Despite considerable literature on breast reconstruction outcomes, studies have lacked rigorous patient-reported outcome data. Santosa and colleagues analyzed self-reported outcomes of 2013 women who had immediate breast reconstruction, comparing outcomes of those who chose autologous breast reconstruction vs those who had implant-based reconstruction. Patients with autologous reconstructions reported greater satisfaction and breast-associated quality of life at 2 years than those who had used implant-based techniques.
Invited Commentary and Related Article
Author Audio Interview
Genetic testing after breast cancer diagnosis is common, but no studies have examined testing rate variations at the surgeon level. Katz and colleagues examined surgeon influence on whether 5080 patients with breast cancer received genetic testing, using Surveillance, Epidemiology, and End Results registries and patient and surgeon surveys. They found that 17% of variation in testing was attributable to the attending surgeon the patient saw. A patient with a surgeon at the fifth percentile of the distribution had a 26% probability of testing, compared with 72% for those who saw a surgeon at the 95th percentile.
Invited Commentary
Continuing Medical Education
Little is known about patients taking opioids prior to surgery. Finding common characteristics can inform perioperative care decisions for this population. Hilliard and colleagues found that, in a sample of 34 186 patients, 7894 (23.1%) were taking an opioid drug at the time of surgery. These patients had higher pain severity, lower life satisfaction, more depression, and more medical comorbidities and were more likely to be tobacco smokers.
Invited Commentary
Burnout and distress are serious, growing issues in surgery, and effective interventions remain scarce. In this pilot randomized clinical trial on 21 surgery interns at an academic center, Lebares and colleagues found formal mindfulness-based stress reduction training to be highly feasible and acceptable, as evidenced by high demand, attendance, independent practice, subjective satisfaction, perceived efficacy, and retention.
Invited Commentary
Continuing Medical Education
Clinical Review & Education
Postsurgical prescribing is a target in combating the opioid epidemic, but the best ways to implement practice changes remain unknown. This systematic review of literature from 2000 through 2018 shows that interventions at a physician or organizational level (eg, workflow changes) are the most effective at reducing postoperative opioid prescribing, while interventions at the patient level (eg, patient education) have mixed results.
Invited Commentary
Continuing Medical Education