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Background: It is unclear how patients with anal fissures are treated in real-world settings, particularly since patients may not see colorectal surgeons. This study describes trends in treatment with medical therapies (calcium-channel blockers [CCBs], nitroglycerin [NTG], and narcotics) and surgical treatments. Methods: Cohorts were created within the TriNetX database platform using codes for anal fissures and surgical interventions. Demographics were compared between patients that received surgical intervention within 1 year of diagnosis, CCB or NTG within 1 year (or preoperatively), or narcotics within 30 days or postoperatively vs those who did not. Results: 121,213 patients were included of which 4.0% had surgical intervention. Factors associated with surgical intervention were male sex (OR 1.40), White race (OR 1.17), and Hispanic ethnicity (OR 1.11). Male patients were more likely to undergo sphincterotomy (OR 1.49). Female (OR 1.27), non-Hispanic (OR 1.34), and White patients (OR 1.41) were more likely to have chemodenervation. Regarding nonoperatively managed patients, non-Hispanic (OR.91) and White patients (OR.89) were less likely to receive CCB/NTG. Male (OR 1.21), non-Hispanic (OR 1.08), and Black patients (OR 1.20) were more likely to receive narcotics. Male patients that required surgery were more likely to be prescribed CCB/NTG preoperatively (OR 1.27). Non-Hispanic surgical patients were more likely to receive narcotics (OR 1.84). Discussion: Male fissure patients were more likely to undergo surgical intervention other than chemodenervation. Differences in the rates of surgery and medical therapy (especially narcotics) between races and ethnicities require exploration to enhance the care of patients with anal fissures. [ABSTRACT FROM AUTHOR]

Objective: Psychological safety (PS) is the shared belief that the team is safe for interpersonal risk-taking. Although some research has been conducted regarding PS in healthcare settings, there is minimal research in surgical training programs. Our objective was to study PS levels in colorectal surgery (CRS) residents., Design: Our survey was adapted from Amy Edmonson's psychological safety scale and the Maslach Burnout Inventory for the surgical work environment. Questions regarding interactions with attending surgeons (AS) and program directors (PD) and regarding burnout were asked. Each question was scored on a 1-9 Likert Scale. Total PS scores for questions targeting AS or PD ranged from 3 (low) to 126 (high) and the overall PS score ranged from 6 (low) to 252 (high). Burnout scores ranged from 0 (low) to 32 (high). Descriptive statistics including medians and interquartile ranges (IQR) are used to present the data., Setting: The survey was distributed to CRS residents in-person at the 2023 Colorectal Career Course in November, 2023., Participants: Of the 87 CRS residents in attendance, 50 completed the survey (57%)., Results: CRS residents had overall high psychological safety overall (median score 228, IQR 198-247) with 92% of CRS residents having PS scores in the top third of the range. CRS residents had low burnout scores (median score 6, IQR 3-11) with 80% having burnout scores in the lowest third of the range., Conclusion: CRS residents generally have high PS levels and low burnout levels. This high level of PS could stem from the consistency of working with the same attendings, the shared interest in 1 subspecialty, and/or more frequent high-quality feedback. Further research to determine the mediators of high PS in surgical residency and CRS can be used to foster PS in other healthcare fields., (Copyright © 2025 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)