster Management and Emergency Preparedness (DMEP)/eDMEP. 

    The first eDMEP scenario addresses earthquake preparedness. The ACS will be rolling out additional scenarios, with the complete collection slated for early 2024. 

    The eDMEP course is a collaborative effort between the ACS and a distinguished panel of surgeons and experts experienced in disaster management. The new online version builds upon the longstanding ACS DMEP course, an in-person trauma education initiative focused on preparing medical professionals for mass casualty incidents. Through engaging lectures and interactive scenarios, DMEP imparts valuable knowledge on incident command terminology, disaster triage principles, injury patterns, and the resources available for assistance. 

    The overarching objectives of the eDMEP course encompass: 

    • Preparing participants for disaster readiness, response, and recovery 
    • Empowering participants to contribute effectively to hospital disaster preparedness 
    • Training participants to practice hospital disaster plans using interactive scenarios 

    More information about both eDMEP and the in-person DMEP courses is available on the ACS website. Both options provide extensive training and equip participants to effectively tackle mass casualty incidents. 

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    About the American College of Surgeons 

    The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has approximately 90,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the American College of Surgeons. 

     

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  • Sixty-Three Esteemed Surgical Educators Inducted Into the Sixth Cohort of the American College of Surgeons Academy of Master Surgeon Educators

    Sixty-Three Esteemed Surgical Educators Inducted Into the Sixth Cohort of the American College of Surgeons Academy of Master Surgeon Educators

    Newswise — CHICAGO (October 10, 2023): Sixty-three esteemed surgical educators were inducted into the American College of Surgeons (ACS) Academy of Master Surgeon Educators® October 6, an honorary distinction that recognizes preeminent surgical educators who have devoted their careers to surgical education and are considered premier leaders in their respective fields.

    The ACS Academy of Master Surgeon Educators works to advance the science and practice of education across all surgical specialties. Individuals are selected as Members, Associate Members, or Affiliate Members following a stringent peer review process. This year’s cohort includes Members (27 Inductees), Associate Members (35 Inductees), and Affiliate Members (1 Inductee). The first inaugural cohort was inducted in 2018 and the Academy has since grown to include 358 Members, Associate Members, and Affiliate Members who represent ten surgical specialties other than general surgery. Inductees are from 18 states and the District of Columbia. They come from nine countries, in addition to those from the United States.

    Once inducted, Academy members actively engage in advancing the Academy’s programs and goals, which are to advance the science and practice of innovative lifelong surgical education, training, and scholarship in the changing milieu of health care; foster the exchange of creative ideas and collaboration; support the development and recognition of faculty; underscore the importance of lifelong surgical education and training; positively impact quality and patient safety through lifelong surgical education and training; disseminate advances in education and training to all surgeons; and offer mentorship to surgeon educators throughout their professional careers.

    “This Academy of preeminent surgical educators has been making landmark contributions to surgical education and is introducing many transformational changes in surgical education that will endure into the future,” said Ajit K. Sachdeva, MD, FACS, FRCSC, FSACME, MAMSE, Director of the ACS Division of Education and co-chair of the Steering Committee of the Academy. “We look forward to leveraging the expertise of the members as we explore innovations that will continue to advance the field of surgical education and positively impact the careers of surgical educators.”

    “The Academy of Master Surgeons Educators, a vital and ‘living body’ of the American College of Surgeons, continues its legacy of advancing the science and practice of surgical education. The Academy is pleased to induct the 2023 class of distinguished and highly accomplished educators. This recognition is a true testament to the unwavering commitment of the College to develop and promote ‘best practices’ in surgical education, with the overarching goal to always improve patient care.” said L. D. Britt, MD, MPH, DSc(Hon), FACS, FCCM, FRCSEng(Hon), FRCSEd(Hon), FWACS(Hon), FRCSI(Hon), FCS(SA)(Hon), FRCS(Glasg)(Hon), MAMSE, past president of the ACS, and co-chair of the Steering Committee of the Academy. To learn more about the Academy of Master Surgeon Educators, please visit the Academy’s homepage.

    “MAMSE” designates that a surgeon is a Member of the ACS Academy of Master Surgeon Educators.

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    About the American College of Surgeons
    The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has approximately 90,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the American College of Surgeons.

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  • Surgical Scorecards May Cut Cost of Surgical Procedures Without Impacting Outcomes

    Surgical Scorecards May Cut Cost of Surgical Procedures Without Impacting Outcomes

    Key takeaways 

    • A tool for evaluating the overall cost of a surgical procedure, called a scorecard, helps reduce costs of surgical procedures between 5% and 20% without adversely affecting clinical outcomes.  
    • Further implementation of scorecards may move surgeons toward energy-efficient operating rooms, which are the largest hospital producer of emissions and waste.   

    Newswise — CHICAGO (October 3, 2023): Surgical scorecards, a tool that gives direct feedback to surgeons about their procedure costs in the operating room, may significantly reduce costs without impacting clinical outcomes, according to a study published in the Journal of the American College of Surgeons (JACS). 

    The surgical scorecard is a novel approach to addressing operating room costs. It is commonly delivered to the surgeon in the form of an email receipt, report card, or informational session summarizing the cost of their own surgical items, staffing, and the time used for any procedure in the operating room, as well as how those costs compare to colleagues’ costs and similar operations performed.   

    “The reality is that healthcare in the United States is exorbitantly expensive, and despite this increased spending, Americans don’t have better health outcomes than our high income country neighbors,” said lead study author Wesley Dixon, MD, an internal medicine resident physician at Brigham and Women’s Hospital in Boston, Massachusetts. “Our results show that scorecard implementation is one of many different methods that can be used to lower health-care costs, particularly operating room costs, which comprise a significant proportion of health-care spending. Using different cost saving interventions together can reduce overall U.S. health care spending without compromising patient care.”   

    Study design 

    The researchers carried out a scoping review, which synthesizes all available study results based on keyword searches, by scanning research databases such as PubMed, Embase, and Web of Science to gather more information about surgical scorecards and their impact on cost reduction. 

    Twenty-one studies published between 2011 and 2022 were included, spanning eight subspecialties and 30 procedures. Through a literature search, key elements of cost such as “surgical supplies,” “implants,” “wasted supplies,” and “operative time” were identified.  

    The data was then analyzed according to the impact of scorecards on the percentage change in cost per operation – from before the intervention to after the intervention, and the impact on patient outcomes, which included operative time, postoperative length of stay, complication rates, readmission rates, and mortality.   

    Key findings 

    • Of 30 total scorecard interventions measured across 21 studies, 16 out of 30 (53%) interventions showed surgical procedure cost reductions between 5% and 20%.  
    • For 11 studies, cost reduction was attributed to reduced use of specific high cost items. Cost savings can come from using less expensive alternatives or wasting fewer supplies (opened but unused during the operation).  
    • The most common surgical subspecialties included in the review were orthopedic and general surgery. A wide variety of procedures were included, but the most common were adult and pediatric laparoscopic appendectomy.  

    Making hospitals more energy efficient 

    “The biggest knowledge gap we identified in this study is that there is essentially no research connecting surgical scorecards to surgeons with environmental or emissions data related to the operating room,” Dr. Dixon said.  

    “Operating rooms contribute around 50% of hospital waste and are much more energy-intensive than the rest of the hospital, adding to the overall carbon footprint. Therefore, some of these data-driven feedback mechanisms that include carbon-related data would be a major step towards making the hospital a more energy-efficient place.” 

    A limitation of the study is that a large part of scorecard use nationwide is implemented as part of quality improvement initiatives and those results are not always published. Therefore, the results of this scoping review might underrepresent the true impact of surgical scorecards.  

    Study coauthors are Allan Ndovu; Millis Faust, MD; Tejas Sathe, MD; Christy Boscardin, PhD; Garrett R. Roll, MD, FACS; Kaiyi Wang, MS; and Seema Gandhi, MD. 

    The study authors have no disclosures. 

    This study is published as an article in press on the JACS website. 

    Citation: Cost-Saving in the Operating Room: A Scoping Review of Surgical Scorecards. Journal of the American College of Surgeons. DOI:10.1097/XCS.0000000000000846 

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    About the American College of Surgeons 

    The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 88,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the American College of Surgeons. 

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  • Historic Redlining Practices Cast a Long Shadow on Cancer Screening Rates

    Historic Redlining Practices Cast a Long Shadow on Cancer Screening Rates

     Key Takeaways

    • Banned since 1968, the legacy of redlining persists: There continue to be instances of discrimination affecting people in these historically redlined areas.
    • Redlining was associated with lower odds of hitting screening targets for all three types of cancer: 24% lower odds in breast cancer, 64% lower odds in colorectal, and 79% lower odds in cervical cancer, compared with non-redlined areas.
    • Actionable initiatives to improve cancer screening rates: Questionnaires to determine barriers to cancer screening, mobile cancer screening efforts, and alternative screening tests, can help address these inequities.

