ACS Surgery News

WASHINGTON – Nonoperative prophylaxis for blunt solid abdominal organ trauma was found safe when given 48 hours post injury, according to data presented at the annual clinical congress of the American College of Surgeons.

Because updated guidelines for nonoperative management of solid abdominal organ injuries do not state an optimal time for initiation of prophylaxis, investigators, including presenter Caitlyn Harrison, a third-year medical student at the University of Arizona, Tucson, sought to determine how soon is too soon in this patient population.

Theorizing that there would be no difference in bleeding complications and failure rates associated with early venous thromboembolism (VTE) prevention, the investigators reviewed 7 years of patient data (2005-2011) from a single trauma center to compare the safety of early (less than 48 hours), intermediate (48-72 hours), and late (more than 72 hours) initiation of unfractionated heparin (5,000 units, subcutaneously, every 8 hours) in blunt abdominal injury patients.

Included for review were patients whose abdominal injuries were equal to or greater than 3 on the Abbreviated Injury Scale (AIS). Patients with head injuries that scored 3 or greater on the AIS and those who had been transferred were excluded.

A total of 116 patients were matched according to whether they had received early (n = 58; 67.2% male; mean age, 40 years), intermediate (n = 29; 69% male; mean age, 44.3 years), or late (n = 29; 72.4% male; mean age, 45 years) initiation of VTE prophylaxis.

They also were matched according to organs injured. The investigators found a preponderance of splenic injuries: 41.4% in the early group, 37.9% in the intermediate, and 45.2% in the late group.

The grade of injury and laboratory values including blood pressure and injury severity also were measured.

The researchers found that none of the patients in the intermediate or late groups reached the primary outcome of the need for a post-treatment blood transfusion, although 3.2% of the early group did, Ms. Harrison said.

No patients in any of the three groups required an operative intervention after nonoperative management, although 1.7% of the early group did require embolization, as did 3.4% each of the intermediate and late groups.

Similarly, while thromboembolisms were not found to have occurred in the early group, they did occur in the intermediate and late groups at a rate of 3.4% each. No mortality was recorded as an outcome in any of the three groups, she said, concluding that "early VTE prophylaxis is safe."

Ms. Harrison reported no relevant disclosures.

[email protected]

WASHINGTON – Nonoperative prophylaxis for blunt solid abdominal organ trauma was found safe when given 48 hours post injury, according to data presented at the annual clinical congress of the American College of Surgeons.

Because updated guidelines for nonoperative management of solid abdominal organ injuries do not state an optimal time for initiation of prophylaxis, investigators, including presenter Caitlyn Harrison, a third-year medical student at the University of Arizona, Tucson, sought to determine how soon is too soon in this patient population.

Theorizing that there would be no difference in bleeding complications and failure rates associated with early venous thromboembolism (VTE) prevention, the investigators reviewed 7 years of patient data (2005-2011) from a single trauma center to compare the safety of early (less than 48 hours), intermediate (48-72 hours), and late (more than 72 hours) initiation of unfractionated heparin (5,000 units, subcutaneously, every 8 hours) in blunt abdominal injury patients.

Included for review were patients whose abdominal injuries were equal to or greater than 3 on the Abbreviated Injury Scale (AIS). Patients with head injuries that scored 3 or greater on the AIS and those who had been transferred were excluded.

A total of 116 patients were matched according to whether they had received early (n = 58; 67.2% male; mean age, 40 years), intermediate (n = 29; 69% male; mean age, 44.3 years), or late (n = 29; 72.4% male; mean age, 45 years) initiation of VTE prophylaxis.

They also were matched according to organs injured. The investigators found a preponderance of splenic injuries: 41.4% in the early group, 37.9% in the intermediate, and 45.2% in the late group.

The grade of injury and laboratory values including blood pressure and injury severity also were measured.

The researchers found that none of the patients in the intermediate or late groups reached the primary outcome of the need for a post-treatment blood transfusion, although 3.2% of the early group did, Ms. Harrison said.

No patients in any of the three groups required an operative intervention after nonoperative management, although 1.7% of the early group did require embolization, as did 3.4% each of the intermediate and late groups.

Similarly, while thromboembolisms were not found to have occurred in the early group, they did occur in the intermediate and late groups at a rate of 3.4% each. No mortality was recorded as an outcome in any of the three groups, she said, concluding that "early VTE prophylaxis is safe."

Ms. Harrison reported no relevant disclosures.

[email protected]

WASHINGTON – Nonoperative prophylaxis for blunt solid abdominal organ trauma was found safe when given 48 hours post injury, according to data presented at the annual clinical congress of the American College of Surgeons.

Because updated guidelines for nonoperative management of solid abdominal organ injuries do not state an optimal time for initiation of prophylaxis, investigators, including presenter Caitlyn Harrison, a third-year medical student at the University of Arizona, Tucson, sought to determine how soon is too soon in this patient population.

Theorizing that there would be no difference in bleeding complications and failure rates associated with early venous thromboembolism (VTE) prevention, the investigators reviewed 7 years of patient data (2005-2011) from a single trauma center to compare the safety of early (less than 48 hours), intermediate (48-72 hours), and late (more than 72 hours) initiation of unfractionated heparin (5,000 units, subcutaneously, every 8 hours) in blunt abdominal injury patients.

Included for review were patients whose abdominal injuries were equal to or greater than 3 on the Abbreviated Injury Scale (AIS). Patients with head injuries that scored 3 or greater on the AIS and those who had been transferred were excluded.

A total of 116 patients were matched according to whether they had received early (n = 58; 67.2% male; mean age, 40 years), intermediate (n = 29; 69% male; mean age, 44.3 years), or late (n = 29; 72.4% male; mean age, 45 years) initiation of VTE prophylaxis.

They also were matched according to organs injured. The investigators found a preponderance of splenic injuries: 41.4% in the early group, 37.9% in the intermediate, and 45.2% in the late group.

The grade of injury and laboratory values including blood pressure and injury severity also were measured.

The researchers found that none of the patients in the intermediate or late groups reached the primary outcome of the need for a post-treatment blood transfusion, although 3.2% of the early group did, Ms. Harrison said.

No patients in any of the three groups required an operative intervention after nonoperative management, although 1.7% of the early group did require embolization, as did 3.4% each of the intermediate and late groups.

Similarly, while thromboembolisms were not found to have occurred in the early group, they did occur in the intermediate and late groups at a rate of 3.4% each. No mortality was recorded as an outcome in any of the three groups, she said, concluding that "early VTE prophylaxis is safe."

Ms. Harrison reported no relevant disclosures.

[email protected]

PHOENIX – A new model based on clinical, hospital, and operative factors predicted the risk of ureteral injury among patients undergoing colorectal surgery.

Using data from the Nationwide Inpatient Sample, which includes more than 2 million patients in the United States, researchers retrospectively studied patients undergoing surgery in the United States between 2001 and 2010 for colorectal cancer, polyps, diverticular disease, or inflammatory bowel disease.

Less than 1% of patients sustained a ureteral injury, but the incidence rose significantly during the study period and injured patients had sharply higher rates of complications, researchers reported at the annual meeting of the American Society of Colon and Rectal Surgeons.

Eight factors were independently associated with the risk of ureteral injury. A predictive model incorporating these factors had an area under the receiver operating characteristic curve of 0.73. The model-predicted probability of injury ranged from 0.1% to 1.65%, depending on hospital factors, disease type, and procedure type, said Dr. Wissam J. Halabi, a research fellow at the University of California-Irvine, Orange.

Patients had higher adjusted odds of ureteral injury if they had rectal cancer (odds ratio, 1.85), adhesions (OR, 1.83), and metastatic cancer (OR, 1.76); if they had lost weight (OR, 1.08); and if they underwent surgery at a teaching hospital (OR, 1.05). On the other hand, patients had lower odds of injury if they had a laparoscopic procedure (OR, 0.91), a transverse colectomy (OR, 0.90), or a right hemicolectomy (OR, 0.43).

With the new predictive model incorporating these factors, the probability of injury ranged from 0.1% for patients undergoing laparoscopic right hemicolectomy to 1.65% for patients having all five adverse risk factors.

"Diverticulitis did not appear as a predictor in our model," Dr. Halabi said. "As for radiation, one of our predictors was metastatic cancer. So this goes for any cancer at advanced stage that has spread to lymph nodes or distant organ metastasis. In the case of rectal cancer, those are most likely to have received radiation therapy. So part of this effect of radiation therapy was apparent in the metastatic cancer group predictor."

Analyses were based on 2,165,848 colorectal surgery procedures. The overall rate of ureteral injury was 0.28%, he reported.

There was a significant 24% increase in the rate during the study period, from 2.5 per 1,000 cases in 2001-2005 to 3.1 per 1,000 cases in 2006-2010.

On average, the patients sustaining injury were younger and were more likely to be female and to have metastatic cancer, to be immunosuppressed, and to have had weight loss. They were less likely to have certain major comorbidities, such as diabetes and hypertension.

"Interestingly, obesity was similar in the two groups," Dr. Halabi commented.

Patients who sustained ureteral injuries had longer hospital stays and higher rates of a variety of postoperative complications, such as anastomotic leak and acute renal failure, but in-hospital mortality was statistically indistinguishable.

In adjusted analysis, patients with ureteral injury were significantly more likely to die (OR, 1.45) and to experience complications (OR, 1.66), and they had a longer hospital stay (+3.65 days) and total hospital charges (+$31,497).

Ureteral injuries "affect a relatively younger and healthier population. However, they have a significant and dramatic impact on outcomes," he added. "This predictive model can be used for risk stratification and counseling."

Dr. Halabi disclosed no relevant conflicts of interest.

PHOENIX – A new model based on clinical, hospital, and operative factors predicted the risk of ureteral injury among patients undergoing colorectal surgery.

Using data from the Nationwide Inpatient Sample, which includes more than 2 million patients in the United States, researchers retrospectively studied patients undergoing surgery in the United States between 2001 and 2010 for colorectal cancer, polyps, diverticular disease, or inflammatory bowel disease.

Less than 1% of patients sustained a ureteral injury, but the incidence rose significantly during the study period and injured patients had sharply higher rates of complications, researchers reported at the annual meeting of the American Society of Colon and Rectal Surgeons.

Eight factors were independently associated with the risk of ureteral injury. A predictive model incorporating these factors had an area under the receiver operating characteristic curve of 0.73. The model-predicted probability of injury ranged from 0.1% to 1.65%, depending on hospital factors, disease type, and procedure type, said Dr. Wissam J. Halabi, a research fellow at the University of California-Irvine, Orange.

