Adjuvant surgical resection in the setting of pulmonary nontuberculous mycobacterial infection removes focal parenchymal disease thought to serve as a poorly perfused reservoir for organisms, thus relatively resistant to standard antimicrobial therapy. Removal of these areas of damaged lung is felt to enhance the effectiveness of the medical treatment. In general, these operations are associated with low morbidity and mortality, although resections that are more extensive carry higher risk. Many of the planned operations may be performed with minimally invasive techniques. More data are needed regarding long-term outcomes in these patients.

BACKGROUND:Gender disparities exist in cardiothoracic (CT) surgery, although qualitative investigations are lacking. We aimed to explore the impact of workplace culture on belonging, burnout, and career exit for women in CT surgery. STUDY DESIGN:We conducted virtual semi-structured interviews with women CT surgeons in practice for 5 years or more across the US from September 2024 to December 2024. The interview asked about macro (national) and micro (institutional) workplace cultures, including belonging, burnout, and decisions to change positions. Interviews were transcribed, coded, and analyzed thematically. RESULTS:Participants (n = 25) included thoracic (40%), adult cardiac (36%), and congenital (16%) surgeons. Six themes were identified to produce a conceptual model. Broadly, elements of macro (national) culture were either augmented or mitigated by the micro (institutional) culture to influence career trajectory. Macro-level themes included (1) a shared ethos-CT surgery is a high-intensity, but rewarding field; (2) babies and burnout-pregnancy and motherhood conflict with work demands; and (3) death by a thousand cuts-gender bias, microaggressions, and discrimination are common. Micro-level themes were (1) setting the tone-leaders drive institutional culture, (2) playing nice-relationships with colleagues influence the working environment, and (3) being heard-having a voice to advocate for changes contributes to belonging and career satisfaction. CONCLUSIONS:Both macro and micro workplace cultures influence one's decision to remain in or leave a position. Inclusive leadership characterized by equity and transparency, collaborative working relationships that prioritize group objectives, and channels to shape the workplace through open communication can be leveraged to retain a diverse workforce.

PURPOSE:Surgery is the primary treatment for early-stage lung cancer. Patients with poor preoperative lung function are at increased risk of pulmonary complications after anatomic lung resection. Surgeons determine candidacy for lung resection using pulmonary function tests (PFTs), calculating predicted postoperative PFTs (PPO PFTs) by estimating the volume of lung to be resected. Conventional PPO PFT calculations assume homogeneous lung function, which can be inaccurate. 4DCT-ventilation is a novel imaging modality developed in radiation oncology that uses 4DCT data to calculate lung function maps. This study reports the primary outcomes of the XXX (Anonymized for Review) trial, a prospective clinical trial comparing 4DCT-ventilation-based PPO PFTs to conventionally measured postoperative lung function. METHODS:The trial enrolled patients with stage I-IIIa lung cancer undergoing evaluation for anatomic lung resection. Patients underwent PFTs and 4DCT imaging before and 3 months after surgery. Validated image processing techniques generated 4DCT-ventilation images using the preoperative 4DCT. We calculated 4DCT-ventilation-based PPO PFTs by scaling preoperative PFTs by the 4DCT-ventilation in the surgical volume and conventional PPO PFTs following standard-of-care methods. Concordance-correlation-coefficients (CCCs) compared PPO PFTs to postoperative PFTs for 3 PFT measures: Forced Expiratory Volume in the first second (FEV1), Forced Vital Capacity (FVC), and Diffusing Capacity of the Lungs for Carbon Monoxide (DLCO). The primary hypothesis was a CCC ≥ 85% for 4DCT-ventilation-based predictions. RESULTS:From 2018 to 2021, 65 patients consented to the study, with 36 considered evaluable. The 4DCT-ventilation-based CCCs were 91% (FEV1), 89% (FVC), and 88% (DLCO), meeting the primary endpoint. Conventional CCCs were comparable, although 4DCT appeared to perform better than the conventional approach in patients with heterogeneous lung function. CONCLUSION:The trial met the primary endpoint with accurate 4DCT-ventilation-based prediction. The data support further investigation in an interventional trial using 4DCT-ventilation to prospectively guide surgical decision-making in lung cancer treatment.