    Newswise — CHICAGO: Although redlining was outlawed more than 50 years ago, new research shows that people today who live in historically redlined areas are less likely to be screened for breast, colorectal, and cervical cancer than people who live in areas not associated with redlining practices.

    Redlining is a discriminatory practice in which financial institutions refuse to provide loans or insurance to people who live in an area deemed to be a poor financial risk. The practice predominately impacted Black home buyers, contributing to segregation and inequality. Congress banned the practice under the Fair Housing Act of 1968, but people who live in the areas that were once redlined continue to be negatively affected, as evidenced by low rates of cancer screening, according to a study recently published in the Journal of the American College of Surgeons. Until this study, the impact of historical redlining on cancer screening, regardless of contemporary social vulnerability, has been largely unexplored.

    “Our study shows that the legacy of redlining has a long historical arc that still persists today due to chronic under investment in these areas,” said the study’s lead author Timothy Pawlik, MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon), a surgical oncologist who is the surgeon-in-chief of The Ohio State University Wexner Medical Center. “Redlining serves as a surrogate for systemic racism, especially as it pertains to those who live in areas that lack adequate investment in education, employment, transportation, and healthcare.”

    An example of how redlining persists is the case of a national real estate company that was sued for discrimination by fair housing groups for its policy of not offering real estate services to owners selling homes under a minimum price level, Dr. Pawlik said. In 2022, the company, Redfin, agreed to a $4 million settlement and to expand its services for lower-priced houses.  

    Key study findings

    Using national 2020 census-tract level data on cancer screening rates and historical redlining grades, the researchers found that:

    • Among 11,831 census-tracts, 3,712 tracts were redlined, with the greatest number of redlined tracts in New York and California, particularly in the New York City and Los Angeles metropolitan areas.
    • Redlining was associated with lower odds of hitting screening targets in all three types of cancer: 24% lower odds in breast cancer, 64% lower odds in colorectal, and 79% lower odds in cervical cancer, compared with non-redlined areas. This association persisted even after adjusting for contemporary social vulnerability and access to care.
    • A large proportion of the total effect of redlining on cancer screening was attributable to poverty, lack of education, and limited English proficiency.

    “I find this study on the impact of historic redlining practices on current cancer screening rates to be incredibly important and sobering. The findings clearly demonstrate that the legacy of redlining continues to contribute to significant disparities in breast, colorectal, and cervical cancer screening, highlighting the urgent need for targeted interventions and policy reforms to address underlying structural racism and improve health equity in our historically marginalized communities,” said David Tom Cooke, MD, FACS, professor and chief of the Division of General Thoracic Surgery at UC Davis Health, and president of the Thoracic Surgery Directors Association.

    Dr. Cooke, who was not involved with the study, added, “This study underscores the responsibility of healthcare systems, including academic and non-academic medical centers, to proactively tackle social determinants of health, such as redlining, to achieve equitable access to cancer screening and ultimately save lives.”

    How to alleviate the impact of redlining on cancer screening rates

    By demonstrating the long-term implications of discriminatory practices, the study results can help shape healthcare and social policy reform to reduce health inequities, Dr. Pawlik said.

    Those efforts start with specific, actionable initiatives, Dr. Pawlik said. To determine how to improve cancer screening rates in specific areas may require resident questionnaires to determine the potential barriers, he said. For example, if transportation was a barrier, travel vouchers could be provided; or if English proficiency was a barrier, an interpreter could be provided.

    Among the approaches that could help improve cancer screening rates in historically redlined areas include:

    • Government policies that target the areas with social services aimed at poverty alleviation, affordable housing, and education.
    • Initiatives to improve access to preventive cancer care may mitigate cancer screening disparities. One example is the Mobile Mammography Van by the Navajo Breast and Cervical Cancer Prevention Program.
    • Alternative methods to make it easier for affected people to get screened. For example, since colonoscopies pose significant barriers, such as bowel prep and devoting most of the day for the exam, tests to detect DNA mutations and blood in the stool may be a more workable approach, Dr. Pawlik said.

    “I think the fact that the cancer screening is so disparate in these communities is a real wake up call to all of us,” Dr. Pawlik said.

    Study coauthors are Zorays Moazzam, MD; Selamawit Woldesenbet, MS, MPH, PhD; Yutaka Endo, MD, PhD; Laura Alaimo, MD; Henrique A. Lima, MD; Jordan Cloyd, MD, FACS; Mary E. Dillhoff, MD, FACS; and Aslam Ejaz, MD, FACS.

    Disclosures: Nothing to disclose.

    Citation: Moazzam Z, Woldesenbet S, Endo Y, et al. Association of Historical Redlining and Present-Day Social Vulnerability with Cancer Screening. Journal of the American College of Surgeons. DOI: 10.1097/XCS.0000000000000779.

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    About the American College of Surgeons

    The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 87,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the American College of Surgeons.

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  • Hospitals Face Challenges When Implementing Enhanced Recovery Programs for Surgery

    Hospitals Face Challenges When Implementing Enhanced Recovery Programs for Surgery

    Key takeaways

    • Striving to improve patient care: Enhanced recovery programs (ERPs) provide hospitals with patient-centered protocols and standards to improve the safety and quality of care for patients undergoing surgery.
    • Understanding barriers to compliance: Although previous studies have shown substantial improvements when hospitals implement ERPs, some hospitals have reported difficulties successfully implementing these programs.
    • ERPs are not always easily implemented: This study found that out of 151 hospitals that implemented an ERP for colorectal surgery, most of them (85%) had difficulty improving compliance with a national protocol.

    Newswise — CHICAGO: Enhanced recovery programs (ERPs) provide hospitals with the highest-quality resources to improve patient care for surgery, but many hospitals still struggle to successfully implement these programs and may need more structured resources to boost compliance rates, according to findings published in the Journal of the American College of Surgeons (JACS). 

    “Enhanced recovery programs have been instrumental in promoting evidence-based, standardized perioperative care that focuses on engaging patients from the moment it’s decided they will have surgery, all the way to their transition back into the community,” said Elizabeth Wick, MD, FACS, a professor of surgery at the University of California, San Francisco (UCSF) and a study co-author. “While some previous studies have reported substantial improvements when hospitals implement these programs, the goal of this study was to take a deep dive into process compliance and understand how successful these hospitals were at implementing enhanced recovery programs.”

    The research stems from the Improving Surgical Care and Recovery Collaborative (ISCR), a partnership between the American College of Surgeons (ACS), the Agency for Healthcare Research and Quality, and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality. That collaboration began in 2016 with the goal of helping hospitals implement ERPs, also known as enhanced recovery after surgery, around the country by providing them with centralized support and tools for standardizing patient care — from guidelines on infection control to optimal nutrition. The program ran until 2022 and assisted about 300 hospitals in initiating and spreading ERPs across multiple surgical specialties, according to Dr. Wick.

    “Another principle we try to emphasize through the program is the importance of multidisciplinary or collaborative surgical care with surgeons, anesthesiologists, hospitals, and nurses,” Dr. Wick explained. “All members of the team need to come together to provide the best surgical care for patients and their families.”

    For this study, researchers analyzed data from 151 hospitals enrolled in an ISCR protocol for colorectal surgery to determine if they got better or worse at complying with ERP process measures — and by how much — over an 18-month period. Participating hospitals, which were located throughout the country but were mostly teaching hospitals in urban areas, entered data on process measure compliance and 30-day patient outcomes into a customized registry through the ACS National Surgical Quality Improvement Program® (ACS NSQIP®).

    The researchers looked at six common components of an ERP protocol for colorectal surgery:

    • Oral antibiotics: Did the patient receive oral antibiotics within 24 hours of the operation?
    • Mechanical bowel preparation: Did the patient complete a mechanical bowel preparation (oral medication used to cleanse the large bowel of fecal matter) before the operation?
    • Multimodal pain control: Did the patient use scheduled, nonopioid pain medication in addition to, or in place of, opioid pain medication within 24 hours of the operation?
    • Early mobilization: Was the patient mobile (able to walk and stand) within 24 hours of the operation?
    • Early liquid intake: Did the patient receive liquid within 24 hours of the operation?
    • Early solid intake: Did the patient receive solid food within 48 hours of the operation?

    Looking at changes in process measure compliance from the start of the program to the end, the team divided compliance rate changes into three categories: worsening (<0%), minimal improvement (0-20% change in compliance), and substantial improvement (greater than 20% change in compliance).

    Researchers looked at each of the six process measures separately as an individual opportunity for improvement and looked at a composite measure of all six process measures by the hospital.

