NASS 2025 Best Papers Q&A
Every year at the NASS Annual Meeting, a handful of papers are recognized for the clarity of their questions and the impact of their answers. Better outcomes often hinge on small choices: a medication, a monitoring lead, a step across the clinic floor. This year’s Best Papers show just how much those choices matter.
This year’s honorees ask practical but forward-looking questions: How can we sharpen intraoperative monitoring to catch complications sooner? Do the medications we prescribe after surgery quietly shape long-term options? What risks are hidden in habits like vaping? Can analyzing gait give us new insight into recovery? Even emerging therapies like GLP-1 agonists are being considered in the context of bone healing and fusion outcomes.
Taken together, these studies point in the same direction: more precise, more personalized, and more thoughtful spine care. In the following Q&As, the award-winning authors share what they set out to learn, what surprised them along the way, and why their findings matter for both today’s patients and tomorrow’s practice.
76. Substance-specific complications after lumbar decompression: distinguishing the effects of tobacco, nontobacco, nicotine, and cannabis
Reme Arhewoh,MD; Abdel Rahman Diab, BS; Omar Diab, BS; Ilyas Aleem, MD, MSc, FRCSC; Joshua D Piche, MD
Q&A not available at time of publishing.
77. Nontobacco nicotine dependence and incidence of pseudarthrosis and other postoperative complications in lumbar fusion surgery: a retrospective analysis
Abdullah Ghali, MD; Jad Lawand, MS; Lorenzo Deveza, MD,PhD; Harris Hafeez, BS
1. What question is your research trying to answer?
Nontobacco nicotine products, most commonly delivered via “vaping” are often marketed as safer alternatives to traditional tobacco, despite a lack of robust clinical evidence to support such claims. Specifically, there is very limited research on their impact in the context of lumbar spinal fusion surgery. Our study aimed to answer whether the use of nontobacco nicotine products, which are largely unregulated and can contain highly variable nicotine concentrations, are associated with postoperative outcomes particularly the incidence of pseudarthrosis and other complications following lumbar fusion procedures.
2. Please summarize your key findings and comment on their clinical significance.
Our study investigated the impact of nontobacco nicotine dependence (NTND) primarily related to vaping and e-cigarette use on postoperative outcomes following lumbar fusion surgery. Compared to non-nicotine users, NTND patients demonstrated significantly higher rates of several 90-day complications, including pneumonia, renal failure, and sepsis. At 2 years, they were at increased risks of pseudarthrosis and postlaminectomy syndrome. Interestingly, they also had lower rates of transfusion and adjacent segment disease.
When compared to traditional tobacco users, NTND patients had a higher risk of pseudarthrosis but lower rates of adjacent segment disease and foot drop. These findings suggest that while non-tobacco nicotine products may differ from traditional tobacco in their risk profile, they are not without their own surgical risks contrary to the common perception that they are a safer alternative.
Clinically, this research underscores the importance of recognizing NTND as a distinct and meaningful risk factor in spine surgery. As the use of non-tobacco nicotine products continues to rise, particularly among younger populations, it is essential for surgeons and perioperative teams to specifically inquire about non-tobacco nicotine use during preoperative assessments. Incorporating this into risk stratification and patient counseling can improve surgical planning, manage patient expectations, and potentially guide interventions to reduce postoperative complications.
3. Your study found that patients with NTND had higher rates of pseudarthrosis than even tobacco users. What mechanisms or hypotheses might explain this unexpectedly elevated risk?
This was one of the most striking and unexpected findings of our study. While the detrimental effects of traditional tobacco use on bone healing are well reported in the literature, NTND patients demonstrated even higher rates of pseudarthrosis. A likely explanation lies in the nicotine concentration and delivery mechanisms of non-tobacco products. Devices such as vapes and nicotine pouches often contain higher nicotine concentrations typically 3% to 6% (30–60 mg/mL), with products like JUUL pods reaching up to 5.9% (59 mg/mL). These products use nicotine salts, which reduce the harshness of inhalation, making them more tolerable than cigarette smoke.
Because of this smoother delivery, users can unknowingly ingest more nicotine overall than with combustible cigarettes, which typically deliver only 1.1–1.8 mg per cigarette or 22–36 mg per pack. This higher systemic nicotine exposure may impair osteoblast function, reduce angiogenesis, and interfere with bone remodeling all crucial for spinal fusion. Additionally, the chemical additives and solvents in these non-tobacco products are poorly studied and may have cytotoxic or inflammatory effects. Altogether, the combination of elevated nicotine bioavailability and potentially harmful additives may contribute to worse fusion outcomes in NTND users than in traditional smokers.
