Creighton University School of Medicine

Complex regional pain syndrome (CRPS) and chronic postsurgical pain (CPSP) are postoperative outcomes that present with debilitating symptoms for patients. The recovery of patients with these conditions is complicated by the lack of standardized prevention and treatment strategies. Current literature suggests that vitamin C may prevent the development of CRPS. Due to the overlapping proposed mechanisms of CRPS and CPSP, the aim of this review is to summarize the available data on the benefits of vitamin supplementation on CRPS and CPSP. A search of the literature for articles published in the last 10 years was conducted. Systematic reviews, meta-analyses, case reports, and articles that were not published in English were excluded. Ultimately, 10 articles met inclusion criteria. The data suggests that systemic vitamin C plays a significant role in preventing CRPS following various orthopedic surgeries and may possess therapeutic benefit as well. Vitamin B12 improved short-term functional and mental health outcomes as well as decreased neuropathic analgesic consumption. While no clinical studies have been performed on alpha-lipoic acid (ALA), preclinical studies suggest that administration decreases cold allodynia and pain in mice models. Moreover, while no studies have evaluated the effects of vitamin D on CRPS and CPSP, retrospective analysis reveals that CRPS incidence is increased in patients with low vitamin D levels. The literature reviewed reveals that there may be value in considering nutritional supplementation through vitamins in CRPS and CPSP, however, large-scale, randomized controlled clinical trials are warranted to evaluate the potential beneficial effects of these supplements in patients. Given the use of vitamins in treating neuropathic chronic pain conditions, investigation into the use of vitamins and nutritional supplementation in the context of complex regional pain syndrome (CRPS) and chronic postsurgical pain (CPSP) is warranted. The literature summarized in this review revealed that consideration of nutritional supplementation in CRPS and CPSP may be valuable due to the overlap between the proposed pathophysiology of these conditions and the mechanism of action of certain vitamins. Further research investigating the benefits of vitamin supplementation on CRPS and CPSP, an optimal dosing regimen, and the ideal patient population for this treatment option is necessary.

INTRODUCTION:The adequate follow-up (FU) of patients undergoing ventral hernia repair (VHR) is crucial for both detecting recurrence and addressing health disparities. Loss to FU can significantly affect clinical outcomes, as it hinders timely interventions and long-term monitoring. Factors such as demographic characteristics, comorbidities, socioeconomic status, and access to care may all influence the likelihood of loss of FU. We aimed to provide a time-dependent analysis of factors associated with the time of postoperative FU and factors influencing FU loss in a specialized hernia center. METHODS:Patients who underwent VHR between 2021 and 2023 were identified through medical chart review. Demographic, geographical, and clinical data were collected. FU was defined as days from surgery to the last office visit, and loss of FU was defined as failure to attend two consecutive scheduled clinic visits with no documented clinical contact for more than 6 months after the last visit. As a surrogate for social, financial, and geographical factors, the Distressed Communities Index (DCI) was used based on patients' ZIP codes. A Cox proportional hazards regression was used to analyze time-to-event data. Variables were selected based on clinical relevance as an exploratory analysis, including the DCI, out-of-city residency, sex, age, hospital length of stay (LOS), race, psychological diagnosis type of hernia, approach (robotic versus open), transversus abdominis release (TAR), hernia size, concomitant procedures, mesh use, postoperative emergency visits and reoperation, surgical site infection (SSI), surgical site occurrences (SSO), recurrence, chronic pain. Model assumptions were assessed, including proportional hazards. Hazard ratios (HR) and 95% confidence intervals (CI) were computed, and statistical significance was assessed using Wald tests. Model performance was evaluated with the concordance index (C-index). Kaplan Meier curves were built for factors identified as relevant for FU loss. All analyses were conducted using R. RESULTS:This study analyzed 264 ventral hernia repair patients (2021-2023; median age 56, BMI 30.3) to identify factors associated with post-operative FU loss. Baseline characteristics included 39.4% recurrent hernias and 22.7% with psychiatric conditions. Postoperative complications were low, but FU significantly declined over time (e.g., 53.0% at 1 year, 12.1% at 3 years). Unadjusted analyses showed open surgical approach, in-city residency, lower DCI, and a prior psychiatric diagnosis were associated with better FU. Multivariable Cox regression revealed that increased age reduced FU loss (HR 0.97). Geographic factors significantly impacted FU, with out-of-city residency (HR 1.82) and higher DCI (HR 1.74) both independently associated with increased FU discontinuation. CONCLUSION:Our findings suggest that the geographical, social, and financial factors represented by the DCI significantly influence the risk of the event. In addition, increased age was associated with reduced risk of FU loss, whereas out-of-city residency and higher DCI were associated with increased risk of FU discontinuation.