Patients had higher adjusted odds of ureteral injury if they had rectal cancer (odds ratio, 1.85), adhesions (OR, 1.83), and metastatic cancer (OR, 1.76); if they had lost weight (OR, 1.08); and if they underwent surgery at a teaching hospital (OR, 1.05). On the other hand, patients had lower odds of injury if they had a laparoscopic procedure (OR, 0.91), a transverse colectomy (OR, 0.90), or a right hemicolectomy (OR, 0.43).

With the new predictive model incorporating these factors, the probability of injury ranged from 0.1% for patients undergoing laparoscopic right hemicolectomy to 1.65% for patients having all five adverse risk factors.

"Diverticulitis did not appear as a predictor in our model," Dr. Halabi said. "As for radiation, one of our predictors was metastatic cancer. So this goes for any cancer at advanced stage that has spread to lymph nodes or distant organ metastasis. In the case of rectal cancer, those are most likely to have received radiation therapy. So part of this effect of radiation therapy was apparent in the metastatic cancer group predictor."

Analyses were based on 2,165,848 colorectal surgery procedures. The overall rate of ureteral injury was 0.28%, he reported.

There was a significant 24% increase in the rate during the study period, from 2.5 per 1,000 cases in 2001-2005 to 3.1 per 1,000 cases in 2006-2010.

On average, the patients sustaining injury were younger and were more likely to be female and to have metastatic cancer, to be immunosuppressed, and to have had weight loss. They were less likely to have certain major comorbidities, such as diabetes and hypertension.

"Interestingly, obesity was similar in the two groups," Dr. Halabi commented.

Patients who sustained ureteral injuries had longer hospital stays and higher rates of a variety of postoperative complications, such as anastomotic leak and acute renal failure, but in-hospital mortality was statistically indistinguishable.

In adjusted analysis, patients with ureteral injury were significantly more likely to die (OR, 1.45) and to experience complications (OR, 1.66), and they had a longer hospital stay (+3.65 days) and total hospital charges (+$31,497).

Ureteral injuries "affect a relatively younger and healthier population. However, they have a significant and dramatic impact on outcomes," he added. "This predictive model can be used for risk stratification and counseling."

Dr. Halabi disclosed no relevant conflicts of interest.

PHOENIX – A new model based on clinical, hospital, and operative factors predicted the risk of ureteral injury among patients undergoing colorectal surgery.

Using data from the Nationwide Inpatient Sample, which includes more than 2 million patients in the United States, researchers retrospectively studied patients undergoing surgery in the United States between 2001 and 2010 for colorectal cancer, polyps, diverticular disease, or inflammatory bowel disease.

Less than 1% of patients sustained a ureteral injury, but the incidence rose significantly during the study period and injured patients had sharply higher rates of complications, researchers reported at the annual meeting of the American Society of Colon and Rectal Surgeons.

Eight factors were independently associated with the risk of ureteral injury. A predictive model incorporating these factors had an area under the receiver operating characteristic curve of 0.73. The model-predicted probability of injury ranged from 0.1% to 1.65%, depending on hospital factors, disease type, and procedure type, said Dr. Wissam J. Halabi, a research fellow at the University of California-Irvine, Orange.

Patients had higher adjusted odds of ureteral injury if they had rectal cancer (odds ratio, 1.85), adhesions (OR, 1.83), and metastatic cancer (OR, 1.76); if they had lost weight (OR, 1.08); and if they underwent surgery at a teaching hospital (OR, 1.05). On the other hand, patients had lower odds of injury if they had a laparoscopic procedure (OR, 0.91), a transverse colectomy (OR, 0.90), or a right hemicolectomy (OR, 0.43).

With the new predictive model incorporating these factors, the probability of injury ranged from 0.1% for patients undergoing laparoscopic right hemicolectomy to 1.65% for patients having all five adverse risk factors.

"Diverticulitis did not appear as a predictor in our model," Dr. Halabi said. "As for radiation, one of our predictors was metastatic cancer. So this goes for any cancer at advanced stage that has spread to lymph nodes or distant organ metastasis. In the case of rectal cancer, those are most likely to have received radiation therapy. So part of this effect of radiation therapy was apparent in the metastatic cancer group predictor."

Analyses were based on 2,165,848 colorectal surgery procedures. The overall rate of ureteral injury was 0.28%, he reported.

There was a significant 24% increase in the rate during the study period, from 2.5 per 1,000 cases in 2001-2005 to 3.1 per 1,000 cases in 2006-2010.

On average, the patients sustaining injury were younger and were more likely to be female and to have metastatic cancer, to be immunosuppressed, and to have had weight loss. They were less likely to have certain major comorbidities, such as diabetes and hypertension.

"Interestingly, obesity was similar in the two groups," Dr. Halabi commented.

Patients who sustained ureteral injuries had longer hospital stays and higher rates of a variety of postoperative complications, such as anastomotic leak and acute renal failure, but in-hospital mortality was statistically indistinguishable.

In adjusted analysis, patients with ureteral injury were significantly more likely to die (OR, 1.45) and to experience complications (OR, 1.66), and they had a longer hospital stay (+3.65 days) and total hospital charges (+$31,497).

Ureteral injuries "affect a relatively younger and healthier population. However, they have a significant and dramatic impact on outcomes," he added. "This predictive model can be used for risk stratification and counseling."

Dr. Halabi disclosed no relevant conflicts of interest.

ATLANTA – A decade after treatment for early-stage breast cancer, women who underwent surgery and radiation had higher survival rates than women who had surgery alone, with no increase in radiation-related cardiac or secondary cancer deaths, investigators reported at the annual meeting of the American Society for Radiation Oncology.

An analysis of Surveillance, Epidemiology and End Results (SEER) data on women treated for stage TIA N0 breast cancer in their mid to late 50s showed that after a median follow-up of 14 years, 10-year overall survival among the 2,397 women who received lumpectomy or mastectomy and radiation was 91.6%, compared with 87% for 2,988 women who had lumpectomy or mastectomy only (P less than .001).

Ten-year cardiac cause–specific survival was 96.7% vs. 92.7% (P less than .001), respectively. Breast cancer–specific survival was also higher among women who had undergone radiation, at 97% vs. 95.7% (P = .01), reported Dr. Jason C. Ye, a resident in radiation oncology at Weill Cornell Medical College, New York.

The data also suggest that breast irradiation does not increase the risk of lung cancer death, which occurred in 6 patients (1.9%) who underwent lumpectomy and radiation, and in 48 (1.6%) of those who had lumpectomies only, a difference that was not significant.

Dr. Ye noted, however, that between-group differences may begin to show up with longer follow-up.

"Although 14 years is a long time, studies have found increases in cardiac mortality and secondary cancers at 20 and 30 years after radiation. Also, there might have been a selection bias by physicians treating at the time, based on patients’ comorbidities and the patient’s health status. This might explain why the overall survival and the cardiac cause–specific survival were different between the two groups, with the no-radiation arm doing worse," he said at a media briefing.

In addition, changes in techniques introduced since the 1990s, such as three-dimensional conformal radiation, prone irradiation, hypofractionation, and intensity-modulated radiation therapy, may have effects on cardiac-specific and overall survival rates in the future, Dr. Ye said.

Dr. Ye and his colleagues reviewed SEER records on 5,385 women treated for early breast cancer during 1990-1997, and stratified them according to treatment with external-beam radiation or no radiation.

They included only patients with stage TIA N0 breast cancer identified as their first malignancy.

The authors used cause-of-death codes to identify cardiac deaths (either from cardiac disease or from atherosclerosis, breast cancer mortality, and deaths from second cancers in the chest area).

Radiation was associated with significantly lower overall mortality (relative risk, 0.69; P less than .001), breast cancer mortality (RR, 0.75; P = .02), and cardiac mortality (RR, 0.53; P less than .001).

Women with tumors in the left breast, whose hearts would presumably receive a larger dose of radiation than women with right breast tumors, were not at increased risk for cardiac-specific death. Deaths from second cancers included lung cancer in 2%; lymphomas and leukemias, each in 0.4%; soft-tissue malignancies (including the heart) in 0.06%; and cancer of the esophagus in 0.04%.

There were no significant differences between the radiation and no-radiation groups in incidence of death from second cancers.

The study was supported by the National Cancer Institute. Dr. Ye reported having no relevant disclosures.

ATLANTA – A decade after treatment for early-stage breast cancer, women who underwent surgery and radiation had higher survival rates than women who had surgery alone, with no increase in radiation-related cardiac or secondary cancer deaths, investigators reported at the annual meeting of the American Society for Radiation Oncology.

An analysis of Surveillance, Epidemiology and End Results (SEER) data on women treated for stage TIA N0 breast cancer in their mid to late 50s showed that after a median follow-up of 14 years, 10-year overall survival among the 2,397 women who received lumpectomy or mastectomy and radiation was 91.6%, compared with 87% for 2,988 women who had lumpectomy or mastectomy only (P less than .001).

Ten-year cardiac cause–specific survival was 96.7% vs. 92.7% (P less than .001), respectively. Breast cancer–specific survival was also higher among women who had undergone radiation, at 97% vs. 95.7% (P = .01), reported Dr. Jason C. Ye, a resident in radiation oncology at Weill Cornell Medical College, New York.

The data also suggest that breast irradiation does not increase the risk of lung cancer death, which occurred in 6 patients (1.9%) who underwent lumpectomy and radiation, and in 48 (1.6%) of those who had lumpectomies only, a difference that was not significant.

Dr. Ye noted, however, that between-group differences may begin to show up with longer follow-up.

"Although 14 years is a long time, studies have found increases in cardiac mortality and secondary cancers at 20 and 30 years after radiation. Also, there might have been a selection bias by physicians treating at the time, based on patients’ comorbidities and the patient’s health status. This might explain why the overall survival and the cardiac cause–specific survival were different between the two groups, with the no-radiation arm doing worse," he said at a media briefing.

In addition, changes in techniques introduced since the 1990s, such as three-dimensional conformal radiation, prone irradiation, hypofractionation, and intensity-modulated radiation therapy, may have effects on cardiac-specific and overall survival rates in the future, Dr. Ye said.

Dr. Ye and his colleagues reviewed SEER records on 5,385 women treated for early breast cancer during 1990-1997, and stratified them according to treatment with external-beam radiation or no radiation.

They included only patients with stage TIA N0 breast cancer identified as their first malignancy.

