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Rude and Disrespectful Surgeons Risk More Complications
Do rude and disrespectful behaviors identified through patient complaints predict postoperative complications? Cooper and colleagues reviewed unsolicited patient complaints for surgeons operating on 32 125 patients in the National Surgical Quality Improvement Program from 7 academic sites. Patients whose surgeons had more patient complaints in the previous 2 years had a significantly increased risk of having postoperative surgical and medical complications.
Continuing Medical Education
Best Case/Worst Case Framework for Surgical Decisions
Taylor et al evaluate surgeon-patient communication after teaching surgeons to use the Best Case/Worst Case framework for high-stakes surgical decisions. In this pre-post study, they analyzed preoperative conversations between surgeons and 32 frail, older inpatients facing an acute surgical problem. Surgeons used the Best Case/Worst Case framework to structure treatment conversations and improved on objective measures of shared decision making.
Ratio-Based Resuscitation in Patients Without Trauma
Hemostatic resuscitation is beneficial for patients with trauma, but there is little evidence that it is equally beneficial for patients who are bleeding without trauma. In a retrospective study of 865 massive transfusion events, Mesar et al examined the fresh frozen plasma to red blood cell transfusion ratios for patients with and without trauma. They found no evidence that a high frozen plasma to red blood cell transfusion ratio improved survival rates among patients without trauma.
Vascular Exposure and Fasciotomy by Residents
Surgeon patient outcomes are related to surgeon skills. Mackenzie et al tested whether undergoing training improved the performance of residents and compared the performance of residents with that of experts. Resident performance was measured before and after Advanced Surgical Skills for Exposure in Trauma deceased donor–based training, and it showed that most residents improved anatomy and landmark skills with training and had reduced errors up to 18 months later, but overall experts were better. Some residents did not improve and made the same errors despite training.
Clinical Review & Education
Role of Genetic Testing in Patients With Breast Cancer
The role of genetic testing in breast cancer is rapidly changing and is an area of active research. This review provided an adequate knowledge of the genetic defects that can be detected, with the goal of allowing early detection in patients and their families to see if earlier therapy may relate to better outcomes. This review addressed genetic mutations, indications for testing, and associated costs. This is a guide for the general surgeon on genetic testing in patients with breast cancer.
Highlights. JAMA Surg. 2017;152(6):513. doi:10.1001/jamasurg.2016.3432
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