Annals of surgery open : perspectives of surgical history, education, and clinical approaches最新文献

{"title":"\"It's Traumatic for All of Us\": A Qualitative Analysis of Providers Caring for Seriously Ill Veterans With Surgical Conditions.","authors":"Adela Wu, Sarah E Bradley, C Ann Vitous, M Andrew Millis, Pasithorn A Suwanabol","doi":"10.1097/AS9.0000000000000518","DOIUrl":"10.1097/AS9.0000000000000518","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to characterize sources of moral distress among providers in the context of surgery.</p><p><strong>Background: </strong>Moral distress is defined as psychological unease generated when professionals identify an ethically correct action to take but are constrained in their ability to take that action. While moral distress has been reported among healthcare providers, the perspectives of providers working in surgery specifically are not often explored and reported. Our study was developed from an overarching effort to investigate end-of-life care for seriously ill patients with surgical conditions.</p><p><strong>Methods: </strong>Using convenience sampling, we conducted 48 semistructured interviews with providers who provide high-intensity care (eg, surgeons, anesthesiologists, intensivists, and midlevel providers) for seriously ill patients with surgical conditions across 14 Veterans Affairs hospitals. Interviews were analyzed iteratively using thematic content analysis.</p><p><strong>Results: </strong>Providers described clinical encounters that generated moral distress while caring for seriously ill patients with surgical conditions: (1) difficulties in conflict resolution with and among patients and families; (2) specific types of patients or situations; (3) systemic factors hindering appropriate end-of-life care; (4) surgical culture and expectations of the surgeon's role.</p><p><strong>Conclusions: </strong>Providers caring for seriously ill patients with surgical conditions report emotions and reactions consistent with moral distress. Our study highlights important triggers for providers and hospital systems to identify and address throughout a surgical provider's training and career.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e518"},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Recurrence After Curative Surgery for Stage I Colon Cancer: Retrospective Cohort Analysis of the Italian Society of Surgical Oncology Colorectal Cancer Network Collaborative Group.","authors":"Giulia Turri, Luigi Martinelli, Daniela Rega, Nicolò Tamini, Lucia Paiano, Simona Deidda, QuocRiccardo Bao, Laura Lorenzon, Raffaele De Luca, Caterina Foppa, Valentina Mari, Giovanni Taffurelli, Arcangelo Picciariello, Patrizia Marsanic, Leandro Siragusa, Francesco Bagolini, Riccardo Nascimbeni, Gianluca Rizzo, Sara Vertaldi, Michele Zuolo, Giorgio Bianchi, Lisa Marie Rorato, Rossella Reddavid, Gaetano Gallo, Lorenzo Crepaz, Alberto Di Leo, Mario Trompetto, Enrico Potenza, Mauro Santarelli, Nicola de'Angelis, Francesco Ciarleglio, Marco Milone, Claudio Coco, Guido Alberto Tiberio, Gabriele Anania, Giuseppe S Sica, Andrea Muratore, Donato Francesco Altomare, Isacco Montroni, Maurizio De Luca, Antonino Spinelli, Michele Simone, Roberto Persiani, Gaya Spolverato, Angelo Restivo, Nicolò de Manzini, Marco Braga, Paolo Delrio, Giuseppe Verlato, Corrado Pedrazzani","doi":"10.1097/AS9.0000000000000510","DOIUrl":"10.1097/AS9.0000000000000510","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to provide solid evidence to update the management of stage I colon cancer (CC) after surgery.</p><p><strong>Background: </strong>Given the low risk of recurrence of stage I CC, some international guidelines do not recommend intensive follow-up after surgery. However, data on the actual incidence, risk factors, and site of recurrences are scarce.</p><p><strong>Methods: </strong>This is a retrospective multicenter cohort study considering patients who underwent surgery at 25 Italian centers between 2010 and 2019, with a minimum follow-up of 24 months. A total of 1883 consecutive adult patients with stage I CC treated with curative surgery were considered, and 1611 fulfilled the inclusion criteria. The primary outcome was the rate of recurrence. Secondary outcomes included survival and risk factors for recurrence.