Background:There is mixed evidence supporting arrhythmia prophylaxis after lobectomy in patients not taking preoperative beta-blockers (BBs). We sought to determine the safety and efficacy of postoperative-BB versus diltiazem in BB-naïve patients in preventing post-lobectomy arrhythmia. Methods:This was a cohort study at one academic medical center (01/2019-03/2023). All patients undergoing elective lobectomy were included. Before May 2021, all patients undergoing lobectomy received low dose oral metoprolol postoperatively for arrhythmia prophylaxis. After May 2021, patients were started on oral diltiazem postoperatively unless they were receiving BB preoperatively, in which case their BB was continued. Patients were divided into pre-implementation versus post-implementation groups. The primary outcome was the rate of postoperative arrhythmia; secondary outcomes were the rates of postoperative heart failure, nonhome discharge, stroke and hypotension. Bivariable and multivariable logistic regression comparisons were performed. Results:In total, 606 patients were included; 318 patients (52.5%) were in the pre-implementation cohort. There were minimal differences in perioperative characteristics between groups. Patients in the post-implementation cohort had significantly lower rates of postoperative cardiac arrhythmias (5.2% vs. 9.7%, P=0.04). There were no differences in rates of postoperative cardiac failure/arrest, nonhome discharge, or stroke. After controlling for confounders, patients in the post-implementation cohort had lower risk-adjusted odds of postoperative arrhythmias (odds ratio 0.40, 95% confidence interval: 0.20-0.76) and hypotension (odds ratio 0.68, 95% confidence interval: 0.48-0.97). Conclusions:Patients had lower risk-adjusted rates of post-lobectomy arrhythmia and hypotension when using diltiazem for arrhythmia prevention compared to metoprolol. Our findings support the use of postoperative diltiazem preferentially in BB-naïve patients.

BACKGROUND:The Accreditation Council for Graduate Medical Education (ACGME) case log system establishes minimum clinical experiences for anesthesiology residency. While core program requirements were last updated in 2016, case log minimums themselves have not undergone a major revision in approximately two decades. Consequently, current requirements may not fully reflect changes in anesthetic practice and the evolving scope of perioperative medicine. In anticipation of major ACGME revisions in 2027, this study aimed to develop consensus-driven recommendations for modernizing residency case logs. METHODS:A three-round modified Delphi study was conducted with a nationally representative panel of 60 stakeholders, including anesthesiology residency program directors and academic and private practice anesthesiologists. Panelists evaluated a comprehensive list of potential case categories across three domains: technical skills, surgical case characteristics, and patient demographics. In Round 1, panelists proposed minimum numbers or suggested that no requirement was necessary. Rounds 2 and 3 utilized iterative feedback to determine consensus on the necessity of requirements and specific minimum thresholds. Consensus was defined as at least two-thirds agreement. RESULTS:Sixty invited experts completed all three rounds (100% response rate). The panel reached consensus to recommend new minimum requirements across several areas not currently tracked with minimums, including arterial lines (40), central lines (20), fiberoptic intubation (10), one-lung ventilation (10), neuromonitoring (10), POCUS (10 Cardiac, 10 Lung), and NORA (20 cases). Regarding existing requirements, consensus was reached to recommend increasing total peripheral nerve blocks from 40 to 60, with added requirements for anatomic specificity, and cardiac case minimums from 20 to 25. The panel also established consensus definitions for life-threatening pathologies to standardize reporting. The panel did not achieve consensus on several areas, including, for example, whether a minimum requirement for patients younger than 3 months should be maintained. CONCLUSION:These findings provide stakeholder-validated recommendations to inform upcoming ACGME requirement revisions.