The authors used cause-of-death codes to identify cardiac deaths (either from cardiac disease or from atherosclerosis, breast cancer mortality, and deaths from second cancers in the chest area).

Radiation was associated with significantly lower overall mortality (relative risk, 0.69; P less than .001), breast cancer mortality (RR, 0.75; P = .02), and cardiac mortality (RR, 0.53; P less than .001).

Women with tumors in the left breast, whose hearts would presumably receive a larger dose of radiation than women with right breast tumors, were not at increased risk for cardiac-specific death. Deaths from second cancers included lung cancer in 2%; lymphomas and leukemias, each in 0.4%; soft-tissue malignancies (including the heart) in 0.06%; and cancer of the esophagus in 0.04%.

There were no significant differences between the radiation and no-radiation groups in incidence of death from second cancers.

The study was supported by the National Cancer Institute. Dr. Ye reported having no relevant disclosures.

ATLANTA – A decade after treatment for early-stage breast cancer, women who underwent surgery and radiation had higher survival rates than women who had surgery alone, with no increase in radiation-related cardiac or secondary cancer deaths, investigators reported at the annual meeting of the American Society for Radiation Oncology.

An analysis of Surveillance, Epidemiology and End Results (SEER) data on women treated for stage TIA N0 breast cancer in their mid to late 50s showed that after a median follow-up of 14 years, 10-year overall survival among the 2,397 women who received lumpectomy or mastectomy and radiation was 91.6%, compared with 87% for 2,988 women who had lumpectomy or mastectomy only (P less than .001).

Ten-year cardiac cause–specific survival was 96.7% vs. 92.7% (P less than .001), respectively. Breast cancer–specific survival was also higher among women who had undergone radiation, at 97% vs. 95.7% (P = .01), reported Dr. Jason C. Ye, a resident in radiation oncology at Weill Cornell Medical College, New York.

The data also suggest that breast irradiation does not increase the risk of lung cancer death, which occurred in 6 patients (1.9%) who underwent lumpectomy and radiation, and in 48 (1.6%) of those who had lumpectomies only, a difference that was not significant.

Dr. Ye noted, however, that between-group differences may begin to show up with longer follow-up.

"Although 14 years is a long time, studies have found increases in cardiac mortality and secondary cancers at 20 and 30 years after radiation. Also, there might have been a selection bias by physicians treating at the time, based on patients’ comorbidities and the patient’s health status. This might explain why the overall survival and the cardiac cause–specific survival were different between the two groups, with the no-radiation arm doing worse," he said at a media briefing.

In addition, changes in techniques introduced since the 1990s, such as three-dimensional conformal radiation, prone irradiation, hypofractionation, and intensity-modulated radiation therapy, may have effects on cardiac-specific and overall survival rates in the future, Dr. Ye said.

Dr. Ye and his colleagues reviewed SEER records on 5,385 women treated for early breast cancer during 1990-1997, and stratified them according to treatment with external-beam radiation or no radiation.

They included only patients with stage TIA N0 breast cancer identified as their first malignancy.

The authors used cause-of-death codes to identify cardiac deaths (either from cardiac disease or from atherosclerosis, breast cancer mortality, and deaths from second cancers in the chest area).

Radiation was associated with significantly lower overall mortality (relative risk, 0.69; P less than .001), breast cancer mortality (RR, 0.75; P = .02), and cardiac mortality (RR, 0.53; P less than .001).

Women with tumors in the left breast, whose hearts would presumably receive a larger dose of radiation than women with right breast tumors, were not at increased risk for cardiac-specific death. Deaths from second cancers included lung cancer in 2%; lymphomas and leukemias, each in 0.4%; soft-tissue malignancies (including the heart) in 0.06%; and cancer of the esophagus in 0.04%.

There were no significant differences between the radiation and no-radiation groups in incidence of death from second cancers.

The study was supported by the National Cancer Institute. Dr. Ye reported having no relevant disclosures.

Clinicians appear to be too quick to perform antireflux procedures in infants, compared with older children, according to a report published online Nov. 6 in JAMA Surgery.

In a retrospective cohort study involving 141,190 pediatric and adolescent hospitalizations for gastroesophageal reflux disease (GERD) across the country over an 8-year period, the proportional hazard ratio of undergoing antireflux surgery was markedly decreased for those aged 7 months to 4 years (0.63) or 5-17 years (0.43), compared with those aged 0-2 months or 2-6 months.

The reasons for this strong difference are not yet known for certain, but the data showed a lack of objective diagnostic studies preceding the surgery in all pediatric age groups, and most strikingly in the youngest patients. It may well be that clinicians are confusing physiologic regurgitation – which is common, benign, and self-resolving in infancy – with a more pathologic process, said Dr. Jarod McAteer of the division of pediatric general and thoracic surgery, Seattle Children’s Hospital, and his associates.

At the very least, it appears that many infants aren’t given an adequate trial of medical management, since most cases of gastroesophageal reflux in infancy will resolve with that alone within 3-6 months, they noted.

"Referral for surgical treatment of GERD is generally presumed to be a last resort after failure of medical management, with optimal candidates having undergone specific preoperative evaluations," the authors wrote. Diagnostic and treatment guidelines are well delineated for adults, but not so for children.

For example, "upper GI fluoroscopy is frequently used in the preoperative workup among children with GERD," even though it has been clearly demonstrated to be a poor predictor of pathologic reflux, the investigators said.

In what they described as the first study to examine the influence of patient age on progression to antireflux procedures, Dr. McAteer and his colleagues analyzed data from the Pediatric Health Information System database, which includes demographic and clinical information from 41 children’s hospitals that cover 85% of major metropolitan areas in the U.S.

Out of 141,190 patients aged 0-7 years who were hospitalized with gastroesophageal reflux or GERD, 64% were younger than 1 year of age, and 53% were younger than 6 months. These numbers highlight how common the diagnosis is in babies, they said.

They also "suggest that physicians may be more likely to apply the diagnosis in this patient group because of diagnostic uncertainty or because other characteristics of these hospitalized infants make it more likely that any regurgitation is perceived as pathologic and indicative of GERD."

Examples of such "other characteristics" include comorbidities such as neurodevelopmental delay, cardiopulmonary disorders, seizures, asthma, and cerebral palsy.

A total of 11,621 of the study population underwent antireflux procedures, of which 52.7% were aged 6 months or younger. Only 14% of these patients had first undergone upper GI endoscopy, 0.2% esophageal manometry, 1.3% a 24-hour esophageal pH study, 65% upper GI fluoroscopy, and 17.1% a gastric emptying study, the investigators said (JAMA Surg. 2013 Nov. 6 [doi: 10.1001/jamasurg.2013.2685]).

The study findings show that the threshold for performing antireflux procedures is lower in infants than in older children. And "despite the fact that expert guidelines urge the use of objective studies in the diagnosis of GERD and despite evidence that supports the use of objective studies before performing antireflux procedures, such a standardized evaluation is not common practice.

"A greater effort is needed to develop and disseminate best-practice standards for the diagnosis and treatment of children, especially infants, with possible GERD. We must clarify the indications for antireflux procedures," Dr. McAteer and his associates said.

No financial conflicts of interest were reported.

Clinicians appear to be too quick to perform antireflux procedures in infants, compared with older children, according to a report published online Nov. 6 in JAMA Surgery.

In a retrospective cohort study involving 141,190 pediatric and adolescent hospitalizations for gastroesophageal reflux disease (GERD) across the country over an 8-year period, the proportional hazard ratio of undergoing antireflux surgery was markedly decreased for those aged 7 months to 4 years (0.63) or 5-17 years (0.43), compared with those aged 0-2 months or 2-6 months.

The reasons for this strong difference are not yet known for certain, but the data showed a lack of objective diagnostic studies preceding the surgery in all pediatric age groups, and most strikingly in the youngest patients. It may well be that clinicians are confusing physiologic regurgitation – which is common, benign, and self-resolving in infancy – with a more pathologic process, said Dr. Jarod McAteer of the division of pediatric general and thoracic surgery, Seattle Children’s Hospital, and his associates.

At the very least, it appears that many infants aren’t given an adequate trial of medical management, since most cases of gastroesophageal reflux in infancy will resolve with that alone within 3-6 months, they noted.

"Referral for surgical treatment of GERD is generally presumed to be a last resort after failure of medical management, with optimal candidates having undergone specific preoperative evaluations," the authors wrote. Diagnostic and treatment guidelines are well delineated for adults, but not so for children.

For example, "upper GI fluoroscopy is frequently used in the preoperative workup among children with GERD," even though it has been clearly demonstrated to be a poor predictor of pathologic reflux, the investigators said.

In what they described as the first study to examine the influence of patient age on progression to antireflux procedures, Dr. McAteer and his colleagues analyzed data from the Pediatric Health Information System database, which includes demographic and clinical information from 41 children’s hospitals that cover 85% of major metropolitan areas in the U.S.

Out of 141,190 patients aged 0-7 years who were hospitalized with gastroesophageal reflux or GERD, 64% were younger than 1 year of age, and 53% were younger than 6 months. These numbers highlight how common the diagnosis is in babies, they said.

They also "suggest that physicians may be more likely to apply the diagnosis in this patient group because of diagnostic uncertainty or because other characteristics of these hospitalized infants make it more likely that any regurgitation is perceived as pathologic and indicative of GERD."

Examples of such "other characteristics" include comorbidities such as neurodevelopmental delay, cardiopulmonary disorders, seizures, asthma, and cerebral palsy.

A total of 11,621 of the study population underwent antireflux procedures, of which 52.7% were aged 6 months or younger. Only 14% of these patients had first undergone upper GI endoscopy, 0.2% esophageal manometry, 1.3% a 24-hour esophageal pH study, 65% upper GI fluoroscopy, and 17.1% a gastric emptying study, the investigators said (JAMA Surg. 2013 Nov. 6 [doi: 10.1001/jamasurg.2013.2685]).

The study findings show that the threshold for performing antireflux procedures is lower in infants than in older children. And "despite the fact that expert guidelines urge the use of objective studies in the diagnosis of GERD and despite evidence that supports the use of objective studies before performing antireflux procedures, such a standardized evaluation is not common practice.

"A greater effort is needed to develop and disseminate best-practice standards for the diagnosis and treatment of children, especially infants, with possible GERD. We must clarify the indications for antireflux procedures," Dr. McAteer and his associates said.

No financial conflicts of interest were reported.

