Surgeon education on intraoperative do not resuscitate (DNR) orders is crucial for enhancing patient care and respecting autonomy. 56.5% of surgery residents mistakenly thought DNR status must be revoked for elective surgeries; 52.1% believed this for emergencies. A simulation-based curriculum significantly boosted residents’ confidence (p < .001) and corrected misconceptions regarding DNR status preservation (p […]
Author: STITCHES Newsletter
New Machine Learning Tool Improves Social Risk Assessment for Surgery
A new machine learning-based index enhances social risk evaluation in surgical patients, crucial for better outcomes and health equity. Models using machine learning outperformed conventional indices, showing a median 8.15-fold increase in predictive power across 14 surgical outcomes. The study analyzed over 3.2 million patients from 688 hospitals, providing tailored social risk insights for different […]
New Endpoint May Streamline Trials for Colon and Liver Surgery
A composite endpoint approach can help assess outcomes in simultaneous resections for colon cancer with synchronous liver metastases, improving clinical trial efficiency. In a study of 1,591 patients, 24.3% had a positive composite postoperative endpoint (CELCSS), indicating potential complications. CELCSS includes key issues like colon anastomotic leak (15.4%) and postoperative bleeding (6.5%), predicting prolonged hospital […]
Thoracoscopic Oesophagectomy Matches Open Approach in Cancer Patients
Thoracoscopic oesophagectomy is non-inferior to open oesophagectomy regarding overall survival for resectable thoracic oesophageal cancer. 300 patients were studied: 150 underwent open surgery, 150 had the thoracoscopic procedure. At the first interim analysis (1.6 years median follow-up), overall survival was statistically preserved for the thoracoscopic group (HR 0.56). Consider thoracoscopic approaches to enhance patient recovery […]
Transcylindrical Cholecystectomy: Fast, Safe, and Effective
Transcylindrical cholecystectomy offers a promising outpatient option for treating cholelithiasis with minimal complications. Operative time averages 40 minutes with a low conversion rate of 0.9%. Complication rates include 2.2% wound infections, 0.5% bile leaks, and 0.1% mortality. Most patients (78%) report good to excellent condition within 24 hours. Consider this technique for low-risk patients, particularly […]
Improved Survival in Gallbladder Cancer Post-Surgery
Textbook outcomes in liver surgery link directly to better survival in gallbladder cancer patients. 61.9% of patients achieved textbook outcomes (TOLS) after curative-intent resection. The 5-year overall survival rate was 45.4% in the TOLS group compared to 21.9% for non-TOLS (p < 0.001). Surgeons should prioritize achieving TOLS to improve long-term patient outcomes. Key risk […]
Proactive Laparoscopic Cholecystectomy Safe for Complex Cases
Surgeons can confidently perform proactive emergency laparoscopic cholecystectomy for complex acute cholecystitis, showing strong outcomes even in high-risk patients. Among 721 patients, the overall complication rate was just 6.9%, with severe complications at 1.2%. Patients older than 80 had no higher complication rates (p = 0.14) compared to younger patients. Indocyanine green cholangiography significantly reduced […]
Biliary Stenting with Radioactive Seeds Enhances Survival in Cholangiocarcinoma
Combining biliary stenting with intraluminal 125 I seed brachytherapy significantly improves outcomes for advanced cholangiocarcinoma patients. Patients receiving the combination treatment had a longer overall survival and better stent patency (p < 0.001) compared to those with stenting alone. Complication rates were comparable between both groups, indicating safety (p > 0.85). Integrating this technique could […]
Effective TROPIS Procedure for High Complex Anal Fistulas
The TROPIS procedure shows promise for treating high complex anal fistulas with strong outcomes. One-time cure rate stands at 80% with a final cure rate of 89%. Recurrence rate after initial surgery is low at 20%, with no reported adverse events. Consider adopting TROPIS as a viable option in surgical practice for this challenging condition. […]
Surgical Strategies for Proximal Early Gastric Cancer: Dtr and Dft Shine
Surgeons need to know that proximal gastrectomy methods dtr and dft outperform tg and eg in key outcomes for early gastric cancer. Reflux esophagitis rates were higher in eg compared to dft and dtr. Anastomotic stenosis was less common with dtr than eg. Dft achieved the highest 12-month hemoglobin levels; hospital stay was shorter compared […]