4. Your findings showed a lower rate of adjacent segment disease in NTND users. How do you interpret this result, and what directions might future research take to better understand it?
It’s possible this unexpected finding is partly related to how the analysis or outcome definitions were captured in the electronic health record. Even subtle differences in how ASD events were identified or classified among institutions within TriNetX (Cambridge, MA) could influence the rates observed between groups. While biomechanical explanations remain important to explore, ensuring that both cohorts are captured and coded in exactly the same way is essential as well. This finding would benefit from validation through more rigorous, standardized research to determine whether it reflects a true clinical difference or a methodological artifact.
5. As nontobacco nicotine use (eg, vapes, pouches) continues to rise, how should spine surgeons incorporate your findings into preoperative risk discussions with younger or “health-conscious” patients who may not view these products as risky?
Spine surgeons should proactively ask about all forms of nicotine use, not just smoking. Many younger or “health-conscious” patients may use vaping or pouch products under the assumption that they are harmless or even beneficial alternatives to smoking. Our findings directly challenge that assumption, showing that nontobacco nicotine use is associated with increased risks of serious postoperative complications, including pseudarthrosis, pneumonia, renal failure, and sepsis.
Surgeons should incorporate these data into preoperative counseling, clearly explaining that nicotine regardless of delivery method can interfere with bone healing and surgical recovery. This is especially important for younger patients who may not see themselves as high-risk. Framing the conversation around outcome optimization rather than judgment can also help encourage more honest disclosure and promote meaningful behavior change.
6. Based on your analysis, what would you recommend as next steps for the spine field – mechanistic studies, patient education campaigns, or clinical screening protocols for NTND?
All three avenues are critical moving forward:
- Mechanistic studies are needed to explore how high-dose nicotine and product-specific additives affect bone healing, vascularity, and systemic inflammation at the cellular and molecular levels.
- Patient education campaigns should be developed to inform the public about the risks of nontobacco nicotine use in the context of surgery.
- Clinical screening protocols should be updated to include NTND as a distinct category during preoperative assessment, ensuring that these patients receive appropriate counseling and risk mitigation strategies.
7. Is there anything else you’d like readers to know about this paper?
This study highlights an important and underrecognized issue in spine surgery: not all nicotine exposure is the same. As nontobacco products continue to evolve and become more prevalent, it is essential for clinicians to understand and address their potential impact on surgical outcomes. We hope this research encourages further investigation, greater clinical awareness, and more nuanced conversations with patients around nicotine use and recovery.
78. Sensitivity and specificity of multimodal neuromonitoring for the detection of neurological adverse events in lumbar spine surgery
Gwyneth C Maloy, BA; Meera Dhodapkar, MD; Scott Halperin, MD; Marcia-Ruth Ndege, BS; Brooke Callahan, AuD; Adam Doan, DC, DABNM; Jonathan N. Grauer, MD
1. What question is your research trying to answer?
The potential advantage of using overlapping or redundant intraoperative neuromonitoring (IONM) modalities to enhance the precision of intraoperative alerts in lumbar spine surgery remains underexplored. To address this gap in the literature, our study compared the utility of several neuromonitoring strategies at predicting dorsiflexion injuries during elective lumbar surgeries.
2. Please summarize your key findings and comment on their clinical significance.
First, we found the overall rate of IONM alerts was reassuringly low, with fewer than 5% of patients had unresolved alerts at the end of the case. Next, we found that the sensitivity of IONM at detecting neurologic injuries that could result in foot drop varied by modality, and improved with overlapping/redundant myotomal and nerve coverage. Finally, we found that the specificity of IONM was excellent, measuring 99% or greater for each of the monitoring modalities. The high specificity suggests that there were very few false positives (instances where there was an unresolved alert at the end of the case, but no postoperative deficit).
3. What is surprising, exciting, or different about your research results?
While much of the IOMN literature focuses on deformity surgery, our study features a large sample size and broader range of lumbar degenerative diagnoses.
4. Combined TcMEP and SSEP monitoring yielded a 100% sensitivity for detecting dorsiflexion injuries. Were there particular case characteristics where multimodal monitoring proved especially valuable?