</p><p><strong>Results: </strong>Eighty patients developed cancer recurrence (5.0%), of which 90% was systemic relapse. The event was more frequent in pT2 (6.0% vs 3.2%, <i>P</i> = 0.013), male patients (6.1% vs 3.6%, <i>P</i> = 0.021), in the presence of lymphovascular invasion (7.2% vs 3.6%, <i>P</i> = 0.01), and in cases of partial resection (11.1% vs 4.6%, <i>P</i> = 0.011). Also, preoperative carcinoembryonic antigen (<i>P</i> = 0.007) and tumor diameter (<i>P</i> < 0.001) were higher in the group who relapsed. Most patients had isolated cancer recurrence (90%). Recurrences peaked between 10 and 18 months after surgery and declined over time. Adjusted Cox regression analysis identified tumor diameter, carcinoembryonic antigen level, lymphovascular invasion, male gender, and less than 12 analyzed lymph nodes as significant risk factors for worse recurrence-free survival.</p><p><strong>Conclusions: </strong>This study showed that a not negligible rate of stage I CC recur after curative surgery. Most relapses occur at a single site within the first 3 years after surgery. This evidence could be used to optimize postoperative follow-up.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e510"},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Palliative Care Following Aborted Cancer Surgery: Results of a Prospective Feasibility Trial.","authors":"Jordan M Cloyd, Rakhsha Khatri, Angela Sarna, Lena Stevens, Victor Heh, Mary Dillhoff, Alex Kim, Timothy M Pawlik, Aslam Ejaz, Sharla Wells-Di Gregorio, Erin Scott, Sachin S Kale","doi":"10.1097/AS9.0000000000000520","DOIUrl":"10.1097/AS9.0000000000000520","url":null,"abstract":"<p><strong>Background: </strong>Although resection is generally necessary for curative-intent treatment of most solid organ cancers, surgery is occasionally aborted due to intraoperative findings. Following aborted cancer surgery, patients have unique care needs that specialized palliative care (PC) providers may be best equipped to manage. We hypothesized that early ambulatory PC referral following aborted cancer surgery would be feasible and acceptable.</p><p><strong>Methods: </strong>This single-institution prospective clinical trial enrolled adult patients with gastrointestinal or hepatopancreatobiliary cancer with no prior PC exposure who had curative-intent oncologic surgery that was unexpectedly aborted. The primary endpoint was the completion of an ambulatory PC consultation within 30 days of enrollment. Secondary outcomes included changes in standardized measures of quality-of-life (QOL) and anxiety/depression during the 3-month follow-up.</p><p><strong>Results: </strong>Among 25 enrolled participants, the mean age was 65.3 ± 9.9 years, 68% were male, and 88% were White. The most common types of cancers were pancreatic (44%), hepatobiliary (20%), and colorectal (12%); reasons for aborting surgery were occult metastatic disease (52%) and local unresectability (36%). Only 13 of 25 (52%) met the primary endpoint of ambulatory PC within 30 days, less than the prespecified threshold of 70%. Overall, 16 (64%) patients completed ambulatory PC consultation a mean of 29.2 ± 15.8 days after enrollment. Of the 9 (36%) who did not, reasons included patient preference (n = 4), withdrawal from study (n = 1), lost to follow-up (n = 1), scheduling conflict (n = 1), and required inpatient PC before discharge (n = 2). Anxiety (4.94 ± 3.56 vs 3.35 ± 2.60, <i>P</i> = 0.06), depression (4.18 ± 4.02 vs 4.76 ± 3.44, <i>P</i> = 0.49), and QOL (82.44 ± 11.41 vs 82.03 ± 15.37, <i>P</i> = 0.92) scores did not significantly differ at 3-month follow-up compared to baseline.</p><p><strong>Conclusions: </strong>Barriers to early ambulatory palliative care consultation exist after aborted cancer surgery. Given the unique and complex care needs of this patient population, additional research is needed to optimize supportive care strategies.