Background: The National Accreditation Program for Rectal Cancer, developed by the American College of Surgeons Commission on Cancer, was established to standardize and improve the quality of rectal cancer care. While prior research has focused primarily on clinical outcomes, limited evidence exists on how National Accreditation Program for Rectal Cancer accreditation affects patient volume and geographical reach in a community hospital setting. This project evaluates the impact of National Accreditation Program for Rectal Cancer accreditation on rectal cancer patient volume and the geographic distribution of patients seeking care. Study Design: Retrospective observational study conducted from July 2016 through December 2024 at a single community-based hospital. Monthly and annual rectal cancer patient volumes and patient zip codes were collected and analyzed to determine changes over time. Results: The average monthly rectal cancer patient volume increased from 1.0 patient per month pre-accreditation to 4.58 patients per month postaccreditation. However, the segmented Poisson regression did not yield a statistically significant change across all periods. The geographic catchment area expanded from 22 zip codes to 79 zip codes after accreditation. Average patient distance traveled increased by 6 miles, but the change did not reach statistical significance. Conclusion: National Accreditation Program for Rectal Cancer accreditation was associated with an increase in patient volume and a broader geographic scope of patients seeking care at a community hospital; however, this change cannot be disentangled from the hiring of 2 fellowship-trained colorectal surgeons. Accreditation may serve as a signal to patients and referring providers of high-quality, disease-specific care, potentially enhancing the institution's competitive standing and patient draw in the health care marketplace. (c) 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Background: Despite a rising incidence among older adults, the effect of malnutrition on perioperative morbidity remains unclear. We assessed the prognostic value of the geriatric nutritional risk index for outcomes after major surgery. Methods: The nationwide Epic COSMOS electronic health record database identified adults undergoing coronary artery bypass grafting, lung resection, abdominal aortic aneurysm repair, or major gastrointestinal resection. The geriatric nutritional risk index was calculated from serum albumin and anthropometric measurements and categorized using established cutoffs as major risk (<82), moderate risk (82-91), low risk (92-98), and no risk (>98). Associations with 30-day mortality, complications, readmission, and nonhome discharge were evaluated using entropy-balanced weighted logistic regression adjusted for patient and operative factors. Results: Among 506,040 patients undergoing major surgery, mean age was 66.9 years and 46.2% were female. Patients with a major geriatric nutritional risk index were older than patients with no geriatric nutritional risk index (median, 71 vs 68 years), more often had a Charlson Comorbidity Index >= 1 (81.1% vs 75.2%), and were Black (16.4% vs 11.5%) (all P < .001). Outcomes worsened with increasing geriatric nutritional risk index: mortality (no risk, 1.7%; low risk, 4.1%; moderate risk, 6.6%; and major risk, 13.3%), readmission (no risk, 12.3%; low risk, 17.0%; moderate risk, 19.0%; and major risk, 23.5%), and nonhome discharge (no risk, 33.1%; low risk, 46.1%; moderate risk, 53.3%; and major risk, 64.3%) (all P < .001). Compared with no geriatric nutritional risk index, low and major geriatric nutritional risk index were independently associated with higher odds of any 30-day complication (low risk: adjusted odds ratio, 1.79; 95% confidence interval, 1.75-1.82; major risk: adjusted odds ratio, 2.47; 95% confidence interval, 2.40-2.54) and mortality (low risk: adjusted odds ratio, 3.35; 95% confidence interval, 3.20-3.50; major risk: adjusted odds ratio, 8.03; 95% confidence interval, 7.70-8.38) (all P < .001). The geriatric nutritional risk index demonstrated a strong inverse association with 30-day mortality, with the highest risk observed among patients with a major geriatric nutritional risk index. Conclusion: Greater geriatric nutritional risk index-defined nutrition-related risk was independently associated with higher mortality, major complications, and readmission compared with no geriatric nutritional risk index. Geriatric nutritional risk index-based assessment may identify nutritionally vulnerable patients for preoperative optimization, early intervention, and tailored postoperative discharge planning.