    Key findings

    • Out of 151 hospitals studied, only 15% of the hospitals achieved substantial improvements in compliance across the entire protocol.
    • The researchers identified 663 individual opportunities available for improvement; of these opportunities, substantial improvement in compliance only occurred 20% of the time.
    • Process measures that involved simple interventions, such as pain control or oral antibiotics, improved the most by 23% and 16%, respectively. In contrast, early mobilization improved the least, by 2%.
    • On average, the individual components of the ERP were implemented for patients less than 70% of the time across all the hospitals.

    The research focused on a national ERP for colorectal surgery, but the authors note that the results may be generalizable across many surgical specialties.

    “I think these findings suggest that there’s a significant opportunity available to improve compliance with enhanced recovery programs, and in turn, improve patient outcomes, because prior studies have shown that high compliance leads to better outcomes,” said Tejen Shah, MD, a general surgery resident at Ohio State University Wexner Medical Center and lead author of the study.

    Addressing barriers

    Though the study only included data from hospitals that participated in the ISCR collaborative, which could cause selection bias, the trends reflected in the study paint a larger picture of barriers to implementing ERPs, the researchers said. When implementing ERPs, inadequate resources or limited leadership support may hinder progress, for example, or there may be ineffective collaboration and communication among team members.

    In their journal article, the researchers identified the ACS Quality Verification Program™ (ACS QVP) as one program that may offer hospitals a more structured approach to achieving quality improvement measures. The ACS QVP provides hospitals with customized, actionable recommendations on improving surgical quality, such as leadership and safety culture, based on the framework of 12 evidence-based standards vetted by the ACS. The program may help hospitals and providers break down each component of the ERP into manageable items, the researchers noted.

    “The overall structure of the ACS QVP may also be advantageous to hospitals. It really helps surgeons engage with hospital leadership at a very high level,” Dr. Wick said.

    “Lower compliance rates didn’t occur because of a lack of effort. People were passionate about trying to implement the enhanced recovery program. But it was challenging,” she added. “I think this study highlights the fact that we need to collectively figure out how to address those barriers and make this work easier. We have the opportunity to improve prioritization and access to resources, whether it’s project management or expertise in data skills, and then ultimately hold people accountable for doing the work.”

    “This research confirms what we as surgeons know — the work of improvement is challenging. It takes tremendous focus and determination,” Dr. Wick said. “The good news is that the ACS has exceptional expertise in how to improve surgical quality. With more than 17 surgical quality programs, the ACS is a valuable resource for every hospital’s quality journey.”

    Study coauthors are Leandra Knapp, MS; Mark E. Cohen, PhD; Stacy A. Brethauer, MD, MBA, FACS; and Clifford Y. Ko MD, MS, MSHS, FACS. All authors are affiliated with the Division of Research and Optimal Patient Care, the American College of Surgeons, Ohio State University Wexner Medical Center, the University of California, San Francisco (UCSF), or the University of California, Los Angeles (UCLA).

    The study authors have no relevant disclosures to report. This research was supported by funding from the Agency for Healthcare Research and Quality (AHRQ). Ms. Knapp is supported by funding from the U.S. Department of Health and Human Services and is employed by the American College of Surgeons, subcontracted under Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality for Improving Surgical Care and Recovery contract with the AHRQ. Dr. Wick is supported by funding from the National Institutes of Health.

    This research was also presented at the Southern Surgical Association 134th Annual Meeting in Palm Beach, Florida, December 2022. This study is published as an article in press on the JACS website.

    Citation: Shah T, Knapp L, Cohen M, et al. Truth of Colorectal Enhanced Recovery Programs: Process Measure Compliance in 151 Hospitals. Journal of American College of Surgeons. DOI: 10.1097/XCS.0000000000000562.

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    About the American College of Surgeons 

    The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. “FACS” designates a surgeon is a Fellow of the American College of Surgeons.  

    The Journal of the American College of Surgeons (JACS) is the official scientific journal of ACS. Each month, JACS publishes peer-reviewed original contributions on all aspects of surgery, with the goal of providing its readership the highest quality rapid retrieval of information relevant to surgeons.

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  • Telemedicine reduces odds of no-show clinic visits by more than two-thirds for surgical patients

    Telemedicine reduces odds of no-show clinic visits by more than two-thirds for surgical patients

    Key takeaways 

    • Telemedicine significantly lowers likelihood of no-show clinic visits among surgical patients and follow-up care during the post-surgery period.   
    • Telemedicine is a convenient tool that can help improve healthcare for all patients, successfully increasing access among vulnerable populations.  

    Newswise — SAN DIEGO: Surgical patients who use telehealth services are much more likely to show up for their initial clinic visit or follow-up appointment during the post-surgery period than those who rely on in-person visits only. Research findings were presented at the Scientific Forum of the American College of Surgeons (ACS) Clinical Congress 2022. During the early months of the COVID pandemic, when everything shut down, telemedicine became an effective tool to reach patients. Building on those successes, more hospitals and clinics are implementing telehealth technology into their patient care practices.  

    Telehealth consists of an at-home interactive video and audio telecommunications system, allowing real-time connection between patients, nurses, and doctors. One major benefit to patients is that they avoid the trouble of travel to and from an appointment at a distant hospital or clinic. 

    “Low access to transportation is the number one reason for patient no-show visits.* Telemedicine is a feasible way for us to reach out to patients who would otherwise have a lot of barriers to access the healthcare system,” said lead study author Connie Shao, MD, a general surgery resident at the University of Alabama Birmingham.  

    “Maintaining routine healthcare such as clinic visits helps prevent emergent visits, which are typically at a point in time when a patient’s condition is much worse. Staying engaged with the healthcare system with timely care before and after surgery improves quality care, reduces costs for the patient, and helps ensure our patients are able to maintain a higher level of health.”  

    Even so, little is known about telemedicine use among surgical patients. 

    About the study  

    For this analysis, researchers evaluated the association between telemedicine use and patient no-show visits. They looked at data collected from seven clinics at the University of Alabama Birmingham among a diverse population of patients, with an average age of 60, undergoing all types of surgery between January 2018 and December 2021. 

    Researchers divided the patients into three categories:  

    1. a historical control of in-person visits from January 2018 to March 2020 
    2. a contemporary control of in-person visits from March 2020 to December 2021 
    3. a contemporary group of patients scheduled for telemedicine visits between March 2020 to December 2021  

    March 2020 was the start of the COVID-19 pandemic and, with that, a ramping up of telemedicine appointments. The three groups were compared for no-show visits.  

    Key findings 

    • Of the 553,475 total visits, 11.3% were no-shows. 
    • Most clinic visits were in the historical control (54.1%), compared with contemporary control (41.5%), and telemedicine visits—which included audio only and video (4.4%  for both types). 
    • The no-show rate was highest among in-person appointments (11.7%) compared to telemedicine visits (2.5%). 
    • Telemedicine was effective at reducing no-show visits. Of the small group of telemedicine visits, a multivariable adjusted analysis found a reduction in odds by 79% of no-show visits.  
    • No-show visits were also less common among older patients, those insured with Medicare, and the historical in-person visits from January 2018 to March 2020, compared with the contemporary in-person visits from March 2020 to December 2021.  
    • Disparities in no-show visits exist. For all visits, male patients were 12% more likely to not complete the appointments than women. Black patients, compared with white patients, were 68% more likely to be no-shows, and Asian patients were 32% more likely to be no-shows.  
    • Compared with private insurance, Medicaid patients were twice as likely to not complete the appointment. And patients from counties with a higher Social Vulnerability Index were 13% more likely to not complete the appointment. 

    Addressing the digital divide for patients  

    “Hopefully with the convenience of telemedicine now, the only bridge that we have to cross is the digital divide. We’ve partnered with a grassroots community program to train people in our community, especially older and more vulnerable people, on how to use telemedicine,” Dr. Shao said. “We can help keep these patients engaged in the healthcare system without having to take up their entire day to come and see us in the hospital.” 

    Giving all patients the option to use telehealth services may be of great benefit to surgical patients in the future. Dr. Shao is also developing best practice guidelines for the use of telemedicine for different surgical specialties during the post-surgery period.  

    “Telemedicine interventions such as training patients and offering more low-tech options, such as audio only, especially for patients who live far away, is an easier option. Some care is better than no care. And it’s far better for us to get some information at a telemedicine visit to take care of our patients in a timely interval than to wait to see the patient later on when they are sicker and have to be admitted to a hospital,” Dr. Shao said. “There is a time and place to use telemedicine. It certainly is an intervention worth considering to reduce no-show visits and to improve quality care across the board.” 

    The main limitation of the study is that the populations that are using telehealth technology are more likely, in general, to show up for a clinic visit (patients with better health literacy and access to the healthcare system disproportionately benefit from telemedicine).  Future studies that incorporate telemedicine training into patient visits will eliminate this confounding.  

    The study was supported by the ACS and the University of Alabama Birmingham Health Services and Outcomes Research Group.  

