BACKGROUND: The Merit-Based Incentive Payment System (MIPS) requires physicians to report quality measures along with supplementary metrics that are used to determine an annual percentage adjustment to physician Medicare...BACKGROUND: The Merit-Based Incentive Payment System (MIPS) requires physicians to report quality measures along with supplementary metrics that are used to determine an annual percentage adjustment to physician Medicare Part B payments. Unfortunately, during the early years of the MIPS program (2017 to 2020), physicians in non-primary care specialties have had few quality measures to choose from. This has resulted in a disadvantage for physicians of non-primary care specialties to receive a positive Medicare part B adjustment. The aim of this study is to determine if significant variation still exists in the number and characteristics of quality measures in the MIPS program across specialties from 2021 to 2024. METHODS: This longitudinal quality improvement study uses Centers for Medicare and Medicaid Services (CMS) Quality Payment Program (QPP) public use file data from 2021 to 2024 to collect descriptive statistics about the number and characteristics of MIPS measures and Qualified Clinical Data Registry (QCDR) measures available for reporting within the Traditional MIPS reporting pathway. Primary outcomes included the number of measure-and-collection-type combinations, number of unique MIPS measures, number of QCDRs, and number of QCDR measures available for reporting within each medical specialty. Secondary outcomes included quality measure characteristics such as each measure's Donabedian class, topped out status, and capped status. All outcomes were established prior to data collection. RESULTS: The average number of unique quality measures and measure-and-collection-type combinations available for reporting by non-primary care specialties is significantly lower than that for primary care specialties (p < 0.001, p < 0.001, respectively). Process measures outnumber outcome and structure measures within all specialties except neurosurgery, orthopedic surgery, and vascular surgery. A large percentage (40.9%) of all measure-and-collection-type combinations in 2024 are topped out and therefore fail to stratify physician performance effectively. CONCLUSION: In this longitudinal study of MIPS and QCDR quality measures, results show that significant variability still exists in the number of quality measures available for reporting in 2024, with non-primary care specialties having the lowest number of reportable measures. Policymakers should ensure that future modifications to the MIPS program provide equal opportunity for physicians to achieve a positive Medicare Part B payment adjustment.
Women surgeons encounter unique challenges in breastfeeding and lactation, influenced by early postpartum return to work, limited childcare options, and inadequate institutional supports. This qualitative study examined...Women surgeons encounter unique challenges in breastfeeding and lactation, influenced by early postpartum return to work, limited childcare options, and inadequate institutional supports. This qualitative study examined the infant-feeding experiences of Canadian women surgeons and trainees, with a focus on breastfeeding and pumping. Participants were recruited through social media, and semi-structured interviews explored motivations, barriers, and workplace experiences. Interviews were audio-recorded, transcribed, and analyzed using constructivist grounded theory with iterative open and focused coding to identify common themes. Sixteen participants across five surgical specialties were included. Three themes emerged: strong personal motivations to breastfeed; substantial structural and systemic barriers, including lack of protected time and private space; and pervasive feelings of guilt and judgment related to feeding choices. These findings highlight persistent obstacles to lactation in surgical environments and underscore the need for targeted institutional, policy, and cultural interventions to better support surgeon-mothers in achieving their infant-feeding goals.
