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Resident and Faculty Perceptions of Wellness During Training
Burnout is one of the major challenges facing physicians and is increasingly prevalent in the surgical community. Williford and colleagues analyzed the perceptions of burnout and depression among 147 surgical residents and faculty in North Carolina with validated survey metrics. Both cohorts underestimated the true prevalence of these conditions but identified the same barriers to seeking care.
Continuing Medical Education
Resident Expectations of Training and Risk of Attrition
General surgery resident expectations of training and their subsequent risk of attrition have not been evaluated. Abelson and colleagues performed a prospective cohort study of 828 residents over 9 years and found that interns with realistic expectations were less likely to drop out of training.
Author Audio Interview and CME
Regional Quality Improvement Through Collaboration
Does collaborative quality improvement impact patient outcomes over time? Hemmila and colleagues used the National Trauma Data Bank to evaluate the association of participation in the American College of Surgeons Trauma Quality Improvement Program (TQIP) (benchmark reporting) or the Michigan TQIP (benchmark reporting and collaborative quality improvement) with outcomes compared with control hospitals that did not participate in either program. After accounting for patient factors and preexisting time trends toward improved outcomes, a regional collaborative model (the Michigan TQIP) was independently associated with improved outcomes for major complications and venous thromboembolism when compared with nonparticipation and with participation in the American College of Surgeons TQIP.
Poor Outcomes After Opioid-Related Adverse Events
Opioids are commonly used for pain control for invasive procedures; however, the incidence and consequences of opioid-related adverse drug events (ORADEs) are not well known. In this retrospective study of 135 379 adult surgical patients, Shafi and colleagues found that 14 386 (10.6%) experienced ORADEs. These were associated with significantly worse outcomes, including increased in-hospital mortality, length of stay, costs, and readmission.
Medicaid Expansion and Trauma Outcomes in Young Adults
Affordable Care Act Medicaid expansion has increased insurance coverage among young adults, but its national impact on trauma outcomes remains unclear. In this study of 272 631 young adult trauma patients from 14 states, Akande and colleagues identified no association of Medicaid expansion, in its first year, with in-hospital mortality, failure to rescue, or readmission. However, they did identify an increase in use of rehabilitation services.
Invited Commentary and CME
JAMA Surgery. JAMA Surg. 2018;153(8):697. doi:10.1001/jamasurg.2017.3687
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