    Study coauthors are Marshall C. McLeod, PhD; Andy Hare, BS; Isabel C. Marques, MD; Lauren Gleason, MD, MSPH; Burkely P. Smith, MD; Eric L. Wallace, MD, FACS; and Daniel I. Chu, MD, FACS.   

    Citation: Shao C, et al. Telemedicine Associated with Decreased No-show Visits among Surgical Specialties, Scientific Forum, American College of Surgeons Clinical Congress 2022.    

    ________________________ 

    * Mieloszyk RJ, Rosenbaum JI, Hall CS, et al. Environmental Factors Predictive of No-Show Visits in Radiology: Observations of Three Million Outpatient Imaging Visits Over 16 Years, J Am Coll Radiol, 2016; 16 (4,B) 554-559.  

    # # #   

    About the American College of Surgeons 
    The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the American College of Surgeons. 

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  • Livers have the potential to function for more than 100 years

    Livers have the potential to function for more than 100 years

    Key takeaways 

    • Understanding the characteristics of livers that live to 100 could potentially expand the donor pool by using older liver donors more often. 
    • New surgical techniques and advances in immunosuppression lead to better outcomes for patients receiving a liver from an older donor.  
    • Optimizing both donor and recipient factors allow for much greater longevity for certain livers. 

    Newswise — SAN DIEGO: There is a small, but growing, subset of livers that have been transplanted and have a cumulative age of more than 100 years, according to researchers from University of Texas (UT) Southwestern Medical Center, Dallas, and TransMedics, Andover, Massachusetts. They studied these livers to identify characteristics to determine why these organs are so resilient, paving the way for considering the potential expanded use of older liver donors. The research team presented their findings at the Scientific Forum of the American College of Surgeons (ACS) Clinical Congress 2022. 

    The researchers used the United Network for Organ Sharing (UNOS) STARfile to identify livers that had a cumulative age (total initial age at transplant plus post-transplant survival) of at least 100 years. Of 253,406 livers transplanted between 1990-2022, 25 livers met the criteria of being centurion livers—those with a cumulative age over 100 years. 

    “We looked at pre-transplant survival—essentially, the donor’s age—as well as how long the liver went on to survive in the recipient,” said lead study author Yash Kadakia, a medical student at UT Southwestern Medical School. “We stratified out these remarkable livers with over 100-year survival and identified donor factors, recipient factors, and transplant factors involved in creating this unique combination where the liver was able to live to 100 years.” 

    Centurion livers came from older donors 

    For these centurion livers, the average donor age was significantly higher, 84.7 years compared with 38.5 years for non-centurion liver transplants. The researchers noted that for a liver to make it to 100, they expected to find an older average donor age as well as healthier donors. Notably, the donors from the centurion group had lower incidence of diabetes and fewer donor infections. 

    “We previously tended to shy away from using livers from older donors,” said study coauthor Christine S. Hwang, MD, FACS, associate professor of surgery, UT Southwestern Medical Center. “If we can sort out what is special amongst these donors, we could potentially get more available livers to be transplanted and have good outcomes.”  

    There are 11,113 patients on liver transplant waiting list as of September 22, 2022.* As Dr. Hwang noted, using older liver donors more often could potentially expand the liver donor pool. 

    Further study details 

    Centurion liver donors had lower transaminases, which are enzymes that play a key role in the liver. Elevated transaminases can cause problems in liver transplantation. Additionally, the recipients of centurion livers had significantly lower MELD scores (17 for the centurion group, 22 for the non-centurion group). A higher MELD score indicates that a patient is more urgently in need of a transplant.  

    “The donors were optimized, the recipients were optimized, and it takes that unique intersection of factors to result in a really good outcome,” Mr. Kadakia said. 

    The researchers found that no grafts in the centurion group were lost to primary nonfunction or vascular or biliary complications. There was notably no significant difference in rates of rejection at 12 months between the centurion group and the non-centurion group. Further, outcomes for the centurion group had significantly better allograft and patient survival.  

    “The existence of allografts over 100 years old is revealing of the dramatic resilience of the liver to senescent events,” the study authors concluded.  

    “Livers are incredibly resilient organs,” said Mr. Kadakia. “We’re using older donors, we have better surgical techniques, we have advances in immunosuppression, and we have better matching of donor and recipient factors. All these things allow us to have better outcomes.” 

    Study coauthors are Malcolm MacConmara, MBBCh, FACS; Madhukar S. Patel, MD; Jigesh A. Shah, DO; Steven I. Hanish, MD, FACS; and Parsia A. Vagefi, MD, FACS. 

    Citation: Kadakia Y, et al. Centurion Livers — Making It to 100 with A Transplant, Scientific Forum, American College of Surgeons Clinical Congress 2022. 

    ________________________  

    * Data. Organ Procurement & Transplantation Network. Accessed September 23, 2022. Available at: https://optn.transplant.hrsa.gov/data/ (.)  

    # # # 

    About the American College of Surgeons  

    The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the American College of Surgeons. 

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  • New palliative care screening tool for surgical ICU patients may facilitate decision-making processes, reduce burden on families, medical staff

    New palliative care screening tool for surgical ICU patients may facilitate decision-making processes, reduce burden on families, medical staff

    Key takeaways 

    • Critically ill patients in the Surgical Intensive Care Unit (SICU) may benefit from palliative care, focusing on quality of life, when aggressive medical interventions will not improve outcomes or extend life. 
    • Across hospital systems, models and access to palliative care vary; identifying patients can be difficult, often occurring late in SICU stays.  
    • Using three key questions, a new screening tool, developed using a quality improvement process, helped the medical team identify which SICU patients may benefit from palliative care or goals of care consultations within seconds; all patients in the SICU could be screened in about 30 seconds. 

    Newswise — SAN DIEGO: To aid in decision-making processes and increase awareness around palliative care in the Surgical Intensive Care Unit (SICU), a research team at the University of North Carolina at Chapel Hill (UNC-Chapel Hill) has developed a screening tool to identify—within seconds—patients who may benefit from palliative care consultations or goals of care discussions. Their research findings, presented at the Scientific Forum during the American College of Surgeons (ACS) Clinical Congress 2022, show that the screening tool successfully identified SICU patients who were later deemed candidates for palliative care by their medical team.  

    As a general and trauma surgeon, Trista Day Snyder Reid, MD, MPH, FACS, an assistant professor of surgery at UNC Health, and the study’s medical advisor, explained that she often witnesses medical teams and families make agonizing decisions for patients in the SICU. When aggressive medical interventions will not improve outcomes or extend life, palliative care treatment, which focuses on symptom management and supportive communication, may improve a patient’s quality of life. Unfortunately, a medical team may hesitate to collectively identify appropriate patients or may refer patients to palliative care late in their SICU stay, increasing the burden and stress on the patient and their families.  

    “One of the things that we found at our institution was sometimes we would involve palliative care, but it would happen way down the line when the patient had been in the SICU for a long time already,” Dr. Reid said. “We want palliative care discussions to be happening sooner. And even if we’re not involving palliative care, we want goals of care discussions to happen early so the family has a rapport with the medical team and understands that their family member is really sick.” 

    Across hospital systems, screening criteria and access to palliative care vary. Research has shown that offering palliative care consultations early in an ICU stay can improve quality of life and even reduce the lengths of stay in the ICU.1 However, integrating palliative care into hospital systems remains challenging due to a lack of resources and insufficient training, among other factors.2 

    Study details  

    The UNC researchers initially developed a screening tool with 12 “yes/no” questions with input from SICU and palliative care physicians, nurses, and advanced practice providers. Fourth-year medical students at UNC-Chapel Hill completed the questionnaire after receiving feedback from the SICU medical team. Any question where the team answered “yes” was deemed a positive indicator that the patient would benefit from a palliative care consultation with a specialist or a goals of care discussion with the surgical team.  

    Three iterations of the screening tool were developed using the Plan-Do-Study-Act (PDSA) method before selecting three questions that the researchers found best correlated with a positive indicator: 

    1. Any team member (nursing, physician, pharmacist, etc.) expresses concern the patient may need palliative care. 
    2. ICU or surgical team answers ‘no’ to the question: “Would you be surprised if this patient died?” 
    3. Comorbidities: irreversible, progressive, or untreatable, severely impairing function. 

    If yes was answered to any of the three checklist questions, the researchers believed the patient would likely benefit from a palliative care consultation or goals of care discussion. 

    Key findings 

    • Screening tools from 282 patients in the SICU were recorded.  
    • Of those 282 patients, the screening tool successfully identified 22 patients, all of whom eventually received referrals for palliative care. 
    • Each patient could be screened in about three seconds; all patients in the SICU could be screened in about 30 seconds. 
    • The tool did not increase the burden on the palliative care team at UNC Health. 