BACKGROUND: The Model for End-Stage Liver Disease (MELD) has prioritized liver transplant candidates since 2002, with revisions yielding 2.0 (2016) and 3.0 (2022) models. Updates aimed to enhance transplant allocation eq...BACKGROUND: The Model for End-Stage Liver Disease (MELD) has prioritized liver transplant candidates since 2002, with revisions yielding 2.0 (2016) and 3.0 (2022) models. Updates aimed to enhance transplant allocation equity, but each model's ability to predict post-transplant outcomes remains unclear. METHODS: Utilizing the Organ Procurement Transplant Network database, binary logistic regression models evaluated associations between MELD cohorts and 10 post-transplant outcomes, adjusting for MELD score. MELD 1.0 served as the reference. Odds ratios (ORs), 95% confidence intervals (CIs), and p-values were reported for MELD 2.0 versus 1.0 and MELD 3.0 versus 1.0. RESULTS: MELD 3.0 had the most significant association with graft failure due to infection (OR = 1.30, p = 0.023), recurrent disease (OR = 0.12, p < 0.001), hepatitis (OR = 0.03, p < 0.001), chronic rejection (OR = 0.67, p = 0.041), hepatic artery thrombosis (OR = 2.51, p < 0.001), primary non-function (OR = 3.93, p < 0.001), diffuse cholangitis (OR = 2.32, p < 0.001), and overall graft loss (OR = 6.34, p < 0.001). Compared to the MELD 1.0 cohort, transplant recipients in the MELD 2.0 cohort were most strongly associated with an increased risk for acute rejection (OR = 1.58, p < 0.001) and chronic rejection (OR = 1.28, p < 0.001). While MELD 2.0 was not the strongest, it still showed significant associations with graft failure due to infection (OR = 1.162, p = 0.017), recurrent disease (OR = 0.486, p < 0.001), hepatitis recurrence (OR = 0.061, p < 0.001), diffuse cholangitis (OR = 1.523, p < 0.001), hepatic artery thrombosis (OR = 2.050, p < 0.001), primary non-function (OR = 2.869, p < 0.001), and graft loss overall (OR = 3.272, p < 0.001) compared to the MELD 1.0 cohort. CONCLUSION: The MELD 3.0 cohort demonstrated significant associations with both increased and decreased risks across multiple post-transplant outcomes. These results underscore the importance of monitoring how allocation policy changes may influence post-transplant outcomes at the population level.
BACKGROUND: Rates of female physician burnout continue to rise, and various aspects of electronic documentation are frequently associated with burnout. Female physicians have been found to spend more time in the electron...BACKGROUND: Rates of female physician burnout continue to rise, and various aspects of electronic documentation are frequently associated with burnout. Female physicians have been found to spend more time in the electronic health record (EHR) compared with males. It remains unclear whether surgeons exhibit similar differences. This study was conducted to analyze EHR usage patterns of surgeons and assess for gender differences. METHODS: This is a retrospective cross-sectional study of all attending surgeons across all surgical specialties at a single institution between May 2022 and May 2023. The primary outcomes were differences in time spent in the EHR, measured by EHR metrics (time in system and subcategories including time in notes, orders, clinical review, and in-basket; messages received by patients and staff and the turnaround time for each type; time spent after hours and on unscheduled days; orders with team contributions). Multivariable linear regression was performed to analyze differences by gender while controlling for practice characteristics. RESULTS: 593 attending surgeons were included (73% male). Female surgeons spent 35% more time in the EHR compared with male surgeons (p < 0.001), received more messages from patients and staff (p ≤ 0.031), and spent more time on unscheduled days and outside scheduled clinical hours (p < 0.001). CONCLUSION: This study found significant differences in EHR usage and message volume between male and female surgeons. Further investigation into causes of these observed differences is warranted.
This retrospective observational study evaluated the impact of the 2022-2023 introduction of the Preference Signaling Program (PSP) and Geographic Preferencing (GP) on orthopaedic surgery residency match outcomes across...This retrospective observational study evaluated the impact of the 2022-2023 introduction of the Preference Signaling Program (PSP) and Geographic Preferencing (GP) on orthopaedic surgery residency match outcomes across 4377 residents from 208 Accreditation Council for Graduate Medical Education-accredited programs spanning 2019-2023. Residents in the PSP/GP cycle reported higher total (mean 5.38) and first-author publications (1.55) than prior cohorts (p < 0.05), while h-index values did not differ. Applicants matching outside their medical school region demonstrated greater research productivity than those matching regionally (5.98 vs 4.70 publications, p = 0.036). The proportion of regional matches remained stable (46.7% vs 50.7%, p = 0.099). PSP and GP were not associated with increased regional matching or differing research burden among out-of-region applicants. Research productivity continues to be a key determinant of match outcomes in orthopaedic surgery.
BACKGROUND: The phrase "getting it" is frequently used in surgical trainee assessment, yet its meaning remains undefined. This study explores how residents and faculty define the concept and whether perceptions align. ME...BACKGROUND: The phrase "getting it" is frequently used in surgical trainee assessment, yet its meaning remains undefined. This study explores how residents and faculty define the concept and whether perceptions align. METHODS: Semi-structured interviews were conducted with 11 residents and 13 faculty at a single institution and analyzed using reflexive thematic analysis. RESULTS: Residents described "getting it" as clinical competence, social awareness, feedback responsiveness, and team integration, while noting challenges with interpreting implicit expectations and the influence of faculty bias. Faculty described "getting it" as a gestalt recognition of initiative, insight, and sound clinical judgment. Both agreed that the concept is difficult to teach, vague, and susceptible to bias. CONCLUSIONS: Because residents and faculty interpret "getting it" differently, making the concept more explicit may enhance feedback quality, support trainee development, and reduce bias in assessment. Future work should focus on developing shared language frameworks around technical and non-technical competencies.