Introduction: Exposure to hands-on anesthesia procedures is important for medical students’ skill acquisition, increased procedural confidence, and for students to feel more connected to the field of anesthesia. However, simulation sessions often put strain on faculty resources. We hypothesized that a near-peer teaching program would effectively train students in core procedural skills while also developing a high level of connection and engagement with the Anesthesiology community. To measure the sustainability of the program, we surveyed students to see if they would want to lead future sessions. Methods: Following the attending-led train-the-trainer sessions, 16 peer educators delivered monthly workshops from July to October 2025. 45 medical students completed training across four sessions. Students rotated through small-group, hands-on practice at three PIV and three intubation stations. Performance was assessed by peer facilitators using rubrics derived from published procedural competency frameworks (17 items for PIV; 21 for intubation; 5-point Likert scale per item). Pre/post surveys (n = 57 pre, n = 44 post) evaluated procedural confidence, connection to the anesthesia community, perceived program value, and interest in future teaching. Results: 45 medical students completed training. Mean skill performance was 93.2% for PIV insertion and 92.0% for intubation, with > 93% achieving proficiency (≥ 80%). Student confidence in performing procedural skills increased significantly from baseline (3.65/5.0) to post-training (intubation: 4.25/5.0; IV: 4.05/5.0), representing a 13.7% improvement (p < 0.001). Connection to the anesthesia community also increased: students reporting high connection (very/extremely connected) increased from 14.0% pre-session to 56.8% post-session. Notably, 93.2% expressed interest or potential interest in teaching these skills in the future (52.3% “yes”; 40.9% “maybe”). This suggests the program's success in developing future peer educators. Conclusion: Peer-led simulation sessions led to an increase in medical student anesthesia procedural skill acquisition, confidence, and connectedness to the anesthesia community. This model represents a scalable approach to procedural teaching. The curriculum resulted in successful skills acquisition, with > 93% of students achieving competency. We expect this to be a sustainable approach to procedural learning with a 93% interest in future teaching. Translation of skills to clinical practice requires further study.

BACKGROUND:Without strategic intervention to support medical education research in anesthesiology, the training of future anesthesiologists may be compromised. Currently no comprehensive strategy exists for developing education research into a robust and self-sustaining discipline within anesthesiology. Few anesthesiologists are qualified to mentor the next generation of rigorous researchers in education who will advance both the theory and practice of medical education in our specialty and throughout medicine. METHODS:The Anesthesia Research Council convened a working group of education leaders and charged them with mapping the future of education research in anesthesiology. This working group sought to understand the current state of anesthesiology education research funding and to identify key initiatives to consider in generating research excellence in this field. This article explores three key aspects of developing a path forward for medical education research: understanding the current state of anesthesiology education research funding and publications as markers of impact; integrating educational frameworks that support diversity, equity, and inclusion to ensure that anesthesiology training reflects the diverse needs of learners and patients; and making recommendations for improving medical education research in anesthesiology to help democratize the resources necessary for research, cultivate collaboration, and advance faculty development. A qualitative thematic analysis of relevant literature was completed. RESULTS:Recommendations for expanding the current education frameworks, measures, and methods include addressing (1) diversification of the physician workforce, (2) teaching styles and learning environments, (3) quality and accountability of graduate medical education, (4) cultural competency and intersectionality, and (5) advocacy. Identifying high-priority immediate and future actions that key stakeholders should undertake to generate centers of excellence and establish early career development programs in medical education research will likely have a national impact in anesthesiology and in medicine. CONCLUSIONS:This article provides a specialty-specific analysis of anesthesiology education research grant funding, publication efficiency, and the integration of diversity, equity, and inclusion frameworks. It sets forth a road map for building robust education research capacity through strategic recommendations, including fostering collaborations, incorporating artificial intelligence competencies, democratizing resources, and transforming funding and review processes.