    “The hope is that by using this screening tool, decisions traditionally made very late in the patient’s SICU stay, could be made much earlier,” said lead author Victoria Herdman, MD. Dr. Herdman was a fourth-year UNC-Chapel Hill medical student at the time of the study and is now completing her residency in cardiothoracic surgery at the University of Kentucky College of Medicine. “Physicians, physician assistants, nurse practitioners and nurses know early on who needs palliative care but sometimes that’s hard to jump into early in the stay. This screening tool is a way to guide everyone into it easier.” 

    The research was performed at a single site, but the team hopes to evaluate the tool within other ICU populations at UNC Health using a Quality Improvement process, possibly using an electronic medical record system or implementing it during daily rounds discussions with only one question. The study team also plans future research to analyze patient demographics to determine which marginalized populations are often left out of palliative care discussions. Simply discussing palliative care more often and educating team members and families, they said, can make a difference. 

    “I think as surgeons we tend to have a lot of ownership of our patients because they’re trusting us with their bodies. But I think that may also bias us a little bit in terms of palliative care. We hear the words ‘palliative care’ and may say, ‘Oh, no, no, no! We don’t want that. That’s like giving up on our patient,’” Dr. Reid said. “But the truth is, I think a lot of surgeons don’t truly understand the definition of palliative care—that the goal is to align what the patient wants with your treatments. Our long-term hope is to make discussions of palliative care more commonplace and to change the culture so that people feel comfortable involving palliative care, or at a minimum having a goals of care discussion, so that patients and their families understand all the possible treatment options.” 

    The study was supported by the UNC Institute for Healthcare Quality Improvement.  

    Study coauthors are Casey Olm-Shipman, MD, MS; Winnie Lau, MD; Kyle Lavin, MD; Marshall W. Fritz, BS; and Geoffrey Orme-Evans, JD, MPH. 

    Dr. Herdman and Dr. Reid have no disclosures to report.    

    Citation: Herdman V, et al. Surgical Intensive Care Unit (SICU) Palliative Care Screening-Tool: A Quality Improvement (QI) Project, Scientific Forum, American College of Surgeons Clinical Congress 2022. 

    ________________________  

    1Rotundo E, Braunreuther E, Dale M, et al. Retrospective Review of Trauma ICU Patients With and Without Palliative Care Intervention. J Am Coll Surg 2022; 235(2): 278-284. 

    2Aslakson RA, Curtis JR, Nelson, JE, et al. The changing role of palliative care in the ICU. Crit Care Med 2014: 42(11):2418. 

    # # #  

    About the American College of Surgeons  

    The American College of Surgeons (ACS) is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the American College of Surgeons.   

    American College of Surgeons (ACS)

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  • Timely Surveillance with Chest Imaging May Benefit Colorectal Cancer Patients

    Timely Surveillance with Chest Imaging May Benefit Colorectal Cancer Patients

    Key takeaways: 

    • Up to 50% of colorectal patients may develop metastatic cancer that has spread to other areas of the body. 
    • One of the most frequent areas colorectal cancer spreads to is the lungs, affecting up to 18% of patients with colorectal cancer; these patients often face a poor prognosis, especially if caught at a late stage. 
    • New study investigated optimal timing intervals and key clinical factors, including genetic factors and tumor characteristics, that may reveal which patients are at risk for developing lung metastases. 

    Newswise — SAN DIEGO: Colorectal cancer patients with certain clinical characteristics may benefit from more frequent chest imaging to help identify and target cancer that has spread to the lungs, according to new research presented at the Scientific Forum of the American College of Surgeons (ACS) Clinical Congress 2022. These findings have the potential to improve long-term outcomes of patients with metastatic colorectal cancer. 

    Despite improved survival rates, colorectal cancer is the third leading cause of cancer-related deaths in the United States.1 Though rates of colorectal cancer have declined among people 65 and older, largely thanks to increased screening efforts, rates among younger adults are rising.2 When the cancer is caught early, many patients can remain disease-free for the rest of their lives after surgical treatment, but colorectal cancer can spread (metastasize) in up to 50% of patients.3 One of the most common areas colorectal cancer spreads to is the lungs, affecting up to 18% of patients with colorectal cancer.4 Detecting cancerous nodules in the lung early provides patients with the best outcomes, but there are no evidence-based standards for when and how often to screen colorectal cancer patients with chest CT or PET scans. 

    “After patients are diagnosed with colorectal cancer, many of them want to better understand what their cancer diagnosis entails in terms of their surveillance and survivorship for the rest of their life, but we currently lack data and uniform guidelines to support how often these patients should be screened with chest imaging,” said co-author Mara Antonoff, MD, FACS, associate professor, thoracic and cardiovascular surgery, UT MD Anderson Cancer Center, Houston, where she also serves as program director of education. “With this study, we sought to develop a strategy that is evidence-based to determine how frequently, at what intervals, and for how long patients at risk of developing lung metastases should undergo imaging of their chest.” 

    Dr. Antonoff specializes in thoracic surgical oncology and has a clinical interest in colorectal cancer that has spread to the lungs. She is leading a multi-institutional study, under the umbrella of the American Association for Thoracic Surgery (AATS) Thoracic Surgery Oncology Group (TSOG) (TSOG 103), on developing optimal treatment strategies for colorectal cancer patients whose cancer spread is limited to the lungs. 

    To identify which colorectal cancer patients may benefit from early chest imaging and at what time intervals, Dr. Antonoff and an interdisciplinary team of researchers at MD Anderson – including cardiothoracic surgeons, colorectal cancer surgeons, and gastrointestinal oncologists – collaborated on this research project to investigate evidence-based surveillance guidelines for colorectal patients who are at risk of developing lung metastases. 

    Study details 

    Using two MD Anderson cancer databases that included both colorectal cancer patients and thoracic cancer patients, the study team retrospectively reviewed data from patients with colorectal cancer who did and did not develop lung metastases. Patients were grouped according to the development of lung metastases and the timing of their diagnosis. The team used statistical methods to investigate which clinical characteristics, such as age or genetic factors, correlated most with the risk of developing lung metastases.  

    Key findings 

    • Of 1,600 patients with colorectal cancer, 233 (14.6%) developed pulmonary (lung) metastases, with a median time of 15.4 months following colorectal surgery.  
    • The team identified age, neoadjuvant or adjuvant systemic therapy (such as chemotherapy or immunotherapy), lymph node ratio, lymphovascular and perineural invasion (high-risk tumor characteristics observed under a microscope), and presence of KRAS genetic mutations as risk factors for developing lung metastases. 
    • Further data analysis revealed that patients who required systemic therapy around the time of their surgical operation for colorectal cancer, who had an elevated lymph node ratio, and a KRAS mutation, were at risk of developing lung metastases within three months of surgery. 
    • The authors concluded that these patients may benefit from more frequent surveillance with chest CT or PET scans. 

    Nathaniel Deboever, MD, general surgery resident, UTHealth Houston McGovern Medical School, and the lead author of the study, noted that while these risk factors are not necessarily surprising from a clinical perspective, they highlight the need to adequately screen certain colorectal cancer patients after surgical treatment. In some cases, removing cancerous lung nodules surgically early on can significantly improve outcomes. 

    “A concrete clinical application of this research, following validation, is to build evidence-based guidelines affecting chest surveillance in patients with resected colorectal cancer,” said Dr. Deboever, who completed this research as part of his research fellowship with the department of thoracic and cardiovascular surgery at MD Anderson. “These guidelines will hopefully allow high-risk patients to undergo radiographic screening in a timely manner, permitting the early diagnosis of pulmonary disease.” 

    Next steps 

    In future research, the team plans to validate findings in a separate group of patients, with the hope of formalizing chest surveillance protocols for widespread clinical adoption. Drs. Antonoff and Deboever noted that as colorectal cancer research evolves, sensitive blood tests to detect cancer or advanced radiographic screening methods using artificial intelligence may also play an important role in monitoring patients. 

    “There are many patients who receive cancer care outside of cancer hospitals, so having algorithms, pathways, and recommended protocols can be very helpful for providers who care for a lot of different diseases with rapidly changing recommendations,” Dr. Antonoff said. “I think this research is really just the tip of the iceberg.” 

    This study was funded by the Department of Thoracic and Cardiovascular Surgery at MD Anderson Cancer Center, which included financial support from the Mason Family Philanthropic Research Fund.  

    Study coauthors are Erin M. Bayley, MD, MS; Brian K. Bednarski, MD, FACS; and Van Morris, MD. 

    Dr. Deboever and Dr. Antonoff have no disclosures to report.    

    Citation: Deboever N, et al. Do Resected Colorectal Cancer Patients Need Early Chest Imaging? Impact of Clinicopathologic Characteristics on Time to Development of Pulmonary Metastases, Scientific Forum, American College of Surgeons Clinical Congress 2022.  

