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Background: Advance care planning (ACP) is recommended for older patients undergoing surgery. ACP consists of creating advance directives (ADs), identifying surrogate decision makers (SDMs), and documenting goals of care. We identified factors associated with documentation of preoperative ACP to identify opportunities to optimize ACP for older surgical patients., Methods: This was a retrospective study of surgical patients ≥70 years old who underwent elective, high-risk abdominal procedures between 01/2015-08/2019. Clinical data were obtained from our institution's National Surgical Quality Improvement Project database. ACP metrics were extracted from the electronic medical record. We analyzed the data to identify patient factors associated with ACP metrics. We also analyzed whether ACP was more frequent for patients who experienced postoperative complications or death., Results: 267/1,651 patients were included. 97 patients (36%) had an AD available on the day of surgery, 57 (21%) had an SDM identified, and 31 (12%) had a documented goals of care conversation. On multivariable analysis, older age and white race were associated with an increased likelihood of having an AD available on the day of surgery. Women were 1.7 times more likely to have an SDM (p = 0.02). No patient or surgeon factors were significantly associated with goals of care documentation. ACP was not performed more frequently in patients who experienced postoperative complications or death., Conclusion: In this series, ACP was not routinely documented for older patients undergoing major surgery. ACP was not more frequent in patients who experienced complications or death, demonstrating the importance of universal preoperative ACP in older patients.

Introduction: Commercial motor vehicle drivers, such as truck drivers, experience unique health, lifestyle, and occupational challenges directly associated with their profession., Methods: All participants in this multistate cross-sectional study completed questionnaire measurements. Participants were categorized with metabolic syndrome (MetS) if they had at least three of the five modified criteria used in the joint scientific statement on metabolic syndrome., Results: Overall MetS prevalence was 52.4% (n = 428) of the 817 participants. Prevalence of MetS criteria were waist circumference (n = 634, 77.0%), low HDL cholesterol (n = 580, 71.0%), elevated triglycerides (n = 552, 67.6%), elevated blood pressure (n = 175, 21.2%), and elevated hemoglobin A1c (n = 97, 11.9%). Truck drivers were 2.7 times more likely to have MetS compared to the general working population., Conclusion: Truck drivers in the United States have a high prevalence of MetS compared to the general working population.

Statistical analyses are a key part of biomedical research. Traditionally surgical research has relied upon a few statistical methods for evaluation and interpretation of data to improve clinical practice. As research methods have increased in both rigor and complexity, statistical analyses and interpretation have fallen behind. Some evidence suggests that surgical research studies are being designed and analyzed improperly given the specific study question. The goal of this article is to discuss the complexities of surgical research analyses and interpretation, and provide some resources to aid in these processes., Competing Interests: The authors have no conflicts of interest to declare.

With the increasing prevalence of obesity, including among women of childbearing age, there is increasing concern regarding the short-term and long-term effects on the offspring of women who are overweight and obese. In this paper we report the results of our review of the recent literature suggesting important adverse short-term and long-term consequences of maternal obesity on their children.

Objective: The American College of Occupational and Environmental Medicine has updated the treatment guidelines in its Elbow Disorders chapter through revision processes begun in 2006. This abbreviated version of that chapter highlights some of the evidence and recommendations developed., Methods: Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 108 high- or moderate-quality trials were identified for elbow disorders., Results: Guidance has been developed for 13 major diagnoses and includes 270 specific recommendations., Conclusion: Quality evidence is now available to guide treatment for elbow disorders, particularly for lateral epicondylalgia.