30-Second Takeaway
- Global hospital budget models modestly improve cancer surgery textbook outcomes while lowering inpatient Medicare spending.
- β-lactam prophylaxis in elective colorectal surgery reduces SSI risk versus non-β-lactam alternatives, independent of timing and dosing adherence.
- National quality collaboratives can rapidly and substantially improve lung cancer nodal staging compliance across diverse hospitals.
- Trauma center care confers a meaningful one-year survival advantage for most injured older adults, supporting liberal transfer policies.
- Age, frailty, and ventilatory strategy strongly influence perioperative risk, arguing for individualized respiratory and operative decision-making.
Week ending April 18, 2026
Recent Evidence Shaping Surgical Practice: Quality Models, Perioperative Management, and Outcomes in High-Risk Patients
Maryland’s Global Budget Model Improves Cancer Surgery Textbook Outcomes and Lowers Spending
Among Medicare patients undergoing cystectomy, prostatectomy, or nephrectomy, hospitals under Maryland’s Global Budget Revenue model achieved more textbook outcomes than matched controls. Textbook outcomes rose from 72.8% to 76.1% in GBR hospitals versus 70.2% to 70.5% in controls, a 2.9–percentage point differential improvement. Improvements were driven by fewer postoperative complications and fewer prolonged lengths of stay, without apparent mortality trade-offs. GBR hospitals also achieved larger reductions in Medicare inpatient spending, with mean savings of $771 per case versus controls. These data suggest fixed-revenue models can align better perioperative outcomes with lower cost for major urologic cancer surgery.
β-Lactam Prophylaxis Lowers SSI Risk in Elective Colorectal Surgery
In over 20,000 elective colorectal procedures, β-lactam prophylaxis was associated with fewer 30-day SSIs than non-β-lactam alternatives. SSI occurred in 6.2% with β-lactams versus 8.4% with non-β-lactams, even after adjustment for patient factors and prophylaxis quality. Adjusted risk of SSI was 26% lower with β-lactams (ARR 0.74; 95% CI 0.63-0.87). Guideline-concordant dosing and timing were not independently associated with SSI risk after adjustment, suggesting antibiotic class is the key driver. These findings support aggressive clarification of penicillin allergies and preferential β-lactam use when feasible in colorectal surgery.
National QI Collaborative Markedly Improves Lung Cancer Nodal Sampling Compliance
An ACS Commission on Cancer collaborative (Lung NODES) targeted adherence to Operative Standard 5.8 for lung cancer resections. Among 354 programs, hospitals achieving at least 80% compliance with sampling ≥3 mediastinal and ≥1 hilar nodal stations increased from 40.7% to 67.2%. Median hospital compliance rose from 67.8% to 90.5%, with the largest gains in community programs. Post-collaborative lung resections had higher odds of compliant nodal assessment (adjusted OR 2.50; 95% CI 2.19-2.86). This experience shows a structured national QI approach can quickly change thoracic operative technique and staging quality across diverse centers.
Trauma Center Care Reduces One-Year Mortality in Injured Older Adults
In a population-based cohort of 55,799 Canadians aged ≥65 with moderate or severe injury, only 28.4% received trauma center care. Overall one-year mortality was 27.4%, but instrumental-variable analysis showed trauma center care reduced mortality by an absolute 3.5%. The survival benefit was consistent across age strata and across moderate and severe injuries. Older patients with isolated severe brain injury did not appear to benefit, with no significant mortality difference by center type. These results support a low threshold to transfer injured older adults, except perhaps those with isolated severe brain injury, to trauma centers.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.