    ________________________ 

    1Key Statistics for Colorectal Cancer. American Cancer Society, January 12, 2022. https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html 

    2Colorectal Cancer Rates Rise in Younger Adults. American Cancer Society, March 5, 2020. https://www.cancer.org/latest-news/colorectal-cancer-rates-rise-in-younger-adults.html  

    3Leporrier J, Maurel J, Chiche L, et al. A population-based study of the incidence, management and prognosis of hepatic metastases from colorectal cancer. British Journal of Surgery 2006: 93(4), 465-474. 

    4Gonzalez M, Gervaz P. Risk factors for survival after lung metastasectomy in colorectal cancer patients: systematic review and meta-analysis. Future oncol. 2015: 11(2s):31-3. 

    # # #  

    About the American College of Surgeons  

    The American College of Surgeons (ACS) is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the American College of Surgeons.   

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  • Fewer patients sent to hospital rehabilitation facilities for recovery after colorectal operations early in the COVID pandemic

    Fewer patients sent to hospital rehabilitation facilities for recovery after colorectal operations early in the COVID pandemic

    Key takeaways 

    • The first months of the COVID pandemic in 2020 caused a discernible change in post-surgery practice; colorectal surgeons discharged more patients direct to home for recovery, thus, bypassing a stay at a rehabilitation facility.   
    • The rate of patients discharged to rehabilitation facilities dropped 3% but the number of patients who were readmitted to the hospital with complications remained stable, even though patients underwent fewer minimally invasive procedures.  
    • Telemedicine visits rose among patients discharged home so care providers could check in on their patients. Study findings showing stable hospital readmission rates in pandemic year 2020 highlight the potential for lowering rehabilitation utilization for colorectal patients.  

    Newswise — SAN DIEGO: The first months of the COVID pandemic had a profound effect on hospital discharge practices and use patterns for patients with colorectal disease, according to findings presented at the Scientific Forum of the American College of Surgeons (ACS) Clinical Congress 2022. A study of more than 100,000 surgical patients who underwent procedures for colorectal cancer found that they had 40% lower odds of being discharged to post-hospital rehabilitation during the pandemic than before.  

    Despite this significantly lower rate, the hospital readmission rate did not change from pre-pandemic levels, said Marc Mankarious, MD, a surgical resident at Penn State Hershey Medical Center, Hershey, Pennsylvania. 

    “We found that discharge to a rehabilitation facility pre-pandemic was 10%, which agreed with previous literature, but once the pandemic hit, the discharge-to-rehabilitation rate dropped to about 7%,” Dr. Mankarious said. “We saw a drop of three percentage points, even though we were doing more emergent operations and more open operations, which are typical risk factors for requiring rehabilitation after surgery.” 

    The authors hypothesized that anecdotally, fear of going into confined spaces, staff and supply shortages, and disease outbreaks contributed to changes in discharge practices. 

    About the Study 

    The retrospective cohort study used two databases from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®): the Participant Use File and Target Colectomy databases. Researchers analyzed data on 116,677 patients: 90,250 from 2017 through 2019, and 26,427 from 2020. For comparison, the first quarter was excluded from all years because the first COVID restrictions did not go into effect until March 2020. ACS NSQIP is the leading nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care in hospitals. It was created by surgeons to help hospitals gauge the quality of their surgical programs and improve surgical outcomes by collecting robust, accurate, and precise clinical patient information. 

    Key findings  

    • In comparing the pre- and post-COVID-19 periods, the proportion of emergent cases and open operations—as opposed to minimally invasive procedures—increased in 2020, from 13 to 15% (p<0.001) and 31 to 32% (p<0.001), respectively.  
    • A multivariable analysis found that patients in 2020 had 40% lower odds of going to a post-discharge facility (odds ratio 0.62, p<0.001), even after the analysis adjusted for reasons for having the operations and other medical conditions the patients had. 
    • The rates of patients going back to the hospital within 30 days of discharge was 10% in both periods (p=0.4). 

    Surgeons’ observations  

    The stability in hospital readmission rates was telling because that may be “one of the factors that goes into deciding whether to offer a rehabilitation stay to a patient,” Dr. Mankarious said. 

    The study data did not include reasons why patients did or did not choose to go to post-discharge rehabilitation to recover; the authors hypothesized that factors included limited availability of beds and patient concerns about visitor restrictions and contracting COVID-19 Dr. Mankarious said. But the pandemic saw a 63-fold increase in telehealth use in 2020 over 2019.* “This situation may have made patients and physicians more comfortable with the patient going home and following up with each other electronically,” he said.  

    The data included some information on medical reasons for going to rehabilitation. “We did find that patients that went to rehabilitation in 2020 were more functionally dependent or functionally impaired than patients that went to rehabilitation in previous years, so those factors may also play a part in it.” Dr. Mankarious said. 

    The study grew out of what surgeons at Penn State Hershey were observing in the early days of the pandemic, said senior author Audrey Kulayat, MD, assistant professor of colorectal surgery. “We wondered if those observations had an impact on a bigger scale other than just at our institution,” she said. “But then we wanted to know, what’s the downside? Was there a downside? Are patients getting readmitted more frequently as a result of going back to their home or whatever institution versus going to a place with a higher level of nursing care? We didn’t find that they were readmitted more often.”  

    Potential change in discharge practice  

    The study findings raise questions about the potential overuse of posthospital rehabilitation for colorectal patients, Dr. Mankarious said. “Medicare spends about $60 billion per year on patients going to post-acute care facilities or rehab in general and any small reductions, even our 3%  reduction, which was significant, could result in considerable cost savings for the healthcare system.  

    “And it really helps us rethink who should go to post-surgery rehab, maybe raise our thresholds as we become more comfortable sending patients home and have better utilization of the new available modalities to help us follow up with them without having to send them to rehab,” Dr. Mankarious added. 

    Dr. Mankarious and Dr. Kulayat have no disclosures. 

    Study co-authors are Austin C. Portolese, MD; Jeffrey S. Scow, MD, FACS; Michael Deutsch, MD, FACS; and Nimalan A. Jeganathan, MD, FACS, all of Penn State Hershey Medical Center.  

    Citation: Mankarious MM, et al. Changing Disposition Patterns of Colorectal Surgery Patients in the Era of COVID-19. Scientific Forum Presentation, American College of Surgeons Clinical Congress 2022.  

    ________________________ 

    * Medicare Beneficiaries’ Use of Telehealth in 2020: Trends by Beneficiary Characteristic and Location. (Issue Brief No. HP-2021-27) Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services; Washington, D.C.; December 2021. Available online.

    # # #  

    About the American College of Surgeons 
    The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the American College of Surgeons. 

    American College of Surgeons (ACS)

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  • Study finds less expensive noninvasive test is an effective alternative to a more costly test for colorectal cancer screening

    Study finds less expensive noninvasive test is an effective alternative to a more costly test for colorectal cancer screening

    Key takeaways 

    • National guidelines suggest a fecal immunochemical test (FIT) can be used as the primary noninvasive screening modality for early-stage colorectal cancer, but a significant proportion of patients still receive a more expensive alternative test called Cologuard®. 
    • Data used for national screening guidelines has shown no difference between the two tests at detecting adenoma versus colorectal malignancy. 
    • These results align with previous studies out of Japan and the Netherlands examining FIT as an appropriate screening modality that is more cost effective than other types of noninvasive colorectal screening tests.  

    Newswise — SAN DIEGO: Commercially available noninvasive screening tests for colorectal cancer—a fecal immunochemical test (FIT) and the multi-target stool DNAtest (mt-sDNA; or Cologuard®)—are equally effective for screening patients with early-stage colorectal cancer. However, a FIT costs about one-fifth of the multi-target DNA test, according to new study results presented at the Scientific Forum of the American College of Surgeons (ACS) Clinical Congress 2022. 

    Pavan K. Rao, MD, a general surgery resident at Allegheny Health Network in Pittsburgh, Pennsylvania, presented study results looking at 117,519 people in the Highmark claims database who underwent colorectal screening in 2019. Highmark is a Blue Cross Blue Shield Association insurer in four Mid-Atlantic states.   

    From that group, the researchers identified 91,297 people who had noninvasive screening with either the fecal immunochemical test (FIT, n=45,487) or the DNA test (mt-sDNA, n=46,110) instead of having a routine colonoscopy.   

    Key findings  

    • Among the study population that underwent colorectal screening, 45,487 (38.7 percent) had one of two commercially available FIT tests and 46,110 (39.2 percent) had the mt-sDNA test.  
    • Patients who were screened with either test presented with early disease, staged from 0 to II, at similar rates: 59.5 percent for FIT and 63.2 percent for mt-sDNA test (p=0.77).  
    • Patients within the Allegheny Health Network Oncology Registry diagnosed with colorectal cancer were matched to their claims data to determine distribution of cancer stage.  If the noninvasive test indicated signs of early disease, patients were then referred for additional testing to confirm the findings.   
    • The total annual costs for the tests were $6.47 million—$1.1 million for a FIT, or about $24 per test, and $5.6 million for mt-sDNA, or about $121 per test. Costs were calculated using Medicare reimbursement rates. 