Laparoscopic gastric ischemic preconditioning (LGIP) prior to esophagectomy has been proposed as a strategy to improve gastric conduit perfusion, potentially reducing the incidence of anastomotic leaks and other complications. This study aimed to evaluate the impact of LGIP on perioperative outcomes, particularly the need for reoperation. We performed a retrospective analysis of a prospectively maintained single institutional database from 2012 to 2025 to identify patients who underwent esophagectomy with and without prior LGIP. Exclusions comprised age < 18 years and the use of colon or jejunal conduits. The primary outcome was need for surgical reoperation. Secondary outcomes were anastomotic leak and hospital length of stay. Comparisons between groups were performed using the Mann–Whitney U test for continuous variables and the chi-square test for categorical variables. A p-value <0.05 was considered the threshold for statistical significance. A total of 335 esophagectomies were included in the study, of which 99 (29.6%) underwent LGIP. There was no significant difference between groups in baseline characteristics including cancer location or esophagectomy type. Patients in the LGIP group had a significantly lower reoperation rate, compared to the controls, 3% vs. 9.7%, respectively (p = 0.036). A trend toward a lower anastomotic leak rate was noted in the LGIP group (14.1%) compared with controls (20.3%), though difference was not significant (p = 0.18). In-hospital length of stay did not differ between groups, median 10 days (9–13 IQR) in LGIP vs. 10 days in controls (9–15 IQR). LGIP is associated with a reduced rate of reoperation following esophagectomy, suggesting a meaningful reduction in a catastrophic ischemic failure of the gastric conduit and lesser leak-associated morbidity. Leaks were more often able to be managed medically or endoscopically in the LGIP group, whereas the non-LGIP group had more severe anastomotic or conduit failures requiring conduit resection or revision. The observed trend toward a lower anastomotic leak rate did not reach statistical significance, likely due to sample size limitations.

BACKGROUND:The BASIC Examination was added to the US examination system for anesthesiology certification in 2014. The American Board of Anesthesiology conducted retrospective analyses to assess whether resident demographics, program characteristics, and/or prior examination performance were associated with first-time BASIC pass rates. METHODS:Anesthesiology residents who took the BASIC Examination for the first time from July 2014 to November 2022 were eligible to participate, and they had at least 2 more attempts (or opportunities to attempt) through December 2023. First-time and eventual pass rates (ie, based on up to 3 attempts) were calculated for each demographic group. For those residents who had the clinical base year in-training examination (CBY ITE) scores available, demographic group performance differences on this examination were first examined. Mixed-effects logistical regression models assessed how resident demographics, program characteristics, and/or prior CBY ITE scores were associated with the odds of passing the BASIC the first time. RESULTS:The analyses included 17,286 examination attempts from 15,789 residents. The majority of residents were male (65.8%), non-Hispanic or Latino (76.2%), White (47.8%), and US medical school graduates (87.4%). Differences in the first-attempt BASIC pass rates included male (92.7%) vs female (88.1%), non-Hispanic or Latino (92.0%) vs Hispanic or Latino (85.8%), Asian (92.6%) and White (92.4%) vs Black/African American (81.9%), respectively, and US (91.5%) vs international (88.6%) medical school graduates. Females had significantly lower odds of passing the BASIC the first time than males (odds ratio [OR] = 0.53, 95% confidence interval [CI], 0.47-0.60); Black/African American residents (OR = 0.41, 95% CI, 0.33-0.51) and Middle Eastern or North African residents (OR = 0.64, 95% CI, 0.46-0.91) had lower odds of passing the BASIC on first attempt than White residents; Hispanic or Latino residents had lower odds of passing the BASIC initially than non-Hispanic or Latino residents (OR = 0.52, 95% CI, 0.42-0.64). Nevertheless, all demographic subgroups' eventual pass rates were >99%.Male and White residents outperformed female and Black/African American residents, respectively, in CBY ITEs. The gender and race performance gaps in the first-time BASIC pass rates were attenuated but not eliminated after controlling for their CBY ITE scores-compared to male and White residents, respectively, the odds of passing the BASIC the first time changed from 46% to 56% for female residents, and from 41% to 53% for Black/African American residents. CONCLUSIONS:Female and nonwhite residents had lower first-time BASIC Examination pass rates. Almost all trainees passed by their up-to-third attempts. Future studies are needed to understand the basis of these differences and identify opportunities for improvement.