BACKGROUND: Large language models (LLM) can pass medical licensing and specialty board exams, but their ability to generate high-quality board-style exam questions is uncertain. METHODS: Three LLMs each generated 20 colo...BACKGROUND: Large language models (LLM) can pass medical licensing and specialty board exams, but their ability to generate high-quality board-style exam questions is uncertain. METHODS: Three LLMs each generated 20 colorectal surgery board questions in accordance with American Board of Colon and Rectal Surgery guidelines. Questions from the Colon and Rectal Surgery Educational Program (CARSEP) served as comparators. Board-certified colorectal surgeons, blinded to source, graded each question on clarity, relevance, suitability, distractor quality, and adequacy of rationale, and categorized questions as "Approved for Committee," "Author to Review," or "Not Accepted." RESULTS: CARSEP demonstrated the highest "Approved for Committee" rate (65%), compared with ChatGPT-4o (7%), Copilot Pro (10%), and Gemini Advanced (10%). CARSEP significantly outperformed most LLMs across all evaluation domains (p < 0.001), except for question suitability, where most LLM questions received >70% very good to good ratings. CONCLUSIONS: Although LLMs demonstrate potential, they are currently unable to consistently generate high-quality, colorectal surgery board-style questions.
Innovation is frequently invoked as an essential driver of progress in modern surgery, yet its definition, implementation, and leadership aspects remain inconsistently understood. Drawing on clinical experience, systems-...Innovation is frequently invoked as an essential driver of progress in modern surgery, yet its definition, implementation, and leadership aspects remain inconsistently understood. Drawing on clinical experience, systems-based research, and translational examples, this narrative review explores innovation as a continuum, from the generation of an idea all the way to scalable impact, within contemporary surgical practice. We examine the distinction between invention and innovation, the importance of environmental context, and the traits associated with sustained productivity. Clinical exemplars including advanced hemostatic technologies, hybrid trauma operating environments, equity-focused surgical care, artificial intelligence-enabled pathways, and austere or space-based surgical planning are presented to illustrate the innovation cycle from conception to implementation. Finally, we discuss leadership principles required to cultivate meaningful, durable innovation in surgery, emphasizing significance over individual success. Together, these perspectives frame innovation not as disruption alone, but as a deliberate, collaborative process that improves patient outcomes and advances the surgical profession.
Secondary hyperparathyroidism often occurs as a result of a disruption in calcium and phosphorus homeostasis caused by chronic kidney disease (CKD). While some individuals experience a remission of parathyroid gland dise...Secondary hyperparathyroidism often occurs as a result of a disruption in calcium and phosphorus homeostasis caused by chronic kidney disease (CKD). While some individuals experience a remission of parathyroid gland disease subsequent to kidney transplantation due to the restoration of calcium homeostasis, a subset continues to exhibit elevated parathyroid hormone due to autonomous secretion, a condition otherwise known as tertiary hyperparathyroidism. This review aims to investigate the intricacies of diagnosis, presentation, medical treatment, state-of-the-art surgical options, and strategies to potentially improve the cure rates of parathyroidectomy in cases of secondary and tertiary hyperparathyroidism.
INTRODUCTION: Patients increasingly use generative artificial intelligence assistants (chatbots) for medical information. We examined surgeon-perceived accuracy, reliability, and readability of chatbot responses to adren...INTRODUCTION: Patients increasingly use generative artificial intelligence assistants (chatbots) for medical information. We examined surgeon-perceived accuracy, reliability, and readability of chatbot responses to adrenal nodule queries. METHODS: Six commonly asked adrenal nodule questions were input into five chatbots. Blinded answers were reviewed by 10 endocrine surgeons for correctness and reliability (6-point Likert scale) and content structure (3-point Likert scale). One-way ANOVAs and Tukey adjusted post hoc analyses tested differences. Inter-rater reliability across surgeon ratings was assessed by two-way intraclass correlation coefficient. Reading grade levels were assessed using Lexile Text Analyzer (MetaMetrics, Inc). RESULTS: Correctness, reliability, and jargon use differed significantly (p ≤ 0.05). Perplexity scored highest for correctness, reliability, and thoroughness but used the most jargon. Gemini scored lowest on all domains, but used the least jargon. Mean Lexile reading level was 8th-10th grade. CONCLUSION: Chatbot responses about adrenal nodules vary significantly. More accurate, reliable, and thorough answers contained excess jargon, but all responses exceeded recommended patient education levels.