    Observations on study results  

    The study followed guidelines issued by the U.S. Preventive Services Task Force (USPSTF) in 2016 and updated in 2019. Since then, the guidelines were updated again in 2021.1 

    “Despite national guidelines suggesting that FIT be used as the primary noninvasive screening modality, we found that on review of our insurer’s claims data, a significant proportion of patients still receive a more expensive alternative test. There is substantial cost savings not only to our patients but to our health system with promoting appropriate use of noninvasive testing,” Dr. Rao said. 

    “There was no difference in the clinical stage at the time of diagnosis between the two tests, which again demonstrates the clinical equipoise maintained by switching to FIT,” Dr. Rao said of the variation between the two tests.  

    He added, “When you look at the national data for which the guidelines put forward, they found no difference between the two tests at detecting adenoma versus colorectal malignancy.”2 

    Cost savings without compromising care  

    The researchers determined that transitioning all noninvasive colorectal cancer screening to FIT would result in a $3.9 million savings annually in the study population.  

    “In the current state of healthcare, we are thinking ever more about efficiency and reduction in costs while maintaining patient outcomes, and not compromising the quality of care we provide,” Dr. Rao said. “I think a colorectal surgeon or any specialist who sees appropriate patients for colorectal cancer screening can use this data to provide recommendations of alternative screening tests to patients who primarily do not want to undergo colonoscopy. We cannot only say it is appropriate from a guideline standpoint, but we’re also reducing wasteful spending in health care by appropriately using the FIT.” 

     What makes this study unique is the methodology used to analyze the claims data, said study coauthor Casey J. Allen, MD, a surgical oncologist at Allegheny Health Network and an assistant professor at Drexel University College of Medicine, Pittsburgh. The researchers analyzed outcomes in the local health registry and then applied those outcomes to the claims database. “It’s not just the cost of the mt-sDNA test kit or the cost of the FIT kit multiplied by the number of members in the healthcare system,” Dr. Allen said. “It’s the full downstream costs depending on the rates of false-positive and false-negative tests and how much it costs to obtain a colonoscopy when that occurs. The cost of a screening colonoscopy in the database the researchers used was $635. 

    These results support previous studies out of Japan3 and the Netherlands4 that found FIT was more cost-effective than other types of noninvasive colorectal screening tests.  

    Study coauthors are Samantha Falls, DO, Stacey Shipley, BA, and Katie Farah, MD, of Allegheny Health Network, Wexford, Pennsylvania; and Patrick L. Wagner, MD, FACS, David L. Bartlett, MD, FACS, and Sricharan Chalikonda, MD, MHA, FACS, of Allegheny Health Network, Pittsburgh.  

    Dr. Rao and Dr. Allen have no disclosures to report. 

    Citation: Rao, PK et al. Comprehensive Cost Implications of Commercially Available Non-invasive Colorectal Cancer Screening Modalities: Results of A Large National Insurer Claims Database Analysis, Scientific Forum, American College of Surgeons Clinical Congress 2022.  

    ________________________ 

    1U.S. Preventive Services Taskforce. Final Recommendation Statement, Colorectal Cancer: Screening. Updated May 18, 2021. Available at: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening (.) 

    2Rex DK, Boland CR, Dominitz et al. Colorectal cancer screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2017;112(7):1016-1030. 

    3Sekiguchi M, Igarashi A, Sakamoto T, Saito Y, Esaki M, Matsuda T. Cost-effectiveness analysis of colorectal cancer screening using colonoscopy, fecal immunochemical test, and risk score. J Gastroenterol Hepatol. 2020 ;35(9):1555-1561.  

    4Lansdorp-Vogelaar I, Goede SL, Bosch LJW, et al. Cost-effectiveness of high-performance biomarker tests vs fecal immunochemical test for noninvasive colorectal cancer screening. Clin Gastroenterol Hepatol. 2018;16(4):504-512.e11.  

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    About the American College of Surgeons  

    The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the American College of Surgeons. 

    American College of Surgeons (ACS)

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  • Operations for diverticulitis decreased in 2020, but the degree of disease severity increased

    Operations for diverticulitis decreased in 2020, but the degree of disease severity increased

    Key takeaways 

    • Overutilization of intubation respirators early in the pandemic may have masked signs and symptoms of diverticulitis in COVID-19 patients. 
    • Restricted access to computed tomography scanning and a preference for antibiotics may have been factors in postponing surgery until patients were sicker. 
    • Future research will look at 2021 data to see if care patterns returned to pre-pandemic levels. 

    Newswise — SAN DIEGO: The first year of the COVID pandemic significantly altered how patients and providers treated diverticulitis, causing a significant drop in operations to manage the disease but a corresponding increase in the proportion of more severe cases and the need for emergency surgery, according to results of a nationwide study presented at the Scientific Forum of the American College of Surgeons (ACS) Clinical Congress 2022. 

    Rolando H. Rolandelli, MD, FACS, chair of surgery at Morristown Medical Center in Morristown, New Jersey, and professor of surgery at Rutgers New Jersey Medical School, presented a study of 12,514 patients who had a colectomy for diverticulitis in 2018 and 10,869 who had the same procedure in 2020 using the ACS National Surgical Quality Improvement (ACS NSQIP®) database. That decline in 2020 represents a 13.14% decrease in operations for diverticulitis, which is an outpouching of the digestive tract causing painful inflammation or infection. ACS NSQIP is the leading nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care in hospitals. It was created by surgeons to help hospitals gauge the quality of their surgical programs and improve surgical outcomes by collecting robust, accurate, and precise clinical patient information. 

     “In the first year of the pandemic, 2020, we saw that patients were accessing the healthcare system less frequently for diverticulitis, but those who did were sicker on presentation. As a result, their postoperative outcomes were not as good,” Dr. Rolandelli said. 

    Key findings 

    • Patients were more likely to have emergency surgery for diverticulitis in 2020, with the proportion increasing to 20% of operations from 17.3% (p<0.001). 
    • The proportion of patients with a known abscess or perforation of the gastrointestinal tract also increased, from 50.1 to 54.55% (p<0.001). 
    • The proportion of Black patients increased in 2020, from 7 to 7.7% (p=0.032), which was offset by a decline in the proportion of white patients, from 82.4 to 77.7% (p<0.001). 

    Dr. Rolandelli said the study findings provide two lessons learned.  

    “One, when we limit access to health care, we do it by setting a priority for patients that are potentially at higher risk of progression of their disease, and in the early phase of the COVID pandemic, the priority was cancer patients,” he said. “This situation may have led to physicians  prescribing antibiotics as an alternative to surgery for diverticulitis, which may have caused patients’ disease to progress. By the time of surgery, they were much sicker.”  

    The second lesson learned: A possible overuse of intubation respirators early in the pandemic. “We had patients who basically had been in a coma for weeks and could not express their symptoms of diverticulitis,” he said, which typically include pain in the lower left quadrant of the abdomen and, less frequently, fever and constipation. “We probably saw patients who were developing diverticulitis and we were not realizing it.” 

    Surgeons’ observations  

    Precautions put into place early in the pandemic may have also contributed to the greater severity of diverticulitis cases at that time, Dr. Rolandelli said. Surgeons were informed that the COVID-19 virus could concentrate in the wall of the gastrointestinal tract, including the colon, and that they should exercise caution when using electrocautery to operate on patients with diverticulitis because it could vaporize the virus and cause it to spread. Also, restricted access to computed tomography scans—an important imaging technique for monitoring the growth of diverticular lesions—may have delayed medical treatment or even surgery.  

    Study coauthor Zoltan H. Nemeth, MD, PhD, a research scientist at the department of surgery at Morristown Medical Center and an adjunct assistant professor at Columbia University, New York, explained that a strength of the study was its size and the large population in the ACS NSQIP database. The limitation of such databases is that they do not provide granular data on how individual patients were treated.  

    Next steps 

    Future research will include analyzing 2021 data to see how they compare to 2018 and 2020, according to Dr. Nemeth. 

    “I think it’s clear that, at the beginning of the pandemic in 2020, we were not sure how to approach these patients; it was a learning experience,” Dr. Rolandelli said. “So, when we compare it with 2021, when we had a year of experience and we did not place patients on the respirator as often, we’re going to be able to sort out the differences in terms of how we’re managing the patients and the actual severity of diverticulitis.” 

    Study coauthors are Sara Soliman, BS; Grace C. Chang, DO; and Amanda K. Nemecz, MD, all from Morristown Medical Center.  

    Dr. Rolandelli and Dr. Nemeth have no disclosures to report.   

    Citation: Rolandelli, RH et al. How the Covid-19 Pandemic Affected the Severity and Clinical Presentation of Diverticulitis, Scientific Forum, American College of Surgeons Clinical Congress 2022.  

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    About the American College of Surgeons  

    The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the American College of Surgeons. 