Our cohort was comprised of adult patients undergoing elective lumbar spine surgery with the use of multimodal neuromonitoring. Of 738 patients, 11 had only TcMEP alerts, 14 had only SSEP alerts, and 10 had both. Given the low rate of intraoperative neuromonitoring alerts observed in the study, sensitivity could not be compared across different case characteristics.
5. Based on your analysis, what considerations should spine teams keep in mind when selecting neuromonitoring strategies for lumbar fusion, especially when balancing sensitivity, specificity, and surgical complexity?
At our institution, it is standard practice to utilize intraoperative neuromonitoring for all instrumented cases. In this context, the specificity is excellent across neuromonitoring strategies, but the sensitivity is more variable. We found that the combined use of TA/EHL TcMEP monitoring improved sensitivity for detecting dorsiflexion injuries to 100%. While not commonly included in IONM protocols, the addition of EHL appears particularly beneficial for improving this sensitivity. Therefore, based on these data, teams may consider adding both TA and EHL TcMEP monitoring to standard SSEP coverage for improved sensitivity of detecting dorsiflexion injuries.
79. Patients receiving GLP-1 agonists have reduced odds of pseudarthrosis and revision following anterior cervical discectomy and fusion surgery
Manaav Mehta, BS; Abhinav Sharma, MD; Paramveer Birring, BS; Michael Sukhyun Kim, MD; Hao-Hua Wu, MD; Sohaib Hashmi, MD; Don Y. Park, MD; Yu-Po Lee, MD; Nitin N. Bhatia, MD
1. What question is your research trying to answer?
With the aging population, the volume of anterior cervical fusion procedures is projected to rise substantially over the next two decades. This growth has been accompanied by an increase in postoperative complications, most notably pseudoarthrosis—. Recent literature has reported improved outcomes in various orthopaedic procedures with postoperative use of glucagon-like peptide-1 (GLP-1) agonists. Building on this evidence, we sought to evaluate the association between GLP-1 agonist use and the risk of pseudoarthrosis, as well as other perioperative outcomes, in patients undergoing anterior cervical discectomy and fusion (ACDF).
2. Please summarize your key findings and comment on their clinical significance.
Using the TriNetX (Cambridge, MA) global health database, 2,144 patients who received GLP-1 agonists within 1 year post-ACDF surgery were compared to propensity matched controls. The cohort was 80% diabetic and 68% obese. GLP-1 agonist usage was significantly associated with reduced odds of radiographic pseudoarthrosis within 2 years post-operation. Furthermore, GLP-1 agonist usage was also significantly associated with reduced odds of ED visits, inpatient hospitalizations, and sepsis within 90 days post-operatively; and dysphagia and revision surgery within 2 years post-operatively. It was not associated with DVT, PE, surgical site infections, wound complications, opioid abuse, adjacent segment disease, and implant failure.
3. Given the high rates of diabetes and obesity in the matched cohort, how do you think those comorbidities may have interacted with GLP-1 use to influence outcomes? Do you suspect the benefits are primary metabolic, anti-inflammatory, or part of a broader physiologic effect?
The primary use of GLP-1 agonists are for glycemic control in patients with diabetes and weight loss in patients with obesity. Recent medical literature has suggested that GLP-1 agonists can improve bone healing and treat cardiovascular disease, heart failure, kidney disease, liver disease, and alcohol use disorder. Much of their utility in these diseases can be indirectly contributed to glycemic and weight control, but there is increasing data favoring independent anti-inflammatory and cell-specific mechanisms. Laboratory studies have demonstrated that GLP-1 agonists have increased osteoblast differentiation and mineralization functionality, osteoclast inhibition, and VEGF upregulation for improved angiogenesis. In this retrospective study of ACDF surgeries, the improved outcomes with GLP-1 agonists are most likely from the combination of metabolic, anti-inflammatory, and bone-specific effects. Further basic science research is required to prove this hypothesis.
4. In a field where spine surgeons often grapple with challenging fusion environments, do you see GLP-1 agonists emerging as a modifiable factor in prehabilitation planning?