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e520"},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Perioperative NonaGEnaRIan And cenTenarian suRgICal (GERIATRIC) Risk Stratification Tool.","authors":"Laurence Weinberg, Dong Kyu Lee, Luke Fletcher, Bobby Ou Yang, Jadon Karp, Anoop N Koshy, Ranjan Guha, Hugh Slifirski, Michael R D'Silva, Rinaldo Bellomo, Leonid Churilov","doi":"10.1097/AS9.0000000000000524","DOIUrl":"10.1097/AS9.0000000000000524","url":null,"abstract":"<p><strong>Objective: </strong>To develop age-appropriate nonaGEnaRIan And cenTenarian suRgICal (GERIATRIC) risk tool for classifying patients who may or may not develop postoperative complications or die within their index hospital admission.</p><p><strong>Background: </strong>There are no validated perioperative risk stratification tools for use in nonagenarian and centenarian patients-people aged 90 to 99 years and >100 years.</p><p><strong>Methods: </strong>In this retrospective observational study, nonagenarians and centenarians undergoing any surgical procedure were profiled. Surgery severity was stratified, and the incidence and grade of postoperative complications were recorded. Multivariable logistic regression analysis was performed on a training cohort, followed by calibration on a validation cohort, followed by performance evaluation on a testing cohort. The discriminative accuracy was compared to that of the age-adjusted Charlson Comorbidity Index for each outcome. The primary outcome was the ability of the risk stratification tool to effectively classify patients into those who may or may not experience a postoperative complications or mortality within their index hospital stay.</p><p><strong>Results: </strong>A total of 3085 patients were enrolled. The GERIATRIC risk tool had good discriminative accuracy for any postoperative complication [area under the receiver operating characteristic curves (AUROC), 0.857; 95% CI = 0.824-0.890] and any severe postoperative complication (AUROC, 0.833; 95% CI = 0.793-0.874), and fair discriminative accuracy for in-hospital mortality (AUROC, 0.780; 95% CI = 0.668-0.893).</p><p><strong>Conclusions: </strong>Compared to the age-adjusted Charlson Comorbidity Index, The GERIATRIC risk tool was accurate in classifying patients into those who may or may not experience severe complications or die during their index admission. The tool can be used to assist perioperative clinicians with shared decision-making and short-term prognostication.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e524"},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nomograms Predicting Survival, Recurrence and Beneficiary Identification of Adjuvant Chemotherapy in Treatment-naïve Patients with Rectal Cancer who Underwent Upfront Curative Resection: A multi-institutional study.","authors":"Yukihide Kanemitsu, Tomofumi Uotani, Shunsuke Tsukamoto, Hideki Ueno, Megumi Ishiguro, Soichiro Ishihara, Koji Komori, Kenichi Sugihara","doi":"10.1097/AS9.0000000000000508","DOIUrl":"10.1097/AS9.0000000000000508","url":null,"abstract":"<p><strong>Objective: </strong>To create and validate nomograms predicting overall survival and recurrence in treatment-naïve rectal cancer (RC) patients who underwent upfront surgery.</p><p><strong>Background: </strong>Although multidisciplinary treatment is standard for locally advanced RC, understanding surgical efficacy is important for determining indications for perioperative adjuvant therapy.</p><p><strong>Methods: </strong>RC patients who underwent upfront surgery at the Japanese Society for Cancer of the Colon and Rectum institutions were analyzed. A training cohort (n = 1925) of treatment-naïve patients who underwent surgery between 2007 and 2008 was analyzed to construct prognostic models predicting postoperative survival and recurrence. Discrimination and calibration were performed using an external validation cohort (n = 2957; Japanese colorectal cancer registry, procedures in 2005-2006). Effects of adjuvant chemotherapy on survival were evaluated based on nomogram prediction and Surveillance, Epidemiology, and End Results (SEER) data (n = 10,482; upfront surgery for RC in 2010-2015).