Roux-en-Y gastric bypass (RYGB) reversal is rare but offers significant symptom relief for select patients with complications. 199 patients underwent RYGB reversal over 16 years, 0.3% of 63,797 RYGBs. 86% reported symptom relief; highest in those with postbariatric hypoglycemia (94.6%). Complications are common: 24.6% had early severe complications, 21.6% experienced late complications. Careful patient selection […]
Author: STITCHES Newsletter
Predicting Days at Home after GI Cancer Surgery with HOMEDAYS
A new prediction model helps surgeons estimate patient recovery time after gastrointestinal cancer surgery, improving preoperative counseling. Among 91,270 patients, the median days at home within 90 days post-surgery was 82 (IQR 77-85). The model achieved strong accuracy (mean absolute error 8.67) and good calibration. This tool enhances shared decision-making by providing tailored recovery expectations […]
High-Risk Substance Use in Elective Surgery Patients
Over one-quarter of elective surgery patients exhibit high-risk substance use, signaling potential complications. 27.6% of patients reported high-risk substance use; 6.6% reported polysubstance use. Most common substances: cannabis (15.0%), alcohol (11.1%), and nicotine (8.5%). Routine preoperative screening is essential to identify these risks and optimize patient outcomes. Highest rates of high-risk use were seen in […]
ACS Verification Improves Surgical Quality Metrics
ACS verification enhances safety and effectiveness across multiple surgical outcomes. 61% of outcomes improved with ACS verification; 34% showed no difference. Significant gains in safety (p=0.0024), effectiveness (p<0.0001), equity (p=0.001), and patient-centeredness (p<0.0001). Consider ACS verification as a pivotal strategy for quality improvement, particularly in safety-focused practices. Efficiency and timeliness outcomes were less consistent and […]
Laparoscopic Enucleation of Insulinomas: A Game Changer
Surgeons can safely enucleate multiple insulinomas near the main pancreatic duct using a novel approach that combines indocyanine green (ICG) fluorescence imaging with intraoperative ultrasound (IOUS). A 12.5 mg ICG bolus delivered intraoperatively allowed rapid tumor enhancement within 15 seconds and clear demarcation at 30 minutes. The procedure resulted in minimal blood loss (50 mL) […]
New Model Accurately Predicts Postoperative Risk
A new model incorporates complex health data to better predict complications after major surgeries, enhancing surgical decision-making and patient safety. Complication prevalence: 8% ICU admission, 4% mechanical ventilation, 7% acute kidney injury, and 1% in-hospital mortality. Model performance: AUROC scores of 0.93 for ICU admission, 0.94 for mechanical ventilation, 0.92 for acute kidney injury, and […]
Gastrointestinal Cancer Surgery: Prolonged Recovery Risks Identified
Older adults undergoing emergency surgery for gastrointestinal cancer often face complicated recovery trajectories that impact care planning. Among 15,398 patients, 13.2% experienced sustained high dependency beyond home, linked to advanced disease and frailty. Factors like stage IV disease (ARR 2.39) and frailty (ARR 2.58) significantly increase the risk of extended hospital stay and institutional dependence. […]
Mapping Surgical Evidence for GEP-NETs
Surgical management of gastro-entero-pancreatic neuroendocrine tumors is inconsistent, highlighting the need for clearer guidelines. Only 4% of studies on surgery for GEP-NETs are prospective; 96.7% are retrospective. Most research focuses on small pancreatic NETs and liver metastases, limiting broader applicability. Surgeons should prioritize evidence from multi-institutional studies for better patient selection and outcomes. Current literature […]
Delayed Recovery in Gastrectomy: Total vs. Other Procedures
Total gastrectomy patients experience slower recovery and greater symptom burden compared to other types of gastrectomy. Recovery rates for total gastrectomy were 63% at one month and only 75% by six months, compared to 79% and 96% for other procedures. Open total gastrectomy had a significantly lower odds ratio for recovery (0.28) compared to robotic […]
Laparoscopic Cholecystectomy Outperforms Open and Robotic Methods
Laparoscopic cholecystectomy reduces mortality and complications compared to open surgery, especially in low- and middle-income settings. Laparoscopic surgery cut mortality risk by 84% (RR 0.16) and complications by 54% (RR 0.46) versus open cholecystectomy. Length of hospital stay decreased by an average of 4.08 days with laparoscopic techniques. Robotic surgery did not show significant advantages […]