Clinicians appear to be too quick to perform antireflux procedures in infants, compared with older children, according to a report published online Nov. 6 in JAMA Surgery.

In a retrospective cohort study involving 141,190 pediatric and adolescent hospitalizations for gastroesophageal reflux disease (GERD) across the country over an 8-year period, the proportional hazard ratio of undergoing antireflux surgery was markedly decreased for those aged 7 months to 4 years (0.63) or 5-17 years (0.43), compared with those aged 0-2 months or 2-6 months.

The reasons for this strong difference are not yet known for certain, but the data showed a lack of objective diagnostic studies preceding the surgery in all pediatric age groups, and most strikingly in the youngest patients. It may well be that clinicians are confusing physiologic regurgitation – which is common, benign, and self-resolving in infancy – with a more pathologic process, said Dr. Jarod McAteer of the division of pediatric general and thoracic surgery, Seattle Children’s Hospital, and his associates.

At the very least, it appears that many infants aren’t given an adequate trial of medical management, since most cases of gastroesophageal reflux in infancy will resolve with that alone within 3-6 months, they noted.

"Referral for surgical treatment of GERD is generally presumed to be a last resort after failure of medical management, with optimal candidates having undergone specific preoperative evaluations," the authors wrote. Diagnostic and treatment guidelines are well delineated for adults, but not so for children.

For example, "upper GI fluoroscopy is frequently used in the preoperative workup among children with GERD," even though it has been clearly demonstrated to be a poor predictor of pathologic reflux, the investigators said.

In what they described as the first study to examine the influence of patient age on progression to antireflux procedures, Dr. McAteer and his colleagues analyzed data from the Pediatric Health Information System database, which includes demographic and clinical information from 41 children’s hospitals that cover 85% of major metropolitan areas in the U.S.

Out of 141,190 patients aged 0-7 years who were hospitalized with gastroesophageal reflux or GERD, 64% were younger than 1 year of age, and 53% were younger than 6 months. These numbers highlight how common the diagnosis is in babies, they said.

They also "suggest that physicians may be more likely to apply the diagnosis in this patient group because of diagnostic uncertainty or because other characteristics of these hospitalized infants make it more likely that any regurgitation is perceived as pathologic and indicative of GERD."

Examples of such "other characteristics" include comorbidities such as neurodevelopmental delay, cardiopulmonary disorders, seizures, asthma, and cerebral palsy.

A total of 11,621 of the study population underwent antireflux procedures, of which 52.7% were aged 6 months or younger. Only 14% of these patients had first undergone upper GI endoscopy, 0.2% esophageal manometry, 1.3% a 24-hour esophageal pH study, 65% upper GI fluoroscopy, and 17.1% a gastric emptying study, the investigators said (JAMA Surg. 2013 Nov. 6 [doi: 10.1001/jamasurg.2013.2685]).

The study findings show that the threshold for performing antireflux procedures is lower in infants than in older children. And "despite the fact that expert guidelines urge the use of objective studies in the diagnosis of GERD and despite evidence that supports the use of objective studies before performing antireflux procedures, such a standardized evaluation is not common practice.

"A greater effort is needed to develop and disseminate best-practice standards for the diagnosis and treatment of children, especially infants, with possible GERD. We must clarify the indications for antireflux procedures," Dr. McAteer and his associates said.

No financial conflicts of interest were reported.

The addition of a transversus abdominis plane block to standard enhanced recovery pathway protocols decreased lengths of stay to less than 3 days in roughly two-thirds of patients who underwent laparoscopic colectomy, findings from a small study showed.

To determine the impact of a TAP block on rates of discharge for colorectal laparoscopic surgery, researchers at University Hospitals Case Medical Center in Cleveland observed 100 consecutive patients who underwent the elective procedure performed over a 1-year period by the same experienced laparoscopic colorectal surgeon. The TAP block was administered at the conclusion of the laparoscopic procedure.

The mean age of the study population was 60.5 years, and 62 were female. The mean body mass index was 28.4 kg/m². Surgical indications in two-thirds of patients included colorectal cancer or polyp. One-third of patients had an inflammatory condition such as diverticulitis, ulcerative colitis, or Crohn’s disease, said Dr. Joanne Favuzza and Dr. Conor P. Delaney (J. Am. Coll. Surg. 2013;217:503-6).

The investigators found that 62% of patients were discharged within 48 hours, with 27% being discharged on day 1. No operative mortality was reported, and only one patient experienced a complication post discharge. Two patients were readmitted, both having had lengths of stay exceeding 48 hours.

Incidence rates of complication or readmission were not significantly affected by the block. Eight patients experienced postoperative complications: one patient on the second day post surgery, another patient on the third day, and the rest after the fourth day. Three patients had complications involving the ileus or lower-bowel obstruction, four patients had anastomotic or gastrointestinal bleed, and one had a urinary tract infection.

"This study demonstrated that the addition of a TAP block to an established ERP can reproducibly reduce length of stay to less than 3 days," wrote Dr. Favuzza and Dr. Delaney, who also noted that a prospective randomized controlled trial is underway to further evaluate the benefits of TAP blocks to ERP in colorectal surgery.

Dr. Favuzza reported no relevant disclosures. Dr. Delaney is a paid a consultant to Adolor Corp., Ferring Pharmaceuticals, and Pacira Pharmaceuticals.

[email protected]

The addition of a transversus abdominis plane block to standard enhanced recovery pathway protocols decreased lengths of stay to less than 3 days in roughly two-thirds of patients who underwent laparoscopic colectomy, findings from a small study showed.

To determine the impact of a TAP block on rates of discharge for colorectal laparoscopic surgery, researchers at University Hospitals Case Medical Center in Cleveland observed 100 consecutive patients who underwent the elective procedure performed over a 1-year period by the same experienced laparoscopic colorectal surgeon. The TAP block was administered at the conclusion of the laparoscopic procedure.

The mean age of the study population was 60.5 years, and 62 were female. The mean body mass index was 28.4 kg/m². Surgical indications in two-thirds of patients included colorectal cancer or polyp. One-third of patients had an inflammatory condition such as diverticulitis, ulcerative colitis, or Crohn’s disease, said Dr. Joanne Favuzza and Dr. Conor P. Delaney (J. Am. Coll. Surg. 2013;217:503-6).

The investigators found that 62% of patients were discharged within 48 hours, with 27% being discharged on day 1. No operative mortality was reported, and only one patient experienced a complication post discharge. Two patients were readmitted, both having had lengths of stay exceeding 48 hours.

Incidence rates of complication or readmission were not significantly affected by the block. Eight patients experienced postoperative complications: one patient on the second day post surgery, another patient on the third day, and the rest after the fourth day. Three patients had complications involving the ileus or lower-bowel obstruction, four patients had anastomotic or gastrointestinal bleed, and one had a urinary tract infection.

"This study demonstrated that the addition of a TAP block to an established ERP can reproducibly reduce length of stay to less than 3 days," wrote Dr. Favuzza and Dr. Delaney, who also noted that a prospective randomized controlled trial is underway to further evaluate the benefits of TAP blocks to ERP in colorectal surgery.

Dr. Favuzza reported no relevant disclosures. Dr. Delaney is a paid a consultant to Adolor Corp., Ferring Pharmaceuticals, and Pacira Pharmaceuticals.

[email protected]

The addition of a transversus abdominis plane block to standard enhanced recovery pathway protocols decreased lengths of stay to less than 3 days in roughly two-thirds of patients who underwent laparoscopic colectomy, findings from a small study showed.

To determine the impact of a TAP block on rates of discharge for colorectal laparoscopic surgery, researchers at University Hospitals Case Medical Center in Cleveland observed 100 consecutive patients who underwent the elective procedure performed over a 1-year period by the same experienced laparoscopic colorectal surgeon. The TAP block was administered at the conclusion of the laparoscopic procedure.

The mean age of the study population was 60.5 years, and 62 were female. The mean body mass index was 28.4 kg/m². Surgical indications in two-thirds of patients included colorectal cancer or polyp. One-third of patients had an inflammatory condition such as diverticulitis, ulcerative colitis, or Crohn’s disease, said Dr. Joanne Favuzza and Dr. Conor P. Delaney (J. Am. Coll. Surg. 2013;217:503-6).

The investigators found that 62% of patients were discharged within 48 hours, with 27% being discharged on day 1. No operative mortality was reported, and only one patient experienced a complication post discharge. Two patients were readmitted, both having had lengths of stay exceeding 48 hours.

Incidence rates of complication or readmission were not significantly affected by the block. Eight patients experienced postoperative complications: one patient on the second day post surgery, another patient on the third day, and the rest after the fourth day. Three patients had complications involving the ileus or lower-bowel obstruction, four patients had anastomotic or gastrointestinal bleed, and one had a urinary tract infection.

"This study demonstrated that the addition of a TAP block to an established ERP can reproducibly reduce length of stay to less than 3 days," wrote Dr. Favuzza and Dr. Delaney, who also noted that a prospective randomized controlled trial is underway to further evaluate the benefits of TAP blocks to ERP in colorectal surgery.

Dr. Favuzza reported no relevant disclosures. Dr. Delaney is a paid a consultant to Adolor Corp., Ferring Pharmaceuticals, and Pacira Pharmaceuticals.

[email protected]

CHICAGO – One in three patients sent to surgery for a suspicious lung nodule by their community pulmonologist did not have cancer in a retrospective analysis of 385 patients.

In addition, half of patients with benign disease underwent an invasive procedure, Dr. Nichole Tanner said at the annual meeting of the American College of Chest Physicians (ACCP).

Physician judgment plays a key role in the newly updated ACCP lung cancer guidelines (Chest 2013;143:e93S-e120S). They recommend that clinicians estimate the pretest probability of malignancy for indeterminate nodules larger than 8 mm either qualitatively by using their clinical judgment and/or quantitatively with a validated risk model.

Patients in the study, conducted at 16 sites across the country, had 8- to 20-mm nodules, and were mostly former (45%) or current smokers (27.5%), white (86%), and covered by private insurance (55.3%) or Medicare (38.2%). Their average age was 64.5 years.

Invasive procedures included anything outside of simple imaging for monitoring. Computed tomography (CT)- and bronchoscopic-guided biopsy were considered minor invasive procedures, while major invasive procedures included any surgical procedure such as mediastinoscopy, thoracotomy, and video-assisted thorascopic surgery (VATS).

Monitoring only was used for 184 patients, and ran the gamut from one to a "shocking seven" CT or positron-emission tomography (PET) scans in 2 years, said Dr. Tanner, with the Medical University of South Carolina, Charleston. None of these nodules were malignant.