    American College of Surgeons (ACS)

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  • Marijuana-dependent patients at higher risk for infection after knee or shoulder arthroscopy procedures

    Marijuana-dependent patients at higher risk for infection after knee or shoulder arthroscopy procedures

    Key takeaways 

    • A higher infection rate found by new research should raise a “red flag” for patients and providers and should be discussed along with other risk factors before an arthroscopic procedure.  
    • Higher rates of deep vein thrombosis (DVT) were also found among these patients, but the study’s analysis determined they were not statistically significant. 
    • The study has identified the need for additional research to better understand the relationship between marijuana dependence and potential postoperative complications. 

    Newswise — SAN DIEGO: Patients who are dependent on marijuana may face higher infection rates following knee and shoulder arthroscopy—a minimally invasive surgery in which a small camera is inserted to diagnose and sometimes treat injury—according to a study presented at the Scientific Forum of the American College of Surgeons (ACS) Clinical Congress 2022. 

    Using PearlDiver, a national insurance claims database, researchers from the University of Chicago performed a retrospective study of patients with marijuana dependence who underwent knee or shoulder arthroscopy for the postoperative complications of deep vein thrombosis (DVT), pulmonary embolism (PE), and infection.  

    “Marijuana has been gaining so much popularity, but it’s a risk factor we aren’t really catching,” said lead study author Sarah Bhattacharjee, MD, who conducted the research while she was a medical student at the University of Chicago. Dr. Bhattacharjee is now a surgical resident in orthopaedic and sports medicine at the University of Washington. “The higher infection rate found by this new study should raise a ‘red flag’ for patients and providers and should be discussed along with other risk factors before an arthroscopic procedure.” 

    Although the effect of marijuana use has been studied in pain management and cardiovascular health, few studies have looked at the potential effects of marijuana use by patients who are undergoing surgery. More states are legalizing marijuana, and the size of the cannabis market is predicted to reach $91.5 billion by 2028.* Given that trend, the team of researchers from the University of Chicago set out to determine if marijuana-dependent users face an increased risk of complications following knee or shoulder arthroscopy.  

    “There’s so much information out there on smoking, alcohol, and other substances, but not on marijuana use,” said study coauthor Jason Strelzow, MD, assistant professor of orthopaedic surgery, University of Chicago. “As providers and surgeons, we should be discussing marijuana use with our patients, something that we have traditionally shied away from.” 

    Study details 

    All patients undergoing knee or shoulder arthroscopy were identified retrospectively in PearlDiver. Next, patients who had a diagnostic code for marijuana dependence were also identified within each surgery category; this is a rigid definition requiring patients to three or more criteria, such as using marijuana longer than intended, difficulty in cutting down use, spending a lot of time in obtaining or recovering from marijuana, and high tolerance.  

    The rates of DVT, PE, and infection within 90 days were assessed for all patients. Univariate analyses of marijuana dependence on all outcomes were performed, followed by a multivariate logistic regression analysis controlling for known patient comorbidities (other medical conditions). 

    Key findings 

    • The researchers identified 1,113,944 knee and 747,938 shoulder arthroscopy patients. Out of those 1,861,892 patients, 21,823 patients had a diagnostic code for marijuana dependence.  
    • Within both subgroups, the marijuana dependence cohort experienced increased rates of infection and DVT, while the PE rate stayed the same.  For the shoulder arthroscopy group, the rates of infection increased from 0.7%  to 1.7%, the DVT rate from 0.2% to 0.4%, while PE stayed at 0.2%. In the knee arthroscopy group, the rates of infection increased from 1.1% to 2.6%, the DVT rate rose from 0.2 to 0.3%, and PE stayed at 0.3%.   
    • In the multivariate analyses controlling for a variety of patient risk factors, including tobacco use or a history of diabetes, marijuana dependence was identified as an independent risk factor for infection within both cohorts. In this study, a statistical measure called a p-value (‘p’ stands for probability) was used to determine if the detected relationship was due to chance (p-values of 0.001 or below) or did, in fact, exist (p-values above 0.001). For the knee group, the p-value was 1.85, and for the shoulder group it was 1.65. 

    (Note: The presenting author reported on updated data from the podium during the conference reflecting stable PE rates.) 

    Dr. Strelzow hopes surgeons will use the study results to help inform marijuana-dependent patients about risks, benefits, and available alternatives, such as reducing or eliminating marijuana use six months prior to an arthroscopic procedure. 

    Although the study focused on minimally invasive surgery, Dr. Strelzow said that “we would expect similar or larger effects with more open or invasive procedures.” 

    Future research opportunities 

    The study has identified the need for additional research to better understand the relationship between marijuana dependence and postoperative complications. In addition, given that the study used very rigid criteria for marijuana dependence, there are opportunities for future clinical studies to investigate how various levels of marijuana use impact postoperative complications.  Dr. Strelzow said he plans to study the impact of marijuana dependence on fracture healing. 

    There are no author disclosures to report. 

    ________________________ 

    *Legal Cannabis Market Size Worth $91.5 Billion By 2028 | CAGR: 26.3%: Grand View Research, Inc. press release, July 27, 2021. Assessed at: https://www.grandviewresearch.com/industry-analysis/legal-cannabis-market?utm_source=prnewswire&utm_medium=referral&utm_campaign=HC_27-July-21&utm_term=legal-cannabis-market&utm_content=rd1 (.) 

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    About the American College of Surgeons  

    The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. “FACS” designates a surgeon is a Fellow of the American College of Surgeons.  

    American College of Surgeons (ACS)

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  • ACS comments on European study on colonoscopies published in New England Journal of Medicine

    ACS comments on European study on colonoscopies published in New England Journal of Medicine

    Newswise — CHICAGO (October 11, 2022): The American College of Surgeons (ACS) is aware of a European study examining colonoscopy in Sweden, Poland, Norway, and the Netherlands, “Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death,” published this week in the New England Journal of Medicine1 that may seem to call into question the effectiveness of colonoscopy screening.

    Although the ACS recognizes global discrepancies in cancer screening recommendations across countries, the ACS remains committed to supporting U.S. evidence-based recommendations and practices based on decades of research, including the use of colonoscopy to screen for colorectal cancer.

    “As an evidence-based and educational organization of surgeons, it is clear that patient outcomes are vastly improved when cancer is detected early,” said ACS Executive Director & CEO, Patricia L. Turner, MD, MBA, FACS. “The value and importance of colonoscopies in preventing and detecting colorectal cancer cannot be overstated, and current U.S. guidelines are based on decades of research in the United States showing that routine screenings with colonoscopy can save lives.”

    “We recognize that this study is generating a lot of attention and could have the effect of discouraging some from getting life-saving colonoscopy screenings. We firmly stand behind the science that has unequivocally demonstrated the benefits of these screenings,” said Heidi Nelson, MD, FACS, Medical Director of the ACS Cancer Programs. As the Emeritus Fred C. Andersen Professor for the Mayo Foundation and consultant for Mayo Clinic’s division of colon and rectal surgery, Dr. Nelson is internationally renowned for her research in the field of colon and rectal cancer. “Significant work has gone on to optimize the reliability and accuracy of the colonoscopy test, both in terms of optimizing bowel preparations performed in advance of the procedure and the specialized training of the clinicians who perform the procedure. The evidence and data are abundantly clear that screenings with colonoscopies save lives. The bottom line is that people should continue to follow their doctors’ recommendations on colonoscopy screening.”

    Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in the United States, according to the American Cancer Society.2 Since the 1990s, national guidelines have supported the use of colonoscopies to screen for colorectal cancer.3 The procedure – in which a tube-like instrument with a light and video camera is inserted into the rectum to visualize abnormalities – can not only detect early cancers but can also prevent colorectal cancer through the removal of polyps, which can take 10-15 years to turn into cancer. 

    Moreover, colonoscopy has been recognized as an effective and reliable preventive health practice by the federal government. In 2000, the law expanded Medicare coverage to beneficiaries who were not considered high risk for colon cancer.4 Today, the American Cancer Society currently recommends that people at average risk of colorectal cancer start regular screening at age 45 through either a colonoscopy or a stool-based test.

    —

    1 Bretthauer M, Løberg M, Wieszczy P, et al. Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death,  New Engl J Med, 2022 Oct 9. doi:10.1056/NEJMoa2208375

    2 American Cancer Society Guideline for Colorectal Cancer Screening: https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html

    3 Trends in Screening for Colorectal Cancer -United States, 1997 and 1999: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5009a2.htm

    4 Moore KJ, Medicare Expands Preventive Screening Benefits, Fam Pract Mang. 2001; 8(6):16: https://www.aafp.org/pubs/fpm/issues/2001/0600/p16.html

     

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    About the American College of Surgeons  

    The American College of Surgeons (ACS) is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the American College of Surgeons.   

     

     

    American College of Surgeons (ACS)

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