The operating room is a high-risk, high-entropy environment, prone to human error and preventable adverse events. Drawing on lessons from high-reliability organizations such as the aviation industry, Aimbient (formerly Operating Room Black Box by Surgical Safety Technologies, New York, NY) collects continuous, multimodal audiovisual and physiologic data capture to deepen our understanding of surgical safety. This platform has demonstrated improvements in patient safety domains across several metrics, including ground-truth benchmarking of checklist adherence, video-based multidisciplinary review conferences, and automated physiologic event tagging. Recent integration of key postoperative morbidity and mortality metrics into the data streams collected by Aimbient monitoring platforms allows for us to achieve a holistic understanding of the perioperative record. As artificial intelligence capabilities rapidly expand and begin to integrate into our health care systems, ambient data capture is uniquely poised to generate real-time insights and open new frontiers in surgical patient safety. (c) 2026 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Background: Patients taking prescription opioids before surgery experience worse postoperative outcomes, including complications, readmissions, and difficult pain control. Despite this, clinician attitudes and experiences related to the management of patients on long-term opioid therapy after surgery are currently underdescribed. We aimed to characterize current clinical challenges in the postoperative care of patients on long-term opioid therapy and identify strategies to optimize postoperative pain management from the clinician perspective. Methods: We conducted semistructured interviews with 61 clinicians. Participants were recruited from surgery, anesthesia, pain medicine, and primary care specialties through statewide surgical quality improvement networks and snowball sampling. Interviews sampled perspectives across diverse clinician types (practicing physicians, residents, and advanced practice providers) and settings (academic/ private, urban/rural). The codebook was iteratively refined, interview transcripts were coded, and themes were developed through an analytic process with regular team discussion and consensus. Results: Three clinical challenges were identified as opportunities to improve care: (1) misaligned patient-clinician perceptions surrounding recovery, which could be addressed by expectation setting and education with patients; (2) diagnostic uncertainty after surgery in the setting of altered pain perception, addressed by knowledge of the anticipated recovery trajectory and recognition of pain greater than expected; and (3) fragmented postoperative coordination between clinicians, addressed by multidisciplinary collaboration and delineation of prescribing responsibilities. Conclusion: Patients on long-term opioid therapy before surgery often have complex postoperative pain needs that challenge conventional perioperative workflows. Care pathways that support proactive patient-centered expectation setting, promote patient education, and strengthen cross-disciplinary communication may improve coordination and safety of postoperative opioid management. (c) 2026 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Background Ablation of benign thyroid nodules has gained clinical favor. However, reliably excluding malignancy remains a diagnostic challenge. We assessed the frequency and spectrum of molecular abnormalities in cytologically benign nodules. Methods This retrospective cohort study of national and institutional cohorts reviewed nodules with cytologically benign fine-needle aspiration results referred for next-generation sequencing-based molecular testing (2017-2024). Frequency/type of molecular abnormalities, histopathology, and clinical variables predictive of positive molecular testing were evaluated. Results Among 825 cases in the national cohort, 121 (15%) tested positive, including 97 (80%) for low-risk RAS/RAS-like alterations, 19 (16%) for intermediate-risk BRAF V600E and BRAF V600E-like alterations, and 5 (4%) for high-risk molecular profiles including TERT and TP53. Twenty-four nodules with intermediate-or high-risk molecular alterations represented 20% of cytologically benign molecular testing-positive nodules and 3% of all nodules. Among 36 patients with surgical outcomes, 16 (44%) nodules were malignant, and 3 (8%) were noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Among 38 cases in the institutional cohort, 11 (29%) tested positive, 7 (64%) carried low-risk, 2 (18%) carried intermediate-risk, and 2 (18%) carried high-risk alterations. Intermediate-or high-risk alterations were present in 36% of nodules with positive molecular testing and 11% of all nodules. Age <55 years (odds ratio, 13.4) and history of nodule growth (odds ratio, 13.6) were independent predictors of positive molecular testing. Of 9 molecular testing-positive nodules managed with surgery, 4 (44%) were malignant. Conclusion Among thyroid nodules with benign cytology referred for molecular testing, 3%-11% demonstrated intermediate-or high-risk alterations. Considering this molecular heterogeneity, further investigation of clinicopathologic factors is warranted to inform nonoperative or preablation molecular risk stratification and ensure accurate exclusion of malignancy.