Of the 124 nodules biopsied, 35% were malignant, 56% were diagnosed as benign, and 8% were benign based on stability.

Of the 77 nodules surgically removed, 64% were malignant and 36% were benign, she said.

While a reassuring 76% of nodules seen by community pulmonologists were benign, the results highlight the complexity involved in managing a patient population that is surely on the rise as lung cancer screening spreads nationally.

During a rousing debate that followed the presentation, audience members expressed concern over the 36% of patients taken to surgery for benign disease, highlighting a 3% death rate associated with thoracotomy and the potential for reduced lung function after surgery.

Others, including a thoracic surgeon, countered that removal of a suspicious nodule can catch lung disease at an earlier stage, eliminates the need for repeat CT/PET imaging exposure, and is requested by some patients for their peace of mind or even to pass a pre-employment physical.

Session comoderator and interventional respirologist Dr. Anne Gonzalez, with McGill University Health Center, Montreal, said in an interview, "I was perhaps shocked there were so many [patients] that went directly to surgery, but on the other hand, the guidelines do recommend that if the suspicion of lung cancer is high enough – 65% – patients should go to surgery."

Dr. Gonzalez also echoed comments from the floor that, importantly, the study failed to detail whether patients’ nodules were identified as incidental findings or were the result of symptom-driven screening.

In a multivariate analysis, current smoking (odds ratio, 3.28) and larger nodule size (12-15 mm: OR, 3.30; 16-20 mm: OR, 4.97) influenced who underwent invasive procedures, Dr. Tanner said. Geographic region of the country did not pan out as a predictor.

Cancer was present in 39% of 16- to 20-mm nodules and 31% of 12- to 15-mm nodules, compared with 12% of 8- to 11-mm nodules.

One attendee commented that the number of patients undergoing surgery for benign disease at his institution has dramatically declined with the establishment of a 45-member multidisciplinary tumor board to review and manage patients with lung nodules.

This approach is helpful in that patients won’t be lost to follow-up and can be presented with a plan that has the support of multiple physicians, but "I don’t see this as a feasible way with which to manage every pulmonary nodule," Dr. Tanner said in an interview. "In the lung cancer screening program we’re implementing at our Veterans Affairs hospital in the very near future, we will have a nodule tracking system to ensure that no patients are lost to follow-up and will make treatment and diagnostic decisions based on the Fleischner criteria for radiographic follow-up of lung nodules, as well as the ACCP guidelines."

Dr. Tanner reported consulting for the study sponsor, Integrated Diagnostics.

[email protected]

CHICAGO – One in three patients sent to surgery for a suspicious lung nodule by their community pulmonologist did not have cancer in a retrospective analysis of 385 patients.

In addition, half of patients with benign disease underwent an invasive procedure, Dr. Nichole Tanner said at the annual meeting of the American College of Chest Physicians (ACCP).

Physician judgment plays a key role in the newly updated ACCP lung cancer guidelines (Chest 2013;143:e93S-e120S). They recommend that clinicians estimate the pretest probability of malignancy for indeterminate nodules larger than 8 mm either qualitatively by using their clinical judgment and/or quantitatively with a validated risk model.

Patients in the study, conducted at 16 sites across the country, had 8- to 20-mm nodules, and were mostly former (45%) or current smokers (27.5%), white (86%), and covered by private insurance (55.3%) or Medicare (38.2%). Their average age was 64.5 years.

Invasive procedures included anything outside of simple imaging for monitoring. Computed tomography (CT)- and bronchoscopic-guided biopsy were considered minor invasive procedures, while major invasive procedures included any surgical procedure such as mediastinoscopy, thoracotomy, and video-assisted thorascopic surgery (VATS).

Monitoring only was used for 184 patients, and ran the gamut from one to a "shocking seven" CT or positron-emission tomography (PET) scans in 2 years, said Dr. Tanner, with the Medical University of South Carolina, Charleston. None of these nodules were malignant.

Of the 124 nodules biopsied, 35% were malignant, 56% were diagnosed as benign, and 8% were benign based on stability.

Of the 77 nodules surgically removed, 64% were malignant and 36% were benign, she said.

While a reassuring 76% of nodules seen by community pulmonologists were benign, the results highlight the complexity involved in managing a patient population that is surely on the rise as lung cancer screening spreads nationally.

During a rousing debate that followed the presentation, audience members expressed concern over the 36% of patients taken to surgery for benign disease, highlighting a 3% death rate associated with thoracotomy and the potential for reduced lung function after surgery.

Others, including a thoracic surgeon, countered that removal of a suspicious nodule can catch lung disease at an earlier stage, eliminates the need for repeat CT/PET imaging exposure, and is requested by some patients for their peace of mind or even to pass a pre-employment physical.

Session comoderator and interventional respirologist Dr. Anne Gonzalez, with McGill University Health Center, Montreal, said in an interview, "I was perhaps shocked there were so many [patients] that went directly to surgery, but on the other hand, the guidelines do recommend that if the suspicion of lung cancer is high enough – 65% – patients should go to surgery."

Dr. Gonzalez also echoed comments from the floor that, importantly, the study failed to detail whether patients’ nodules were identified as incidental findings or were the result of symptom-driven screening.

In a multivariate analysis, current smoking (odds ratio, 3.28) and larger nodule size (12-15 mm: OR, 3.30; 16-20 mm: OR, 4.97) influenced who underwent invasive procedures, Dr. Tanner said. Geographic region of the country did not pan out as a predictor.

Cancer was present in 39% of 16- to 20-mm nodules and 31% of 12- to 15-mm nodules, compared with 12% of 8- to 11-mm nodules.

One attendee commented that the number of patients undergoing surgery for benign disease at his institution has dramatically declined with the establishment of a 45-member multidisciplinary tumor board to review and manage patients with lung nodules.

This approach is helpful in that patients won’t be lost to follow-up and can be presented with a plan that has the support of multiple physicians, but "I don’t see this as a feasible way with which to manage every pulmonary nodule," Dr. Tanner said in an interview. "In the lung cancer screening program we’re implementing at our Veterans Affairs hospital in the very near future, we will have a nodule tracking system to ensure that no patients are lost to follow-up and will make treatment and diagnostic decisions based on the Fleischner criteria for radiographic follow-up of lung nodules, as well as the ACCP guidelines."

Dr. Tanner reported consulting for the study sponsor, Integrated Diagnostics.

[email protected]

CHICAGO – One in three patients sent to surgery for a suspicious lung nodule by their community pulmonologist did not have cancer in a retrospective analysis of 385 patients.

In addition, half of patients with benign disease underwent an invasive procedure, Dr. Nichole Tanner said at the annual meeting of the American College of Chest Physicians (ACCP).

Physician judgment plays a key role in the newly updated ACCP lung cancer guidelines (Chest 2013;143:e93S-e120S). They recommend that clinicians estimate the pretest probability of malignancy for indeterminate nodules larger than 8 mm either qualitatively by using their clinical judgment and/or quantitatively with a validated risk model.

Patients in the study, conducted at 16 sites across the country, had 8- to 20-mm nodules, and were mostly former (45%) or current smokers (27.5%), white (86%), and covered by private insurance (55.3%) or Medicare (38.2%). Their average age was 64.5 years.

Invasive procedures included anything outside of simple imaging for monitoring. Computed tomography (CT)- and bronchoscopic-guided biopsy were considered minor invasive procedures, while major invasive procedures included any surgical procedure such as mediastinoscopy, thoracotomy, and video-assisted thorascopic surgery (VATS).

Monitoring only was used for 184 patients, and ran the gamut from one to a "shocking seven" CT or positron-emission tomography (PET) scans in 2 years, said Dr. Tanner, with the Medical University of South Carolina, Charleston. None of these nodules were malignant.

Of the 124 nodules biopsied, 35% were malignant, 56% were diagnosed as benign, and 8% were benign based on stability.

Of the 77 nodules surgically removed, 64% were malignant and 36% were benign, she said.

While a reassuring 76% of nodules seen by community pulmonologists were benign, the results highlight the complexity involved in managing a patient population that is surely on the rise as lung cancer screening spreads nationally.

During a rousing debate that followed the presentation, audience members expressed concern over the 36% of patients taken to surgery for benign disease, highlighting a 3% death rate associated with thoracotomy and the potential for reduced lung function after surgery.

Others, including a thoracic surgeon, countered that removal of a suspicious nodule can catch lung disease at an earlier stage, eliminates the need for repeat CT/PET imaging exposure, and is requested by some patients for their peace of mind or even to pass a pre-employment physical.

Session comoderator and interventional respirologist Dr. Anne Gonzalez, with McGill University Health Center, Montreal, said in an interview, "I was perhaps shocked there were so many [patients] that went directly to surgery, but on the other hand, the guidelines do recommend that if the suspicion of lung cancer is high enough – 65% – patients should go to surgery."

Dr. Gonzalez also echoed comments from the floor that, importantly, the study failed to detail whether patients’ nodules were identified as incidental findings or were the result of symptom-driven screening.

In a multivariate analysis, current smoking (odds ratio, 3.28) and larger nodule size (12-15 mm: OR, 3.30; 16-20 mm: OR, 4.97) influenced who underwent invasive procedures, Dr. Tanner said. Geographic region of the country did not pan out as a predictor.

Cancer was present in 39% of 16- to 20-mm nodules and 31% of 12- to 15-mm nodules, compared with 12% of 8- to 11-mm nodules.

One attendee commented that the number of patients undergoing surgery for benign disease at his institution has dramatically declined with the establishment of a 45-member multidisciplinary tumor board to review and manage patients with lung nodules.

This approach is helpful in that patients won’t be lost to follow-up and can be presented with a plan that has the support of multiple physicians, but "I don’t see this as a feasible way with which to manage every pulmonary nodule," Dr. Tanner said in an interview. "In the lung cancer screening program we’re implementing at our Veterans Affairs hospital in the very near future, we will have a nodule tracking system to ensure that no patients are lost to follow-up and will make treatment and diagnostic decisions based on the Fleischner criteria for radiographic follow-up of lung nodules, as well as the ACCP guidelines."

Dr. Tanner reported consulting for the study sponsor, Integrated Diagnostics.

[email protected]

In the academic world, ‘tis the season of interviews. The medical school’s admission committee is sorting through hundreds of applications, each one telling a story about one person’s journey. Fourth-year medical students are interviewing residency programs. They are looking for a match for the next 3 or more years. Then there are the job interviews to replace faculty who transfer or retire.

