Days alive and out of hospital after lung transplant, and burnout figures that depend on where you draw the line

A genuinely quiet day. All fourteen priority journals returned zero for 5–6 September — verified as real zeros, not the silent-failure mode that caught an earlier run — and the aggregator has nothing dated either day. It is a Sunday. The two items below are from Friday, and the third is from the ESC Congress batch.

1. Days alive and out of hospital around lung transplantation

Journal · Published: Chest, 4 September 2026 — 2 days old El Kik, Bian, Pellet, Chatellier et al. (France)

Days alive and out of hospital (DAOH) is a validated patient-centred outcome that had not been applied to lung transplantation. Calculated for the year before first transplant and the two years after, for all patients transplanted in France between 2020 and 2023.

• 1,222 patients, 56% male, median age 57 (IQR 47–62)
• Median DAOH before transplant: 95% (IQR 89–99)
• Median DAOH in the first year after: 80% (IQR 64–87)
• DAOH was lowest in patients with connective tissue disease and after single lung transplant
• It improves substantially beyond the first year

The deposited abstract truncates at the p-value for the before-versus-after comparison.

The authors frame the purpose explicitly as counselling: informing patients about “the demanding nature of the first year post-LT while offering reassurance that DAOH improves substantially beyond this period.”

Interpretation. A simple, honest metric doing something survival curves cannot. A patient asking “what will my life look like?” is not asking about one-year mortality; they are asking how much of the year they will spend at home. Going from 95% to 80% of days at home means roughly 55 days in hospital across that first year — a number you can actually say out loud in clinic, and one most patients would not guess from a survival statistic.

The two predictors are useful precisely because they are known before the operation. Connective tissue disease and single-lung transplant identify patients whose counselling should differ, which is the practical yield here.

It also pairs with the two-surgeon donor review paper sent yesterday. That one was about increasing transplant volume; this one is about what the year after actually costs the patient. Both are needed for the same conversation, and neither is visible in the survival figures that usually carry it.

Read the paper · PMID 42697365

2. Burnout among practising anaesthesia providers

Journal · Published: Anaesthesia, 4 September 2026 — 2 days old Dignam, Lee, Tuyishime, Cunningham, Vittori, Bould

Systematic review quantifying burnout prevalence and appraising the methodological quality of the evidence — the second aim turning out to be the interesting one.

• 50 studies, 35,599 fully qualified anaesthesia providers (31,500 physicians, 4,099 non-physicians); 86% used the Maslach Burnout Inventory
• Median prevalence 42% (IQR 21–59, range 9–99)
• 15 distinct and reproducible MBI-based criteria for dichotomising burnout were identified
• Re-analysis of five datasets gave prevalence estimates for the same population ranging from 3.1% to 69.9%, depending only on which criterion was applied
• Most studies used non-random sampling and were at unclear or high risk of bias

Interpretation. The finding worth carrying is not 42%. It is that the same data yields 3.1% or 69.9% depending on where you draw the line — and that fifteen different lines are in active use.

That should change how you read every burnout headline you encounter, including the ones used to argue for or against workforce interventions. A figure quoted without its dichotomisation criterion is close to meaningless, and the range in this review spans almost the entire possible interval. The authors’ call for standardised subscale reporting and validated binary classification is the right response; until that happens, “burnout prevalence” is a number that can be manufactured to order.

None of which means the problem is not real — a median of 42% across 35,599 providers is not nothing, and the non-random sampling in most studies probably biases toward those motivated to respond. But the measurement critique is the contribution here, and it applies well beyond anaesthesia.

Read the paper · PMID 42695449

3. TARGET-CTCA — CT coronary angiography after myocardial infarction is ruled out

Journal · Published: NEJM, 29 August 2026 — 8 days old, from the ESC Congress batch Lee, Wereski, Lowe, Curzen et al. (UK)

Multicentre randomised trial, 14 UK hospitals. Patients presenting to the emergency department in whom myocardial infarction had been ruled out but whose high-sensitivity troponin indicated intermediate risk (maximum hs-cTnI or T >5 ng/L), randomised 1:1 to outpatient CT coronary angiography-guided care or standard care. Primary outcome: composite of myocardial infarction or cardiac death.

• 3,170 participants (median age 61, 30.2% female), enrolled Sept 2019 – May 2023
• CTCA performed in 92.1% of the CTCA group vs 2.2% of standard care — clean separation
• CTCA-related adverse events in 7 participants (0.4%)
• At a median of 3.0 years: primary outcome in 112 (7.1%) vs 116 (7.3%) — adjusted HR 0.95 (95% CI 0.73–1.23), P=0.71

Interpretation. A clean negative, and a useful one because the trial was well executed — 92% versus 2% is about as good as protocol separation gets in an open trial, so this is not a failure of adherence.

The question it answers is a real and increasingly common one: high-sensitivity troponin rules out infarction in far more patients than the old assays did, leaving a large group who are troponin-detectable, not infarcting, and demonstrably still at risk — 7.3% had an MI or cardiac death within three years. The intuition that finding their coronary disease must help turns out not to hold. Knowing about the plaque did not change the outcome.

Worth reading against SCOT-HEART, which found CTCA reduced MI in stable chest pain. The difference in population is the point: stable outpatients with suspected angina are not the same as ruled-out emergency presentations, and a test’s value does not transfer between them. Note also the ~4-year enrolment and 3-year follow-up — this began before the current era of very-low-level troponin thresholds, though the >5 ng/L entry criterion is squarely contemporary.

Read the paper · PMID 42670980