Although the mechanical load associated with obesity may not directly affect the success rates of cervical fusion surgery, the heightened baseline inflammatory state seen in obesity and metabolic syndrome can significantly impair bone healing. Large trials such as SELECT, STEP, STEP-HFpEF, and FLOW have demonstrated the ability of GLP-1 agonists to slow, and in some cases reverse, the effects of metabolic syndrome. In addition to their metabolic benefits, GLP-1 agonists have shown favorable effects on bone formation and remodeling. These combined biological effects may not only improve outcomes in current surgical candidates but also expand eligibility to patients who previously did not meet surgical criteria. Further research is needed to determine the optimal timing of GLP-1 agonist administration relative to surgery, including the potential benefits of preoperative use, before formal recommendations can be made.
5. What would an ideal next step look like – whether a prospective trial, animal model, or mechanistic study – to explore how GLP-1 use may influence bone biology and healing postfusion?
Retrospective observational studies—such as this study—have found favorable effects of GLP-1 agonists on fusion and other perioperative outcomes; however, prospective trials are necessary to quantify association versus causation and identify risks hidden by observational studies. Animal models and mechanistic studies would be useful for understanding the biology underlying the outcomes, but clinical studies would be more influential in surgical decision making.
80. The effect of lumbar decompression on walking in patients with symptomatic lumbar degenerative disease
Ram Haddas, PhD, MBA, MEng; Ashley L Rogerson, MD; Paul T. Rubery, MD; Haseeb Goheer, BS; Clarke Cady-McCrea, MD; Kostantinos Vasalos, MPT, MBA; Jake Keller, PT, DPT, OCS; Varun Puvanesarajah, MD
1. What question is your research trying to answer?
This study aimed to objectively evaluate the impact of lumbar decompression and fusion on functional disabilities. Specifically we studied gait performance and balance, as well as patient-reported outcome measures (PROMs), in patients with lumbar spinal stenosis with symptoms of either neurogenic claudication or unilateral radiculopathy. We quantified how surgical intervention modifies the gait-related impairment that significantly affects quality of life in this population.
2. Please summarize your key findings and comment on the clinical significance.
This study demonstrates that lumbar decompression, with or without fusion, results in clinically meaningful improvements in gait mechanics, balance, and patient-reported outcomes as early as 3 months postoperatively. Patients showed significant increases in stride length, reductions in stride time, and improved Gait Deviation Index (GDI), accompanied by reduced disability (ODI), pain interference (PROMIS), and kinesiophobia. These findings underscore that surgical decompression not only relieves neural compression but also restores functional mobility and motor control, facilitating earlier return to ambulation and improved quality of life. Importantly, the data support the utility of objective gait analysis as a valuable adjunct to PROMs and radiographic outcomes in evaluating surgical efficacy and informing rehabilitation strategies.
3. Your study uses 3D gait analysis to objectively quantify improvements postsurgery, which is something that’s still uncommon in spine research. What inspired you to incorporate this method, and how do you see it shaping future assessments of functional recovery?
3D gait analysis offers a robust, validated, and objective method to quantify post-surgical functional outcomes. Unlike commonly used clinical scales, which are subject to bias and subjectivity, this tool allows for high-resolution measurement of joint kinematics, ground reaction forces, and neuromuscular coordination in real time. This level of detail facilitates individualized treatment planning and enables us to detect subtle improvements or compensatory patterns not otherwise visible in standard assessments. Looking ahead, the evolution of marker-less gait analysis systems will allow for widespread clinical deployment, including in outpatient or perioperative settings. Preliminary data from our lab using such systems will be presented at NASS this year, offering a glimpse into future scalable applications of this technology.
4. You found measurable improvements in stride time, step length, and GDI at just 3 months postop. Were you surprised by how quickly patients regained function, and do you anticipate further gains beyond this early window?
While the early improvements were encouraging, they were not entirely unexpected. From a biomechanical and neurophysiological standpoint, decompression of neural structures, particularly in cases of central stenosis and neurogenic claudication, can rapidly alleviate nociceptive input, reduce neurogenic inhibition, and restore afferent feedback loops essential for coordinated movement. By reducing mechanical compression and radicular symptoms, surgical intervention likely enables more efficient recruitment of musculature and improved motor control, which directly translates into normalized gait patterns. The observed improvement in stride mechanics and gait efficacy at 3 months supports this mechanism of recovery and confirms that functional gains occur early in the rehabilitation course. Our concurrent collection of kinesiophobia, ODI and PROMIS metrics indicates that pain relief is closely tied to reduced movement avoidance and more confident, efficient locomotion. While most study patients had not yet reached normal gait levels, we anticipate further gains beyond the 6-month window, particularly as neuroplastic adaptation, muscle reconditioning, and targeted rehabilitation continue. These findings advocate for early mobilization and tailored rehab programs that build on the neuromechanical reset afforded by surgery, aiming for full restoration of dynamic function.