Part of the application/interview process is assessing knowledge and technical skills. There are test scores, such as MCAT (Medical College Admission Test) or Part One of the boards. Those are important, but not decisive data. There are letters of reference to review. Garrison Keillor notes that, in his fictional town of Lake Wobegon, all the children are above average. Based on letters of reference, nobody graduates in the bottom half of the class of medical school either.

The real purpose of the applications and interviewing is to go beyond knowledge and technical skills. There is an assessment of the person and his/her potential to be a fine physician. There are various interpretations of what that means. I think a big piece of it is empathy, defined as the ability to connect with the patient on an emotional level and truly understand what the patient is feeling and suffering. This summer and fall, there has been a flurry of books and articles noting how students enter medical school altruistic and compassionate but get most of that drummed out of them during medical school.

I don’t really understand the hubbub. This phenomenon was well known a generation ago. The sleep deprivation of residency used to be effective at eliminating any recalcitrant empathy. With the new duty hours, the sleep deprivation mechanism has been attenuated. There are no data yet on whether shorter duty hours produce more empathetic doctors. No data yet to indicate that they are making fewer mistakes, either.

There also has been a recent flurry of activity attempting to increase rational thinking in medical care. Not rationing, just being rational. Three years ago it was Provenge, which cost of $93,000 to add 4 months to the life of an elderly patient with metastatic prostate cancer. Medicare decided to cover the cost. Last year, the poster child was Zaltrap, with an estimate of $75,000 to add 42 days of life to someone with metastatic colon cancer. It was very expensive and marginally better than cheaper, older drugs. In an Oct. 14, 2012, op-ed in the New York Times, three physicians from Memorial Sloan-Kettering Cancer Center indicated that the hospital would not use the drug because of its poor value.

Now, this issue has simultaneously become the cover story for both New York magazine ("The Cost of Living," Oct. 20, 2013) and MIT Technology Review ("A Tale of Two Drugs," Oct. 22, 2013). Those are two extremely disparate magazines with very different target audiences, each addressing the same issue. Surely, that is a reason to sit up and take notice. There is a tipping point at which the cost of a medical therapy becomes irrational. The empathetic doctor of the future cannot hide behind a claim that life is priceless. A more nuanced understanding of the financial limits of care will be necessary.

Medications aren’t the only expensive medical care. Diagnostic tests also can be of poor value. Over the past 2 years, many states and hospital systems have introduced pulse oximetry screening of newborns before discharge to detect rare, asymptomatic critical congenital heart defects. Analysis put the cost at about $40,000 for each incremental case identified prior to discharge.

There are no data yet to indicate how many of those early detections translate into a life saved, and it is beyond the scope of this editorial to make such an evaluation. I would hope, however, that those promoting this policy change are nuanced in their thinking rather than being swayed by a photo opportunity for the governor to hold a baby identified by the program in New Jersey. Alas, that was not my impression at a recent American Academy of Pediatrics event. That doesn’t mean I’m against this practice. I’m just concerned about the quality and process of the policy making. New York magazine and MIT Technology Review have different approaches to the problem. Truth probably lies somewhere in between.

Dr. Powell practices as a hospitalist at SSM Cardinal Glennon Children’s Medical Center in St. Louis. He is associate professor of pediatrics at Saint Louis University. He is also listserv moderator for the AAP Section on Hospital Medicine and is a member of the Law and Bioethics Affinity Group of the American Society for Bioethics and Humanities. E-mail him at [email protected].

In the academic world, ‘tis the season of interviews. The medical school’s admission committee is sorting through hundreds of applications, each one telling a story about one person’s journey. Fourth-year medical students are interviewing residency programs. They are looking for a match for the next 3 or more years. Then there are the job interviews to replace faculty who transfer or retire.

Part of the application/interview process is assessing knowledge and technical skills. There are test scores, such as MCAT (Medical College Admission Test) or Part One of the boards. Those are important, but not decisive data. There are letters of reference to review. Garrison Keillor notes that, in his fictional town of Lake Wobegon, all the children are above average. Based on letters of reference, nobody graduates in the bottom half of the class of medical school either.

The real purpose of the applications and interviewing is to go beyond knowledge and technical skills. There is an assessment of the person and his/her potential to be a fine physician. There are various interpretations of what that means. I think a big piece of it is empathy, defined as the ability to connect with the patient on an emotional level and truly understand what the patient is feeling and suffering. This summer and fall, there has been a flurry of books and articles noting how students enter medical school altruistic and compassionate but get most of that drummed out of them during medical school.

I don’t really understand the hubbub. This phenomenon was well known a generation ago. The sleep deprivation of residency used to be effective at eliminating any recalcitrant empathy. With the new duty hours, the sleep deprivation mechanism has been attenuated. There are no data yet on whether shorter duty hours produce more empathetic doctors. No data yet to indicate that they are making fewer mistakes, either.

There also has been a recent flurry of activity attempting to increase rational thinking in medical care. Not rationing, just being rational. Three years ago it was Provenge, which cost of $93,000 to add 4 months to the life of an elderly patient with metastatic prostate cancer. Medicare decided to cover the cost. Last year, the poster child was Zaltrap, with an estimate of $75,000 to add 42 days of life to someone with metastatic colon cancer. It was very expensive and marginally better than cheaper, older drugs. In an Oct. 14, 2012, op-ed in the New York Times, three physicians from Memorial Sloan-Kettering Cancer Center indicated that the hospital would not use the drug because of its poor value.

Now, this issue has simultaneously become the cover story for both New York magazine ("The Cost of Living," Oct. 20, 2013) and MIT Technology Review ("A Tale of Two Drugs," Oct. 22, 2013). Those are two extremely disparate magazines with very different target audiences, each addressing the same issue. Surely, that is a reason to sit up and take notice. There is a tipping point at which the cost of a medical therapy becomes irrational. The empathetic doctor of the future cannot hide behind a claim that life is priceless. A more nuanced understanding of the financial limits of care will be necessary.

Medications aren’t the only expensive medical care. Diagnostic tests also can be of poor value. Over the past 2 years, many states and hospital systems have introduced pulse oximetry screening of newborns before discharge to detect rare, asymptomatic critical congenital heart defects. Analysis put the cost at about $40,000 for each incremental case identified prior to discharge.

There are no data yet to indicate how many of those early detections translate into a life saved, and it is beyond the scope of this editorial to make such an evaluation. I would hope, however, that those promoting this policy change are nuanced in their thinking rather than being swayed by a photo opportunity for the governor to hold a baby identified by the program in New Jersey. Alas, that was not my impression at a recent American Academy of Pediatrics event. That doesn’t mean I’m against this practice. I’m just concerned about the quality and process of the policy making. New York magazine and MIT Technology Review have different approaches to the problem. Truth probably lies somewhere in between.

Dr. Powell practices as a hospitalist at SSM Cardinal Glennon Children’s Medical Center in St. Louis. He is associate professor of pediatrics at Saint Louis University. He is also listserv moderator for the AAP Section on Hospital Medicine and is a member of the Law and Bioethics Affinity Group of the American Society for Bioethics and Humanities. E-mail him at [email protected].

In the academic world, ‘tis the season of interviews. The medical school’s admission committee is sorting through hundreds of applications, each one telling a story about one person’s journey. Fourth-year medical students are interviewing residency programs. They are looking for a match for the next 3 or more years. Then there are the job interviews to replace faculty who transfer or retire.

Part of the application/interview process is assessing knowledge and technical skills. There are test scores, such as MCAT (Medical College Admission Test) or Part One of the boards. Those are important, but not decisive data. There are letters of reference to review. Garrison Keillor notes that, in his fictional town of Lake Wobegon, all the children are above average. Based on letters of reference, nobody graduates in the bottom half of the class of medical school either.

The real purpose of the applications and interviewing is to go beyond knowledge and technical skills. There is an assessment of the person and his/her potential to be a fine physician. There are various interpretations of what that means. I think a big piece of it is empathy, defined as the ability to connect with the patient on an emotional level and truly understand what the patient is feeling and suffering. This summer and fall, there has been a flurry of books and articles noting how students enter medical school altruistic and compassionate but get most of that drummed out of them during medical school.

I don’t really understand the hubbub. This phenomenon was well known a generation ago. The sleep deprivation of residency used to be effective at eliminating any recalcitrant empathy. With the new duty hours, the sleep deprivation mechanism has been attenuated. There are no data yet on whether shorter duty hours produce more empathetic doctors. No data yet to indicate that they are making fewer mistakes, either.

There also has been a recent flurry of activity attempting to increase rational thinking in medical care. Not rationing, just being rational. Three years ago it was Provenge, which cost of $93,000 to add 4 months to the life of an elderly patient with metastatic prostate cancer. Medicare decided to cover the cost. Last year, the poster child was Zaltrap, with an estimate of $75,000 to add 42 days of life to someone with metastatic colon cancer. It was very expensive and marginally better than cheaper, older drugs. In an Oct. 14, 2012, op-ed in the New York Times, three physicians from Memorial Sloan-Kettering Cancer Center indicated that the hospital would not use the drug because of its poor value.

Now, this issue has simultaneously become the cover story for both New York magazine ("The Cost of Living," Oct. 20, 2013) and MIT Technology Review ("A Tale of Two Drugs," Oct. 22, 2013). Those are two extremely disparate magazines with very different target audiences, each addressing the same issue. Surely, that is a reason to sit up and take notice. There is a tipping point at which the cost of a medical therapy becomes irrational. The empathetic doctor of the future cannot hide behind a claim that life is priceless. A more nuanced understanding of the financial limits of care will be necessary.

Medications aren’t the only expensive medical care. Diagnostic tests also can be of poor value. Over the past 2 years, many states and hospital systems have introduced pulse oximetry screening of newborns before discharge to detect rare, asymptomatic critical congenital heart defects. Analysis put the cost at about $40,000 for each incremental case identified prior to discharge.

There are no data yet to indicate how many of those early detections translate into a life saved, and it is beyond the scope of this editorial to make such an evaluation. I would hope, however, that those promoting this policy change are nuanced in their thinking rather than being swayed by a photo opportunity for the governor to hold a baby identified by the program in New Jersey. Alas, that was not my impression at a recent American Academy of Pediatrics event. That doesn’t mean I’m against this practice. I’m just concerned about the quality and process of the policy making. New York magazine and MIT Technology Review have different approaches to the problem. Truth probably lies somewhere in between.