</p><p><strong>Results: </strong>In the training cohort, age predicted survival, venous invasion predicted recurrence, and sex, tumor location, histological type, preoperative carcinoembryonic antigen, invasion depth, lymphatic invasion, positive radial margin, and numbers of metastatic nodes and examined nodes predicted both. Internal and external validated Harrell's C-index values were respectively 0.77 and 0.75 for survival and 0.75 and 0.74 for recurrence. RC patients who underwent upfront surgery in the SEER database were stratified into 3 risk levels by nomogram score. Adjuvant chemotherapy did not improve 5-year survival in low-risk patients, but did so for middle-risk (62.4% <i>vs</i> 76.8%) and high-risk (39.4% <i>vs</i> 63.5<i>%</i>) patients.</p><p><strong>Conclusion: </strong>These nomograms could predict survival and recurrence after upfront curative resection of RC and identify cases expected to benefit more from adjuvant chemotherapy.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e508"},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Celiac Axis Stenosis Is an Underestimated Risk Factor for Increased Morbidity After Pancreatoduodenectomy\".","authors":"Nobuhiro Hasui, Hirokazu Momose, Shohei Kudo, Yoshihiro Sakamoto","doi":"10.1097/AS9.0000000000000519","DOIUrl":"10.1097/AS9.0000000000000519","url":null,"abstract":"","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e519"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Comment on: \"Impact of Back-to-Base Normothermic Machine Perfusion on Complications and Costs: A Multicenter, Real-World Risk-Matched Analysis\".","authors":"Chase J Wehrle, Sangeeta Satish, Charles Miller, Koji Hashimoto, Andrea Schlegel","doi":"10.1097/AS9.0000000000000525","DOIUrl":"10.1097/AS9.0000000000000525","url":null,"abstract":"","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e525"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Treatment Intensity at the End of Life in Patients With Cancer: A Systematic Review.","authors":"Samuel Lawday, Benjamin E Zucker, Shona Gardner, James Robb, Lorna Leandro, William Hollingworth, Jane Blazeby, Angus G K McNair, Charlotte Chamberlain","doi":"10.1097/AS9.0000000000000514","DOIUrl":"10.1097/AS9.0000000000000514","url":null,"abstract":"<p><strong>Objective: </strong>To synthesize evidence of surgical treatment intensity, defined as a measure of the quantity of invasive procedures, received by patients in patients with cancer within a defined time period around the 'end of life' (EoL).</p><p><strong>Background: </strong>Concern regarding overly 'aggressive' care or high health care utilization at the EoL, particularly in cancer, is growing. The contribution surgery makes to the quality and cost of EoL care in cancer has not yet been quantified.</p><p><strong>Methods: </strong>This PROSPERO registered systematic review used PRIMSA guidelines to search electronic databases for observational studies detailing surgical intensity at the EoL in adult cancer patients. Intensity was compared by disease, individual characteristics, geographical region, and palliative care involvement. A risk of bias tool assessed quality and a narrative synthesis of findings was completed.</p><p><strong>Results: </strong>In total, 39 papers were identified in this search. Up to 79% of patients underwent invasive procedures in the last month of life. Heterogeneity in patient groups, inclusion criteria, and EoL time periods lead to huge variation in results, with treatment intention often not identified. Patient, geographical, and pathological factors, alongside involvement of palliative/hospice care, were all identified as contributors to treatment intensity variation.</p><p><strong>Conclusions: </strong>A significant proportion of patients with cancer undergo invasive and costly invasive procedures at the EoL. There is significant reporting heterogeneity, with variation in patient inclusion criteria and EoL timeframes, demonstrating uncertainty within the literature. Identification of the context where surgical treatment intensity at the EoL is potentially inappropriate is not currently possible.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e514"},"PeriodicalIF":0.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors and Management of Portal Vein Thrombosis after Hepatectomy: A Single-Center Experience.","authors":"Kazuki Wakizaka, Shunsuke Shichi, Takeshi Aiyama, Yoh Asahi, Akihisa Nagatsu, Tatsuya Orimo, Tatsuhiko Kakisaka, Akinobu Taketomi","doi":"10.1097/AS9.0000000000000523","DOIUrl":"10.1097/AS9.0000000000000523","url":null,"abstract":"<p><strong>Objective: </strong>This study investigated the risk factors and management of portal vein thrombosis (PVT) after hepatectomy.