Non-benchmark patients with perihilar cholangiocarcinoma can achieve good outcomes despite higher complexity. 64% of 648 patients analyzed were classified as non-benchmark, with median overall survival at 46 months. Postoperative liver failure occurred in 16.7%, bile leakage in 22.8%, and in-hospital mortality was 2.9%, all within benchmark limits. Choose treatment strategies carefully: complexity impacts survival significantly, […]
Author: STITCHES Newsletter
Radiation and chemotherapy improve rectal cancer outcomes
Total neoadjuvant therapy (TNT) drastically reduces the risk of distant metastasis in locally advanced rectal cancer compared to traditional methods. 5-year locoregional recurrence rate is only 6%, and distant metastasis rate is 25%. Among 109 patients with clinical complete response (25%), there were no locoregional recurrences and just 13% had distant metastasis. Rethink patient selection […]
Volume of EMS Clinicians Linked to Lower Trauma Mortality
Increased annual trauma volumes per EMS clinician significantly lower early mortality in severely injured patients. For every 5 additional adult trauma patients annually, 6-hour mortality decreases by 10% (adjusted odds ratio 0.899). A 2.6% reduction in in-hospital mortality is also observed with increased volume (aor 0.974). Consider optimizing EMS staffing and training to improve early […]
Circulating Tumor DNA Enhances Risk Stratification in Esophageal Cancer
Preoperative circulating tumor DNA (ctDNA) testing can significantly improve risk stratification for patients with early-stage esophageal squamous cell carcinoma (ESCC). CtDNA detected in 48.6% of patients; higher prevalence in t2n0 (57.8%) vs t1b (20%). Positive ctDNA results correlate with worse recurrence-free survival (RFS) and overall survival (OS) — hazard ratios of 4.15 and 4.02, respectively. […]
Long-Term Outcomes: Laparoscopic vs Open Adhesiolysis
Laparoscopic adhesiolysis for small bowel obstruction (SBO) offers short-term recovery advantages but shows no long-term superiority over open surgery. At five years, recurrence rates were similar: 9.7% for open vs. 12.5% for laparoscopic (p>.99). Incisional hernia rates were also comparable at 6.1% for open vs. 6.3% for laparoscopic (p>.99). Quality of life scores, based on […]
Circulating Tumor DNA Predicts Recurrence in Pancreatic Cancer
Preoperative and postoperative circulating tumor DNA (ctDNA) are crucial for predicting outcomes in pancreatic cancer patients undergoing surgery. Preoperative ctDNA presence linked to 2.08-fold higher risk of disease-free survival (DFS) and 2.31-fold increased risk of overall survival (OS). Postoperative positivity raises the risk of DFS by 3.29 times and OS by 3.42 times. Monitoring ctDNA […]
Improving Surgical Decision-Making for Dementia Patients
Surgeons must navigate the complex landscape of surgical decision-making for patients with dementia, emphasizing informed choices and collaboration. 28 recommendations were developed, with 25 deemed critically important but feasible only in the long-term. Consensus among 23 stakeholders highlighted the need for better resources and team-based care for surgical candidates with cognitive impairment. Prioritize education on […]
Elective Surgery Waitlists Linked to High Emergency Admissions
Patients awaiting elective procedures are facing significant emergency hospital admissions, highlighting a need for timely surgical interventions. Over 33 million waiting days led to 69,322 emergency admissions, using 535,806 bed days. Highest emergency admission rates were for urinary stent procedures (0.71) and endoscopic retrograde cholangiopancreatography (0.63). Surgeons should prioritize timely treatment to reduce patient risks […]
Multimodal Prehabilitation Shows Limited Impact on Surgery
Multimodal prehabilitation didn’t significantly reduce complications or hospital stays for elective surgery patients, suggesting a need for focused patient selection. Among 4,131 patients, no difference in complications (adjusted risk ratio 1.02) or hospital stay (adjusted ratio 1.04) was found between standard care and prehabilitation. In high-risk gastrointestinal surgery patients, complication risk was 9% lower but […]
Medicare Advantage Limits Access for Surgical Specialists
Medicare Advantage plans often limit patient access to surgical specialists, which can affect care delivery and outcomes. Among 36,584 counties, the average Medicare Advantage network included only 57.6% of surgical specialists. Plastic surgery networks had the least access, averaging 47.1%, while vascular, thoracic, and orthopedic networks exceeded 60%. Over 1 million enrollees reside in counties […]