Dr. Powell practices as a hospitalist at SSM Cardinal Glennon Children’s Medical Center in St. Louis. He is associate professor of pediatrics at Saint Louis University. He is also listserv moderator for the AAP Section on Hospital Medicine and is a member of the Law and Bioethics Affinity Group of the American Society for Bioethics and Humanities. E-mail him at [email protected].

Analysis of the results of surgical interventions has always been central to the profession of surgery. Whether in the Morbidity and Mortality Conference or in scientific reviews of surgical outcomes, the concept of studying the outcomes of surgical procedures in hopes of improving them in the future has long been a tenet of surgical practice. Quality surgical care and the advancement of the science of surgery demand it. The past must inform the future. There is nothing to hide and such data should be public and inform public policy.

The Current Climate

The Centers for Medicare and Medicaid Services (CMS) has mandated the Physician Quality Reporting System (PQRS) to encourage physicians to participate in continuous quality improvement. CMS has also mandated adoption of the Electronic Health Record (EHR). Other recent legislation has focused on including a measure of quality into payment for medical and surgical treatments.

The American Board of Medical Specialties has defined part IV of Maintenance of Certification as "Practice Performance Assessment –They (physicians and surgeons) are evaluated in their clinical practice according to specialty-specific standards for patient care. They are asked to demonstrate that they can assess the quality of care they provide compared to peers and national benchmarks and then apply the best evidence or consensus recommendations to improve that care using follow-up assessments."

Key Issues

• Surgeons need access to outcomes data in order to improve themselves and the practice of surgery.

• Patients need access to outcomes data so that they may make decisions about treatment options.

• Health policymakers need access to outcomes data in order to shape public policy as it relates to the health care system.

• Payers want access to outcomes data so that they may calculate and compare value across providers.

ACS Perspective

Adequate analysis of outcomes, however, requires robust databases that adequately capture confounding variables and relevant co-variables. Outcomes data must be risk adjusted. It must include adequate follow-up. It must be seamlessly integrated into the EHR, and must be available to serve multiple requirements including, but not limited to those mandated by CMS, the various Boards of the ABMS, and various national, state, and local licensing and credentialing bodies.

All of these efforts are ultimately aimed at improving quality and decreasing costs, thus improving value. It must be explicitly stated that the purpose of this data is to improve quality, decrease costs, and improve value but NEVER to be used in a punitive manner. All these efforts demand access to high quality, risk adjusted data on surgical outcomes with adequate follow-up.

There may be unanticipated consequences of the reporting of such data. Practice patterns may change in both a positive and negative way and there must be a mechanism in place to study the outcomes of such public reporting in and of itself.

These various efforts must be aligned and coordinated for optimal implementation. It should be mandated that EHR’s be developed in such a way that they collect data that can be used for PQRS and that this data then qualify for MOC and eventually maintenance of licensure (MOL). The collection of this data must not be an unfunded mandate on the individual physician and surgeon, but instead should be built into the health care system in such a way that it serves the physician/surgeon, the patient, and the public alike. The EHR, linked to such systems as the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) is probably the most effective way to achieve that objective and the development of these systems should proactively include the acquisition of ACS NSQIP data.

The American College of Surgeons believes strongly in the acquisition of high quality, risk adjusted surgical outcomes data and supports efforts to study, codify, and systematize the collection of such data.

Analysis of the results of surgical interventions has always been central to the profession of surgery. Whether in the Morbidity and Mortality Conference or in scientific reviews of surgical outcomes, the concept of studying the outcomes of surgical procedures in hopes of improving them in the future has long been a tenet of surgical practice. Quality surgical care and the advancement of the science of surgery demand it. The past must inform the future. There is nothing to hide and such data should be public and inform public policy.

The Current Climate

The Centers for Medicare and Medicaid Services (CMS) has mandated the Physician Quality Reporting System (PQRS) to encourage physicians to participate in continuous quality improvement. CMS has also mandated adoption of the Electronic Health Record (EHR). Other recent legislation has focused on including a measure of quality into payment for medical and surgical treatments.

The American Board of Medical Specialties has defined part IV of Maintenance of Certification as "Practice Performance Assessment –They (physicians and surgeons) are evaluated in their clinical practice according to specialty-specific standards for patient care. They are asked to demonstrate that they can assess the quality of care they provide compared to peers and national benchmarks and then apply the best evidence or consensus recommendations to improve that care using follow-up assessments."

Key Issues

• Surgeons need access to outcomes data in order to improve themselves and the practice of surgery.

• Patients need access to outcomes data so that they may make decisions about treatment options.

• Health policymakers need access to outcomes data in order to shape public policy as it relates to the health care system.

• Payers want access to outcomes data so that they may calculate and compare value across providers.

ACS Perspective

Adequate analysis of outcomes, however, requires robust databases that adequately capture confounding variables and relevant co-variables. Outcomes data must be risk adjusted. It must include adequate follow-up. It must be seamlessly integrated into the EHR, and must be available to serve multiple requirements including, but not limited to those mandated by CMS, the various Boards of the ABMS, and various national, state, and local licensing and credentialing bodies.

All of these efforts are ultimately aimed at improving quality and decreasing costs, thus improving value. It must be explicitly stated that the purpose of this data is to improve quality, decrease costs, and improve value but NEVER to be used in a punitive manner. All these efforts demand access to high quality, risk adjusted data on surgical outcomes with adequate follow-up.

There may be unanticipated consequences of the reporting of such data. Practice patterns may change in both a positive and negative way and there must be a mechanism in place to study the outcomes of such public reporting in and of itself.

These various efforts must be aligned and coordinated for optimal implementation. It should be mandated that EHR’s be developed in such a way that they collect data that can be used for PQRS and that this data then qualify for MOC and eventually maintenance of licensure (MOL). The collection of this data must not be an unfunded mandate on the individual physician and surgeon, but instead should be built into the health care system in such a way that it serves the physician/surgeon, the patient, and the public alike. The EHR, linked to such systems as the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) is probably the most effective way to achieve that objective and the development of these systems should proactively include the acquisition of ACS NSQIP data.

The American College of Surgeons believes strongly in the acquisition of high quality, risk adjusted surgical outcomes data and supports efforts to study, codify, and systematize the collection of such data.

Analysis of the results of surgical interventions has always been central to the profession of surgery. Whether in the Morbidity and Mortality Conference or in scientific reviews of surgical outcomes, the concept of studying the outcomes of surgical procedures in hopes of improving them in the future has long been a tenet of surgical practice. Quality surgical care and the advancement of the science of surgery demand it. The past must inform the future. There is nothing to hide and such data should be public and inform public policy.

The Current Climate

The Centers for Medicare and Medicaid Services (CMS) has mandated the Physician Quality Reporting System (PQRS) to encourage physicians to participate in continuous quality improvement. CMS has also mandated adoption of the Electronic Health Record (EHR). Other recent legislation has focused on including a measure of quality into payment for medical and surgical treatments.

The American Board of Medical Specialties has defined part IV of Maintenance of Certification as "Practice Performance Assessment –They (physicians and surgeons) are evaluated in their clinical practice according to specialty-specific standards for patient care. They are asked to demonstrate that they can assess the quality of care they provide compared to peers and national benchmarks and then apply the best evidence or consensus recommendations to improve that care using follow-up assessments."

Key Issues

• Surgeons need access to outcomes data in order to improve themselves and the practice of surgery.

• Patients need access to outcomes data so that they may make decisions about treatment options.

• Health policymakers need access to outcomes data in order to shape public policy as it relates to the health care system.

• Payers want access to outcomes data so that they may calculate and compare value across providers.

ACS Perspective

Adequate analysis of outcomes, however, requires robust databases that adequately capture confounding variables and relevant co-variables. Outcomes data must be risk adjusted. It must include adequate follow-up. It must be seamlessly integrated into the EHR, and must be available to serve multiple requirements including, but not limited to those mandated by CMS, the various Boards of the ABMS, and various national, state, and local licensing and credentialing bodies.

All of these efforts are ultimately aimed at improving quality and decreasing costs, thus improving value. It must be explicitly stated that the purpose of this data is to improve quality, decrease costs, and improve value but NEVER to be used in a punitive manner. All these efforts demand access to high quality, risk adjusted data on surgical outcomes with adequate follow-up.

There may be unanticipated consequences of the reporting of such data. Practice patterns may change in both a positive and negative way and there must be a mechanism in place to study the outcomes of such public reporting in and of itself.

These various efforts must be aligned and coordinated for optimal implementation. It should be mandated that EHR’s be developed in such a way that they collect data that can be used for PQRS and that this data then qualify for MOC and eventually maintenance of licensure (MOL). The collection of this data must not be an unfunded mandate on the individual physician and surgeon, but instead should be built into the health care system in such a way that it serves the physician/surgeon, the patient, and the public alike. The EHR, linked to such systems as the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) is probably the most effective way to achieve that objective and the development of these systems should proactively include the acquisition of ACS NSQIP data.

The American College of Surgeons believes strongly in the acquisition of high quality, risk adjusted surgical outcomes data and supports efforts to study, codify, and systematize the collection of such data.

In acknowledgement of her steadfast commitment to the initiatives and principles of the American College of Surgeons (ACS), Barbara Lee Bass, MD, FACS, is the recipient of this year’s Distinguished Service Award . A Fellow since 1987, Dr. Bass is the John F. and Carolyn Bookout Distinguished Endowed Chair, chair of the department of surgery, and general surgery residency program director at The Methodist Hospital, Houston, TX. The Distinguished Service Award is the ACS’s highest honor and was presented during the Convocation ceremonies at the 2013 Clinical Congress.

Leadership in the ACS

The DSA Award to Dr. Bass is given in appreciation of her exceptional service to ACS "for more than 20 years in noteworthy leadership roles," according to the award citation. Dr. Bass served as an ACS Regent (2001-2010) and on the Executive Committee of the Board of Regents (2005-2009). As a Regent, she was a member of the Finance Committee (2005-2010), the Member Services Liaison Committee (2004-2008), the Central Judiciary Committee (2002-2005), the Women in Surgery Committee (2000-present), and the Scholarship Committee. She is a Past-Chair of both the ACS Committee on Education (2003-2006) and the Clinical Congress Program Committee (2005-2011).

Previously, Dr. Bass served on the ACS Board of Governors (1995-2001), as a member of the Governors Executive Committee (1998-2001), and ultimately as Chair (1999-2001). She chaired the Governors Committee on Surgical Practice (1997-1998) and was a member of the Governors Committees on Socioeconomic Issues (1996-1998) and Physician Competence (1999-2001).