Background: The impact of surgeon subspecialty on postoperative outcomes is relatively unstudied in emergency thoracic surgery. The purpose of this study was to compare the outcomes of patients who undergo emergency thoracic operations by cardiothoracic surgeons versus other surgical subspecialties. Methods: This was a retrospective cohort using the National Surgical Quality Improvement Program database (2005-2018). A list of Current Procedural Terminology codes was generated by limiting the database to emergency operations performed by thoracic surgeons. Current Procedural Terminology codes occurring with frequency >10 were then used to search the entire database to identify patients who underwent emergency surgery by any surgeon specialty. Patients were grouped by operative surgeon primary subspecialty (cardiothoracic compared with other). Outcomes were compared using bivariable and multivariable regression analysis. Subgroup analysis was performed for lung and chest wall, hiatal hernia, esophagus, and pericardial operation-specific cohorts. Results: A total of 4,044 patients were included; 2,162 (53.5%) had emergency operations performed by cardiothoracic surgeons and 1,882 (46.5%) by other surgeons. Patients who underwent operations performed by cardiothoracic surgeons were more likely to have 6 of 18 medical comorbidities (all P < .05). Patients who had pericardial operations by cardiothoracic surgeons had lower risk-adjusted rates of mortality (odds ratio, 0.58; 95% confidence interval, 0.34-0.99), renal complications (odds ratio, 0.28; 95% confidence interval, 0.09-0.87), and bleeding (odds ratio, 0.45; 95% confidence interval, 0.24-0.84). There were no risk-adjusted differences in outcomes in the other subgroups. Conclusion: Patients who underwent emergency pericardial operations by cardiothoracic surgeons had improved postoperative outcomes compared with other surgeon specialties. These differences are important to consider when consulting surgeons for emergency thoracic operations. (c) 2025 Published by Elsevier Inc.

Background:Given the continued disruption of the coronavirus disease 2019 (COVID-19) pandemic throughout 2021, we aimed to assess for continued implications of the altered healthcare landscape on non-small cell lung cancer (NSCLC) presentation and treatment in the second year of the pandemic. Methods:This was a retrospective cohort study using the United States National Cancer Database (2019-2021). Demographic, cancer-related, and treatment variables were compared between patients diagnosed in the pre-pandemic year [2019], pandemic-year-one [2020], and pandemic-year-two [2021]. Multivariate logistic regression was performed to control for the impact of demographics on oncologic variables, and then for the impact of oncologic variables on treatment modalities and outcomes. Results:Of 376,193 NSCLC cases, 135,649 (36.1%) were pre-pandemic, 119,338 (31.7%) were pandemic-year-one, and 121,206 (32.2%) were pandemic-year-two. Compared to the pre-pandemic year, patients diagnosed in pandemic-year-two had risk-adjusted increases in clinical T stage [odds ratio (OR) =1.017; 95% confidence-interval (CI): 1.003-1.031], N stage (OR =1.048; 95% CI: 1.033-1.063), M stage (OR =1.044; 95% CI: 1.028-1.060), and overall stage (OR =1.038; 95% CI: 1.023-1.052). Additionally, compared to the pre-pandemic year, patients diagnosed in pandemic-year-two continue to see risk-adjusted increases in time from diagnosis to staging (OR =1.044; 95% CI: 1.017-1.072), to first treatment (OR =1.143; 95% CI: 1.133-1.154), to surgery (OR =1.117; 95% CI: 1.093-1.141) and to systemic therapy (OR =1.021; 95% CI: 1.924-1.039). Conclusions:Compared to the pre-pandemic year, patients diagnosed with NSCLC in the United States during pandemic-year-two continue to present at later clinical stage and experience delays to treatment. The oncologic and treatment characteristics of NSCLC have not returned to pre-pandemic baseline in the United States, possibly due to compounding delays to diagnosis and treatment and a growing back log of cases.

