As interest in payment-for-performance initiatives in graduate medical education grows, it becomes increasingly necessary to define and quantify residency program performance. In a retrospective study of hospital discharge data in New York and Florida between 2008 and 2011, Bansal et al assessed general surgery program performance using clinical outcomes of patients operated on by program graduates. They demonstrated that residency programs can be stratified by 3 primary clinical outcomes of interest.
Safety-net hospitals care for a unique, vulnerable patient population. Hoehn et al examined 12 638 166 patients undergoing a major procedure. For all 9 procedures examined in 231 hospitals, patients at hospitals with high safety-net burden were most likely to be young, to be black, to be of the lowest socioeconomic status, and to have the highest severity of illness and the highest cost for surgical care. They found that high safety-net burden correlated with increased surgical costs that were independent of patient factors. Medicare Hospital Compare data indicated that these centers also had slower emergency department throughput, suggesting inferior staffing or systems.
Author Audio Interview and Continuing Medical Education
Little is known about comorbidity remission after bariatric surgery. In a retrospective cohort study of 33 718 patients, Hatoum and colleagues identified comorbidities before and after surgery and assessed remission rates. This study confirmed established predictors and revealed novel variables associated with comorbidity remission after bariatric surgery.
The appropriate transfusion threshold in patients with postoperative myocardial infarction (MI) is unclear. Hollis et al performed a retrospective study of 7361 patients with a history of coronary artery disease who underwent surgery and had postoperative anemia. They found that postoperative blood transfusion was associated with lower mortality among patients who had a postoperative MI and a nadir hematocrit of 20% to 24%.
Continuing Medical Education
In 2003, the American College of Surgeons developed a research agenda for surgical palliative care. This review sought to provide a comprehensive overview of the extant literature. The results of the 25 articles included suggest the benefits of palliative care interventions in symptom management, communication, health care utilization, and mortality outcomes; however, evidence remains sparse. Further research is needed to delineate palliative care’s role in surgical practice.
Highlights. JAMA Surg. 2016;151(2):105. doi:10.1001/jamasurg.2015.2898