Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Data cited in this article showed that surgeons are aging, and the surgical workforce, as a whole, is getting older. Within the next decade, more than 40% of practicing surgeons will be 65 years of age or above. To provide maximum protection of patients, it is important to recognize that age-related cognitive decline and deterioration of skills are an important phenomenon and measures to detect these changes and facilitate initiatives to protect patients and surgeons are needed.
In this article, the Physician Competency and Health Workgroup of the ACS presented an evidence-based strategic plan for responding to these issues. The main components of the proposed plan include:
Career-long competency testing
Career-long transition planning
Continuing medical education, professional development, and mentorship/peer support
Development of interventions that assure maximum patient and surgeon protection
There likely will be to implementing this strategy, and these are noted by the authors. Professional societies should play a role in leading this effort but implementing the necessary programs and responding to the social and legal issues will need to take place at the institutional level. Several examples of existing programs are provided in the article.
The editorial by Alverdy provided valuable perspectives, including the fact that retirement from active practice is a personal decision and assisting surgeons with this process will be a critical component of a successful effort.
Adults older than 65 years of age compose more than one-third of patients undergoing inpatient surgical procedures. This patient group is at increased risk for perioperative mortality and complications that can negatively affect functional outcomes and quality of life.
Comorbid conditions and age-related physiological changes contribute to these outcomes, but there are also unique psychological and social situations that make older patients more susceptible to poor outcomes. Poor emotional wellbeing has been linked to adverse outcomes of surgical procedures.
The authors conducted interviews of surgical patients and caregivers at multiple time points during the perioperative period to gain an improved perspective of patients’ psychosocial experience. All patients were scheduled to undergo procedures with a known mortality risk of >1%.
The data showed that there were significant psychosocial challenges faced by these patients, and the interview results identified three predominant themes.
Challenges to emotional wellbeing were prevalent and negatively impacted recovery
Older adults relied on a combination of personal and social coping strategies
Patients and caregivers desired more resources to address mental and emotional needs
The authors concluded that access to educational campaigns, hotlines and emotional support groups, and mental health services via telepsychiatry could potentially reduce these stresses and improve surgical outcomes.
Percutaneous Needle Biopsy Opens Neoadjuvant Therapy Options in Nodal Melanoma
Recent clinical trials have confirmed a clear benefit for neoadjuvant checkpoint inhibitor immunotherapy for patients with nodal metastatic melanoma. This viewpoint article reviewed data from these trials and presented an evidence-based recommendation that patients diagnosed with nodal metastatic melanoma using imaging should undergo a percutaneous biopsy to confirm the diagnosis followed by neoadjuvant therapy in eligible patients.
The authors presented a hypothetical case of a patient who had undergone wide local excision of a cutaneous melanoma and presented later with an enlarged regional lymph node. Most such patients are managed by general surgeons.
Historically, the treatment for such patients is regional node dissection; substituting percutaneous needle biopsy to confirm the diagnosis would permit the patient to undergo evaluation for neoadjuvant therapy. Neoadjuvant therapy would present the patient with the opportunity for improved overall survival.
They noted that current guidelines recommend percutaneous biopsy. Data from recent trials have generated enthusiasm for this approach; it is important to note that response rates vary from 21%-61% according to data cited in the article. Surgeons should be aware of this variability and be prepared to discuss options with patients to choose the approach that is most likely to provide the best possible outcome.