5. The study also evaluated psychological fear of movement, which improved significantly after surgery. How do you think these psychosocial shifts contributed to physical recovery, and should they be more routinely measured in surgical follow-up?
Fear-avoidance behavior creates a feedback loop wherein pain leads to reduced movement, muscle inhibition, and further deconditioning. Our findings show that effective surgical intervention can disrupt this cycle, leading to improved confidence in movement, which in turn facilitates physical recovery. Kinesiophobia and PROMIS Mood, as measured in our study, significantly declined postoperatively and correlated with improved gait performance. Given the bidirectional relationship between psychological factors and physical function, routine incorporation of validated psychosocial measures (eg, Tampa Scale for Kinesiophobia and PROMIS) into postoperative care may enhance our ability to identify at-risk patients and implement more targeted rehabilitation strategies.
6. Given your findings, how might gait analysis be used preoperatively to support shared decision-making—whether to confirm disability severity, guide timing of surgery, or tailor postoperative care plans?
Preoperative gait analysis provides objective, quantifiable evidence of functional impairment, which can enhance patient counseling and shared decision-making. This technology enables surgeons and the broader spine care team, including physiatrists and physical therapists, to better identify the severity and nature of disability, customize rehabilitation protocols, and potentially predict responsiveness to surgery. Our group is currently analyzing long-term data to determine which biomechanical variables best correlate with sustained functional recovery and may be used as predictive biomarkers for surgical outcomes.
7. What role do you see objective gait analysis playing in standardizing disability assessment or setting patient expectations in lumbar degenerative disease treatments?
Objective gait analysis has the potential to standardize functional disability assessments and create a more uniform language across institutions. Gait is increasingly recognized as the “sixth vital sign,” particularly in populations with spinal pathology where ambulation is a key marker of independence and quality of life. As motion analysis becomes more accessible, through advancements in technology and cost reduction, integrating these assessments into routine pre- and postoperative evaluations can help calibrate patient expectations, document functional progress, and guide return-to-activity decisions with greater precision.
8. Is there anything else you’d like readers to know about your paper?
This study uniquely examines joint kinematic patterns and intersegmental compensations, highlighting how lumbar decompression and fusion influences whole-body biomechanics. These compensatory mechanisms, often overlooked in traditional clinical assessments, were significantly reduced postoperatively, suggesting return of normal and efficient movement. This study underscores the value of detailed motion analysis in refining our understanding of how surgical interventions impact the kinematic chain and may aid in developing more effective, individualized rehabilitation protocols.
81. The predictive value of Hounsfield units for titanium mesh cage subsidence after anterior cervical corpectomy and fusion
Sibo Wang, PhD; Haimiti Abudouaini, MD
Q&A not available at time of publishing.
82. Comparison of postoperative proton pump inhibitors vs histamine H2-receptor antagonists use on complication rates following Multilevel lumbar fusions
Uttsav Patel, BA; Kenny Ling, MD; Rafael Madera, BS; Sean Jang, BS; Joseph Kim, BS; Brian Lynch, MD
1. What question is your research trying to answer?
Our study aimed to determine whether postoperative use of proton pump inhibitors (PPIs), compared to histamine-2 receptor antagonists (H2RAs), is associated with higher complication rates in patients undergoing multilevel lumbar fusion. Specifically, we aimed to investigate the effects of these two common forms of gastrointestinal prophylaxis on short-term complications, such as pneumonia, as well as long-term outcomes, including mechanical failure, pseudarthrosis, and revision surgery.
2. Please summarize your key findings and comment on the clinical significance.
In a propensity-matched cohort of over 14,000 patients, we found that postoperative PPI use was associated with significantly higher rates of several complications compared to H2RA use. Within 90 days of surgery, PPI users experienced increased rates of pneumonia (1.98% vs. 1.26%, RR = 1.57, P = 0.001) and postoperative anemia (15.22% vs. 13.74%, RR = 1.11, P = 0.011). At two years postoperatively, these patients also had higher rates of revision surgery (9.14% vs. 7.38%, RR = 1.24, P < 0.001), radiographic pedicle screw loosening (5.29% vs. 4.29%, RR = 1.23, P = 0.005), and general mechanical complications (21.41% vs. 20.00%, RR = 1.07, P = 0.034).
