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.
With increasing frequency of cross-sectional imaging, adrenal incidentalomas are being discovered more often. Biochemically functional tumors or tumors with metastases are diagnosed in 10%–25% of patients with incidentalomas.
A recent article presented evidence that adrenal pheochromocytomas are most often diagnosed after discovery of the tumor as an incidentaloma. Available evidence has confirmed that adrenal incidentalomas are infrequently investigated following discovery. This article described outcomes of a quality improvement program designed to increase rates of investigation of incidentalomas following initial discovery.
The program focused on primary care physicians in a single healthcare system and included chart-based messages, emails, a furnished evaluation algorithm, and standardized recommendations in radiology reports. A prospective cohort (n = 437) was compared to a historical sample (n = 210), and the data analysis showed that 35.5% of patients in the prospective cohort underwent recommended investigation of the adrenal incidentaloma compared with 27.6% of the historical cohort.
The authors concluded that the quality improvement initiative was effective, although there was still significant room for improvement.
Adult Risk-Adjusted Mortality Is Not Reliable Indicator of Pediatric Outcomes, Article Suggests
Most children who sustain injuries requiring hospitalization are not treated in pediatric trauma centers; initial treatment in a non-trauma center or an adult trauma center with subsequent transfer to a pediatric trauma center is common.
“Mixed” trauma centers offer both adult and pediatric trauma care. Quality of trauma care for children who are treated in mixed trauma centers is measured using adult trauma quality benchmarks provided in the ACS Trauma Quality Improvement Program; however, this approach may not accurately measure quality of care for children because of differing mortality rates for injuries of equivalent severity (measured by standard injury severity scores) in children versus adults and because measuring only mortality rates is an inadequate assessment of quality of care for injured children.
This article presented results of an analysis of observed-to-expected mortality rates for adults and children obtained in adult and pediatric trauma centers that were then used to calculate risk-adjusted mortality rates for adults and children treated in mixed trauma centers. A total of 394,075 adults and 97,698 children were included in the study cohorts, and the analysis showed that expected pediatric mortality estimates had only moderate correlation between adult and pediatric cohorts in mixed centers.
The authors concluded that adult mortality benchmarks are not reliable surrogates for pediatric trauma quality assessment, recommending that pediatric-specific benchmarks be developed for measuring quality in mixed trauma centers.
In the editorial that accompanies the article, Mary Fallat, MD, FACS, agreed that pediatric and adult trauma surgeons should work together to produce accurate benchmarks for documenting quality of care delivered in mixed trauma centers. She provided a set of steps for establishing dependable quality benchmarks. Cooperation between professional societies could facilitate this effort.
BRCA Carriers Show No Increase in Maternal Complications or Adverse Fetal Outcomes during Pregnancy, Study Finds
Young women with BRCA1 or BRCA2 genetic variants who are diagnosed with breast cancer face unique challenges when considering future pregnancy because of fear of transmitting the variant to their offspring, the possible negative impact of treatment of the cancer on ovarian function, and the need to consider salpingo-oophorectomy to reduce risk of ovarian cancer.
This article examined frequency and outcomes of pregnancy in nearly 5,000 women with the BRCA variants who were followed for 10 years. The data analysis showed that 20% of the cohort became pregnant during the follow-up interval.
Compared with outcomes in normal women, there was no increase in rates of unplanned termination of pregnancy or congenital abnormalities in the fetus. Pregnancy was not associated with increased maternal complications or adverse fetal outcomes; disease-free and overall survival was not affected by pregnancy. The authors recommended that these data be used to counsel patients in this group.
Addition of Compression Stockings Provides No Additional Benefit versus Pharmacologic Prophylaxis Alone in Surgical Inpatients
Venous thromboembolism (VTE) is common and carries significant mortality and morbidity risks for hospitalized patients, responsible for 10%–12% of deaths occurring in this group. Thromboprophylaxis for prevention of VTE complications such as pulmonary embolism and post-thrombotic syndrome is accomplished with pharmacological prophylaxis using anticoagulant drugs with or without the addition of graduated compression stockings.
Previous studies have shown that graduated compression stockings do not provide additional benefit compared with pharmacologic prophylaxis alone and they are associated with significant morbidity, such as rash, ulceration, and abrasions. This updated analysis examined data from research that focused on orthopedic lower extremity procedures with VTE confirmed with venography. The research studies included in the systematic review were judged to be of high quality.
The analysis confirmed the findings of earlier research suggesting the addition of graduated compression stockings did not provide additional benefit compared with pharmacologic prophylaxis alone.
