General Surgery

New persistent opioid use affects about 7% of opioid‑naïve US surgical patients.

Meta-analysis of 43 observational studies (n=6,507,173) estimated pooled new persistent opioid use (NPOU) at 7.15% (95% CI 6.02–8.38). Estimates varied substantially by definition: 8.29% for 90–180 day definitions versus 2.89% for ≥180‑day definitions. High heterogeneity (I2=100%) limits precision and causal inference from pooled observational data. Applicability is to opioid‑naïve adults in the USA prescribed opioids for postsurgical pain; nonopioid analgesic strategies deserve emphasis. 1

Modified Zelen randomized design was acceptable to most THA participants.

Survey of 235 CAPS‑THA participants (81% response) found 76% agreed the delayed‑consent design was justified after disclosure. Most reported unchanged or increased trust in research (94%) and 71% would join a similar study again. Participants often had a preexisting pathway preference, supporting the modified Zelen design when preference would bias enrollment. Use robust debriefing and clear ethics oversight if employing modified Zelen designs in trials. 2

Author specialty predicts direction in nonrandomized RP versus RT studies.

Review of 105 nonrandomized comparisons found 42% favored radical prostatectomy, 14% favored radiation, and 44% reported no difference. Multivariate analysis linked urology author specialty and use of national databases with conclusions favoring surgery (p=0.01). Association persisted in sensitivity analyses excluding studies relying only on biochemical outcomes (p=0.006). Clinicians should prioritize multidisciplinary interpretation when counseling patients on RP versus RT. 3