These findings suggest that the type of acid suppression therapy prescribed postoperatively may meaningfully influence both early and late outcomes following multi-level lumbar fusion. While PPIs remain effective at preventing stress ulcers, their potential impact on bone metabolism, infection risk, and tissue integrity may warrant greater caution when used routinely in spinal surgery populations. H2RAs may offer a safer alternative in patients without a strict indication for PPI therapy. Our study highlights the importance of re-evaluating standard GI prophylaxis practices in the perioperative care of spine patients.
3. Your study found significantly higher short- and long-term complications in patients receiving PPIs compared to H2 blockers. Given their widespread use, how do you think this should shape prescribing habits in the postoperative spine setting?
We envision that PPI use in the postoperative spine setting will gradually decline as awareness and understanding of their risk profile continues to grow. Although PPIs are effective for gastrointestinal prophylaxis, this benefit should be cautiously weighted against post-operative risks . H2 receptor antagonists (H2RAs) may offer a more favorable risk profile with respect to postoperative complications and can therefore be considered as a first line of prophylaxis. The lowest effective PPI dose may then be reserved for those with specific indications or contraindications to H2RAs. Furthermore, clinicians may wish to consider a history of long-term and/or high-dose PPI use as a risk factor for certain postoperative complications when evaluating patients’ surgical candidacy.
4. While PPIs have been previously linked to poor bone healing in cervical fusion, your study extends that concern to multilevel lumbar fusion. Were you expecting to see such broad and consistent differences across outcome measures?
Yes, we anticipated these differences prior to conducting our analysis. Beyond the aforementioned concerns on bone healing in cervical fusion, PPI usage has been broadly linked to poorer bone health and greater fracture susceptibility across several other skeletal regions, such as the hip and wrist. Given the growing concerns regarding the deleterious effects of PPIs on bone health, we found it reasonable to study lumbar fusions.
5. For surgical teams who want to consider switching to H2 blockers but may be unfamiliar with them in this context, what should they know about their use and tolerability postop?
Histamine-2 receptor antagonists (H2RAs) are overall well tolerated and effective for postoperative gastrointestinal prophylaxis. While they are comparatively less potent than PPIs, they offer a reduced risk profile and are nonetheless effective at reducing gastric volume and acidity. Tolerability is generally favorable, though a few rare adverse effects have been documented. Central nervous system symptoms and gastrointestinal disturbances are among the more commonly reported adverse effects, but are typically mild in severity. As previously discussed, H2RAs may be suitable as a conservative first-line option for postoperative gastrointestinal prophylaxis, with possible escalation to PPIs if clinically indicated.
6. Given the strength of your findings, what would a prospective trial need to look like to further validate this data and support formal guideline changes?
To further validate the findings of our study and support formal guideline changes, a prospective trial would ideally take the form of a single-center randomized controlled trial (RCT), with the potential to expand to multiple centers. In this trial, multi-level lumbar fusion patients would be randomly assigned to receive either a PPI or an H2RA, with follow-up over a two-year period. The trial would assess short-term complications within 90 days, such as pneumonia, anemia, and dural tears, as well as long-term surgical outcomes including mechanical failure, revision surgery, and pseudarthrosis. This design would allow for a rigorous comparison of the effectiveness and safety of PPIs versus H2RAs in a controlled postoperative spine surgery setting.
A cost-effectiveness analysis would also be incorporated to evaluate the financial implications of postoperative PPI versus H2RA use. Dosing regimens would be standardized across both groups to minimize variability and ensure meaningful comparisons. Although DEXA scans are not currently included in the conceptual design, they may be considered in future iterations to explore long-term effects on bone health. The primary focus, however, would remain on drug-related complications, with the goal of generating evidence that could inform clinical decision-making and guideline updates.
7. Is there anything else you’d like readers to know about your paper?
We would like readers to consider the implications of routinely prescribed medications postoperatively that may not have an obvious connection to negative outcomes but may in fact play a role. We would encourage all surgeons and healthcare providers to carefully evaluate their postoperative regimens and consider potentially safer alternatives.