</p><p><strong>Background: </strong>PVT after hepatectomy can cause liver dysfunction and portal hypertension, and may be fatal. However, it has not been sufficiently investigated.</p><p><strong>Methods: </strong>The study included 1403 consecutive patients who underwent elective hepatectomy at our department from January 2010 to July 2022. The patients were divided into PVT and non-PVT groups based on the presence or absence of PVT, and relevant risk factors were analyzed. The management and prognosis of patients with PVT were investigated.</p><p><strong>Results: </strong>Among the 1403 patients, PVT occurred in 33 cases, giving a frequency of 2.4%. In univariate analyses, female sex (<i>P</i> = 0.03), portal vein reconstruction (<i>P</i> = 0.01), and left lateral sectionectomy (<i>P</i> < 0.001) were significant risk factors for PVT. On multivariate analysis, portal vein reconstruction (<i>P</i> = 0.01) and left lateral segmentectomy (<i>P</i> < 0.001) remained significant risk factors for PVT. The management options for PVT were thrombectomy, antithrombotic therapy, and observation. With antithrombotic therapy, 96.4% of patients achieved PVT resolution. Among patients who underwent hepatectomy with portal vein reconstruction, the PVT site was the main trunk of the portal vein in all 3 cases, and thrombectomy was performed in 2 cases. No perioperative mortality was observed.</p><p><strong>Conclusions: </strong>In the present study, portal vein reconstruction and left lateral sectionectomy were identified as risk factors for PVT after hepatectomy. As PVT can be fatal, early detection and appropriate treatment according to the status of PVT are important.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e523"},"PeriodicalIF":0.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Opioid Consumption After Discharge: An Update From the Michigan Surgical Quality Collaborative Registry.","authors":"Ashwin J Kulkarni, Vidhya Gunaseelan, Chad M Brummett, Jennifer Waljee, Michael Englesbe, Mark C Bicket","doi":"10.1097/AS9.0000000000000517","DOIUrl":"10.1097/AS9.0000000000000517","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate opioid consumption for 21 procedures over 4 years from the Michigan Surgical Quality Collaborative (MSQC) registry and update post-discharge prescribing guidelines.</p><p><strong>Background: </strong>Opioids remain a common treatment for postoperative pain of moderate-to-severe intensity not adequately addressed by nonopioid analgesics, but excessive prescribing correlates with increased usage. This analysis provides updates and compares patient-reported consumption in response to new guidelines.</p><p><strong>Methods: </strong>We examined data from the MSQC registry for opioid-naive adult patients undergoing surgery between January 1, 2018, and October 31, 2021. The primary outcome was patient-reported opioid consumption in oxycodone 5 mg equivalents. Guidelines were anchored to the 75th percentile of consumption, updating previous guidelines from January 2020 based on data from January 1, 2018, to May 31, 2019.</p><p><strong>Results: </strong>39,493 opioid-naive surgical patients (average age 53.8 years [SD 16.4], 56.3% female, 19.1% non-White, 43.9% with public insurance) were included. Guidelines did not change for 7 of the 16 procedures including the most common procedures: minor hernia, laparoscopic cholecystectomy, laparoscopic appendectomy, and laparoscopic hysterectomy. Recommended prescribing ranges were lower for 9 procedures, with most (8) procedures having a reduction of 5 pills. Prescribing guidelines were developed for 5 new procedures. All procedures had upper-limit guidelines of 10 pills or less.</p><p><strong>Conclusions: </strong>For most procedures, patient-reported opioid consumption decreased between 2018 and 2021 when compared to the period between 2018 and 2019. New guidelines were established for a dozen procedures to balance maximizing pain control with reducing harms from inappropriate prescribing.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e517"},"PeriodicalIF":0.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}