Timely surgical resection is an important component of treatment for non-small cell lung cancer (NSCLC). The Social Vulnerability Index (SVI) is a validated, composite metric for social determinants of health. This study aimed to determine whether social vulnerability is associated with delayed surgery for NSCLC. The study identified patients with stages IA to IIIA NSCLC who underwent upfront surgery between 2011 and 2021 in a single health care system. High social vulnerability was defined as SVI ≥ 75th percentile. Delayed surgery was defined as longer than 9 weeks after diagnosis. Unadjusted and risk-adjusted predictors of delayed surgery were identified. Time to surgery also was analyzed as a continuous variable. A negative binomial model was fitted to assess the individual impact of social vulnerability on time to surgery in days. Of 595 patients, 120 (20

BACKGROUND:Milestones evaluation is mandated by the Accreditation Council for Graduate Medical Education (ACGME) to help training programs measure residents' progress toward competency and identify specific areas for trainee improvement. Data from training programs raised concerns that Milestones ratings may reflect the year of training more than resident progress toward competency. We examined the relationship between residents' Milestones ratings toward the end of residency training and their performance on the American Board of Anesthesiology (ABA) examinations, widely considered as the gold standard of competency. METHODS:We compared Milestones 2.0 ratings and board scores of all anesthesiologists who completed an ACGME-accredited residency program between July 2021 and June 2022 (AY22) and had their first-time ABA ADVANCED Examination (written), Standardized Oral Examination (SOE) and Objective Structured Clinical Examination (OSCE) performance available by 2023. We first assessed the correlation between the average rating achieved across all 23 Milestones during the last 6 months of residency training and the Z-scores of these three examinations among first-time takers. Then, we evaluated the correlations between 9 specific Milestones and their conceptually related domains tested by the ADVANCED, the SOE, and the OSCE; we calculated Pearson and polychoric correlation coefficients for continuous and ordinal data, respectively. RESULTS:All 23 Milestones 2.0 AY22 ratings were available for 1849 Post Graduate Year (PGY)-4, Clinical Anesthesia Year 3 (CA-3) residents. These were matched to 1799 first-time ADVANCED and 1383 first-time SOE and OSCE takers. The average ACGME Milestones ratings across all competencies were significantly correlated with examination Z-scores (all P < .001)-the ADVANCED (r = 0.135 [95% confidence interval {CI}, 0.089-0.180], the SOE (r = 0.117 [0.065-0.169]), and the OSCE (r = 0.112 [0.060-0.164]). For the domain-specific comparisons, scores on the ADVANCED Examination correlated modestly with the Medical Knowledge Milestone domain (r = 0.289, P < .001), but there were no statistically significant associations between SOE task ratings and their related Milestones domains (ρ = 0.027 to 0.091, P = .31 to 0.81). In comparisons of similar domains evaluated by OSCE stations and the Milestones, 2 were statistically significantly correlated with a weak magnitude (Interpretation of Monitors and Echocardiograms [ρ = 0.093, P = .031] and Ethical Issues [ρ = 0.049, P = .003]) while 2 others were not statistically significant (Application of Ultrasonography [ρ = 0.052, P = .775] and Communication with other Professionals [ρ = 0.052, P = .086]). CONCLUSIONS:There was a modest correlation between the last Medical Knowledge Milestone achieved and the ADVANCED Examination. However, the weak correlations between residency Milestones and the SOE or OSCE performance suggest that the Milestones system, as currently implemented by anesthesiology training programs, does not predict certifying examination performance.