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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.
Ali Aminian, MD, and co-authors reported a matched cohort study of adult patients with a body mass index of 35 or greater who underwent bariatric surgery in the US 2004−2017. Patients who underwent bariatric surgery were matched with patients who had not had surgery to compare the frequency of malignant tumors in the two groups. More than 30,000 patients were included in the cohort; the mean age of the included patients was 46 years, and the median body mass index was 45. Women comprised 77% of the group, and most of the patients were White.
The data analysis showed that malignant tumors occurred significantly less often in patients who had sustained weight loss following bariatric surgery. Of interest was the observation that not only malignant tumors associated with obesity were reduced, but also tumors not known to be associated with obesity were reduced in frequency. Risk of death from malignant disease also was significantly reduced in patients who underwent bariatric surgery.
In the editorial that accompanied this article, Anita P. Courcoulas, MD, MPH, stressed that patients who undergo bariatric surgery are likely to adhere to other practices that may reduce cancer risk, such as smoking cessation. This finding raises the possibility that the cohorts compared in this study were drawn from significantly different populations, which may influence interpretation of the cancer-related outcomes. Additional studies will be needed to fully clarify the effect of bariatric surgery on cancer risk.
Early Specialization Program Is an Effective Pathway to Certification in Vascular and General Surgery
The early specialization program, as the authors noted, was implemented as a pilot more than a decade ago as a truncated training program for surgeons who intended to practice vascular surgery and who sought eligibility for certification in general surgery from the American Board of Surgery. Data regarding outcomes of these programs are lacking. The intent of this study was to document characteristics of the training environment, operative experience during training, and ultimate certification status of surgeons who participated in the program. A relatively small number of surgeons have completed the program (N = 34). Complete information on 20 participants was available.
The data analysis showed, not unexpectedly, that the main area of operative experience was in vascular surgery. Operative cases classified as “junior level” were the lowest numbers recorded. Operative cases classified as “senior level” were equivalent to a comparison group of general surgery trainees. Certification status was available for 24 respondents. Of these surgeons, 19 maintained general surgery certification; all the surgeons were certified in vascular surgery. The authors concluded that the early specialization program was an effective pathway for surgeons seeking certification in both vascular surgery and general surgery.
Systems Approach Is Necessary for Crisis Preparedness in Surgery
This article described a framework for developing patient safety interventions adapted from practices confirmed as effective in the aviation industry. The authors used observations of aviation safety practices, interviews with senior airline pilots, and focus groups comprising airline pilots and surgeons to identify and develop the processes for implementation of patient safety interventions. The set of instruments developed focused on crisis preparedness and failure management.
Included in the interventions were programs to anticipate threats and errors by building situational awareness, briefing programs, checklists, emergency skill rehearsals, and team building. Team-building education emphasized emotional intelligence, the development of mutual trust, and training of individuals with the main goal of increasing the ability to recognize problems and articulate them to other team members. The authors recommended the development of patient safety systems rather than the introduction of individual interventions.
They emphasized, as did Sara Ginzberg, MD, and Rachel R. Kelz, MD, MBA, FACS, in the accompanying editorial, that successful organization and implementation of these systems would require dedicated healthcare professionals, strong administrative support, and significant institutional resources. These needs, once recognized, are essential but also create obstacles to accomplishing the goals that the authors articulated. The obstacles occur because of competing priorities among the essential participants, difficulties in maintaining support, and the complexity of healthcare systems. Patient safety interventions have been implemented inconsistently and have not been universally successful. The editorialists stressed this crucial point. Widespread achievement of high-performing healthcare systems that emphasize patient safety is a worthwhile goal, but it will be difficult to reach.
