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.
There is a lack of consensus on how to confirm population-level and hospital-level disparities in surgical care. This article used data from the ACS National Quality Improvement Program (NSQIP) to detect disparities in surgical outcomes according to the Area Deprivation Index, which is a measure of socioeconomic status in a community/neighborhood, race, and ethnicity.
Outcomes of interest included inpatient mortality, urgent readmission, surgical site infection, colectomy mortality, and spine surgery complications. Data on more than 4 million patients were included.
The analysis showed that population-level disparities were defined by ADI; these were consistent after statistical adjustments. After adjustment for patient risk factors, disparities were identified in 1.1% of hospitals. The authors noted that these findings were probably influenced by sample size variations among healthcare facilities and the fact that NSQIP hospitals tend to be larger academic centers; low-income patients and black patients are more likely to be treated in smaller hospitals with limited resources.
Additional research to identify and quantify surgical care disparities at the hospital level is needed.
Active Surveillance Is Safe, Effective for Patients with Low-Risk Papillary Thyroid Cancer
Active surveillance (AS) of patients with low-risk papillary thyroid cancer with conversion surgery performed if progression of disease is detected is a practice introduced in the mid-1990s; however, surgical and oncologic outcomes of conversion surgery have not been well documented.
This article reported outcomes from a patient cohort (n = 550) containing three comparison groups of patients: those who underwent conversion surgery because of disease progression, those who underwent conversion surgery without evidence of disease progression, and those who underwent immediate thyroidectomy. Propensity scoring was used to match patient characteristics.
The data analysis showed that the overall 5-year survival was 100% in all groups. Although the conversion surgery group had higher risk for aggressive tumor behavior, the rates of regional recurrence (5.1%), local recurrence (0%), and distant metastasis (0%) were similar in all groups.
The authors concluded that AS was a safe and effective approach for patients with low-risk papillary thyroid cancer.
In the editorial that accompanied the article, Ho noted that adoption of AS among surgeons in the US has been slow, in part because of perceived malpractice risk associated with this approach.
Bariatric Surgery May Reduce Risk of Breast Cancer in Obese Patients
Kristensson and coauthors reported data from a prospective randomized trial conducted in Sweden. They compared rates of breast cancer at more than 20 years after a bariatric surgery procedure (n = 1,420) with patients treated for obesity (n = 1,447) with non-operative measures.
The data showed that there was a significant reduction in risk for breast cancer in patients who underwent bariatric surgery. The risk reduction was most pronounced in patients with elevated baseline levels of insulin.
The authors concluded that bariatric surgery was associated with reduced incidence of breast cancer in obese patients.
In the editorial that accompanied the article, Kulkarni and Sterbling noted that it is not known whether hyperinsulinemia or insulin resistance are true markers of increased breast cancer risk. They also emphasized that data adjusted for patient age were not reported. Other factors that may influence breast cancer risk in this patient group include estrogen levels, inflammatory markers, and types of bariatric surgery. These data support recognition of another important benefit of bariatric surgery in obese women.
