American College of Surgeons, Oct. 22-25

The annual meeting of the American College of Surgeons was held this year from Oct. 22 to 25 in Boston and attracted participants from around the world, including surgeons, medical experts, allied health professionals, and administrators. The conference included hundreds of general and specialty sessions, postgraduate courses, scientific paper presentations, video-based education presentations, and posters focusing on the latest advances in surgical care.

In one study, Aaron Jensen, M.D., of the University of California San Francisco and Benioff Children's Hospital Oakland, and colleagues found that children initially receiving treatment at trauma centers reporting pediatric readiness scores in the highest quartile have the best risk-adjusted survival.

The authors analyzed data from the 2021 national assessment administered by the National Pediatric Readiness Project, which aims to ensure that all U.S. emergency departments are prepared to provide high-quality emergency care to adolescents and children. The investigators found that emergency departments reporting pediatric readiness in the top 25th percentile had the best risk-adjusted survival. The researchers suggest that all trauma centers should optimize the readiness of their emergency departments to provide initial postinjury care, even if most children will be transferred to a verified pediatric trauma center.

"These data support the American College of Surgeons trauma center quality standard that calls for all trauma centers to assess their own emergency department pediatric readiness and generate a plan to address any deficiencies," Jensen said. "Only approximately 60 percent of children have timely access to a pediatric trauma center nationally, but approximately 90 percent have access to a high-level trauma center. Optimizing emergency department pediatric readiness at adult trauma centers could improve timely access to high-quality initial postinjury care at trauma centers and improve survival for injured children nationally."

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In another study, Emily Palmquist, M.D., of the University of Washington School of Medicine in Seattle, and colleagues found that educational materials about breast surgery are difficult to locate and present at higher reading levels than recommended.

The authors analyzed patient education materials about types of breast surgery, including breast-conserving surgery, mastectomy, and lymph node surgery, provided by National Cancer Institute-designated Comprehensive Cancer Center (NCI-CCC) websites. The researchers found that patient education materials on NCI-CCC sites far exceeded the National Institutes of Health (NIH) recommendations, with the mean readability score being above the 11th grade reading level.

"These results are concerning given low health literacy contributes to poorer health outcomes. Improving readability of these materials is necessary to support informed patient decision-making in breast cancer patients," Palmquist said. "As providers, we can help support the informed patient decision-making by guiding patients to reputable sources, but also helping to clarify when things are not clear. It will take time to develop better online resources for patients, but providers can help fill in the gaps in the meantime."

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Anai Kothari, M.D., of the Medical College of Wisconsin in Milwaukee, and colleagues found that patients who take fewer steps per day have a higher risk for postoperative complications.

The authors evaluated the impact of preoperative health status, measured using wearable-device data, on postoperative complications among 475 patients participating in the All of Us Research Program (an NIH program assessing the relationship between lifestyle, biology, and environment). The investigators were able to use real-world wearable device data that were not specifically collected in the preoperative period but instead included long-term data, allowing an estimate more representative of baseline steps per day. The researchers found that using a threshold of 7,500 steps per day can help guide clinicians and patients to estimate risk and improve shared surgical decision-making.

"Our study provides evidence that leveraging data from wearable devices can be an important source of information to guide and inform surgical risk stratification," Kothari said. "It also highlights that strategies directed at improving physical fitness prior to surgery might improve outcomes."

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