American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

New Crucial Literature: The Science You Need to Know

Literature selections curated by Lewis Flint, MD, FACS, and reviewed by the Bulletin Brief editorial board.

Pair of JACS

New Study Examines Association between Gender and Faculty Teaching Evaluation Scores in General Surgery Residency

Shellito AD, de Virgilio C, Lee G, et al. Investigating Association Between Sex and Faculty Teaching Evaluation in General Surgery Residency Programs: A Multi-Institutional Study. J Am Coll Surg. 2020;231(3):309-315 e1.

The authors noted that data from residency programs in nonsurgical specialties have shown that women faculty members usually receive lower ratings on teaching evaluations compared with male faculty. They gathered anonymous, resident-derived teaching evaluations from 21 general surgery residency programs to compare evaluation scores for women and men. More than 20,000 evaluations were reviewed, and composite evaluation scores were calculated for each faculty member.

Data were stratified based on the proportion of female faculty members and female residents in each program. The data analysis showed that women faculty received higher scores (90.6 percent versus 89.5 percent) and this small difference reached statistical significance. The difference in scores was present even when the proportions of women faculty and/or women residents was small in the included training programs.

The authors hypothesized that these differences might be related to the slowly changing gender balance within the specialty of general surgery and/or changing attitudes toward women faculty in a male-dominated specialty. Although these data were drawn from a small, select group of programs, the evidence suggests that some progress is being made toward achieving gender equity in academic surgery; this finding is encouraging.

Medicaid Expansion Associated with Improved Surgical Care for Colon Cancer Patients

Hoehn RS, Rieser CJ, Phelos H, et al. Association Between Medicaid Expansion and Diagnosis and Management of Colon Cancer. J Am Coll Surg. November 23, 2020 [Epub ahead of print].

Data are available to support the conclusion that Medicaid expansion is associated with improved access to health care and, for some diseases (including diabetes, cardiovascular disease and breast cancer), improved outcomes. The authors queried a national cancer database and compared Medicaid-insured versus non-insured patients diagnosed with colon cancer in time intervals before and after Medicaid expansion.

Study results indicated that the proportion of Stage 1 colon cancer diagnoses increased significantly in the after period. Similarly, the proportion of patients receiving treatment within 30 days of diagnosis increased. Proportions of patients undergoing nonurgent procedures and minimally invasive procedures increased after expansion. Postoperative outcomes and rates of receipt of chemotherapy were equivalent in both intervals.

The authors concluded that efforts to improve access to health insurance can potentially improve disease outcomes.

Other Articles

Can Breast Density Be Used to Predict Severity of Breast Cancer-Related Lymphedema? New Article Investigates

Kwan JYY, Famiyeh P, Su J, et al. Development and Validation of a Risk Model for Breast Cancer-Related Lymphedema. JAMA Netw Open. 2020;3(11):e2024373.

DiNome ML. Repurposing the Mammographic Breast Density Category for Predicting Lymphedema Risk in Patients With Breast Cancer. JAMA Netw Open. 2020;3(11):e2024923.

Approximately 20 percent of patients who undergo axillary node dissection for treatment of breast cancer develop lymphedema, a condition that adversely effects quality of life in affected patients. The authors reviewed health records of 373 patients who were enrolled in a Canadian cancer treatment program. Risk factors associated with development of lymphedema included lower breast density, BMI, number of lymph nodes removed and complete axillary dissection. The authors created a risk-scoring system based on breast density that was 72 percent effective for predicting mild lymphedema and 83 percent effective for predicting severe lymphedema.

In the editorial that accompanied the article, DiNome noted that accurate prediction of risk for developing lymphedema would lead to appropriate counseling and earlier interventions to mitigate the effects of this condition. The editorialist also noted that lower breast density is associated with higher tissue fat content and hypothesized that compromised lymphatic drainage in breast tissue with higher fat content might contribute to the observed increased lymphedema risk.

Article Discusses Potential Value of Perioperative Cannabis in Reducing Reliance on Opioids for Pain Control

Stewart C, Fong Y. Perioperative Cannabis as a Potential Solution for Reducing Opioid and Benzodiazepine Dependence. JAMA Surg. December 2, 2020 [Epub ahead of print].

Stewart and Fong reviewed legal aspects and available medical data (types of drugs available, dosages, and route of delivery) related to the use of cannabis as an adjunct to perioperative pain control. High-quality data support the effectiveness of cannabis for relief of pain, nausea, and insomnia. The authors noted that prospective trials of perioperative cannabis are underway, but there is currently no reliable data available to support the use of these agents in surgical patients. The article provided clear recommendations for surgeons who need to counsel patients that use cannabis.

They concluded that there is potential value of cannabis as a means of reducing reliance on opioids and benzodiazepine for perioperative pain control.

Open, Transcervical Surgical Approach to Zenker Diverticulum Appears Superior to Endoscopy, Article Suggests

Bhatt NK, Mendoza J, Kallogjeri D, Hardi AC, Bradley JP. Comparison of Surgical Treatments for Zenker Diverticulum: A Systematic Review and Network Meta-analysis. JAMA Otolaryngol Head Neck Surg. December 3, 2020 [Epub ahead of print].

The authors reported results of a systematic review of the literature to compare rates of persistent or recurrent symptoms for endoscopic laser-assisted diverticulotomy, endoscopic stapler-assisted diverticulotomy and transcervical diverticulectomy with cricopharyngeal myotomy.

Two authors reviewed the selected articles, and the PRISMA checklist was used to report study findings. Nine studies involving 903 patients were selected. Endoscopic procedures were performed in 753 patients. The outcomes analysis showed that transcervical diverticulectomy with cricopharyngeal myotomy was associated with a significantly lower rate of persistent or recurrent symptoms compared with the endoscopic techniques. Data comparing perioperative morbidity for the three procedures were not presented.

The authors concluded that these data have potential value for counseling patients regarding choice of procedure for treatment of Zenker diverticulum.