The development of incisional hernias (IH) is an uncommon but complex outcome following pancreatic surgery, especially through the open approaches. The etiology of this complication is multifactorial and can be related to the patient and to the surgical technique. We aimed to perform a systematic review and meta-analysis assessing the risk factors for development of IH following pancreatic surgery. Pubmed, Cochrane, and EMBASE databases were systematically searched from inception to September 2024. Observational studies and randomized controlled trials assessing patients > 18 years old undergoing pancreatic surgery and reporting data on incidence and risk factors for IH were selected. Outcomes were mean age, mean body mass index (BMI), diabetes mellitus, female and male gender, active smoking, and surgical site infections (SSI). We used RStudio for statistical analysis. 686 records were reviewed, and 7 observational retrospective studies were included, totaling 3,391 patients. The incidence of IH in the pooled analysis was 368 (10.8

To summarize key findings from cardiovascular disease prevention trials at the 2026 American College of Cardiology (ACC) Conference. The Ez-PAVE trial demonstrated that targeting low-density lipoprotein cholesterol (LDL-C) levels < 55 mg/dL significantly reduces major adverse cardiovascular events compared with a target of < 70 mg/dL in patients with established atherosclerotic cardiovascular disease (ASCVD). A subgroup analysis of the VESALIUS-CV trial showed that Evolocumab reduced first cardiovascular events in high-risk individuals with diabetes who did not have known significant atherosclerosis. The CORALreef AddOn trial demonstrated the superior LDL-C-lowering efficacy of the oral PCSK9 inhibitor Enlicitide compared with ezetimibe, bempedoic acid, and the combination of the two. The Ez-PAVE trial demonstrated that targeting low-density lipoprotein cholesterol (LDL-C) levels < 55 mg/dL significantly reduces major adverse cardiovascular events compared with a target of < 70 mg/dL in patients with established atherosclerotic cardiovascular disease (ASCVD). A subgroup analysis of the VESALIUS-CV trial showed that Evolocumab reduced first cardiovascular events in high-risk individuals with diabetes who did not have known significant atherosclerosis. The CORALreef AddOn trial demonstrated the superior LDL-C-lowering efficacy of the oral PCSK9 inhibitor Enlicitide compared with ezetimibe, bempedoic acid, and the combination of the two. Imaging and diagnostic advances were highlighted by the GPS-CAD study, which demonstrated variability in the reliability of a coronary artery calcium score (CACS) of zero across diverse populations. In contrast, the Essence-TIMI 73b substudy found no significant impact of triglyceride lowering with olezarsen on coronary plaque progression over 12 months. Lifestyle and health equity-focused interventions, including the GoFreshRx and THRIVE trials, demonstrated meaningful reductions in blood pressure through dietary and food-as-medicine strategies in underserved populations. Additionally, the SURPASS-CVOT post hoc analysis showed that tirzepatide reduced composite cardiorenal outcomes compared with dulaglutide in patients with type 2 diabetes. Finally, the SMART-DECISION trial suggested that discontinuation of beta-blockers in stable patients one year after myocardial infarction with an LVEF of at least 40

This study reviews urine drug screening (UDS) outcomes in patients undergoing chronic opioid therapy for non-cancer related pain. The objective was to assess the prevalence of aberrant results, including the presence of non-prescribed substances, absence of prescribed opioids, and other discrepancies, using random electronic medical record (EMR) review over a one-year period. Fifty-six patient records from January 1, 2024, to December 31, 2024, were randomly selected and reviewed. Urine drug screens were compared against prescribed opioid regimens. Eight patients (14.3