In older adults undergoing surgery, new Do Not Resuscitate (DNR) orders often indicate significant risk factors and timing that can guide surgical decision-making. Only 2.3% of 47,564 cases resulted in new perioperative DNR orders. Key predictors of DNR orders: ASA IV/V (2.6x), disseminated cancer (3.3x), and emergent surgery (3.5x). DNR orders typically occur early post-surgery; […]
Author: STITCHES Newsletter
Navigating Surgical Responsibilities in Acute GI Care
Surgeons must clarify roles between acute care and colorectal surgeons for better patient outcomes in acute lower gastrointestinal conditions. Consensus reached on service assignment for only 10 of 20 conditions (50%). Key determinants for service allocation include surgeon expertise, patient status, and institutional resources. Understanding these factors can enhance triage protocols and improve patient management […]
Novel Laparoscopic Technique for Duodenal Perforation Repair
A new laparoscopic approach for treating duodenal perforations could reshape surgical practices. Successfully repaired a descending duodenal perforation using a trans-mesocolic technique in a 69-year-old woman. The surgery utilized the superior mesenteric vein for safe access, leading to an uncomplicated recovery. This technique may reduce operative trauma compared to traditional methods, highlighting the need for […]
Conservative management of postoperative bowel obstructions works for some patients.
63.4% of patients with adhesive small bowel obstruction (ASBO) had successful conservative treatment. Key factors predicting treatment failure include: vomiting (aOR 0.476), abdominal distension (aOR 0.301), and guarding/rebound tenderness (aOR 0.354). Generalized tenderness was positively associated with success (aOR 1.903). Surgeons can use these clinical symptoms and imaging findings to identify patients who may need […]
Ventral hernia management shifting based on new trials
Recent RCTs show significant reversals in accepted hernia practices, urging surgeons to reassess interventions. One-third of relevant trials led to medical reversals, highlighting outdated practices. Of 396 guideline comparisons, 37.5% contradicted current recommendations. Surgeons must stay updated on emerging evidence to ensure optimal patient outcomes. Over half of trials explored areas not covered by existing […]
Frailty Risks Drive Mortality After Pancreatectomy
Frailty significantly raises the risk of death and readmission after pancreatic surgery, primarily through postoperative complications. 22.2% of 71,104 patients were frail, with 30-day mortality linked to frailty (aOR 1.29) and readmission (aOR 1.11). Complications mediated 80.72% of the frailty-mortality association, with unplanned reintubation and major infections among the top culprits. Focus on preventing complications […]
Optimize Postoperative Nutrition for Pancreatoduodenectomy
Early enteral nutrition (EEN) via nasojejunal tube reduces complications after pancreatoduodenectomy compared to oral nutrition (ON). EEN patients had a mean 90-day complication index of 25.5 vs. 35.8 for ON (p = .02). Overall morbidity was slightly higher in ON (51/59) vs. EEN (45/59), but not statistically significant. Implementing EEN in nutritionally at-risk patients can […]
Funnel-Shaped Mesh Reduces Parastomal Hernias After Colostomy
Using funnel-shaped mesh during rectal adenocarcinoma surgery cuts parastomal hernias significantly. At 3 years, CT-confirmed parastomal hernia occurred in 57% of the mesh group vs. 82% in controls, a 25% reduction. Clinically diagnosed hernias were 10% in the mesh group compared to 39% in the control group, marking a 29% difference. This supports funnel-shaped mesh […]
Watch and Wait for Rectal Cancer: Surveillance Gaps Identified
Surgeons need to know that only 62% of patients on watch and wait for rectal cancer adhered to optimal surveillance, raising concerns about early regrowth detection. 53 patients studied, median follow-up of 17 months. Younger patients (median age 54) were more likely to follow optimal surveillance (p = .04). Surveillance failures commonly occurred within the […]
Minimally invasive gastric cancer surgery outperforms open approach
Minimally invasive techniques, especially robotic surgery, yield better results for gastric cancer patients. Textbook outcome achieved in 31.4% of open cases, 56.8% of laparoscopic, and 68.6% of robotic. Hospital stays were shorter for laparoscopic and robotic procedures. Achieving a textbook outcome is linked to improved 1-year survival rates across all techniques. Robotic gastrectomy showed superior […]