Dr. Bass also is recognized as a surgeon champion of the ACS National Surgical Quality Improvement Program (ACS NSQIP®) and served on the Steering Committee for that program (2004-2010). In addition, she served on the ACS Health Policy Advisory Committee (2008-2010) and the Transition to Practice working group (2011).

Dr. Bass has held leadership roles in many other professional organizations including chair of the American Board of Surgery, chair and president of the Society for Surgery of the Alimentary Tract, and president of the Society of Surgical Chairs.

She has inspired other women in surgery and as a result has received the Nina Starr Braunwald Award and the Distinguished Member Award from the Association of Women Surgeons.

Dedicated surgical educator

The award also is being presented, "In acknowledgement of her outstanding clinical and academic contributions to the field of general surgery" and "her commitment to teaching the next generation of surgeons," the citation states. In addition to her previously mentioned positions at The Methodist Hospital, Dr. Bass is the executive director of the Methodist Institute for Technology, Innovation and Education and serves on the Education Institute steering committee. She is course director, department of surgery grand rounds, and clinical faculty for students from other institutions on rotations at The Methodist Hospital. She is professor of surgery at Weill Cornell Medical College, New York, NY, and senior member of The Methodist Hospital Research Institute.

Dr. Bass has been responsible for mentoring 27 pre- and postdoctoral fellows, presented and published more than 130 manuscripts with trainees throughout her career, and delivered more than 70 named lectureships and invited talks.

Prior to taking on her roles at The Methodist Hospital in 2005, Dr. Bass was associate chair for research and academic affairs, general surgery residency program director, and professor of surgery, department of surgery, University of Maryland, Baltimore. While at the University of Maryland, Dr. Bass also held several positions at the Veterans Affairs Medical Center in Baltimore, culminating in her service as director of the surgical care center and chief of surgical service.

Dr. Bass’s career in surgical education began at George Washington University in Washington, DC, which she left in 1994 as an associate professor of surgery. She also held various prestigious posts at the Uniformed Services University of the Health Sciences, Bethesda, MD; Walter Reed Army Institute of Research, Washington, DC; and the Veterans Affairs Medical Center, Washington, DC.

Dr. Bass studied at Bennington College, VT, and Cornell University, Ithaca, NY, and graduated summa cum laude with a bachelor of science degree from Tufts University, Medford, MD. She earned her medical degree from the University of Virginia, Charlottesville. She completed her surgical internship and general surgery residency at George Washington University and a gastrointestinal surgical research fellowship at Walter Reed.

In acknowledgement of her steadfast commitment to the initiatives and principles of the American College of Surgeons (ACS), Barbara Lee Bass, MD, FACS, is the recipient of this year’s Distinguished Service Award . A Fellow since 1987, Dr. Bass is the John F. and Carolyn Bookout Distinguished Endowed Chair, chair of the department of surgery, and general surgery residency program director at The Methodist Hospital, Houston, TX. The Distinguished Service Award is the ACS’s highest honor and was presented during the Convocation ceremonies at the 2013 Clinical Congress.

Leadership in the ACS

The DSA Award to Dr. Bass is given in appreciation of her exceptional service to ACS "for more than 20 years in noteworthy leadership roles," according to the award citation. Dr. Bass served as an ACS Regent (2001-2010) and on the Executive Committee of the Board of Regents (2005-2009). As a Regent, she was a member of the Finance Committee (2005-2010), the Member Services Liaison Committee (2004-2008), the Central Judiciary Committee (2002-2005), the Women in Surgery Committee (2000-present), and the Scholarship Committee. She is a Past-Chair of both the ACS Committee on Education (2003-2006) and the Clinical Congress Program Committee (2005-2011).

Previously, Dr. Bass served on the ACS Board of Governors (1995-2001), as a member of the Governors Executive Committee (1998-2001), and ultimately as Chair (1999-2001). She chaired the Governors Committee on Surgical Practice (1997-1998) and was a member of the Governors Committees on Socioeconomic Issues (1996-1998) and Physician Competence (1999-2001).

Dr. Bass also is recognized as a surgeon champion of the ACS National Surgical Quality Improvement Program (ACS NSQIP®) and served on the Steering Committee for that program (2004-2010). In addition, she served on the ACS Health Policy Advisory Committee (2008-2010) and the Transition to Practice working group (2011).

Dr. Bass has held leadership roles in many other professional organizations including chair of the American Board of Surgery, chair and president of the Society for Surgery of the Alimentary Tract, and president of the Society of Surgical Chairs.

She has inspired other women in surgery and as a result has received the Nina Starr Braunwald Award and the Distinguished Member Award from the Association of Women Surgeons.

Dedicated surgical educator

The award also is being presented, "In acknowledgement of her outstanding clinical and academic contributions to the field of general surgery" and "her commitment to teaching the next generation of surgeons," the citation states. In addition to her previously mentioned positions at The Methodist Hospital, Dr. Bass is the executive director of the Methodist Institute for Technology, Innovation and Education and serves on the Education Institute steering committee. She is course director, department of surgery grand rounds, and clinical faculty for students from other institutions on rotations at The Methodist Hospital. She is professor of surgery at Weill Cornell Medical College, New York, NY, and senior member of The Methodist Hospital Research Institute.

Dr. Bass has been responsible for mentoring 27 pre- and postdoctoral fellows, presented and published more than 130 manuscripts with trainees throughout her career, and delivered more than 70 named lectureships and invited talks.

Prior to taking on her roles at The Methodist Hospital in 2005, Dr. Bass was associate chair for research and academic affairs, general surgery residency program director, and professor of surgery, department of surgery, University of Maryland, Baltimore. While at the University of Maryland, Dr. Bass also held several positions at the Veterans Affairs Medical Center in Baltimore, culminating in her service as director of the surgical care center and chief of surgical service.

Dr. Bass’s career in surgical education began at George Washington University in Washington, DC, which she left in 1994 as an associate professor of surgery. She also held various prestigious posts at the Uniformed Services University of the Health Sciences, Bethesda, MD; Walter Reed Army Institute of Research, Washington, DC; and the Veterans Affairs Medical Center, Washington, DC.

Dr. Bass studied at Bennington College, VT, and Cornell University, Ithaca, NY, and graduated summa cum laude with a bachelor of science degree from Tufts University, Medford, MD. She earned her medical degree from the University of Virginia, Charlottesville. She completed her surgical internship and general surgery residency at George Washington University and a gastrointestinal surgical research fellowship at Walter Reed.

In acknowledgement of her steadfast commitment to the initiatives and principles of the American College of Surgeons (ACS), Barbara Lee Bass, MD, FACS, is the recipient of this year’s Distinguished Service Award . A Fellow since 1987, Dr. Bass is the John F. and Carolyn Bookout Distinguished Endowed Chair, chair of the department of surgery, and general surgery residency program director at The Methodist Hospital, Houston, TX. The Distinguished Service Award is the ACS’s highest honor and was presented during the Convocation ceremonies at the 2013 Clinical Congress.

Leadership in the ACS

The DSA Award to Dr. Bass is given in appreciation of her exceptional service to ACS "for more than 20 years in noteworthy leadership roles," according to the award citation. Dr. Bass served as an ACS Regent (2001-2010) and on the Executive Committee of the Board of Regents (2005-2009). As a Regent, she was a member of the Finance Committee (2005-2010), the Member Services Liaison Committee (2004-2008), the Central Judiciary Committee (2002-2005), the Women in Surgery Committee (2000-present), and the Scholarship Committee. She is a Past-Chair of both the ACS Committee on Education (2003-2006) and the Clinical Congress Program Committee (2005-2011).

Previously, Dr. Bass served on the ACS Board of Governors (1995-2001), as a member of the Governors Executive Committee (1998-2001), and ultimately as Chair (1999-2001). She chaired the Governors Committee on Surgical Practice (1997-1998) and was a member of the Governors Committees on Socioeconomic Issues (1996-1998) and Physician Competence (1999-2001).

Dr. Bass also is recognized as a surgeon champion of the ACS National Surgical Quality Improvement Program (ACS NSQIP®) and served on the Steering Committee for that program (2004-2010). In addition, she served on the ACS Health Policy Advisory Committee (2008-2010) and the Transition to Practice working group (2011).

Dr. Bass has held leadership roles in many other professional organizations including chair of the American Board of Surgery, chair and president of the Society for Surgery of the Alimentary Tract, and president of the Society of Surgical Chairs.

She has inspired other women in surgery and as a result has received the Nina Starr Braunwald Award and the Distinguished Member Award from the Association of Women Surgeons.

Dedicated surgical educator

The award also is being presented, "In acknowledgement of her outstanding clinical and academic contributions to the field of general surgery" and "her commitment to teaching the next generation of surgeons," the citation states. In addition to her previously mentioned positions at The Methodist Hospital, Dr. Bass is the executive director of the Methodist Institute for Technology, Innovation and Education and serves on the Education Institute steering committee. She is course director, department of surgery grand rounds, and clinical faculty for students from other institutions on rotations at The Methodist Hospital. She is professor of surgery at Weill Cornell Medical College, New York, NY, and senior member of The Methodist Hospital Research Institute.

Dr. Bass has been responsible for mentoring 27 pre- and postdoctoral fellows, presented and published more than 130 manuscripts with trainees throughout her career, and delivered more than 70 named lectureships and invited talks.

Prior to taking on her roles at The Methodist Hospital in 2005, Dr. Bass was associate chair for research and academic affairs, general surgery residency program director, and professor of surgery, department of surgery, University of Maryland, Baltimore. While at the University of Maryland, Dr. Bass also held several positions at the Veterans Affairs Medical Center in Baltimore, culminating in her service as director of the surgical care center and chief of surgical service.

Dr. Bass’s career in surgical education began at George Washington University in Washington, DC, which she left in 1994 as an associate professor of surgery. She also held various prestigious posts at the Uniformed Services University of the Health Sciences, Bethesda, MD; Walter Reed Army Institute of Research, Washington, DC; and the Veterans Affairs Medical Center, Washington, DC.

Dr. Bass studied at Bennington College, VT, and Cornell University, Ithaca, NY, and graduated summa cum laude with a bachelor of science degree from Tufts University, Medford, MD. She earned her medical degree from the University of Virginia, Charlottesville. She completed her surgical internship and general surgery residency at George Washington University and a gastrointestinal surgical research fellowship at Walter Reed.