Trends in opioid prescribing and new persistent opioid use after surgery in the US

Among 989,354 opioid-naive individuals, the initial opioid prescription decreased from 282mg oral morphine equivalents (OME) in 2013 to 164mg OME in 2021. The incidence of new persistent opioid use decreased from 2.7% to 1.1%. Predictors of persistent use included orthopaedic procedures (knee arthroplasty OR=3.4). The authors concluded that opioid stewardship practices over the past decade had favourable effects on the risk of long-term opioid use.

Luby AO, Alessio-Bilowus D, Hu HM, Brummett CM, Waljee JF, Bicket MC.
Ann Surg 2025; 281(3): b347–352. 

Dutch national guideline on the management of intergluteal pilonidal sinus disease

This national guideline on pilonidal sinus management aims to reduce the variation in surgical treatments and improve understanding of its aetiology, diagnosis, classification and prevention strategies.

Huurman EA, de Raaff CAL, Sloots PCEJ, et al. Br J Surg 2024; 111(12): znae281.

Role of obesity-management medications (OMMs) before and after metabolic bariatric surgery

This review evaluates the role of preoperative OMMs to optimise health for bariatric surgery, postoperative use of OMMs to enhance overall outcomes, and postoperative OMMs as adjunctive therapy for patients with suboptimal initial response to bariatric surgery.

Cohen RV, Park JY, Prager G, et al. Br J Surg 2024; 111(12): znae284.

Perioperative chemotherapy or preoperative chemoradiotherapy in esophageal cancer

This trial randomised 221 patients with resectable esophageal adenocarcinoma to perioperative FLOT chemotherapy and 217 patients to preoperative chemoradiotherapy. Overall survival at three years was 57% in the FLOT group and 51% in the chemoradiotherapy group (p=0.01). Mortality at 90 days after surgery was 3.1% in the FLOT group and 5.6% in the chemoradiotherapy group. The authors concluded that perioperative chemotherapy led to improved survival with resectable esophageal adenocarcinoma.

Hoeppner J, Brunner T, Schmoor C, et al. N Engl J Med 2025; 392(4): 323–335.

Positive and negative framing of complication risk and long-term outcomes 

This study looked at whether framing complication risk in total hip arthroplasty (THA) and long-term satisfaction rates in total knee arthroplasty (TKA) influenced patient decision-making using hypothetical vignettes. For THA (622), 95% of patients indicated they would proceed with surgery in the positive-framing group compared with 88% of the negative-framing group. For TKA (623), 97.1% indicated they would proceed in the positive-framing group compared with 89.7% in the negative-framing group. Self-reported ‘worry’ differed based on framing in both surveys. The authors concluded that framing of complications and outcomes influences patient decisions.

Boyle AB, Sunstein CR. Surgeon 2025; 23(1): 1–5.

Scottish open fractures of tibia audit

This audit during 2021-23 evaluated 196 open tibial shaft fractures in adults. Complications including infection (24%), return to theatre (17%) and amputation (7.1%) were associated with higher-grade injuries. Complete compliance with British Orthopaedic Association guidelines was documented in only 9%. The authors concluded there was room for improvement in the timing of antibiotic delivery and soft tissue cover.

Dixon JE, Rankin IA, Rangarajan S, et al. Surgeon [in press] 2025. doi.10.1016/j.surge.2025.01.006.