Medicaid Expansion in southern states significantly increased insurance access for underserved groups with pancreatic ductal adenocarcinoma (PDAC). Expanded states had a 36% higher odds of Medicaid insurance and increased proportions of insured black, rural, and impoverished patients. However, the odds of receiving radiation therapy decreased annually in expanded states. Although ME did not impact the […]
Author: STITCHES Newsletter
Adjuvant Therapy Benefits Pancreatic Cancer Patients with Short Neoadjuvant Duration or Microscopic Margins
A retrospective study on 529 pancreatic cancer patients after neoadjuvant therapy reveals adjuvant therapy’s survival benefit. For the entire cohort, no significant overall survival difference was observed. However, subgroup analysis shows a survival advantage with adjuvant therapy for those with less than 4 months of neoadjuvant treatment or microscopic margin positive surgical resections. This insight […]
Similar Pain and Opioid Use in Benign and Malignant Colorectal Resections
Comparing 641 benign and 276 malignant colorectal resection patients, initial unadjusted analysis showed higher pain scores and more opioids for benign cases. Yet, in an enhanced recovery pathway emphasizing non-opioid strategies, regression analysis nullified the differences. Notably, both groups exhibited comparable pain levels and opioid prescriptions postoperatively. This challenges previous inconclusive findings, suggesting that pain […]
Implication of Geriatric Assessment in Colorectal Surgery
Colorectal surgery among older adults is increasing, with geriatric conditions posing risks for poor outcomes. A systematic review found 25 cohort studies but no randomized trials on geriatric assessment in this context. Few studies focused on the domain of what matters most to geriatric patients, revealing a gap in evidence for tailored management strategies. Evidence […]
Effectiveness of REBOA as a Bridge to Hemostasis in Massive Gastrointestinal Bleeding
Resuscitative endovascular balloon occlusion of the aorta (REBOA) was used in five cases of severe gastrointestinal bleeding, providing temporary hemorrhage control and enabling additional hemostatic maneuvers. Systolic blood pressure increased post-REBOA placement, and three patients survived beyond 24 hours. Although all patients ultimately succumbed to hemorrhagic shock, REBOA proved effective as a bridging tool for […]
LMIC Perspectives on Global Surgery Partnerships
LMIC surgeons value clinical and educational partnerships in global surgery collaborations with HICs. They express the need for a formal process to assess resources and needs at the beginning of partnerships and cite a lack of structure for long-term collaborations. Despite challenges during the COVID-19 pandemic, most partnerships continued, with some partners reporting weaker relationships. […]
Vacuum External Fixation Outperforms Chest Strap in Treating Multiple Rib Fractures in Polytrauma Patients
Vacuum external fixation showed superior therapeutic efficacy compared to chest strap in polytrauma patients with multiple rib fractures. Patients with vacuum external fixation had significantly lower pain scores, reduced pleural drainage, lower risk of complications, improved lung function, and shorter hospital stays. Overall, vacuum external fixation demonstrated benefits in reducing complications and improving clinical outcomes […]
Long-term Mortality Risk in Total Pancreatectomy Patients with Islet Autotransplant
Total pancreatectomy with islet autotransplant (TPIAT) for pancreatitis patients has a 10-year survival rate of 85.2% and a 15-year rate of 76.2%. Most deaths (53 out of 89) were possibly related to TPIAT, with causes including chronic gastrointestinal issues, malnutrition, and diabetes. Younger age, longer disease duration, and recent procedures were linked to lower mortality. […]
Impact of KRAS and Histopathological Growth Patterns on Resection Margins in Colorectal Liver Metastases
In colorectal liver metastases (CRLM), the review investigates the association between KRAS status, histopathological growth patterns (HGPs), and their impact on resection margins around major vasculature and bile ducts. The study emphasizes the importance of balancing negative margins and preserving vascular and biliary structures during surgery. While parenchymal sparing is crucial, the review explores how […]
Identifying Low Phospholipid Associated Cholelithiasis as an Under-Recognized Cause of Post-Cholecystectomy Pain
Among patients under 40 undergoing cholecystectomy, 1.9% exhibited symptoms suggestive of low phospholipid associated cholelithiasis (lpac). Family and obstetric history may aid in its diagnosis, as none of the lpac cases were initially recognized by clinicians. This study highlights the importance of considering lpac in cases of post-cholecystectomy pain, as timely treatment can prevent long-term […]