Vascular sarcomas, including angiosarcoma (AS) and epithelioid hemangioendothelioma (EHE), are rare neoplasms for which there do not exist standardized treatment guidelines. This study retrospectively analyzed the Nation...Vascular sarcomas, including angiosarcoma (AS) and epithelioid hemangioendothelioma (EHE), are rare neoplasms for which there do not exist standardized treatment guidelines. This study retrospectively analyzed the National Cancer Database to identify a total of 12,640 malignant vascular sarcoma cases, including 11,311 AS and 1329 EHE cases. We then characterized differences in presentation, treatment, and survival across pediatric, young adult, and older adult cohorts. Pediatric AS patients were more likely to present with metastatic and visceral disease than adults. Metastatic AS had the highest mortality across all age groups. Despite their higher-risk presentation, pediatric patients paradoxically exhibited improved survival compared to adults. M0 status was associated with surgical management, but surgery and chemotherapy were less consistently applied. The findings underscore the clinical heterogeneity of these tumors and the need for standardized, age-specific treatment protocols to improve outcomes in this rare tumor population.
Dacier BM, Mejia J, Jones AN
… +11 more, Rosario A, Allar BG, Murphy RE, Bergmark RW, Patino S, Gershanik EF, Pusic AL, Peck GL, Fernandez A, Bates DW, Ortega G
BACKGROUND: Patients with Limited English Proficiency (LEP) face poorer surgical outcomes, yet language-access capacity varies by hospital. OBJECTIVE: Compare 7-day readmission after common surgeries among adult patients...BACKGROUND: Patients with Limited English Proficiency (LEP) face poorer surgical outcomes, yet language-access capacity varies by hospital. OBJECTIVE: Compare 7-day readmission after common surgeries among adult patients with LEP at Language Serving Hospitals (LSH) and non-LSH, stratified by Spanish, Common Non-English, Non-Spanish (NENS) and Rare NENS Languages using the New Jersey State Inpatient Database. RESULTS: 34,342 adult surgical patients were discharged from LSH with 2.5% readmitted compared to 5.0% of those from non-LSH. Patients from LSH who spoke Spanish, (aOR 0.46, 95% CI 0.40-0.54), Common NENS (aOR 0.49, 95% CI 0.31-0.79), and Rare NENS Languages (aOR 0.50, 95% CI 0.40-0.63) had reduced odds of readmission compared to those from non-LSH. CONCLUSIONS: Surgical patients with LEP discharged from LSH had lower odds of readmission, suggesting LSH may be better equipped than non-LSH. Worse disparities for Common and Rare NENS Languages suggest the need to expand resources beyond Spanish.
BACKGROUND: Polycystic liver disease (PLD) comprises a spectrum of inherited disorders characterised by progressive cyst development and highly variable clinical manifestations. A significant subset of patients develops...BACKGROUND: Polycystic liver disease (PLD) comprises a spectrum of inherited disorders characterised by progressive cyst development and highly variable clinical manifestations. A significant subset of patients develops debilitating symptoms and despite advances, a unified treatment algorithm is lacking. AIM: To review current evidence for medical, interventional and surgical management of PLD and identify gaps preventing an integrated, evidence-based care pathway. SUMMARY: Somatostatin analogues (SSAs) are the principal disease-modifying therapy, producing modest but reproducible liver-volume reductions of 3-7% and clinically meaningful symptom improvement in selected patients with diffuse small-to-medium cystic disease. Other pharmacologic strategies have shown limited or inconsistent benefit and currently have no established role outside research settings. Interventional radiologic and surgical options provide more substantial debulking but are phenotype-dependent. Partial hepatectomy offers the largest volume reduction but carries high morbidity and liver transplantation (LT) remains the only curative option for advanced disease, with excellent long-term outcomes but significant perioperative risk. Across all modalities, heterogeneous endpoints limit meaningful comparison and hinder integration of therapies into a unified treatment pathway. CONCLUSION: A phenotype-driven management framework and coordinated research strategy incorporating standardised volumetrics, symptom scoring and prospective multicentre cohorts are urgently needed to define optimal sequencing of medical, interventional and surgical therapies in PLD.