--- title: 'Morning Brief — Monday, October 26, 2026' type: 'episode' url: 'https://doc.social/episodes/morning-brief-2026-10-26' show: 'doc social Morning Brief' show_url: 'https://doc.social/podcasts/morning-brief' published: '2026-10-26' audio: 'https://media.doc.social/podcasts/morning-brief/2026-10-26.mp3' --- # Morning Brief — Monday, October 26, 2026 FDA device center director Michelle Tarver: about 22% staff attrition over the past year and a half, up to 30% of clinical reviewers lost; 65 hires at White Oak beat the FY26 MDUFA goal of 63; 151 novel devices authorized in FY26; MDUFA VI targeted to Congress by January 2027 · J Arthroplasty microsimulation: US orthopaedic surgeon supply falls 1.7% by 2038 under status quo; adequacy 79.5% in the… ## Summary 4 stories this morning, for surgeons and the people who support them. - **FDA device center director Michelle Tarver: about 22% staff attrition over the past year and a half, up to 30% of clinical reviewers lost; 65 hires at White Oak beat the FY26 MDUFA goal of 63; 151 novel devices authorized in FY26; MDUFA VI targeted to Congress by January 2027** — MedTech Dive (Elise Reuter, October 21, 2026), reporting Tarver's remarks at AdvaMed's MedTech Conference in Boston: ~22% attrition, up to 30% of clinical reviewers and many digital health/AI specialists lost; more than 65 hired vs FY26 MDUFA target of 63; 'We are not done.' Cross-checked against RAPS (Ferdous Al-Faruque, October 21, 2026, https://www.raps.org/resource/tarver-cdrh-on-a-recruiting-tear-looking-ahead-to-mdufa-vi.html): 65 hires at White Oak vs goal of 63; on track for nearly all MDUFA V review goals as of September 30; deficiency letters must now state reasons; 151 novel devices in FY26; MDUFA VI (FY2028-2032) targeted to Congress by January 2027, proposes a meeting within 30 days of a de novo application. [Source](https://www.medtechdive.com/news/cdrh-on-hiring-spree-after-significant-staff-losses-director-says/833659/) - **J Arthroplasty microsimulation: US orthopaedic surgeon supply falls 1.7% by 2038 under status quo; adequacy 79.5% in the South vs 102% in the Northeast, and 48.8% in non-metro vs 94.0% in metro areas** — Silvestre J, Leddy LR, Kelly JD, Harris MB, Ahn J, Nelson CL. Published online October 23, 2026 (PMID 42918275). Microsimulation of FTE orthopaedic surgeons using HRSA data, 2026-2038. Status quo supply -1.7%; 10% fewer residency graduates -5.7%; 10% more +1.6%. 2038 adequacy: South 79.5%, West 89.7%, Midwest 90.9%, Northeast 102%; non-metro 48.8% vs metro 94.0%. Lowest states: West Virginia 65.2%, Arkansas 65.7%, Alabama 66.7%, Florida 68.1%, Mississippi 68.8%. [Source](https://doi.org/10.1016/j.arth.2026.10.011) - **Spine J, European Spine Study Group: rod breakage in 30 of 83 adult spinal deformity fusions to the pelvis over ~5 years; titanium HR 0.50 vs cobalt-chromium, diameter >5.5 mm HR 1.90, L4-S1 rod curvature >=33 degrees at 6 weeks HR 2.25** — Baroncini A et al., published online October 23, 2026 (PMID 42918346). Retrospective analysis of prospectively collected six-center data; long posterior fusion to pelvis, multiple-rod constructs excluded; mean follow-up 60.0 months. 30 of 83 broke a rod at mean 41.7 months. L4-S1 curvature >=33 degrees at 6 weeks HR 2.25 (95% CI 1.06-4.77); maximum L1-S1 curvature increase <=4 degrees HR 3.33 (1.25-8.84); titanium vs cobalt-chromium HR 0.50 (p=0.02); diameter >5.5 mm HR 1.90 (p=0.02). Model with rod geometry C-index 0.74. Level III. [Source](https://doi.org/10.1016/j.spinee.2026.10.004) - **ESRA PROSPECT recommendations for pain after total shoulder arthroplasty: acetaminophen, NSAID, IV dexamethasone 8-10 mg, single-shot interscalene with plain bupivacaine or ropivacaine (not liposomal); local infiltration as the alternative** — Mrazek I et al., PROSPECT Working Group of ESRA, Anaesthesia, published online October 22, 2026 (PMID 42910655). Systematic review of 30 RCTs and 7 systematic reviews/meta-analyses. Recommended: paracetamol, perioperative NSAID continued postoperatively, IV dexamethasone 8-10 mg, rescue opioids; single-bolus interscalene block with long-acting local anaesthetic (bupivacaine or ropivacaine), but not liposomal bupivacaine; local infiltration analgesia if contraindicated or no expertise. Conflicting evidence for continuous interscalene catheters and for liposomal bupivacaine in ISB or LIA; no evidence for a specific surgical technique. [Source](https://doi.org/10.1111/anae.70427) ### Contribute to the Brief Faculty can send the show a note — a reaction to a paper, a correction, a read on a rule change — either written, which we shape for broadcast and read in the show's voice, or as a voice note under three minutes, which airs in your own voice. Send one from [Studio](https://next.doc.social/studio). Not on doc social yet? 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