Patients who bypass their nearest surgical hospitals for urgent procedures may face worse clinical outcomes. Bypass is linked to higher odds of disease progression (adjusted odds ratio 1.22). Complications increase by 12% (aor 1.12) and length of stay by 20% (aor 1.20) for bypass patients. Understanding these risks is essential for optimizing patient selection and […]
Category: General Surgery
Postoperative Triage Matters: Undertriage Increases DNR Orders
Postoperative undertriage of high-acuity patients leads to higher rates of do-not-resuscitate orders and respiratory failure. Patients on standard floors had a 7.2% transition to DNR status versus 2.8% in ICU. Unplanned intubation rates were 12.1% in undertriaged patients compared to 7.1% in ICU counterparts. Surgeons should prioritize optimal triage to prevent adverse outcomes and facilitate […]
Lower diabetes risk with minimally invasive parenchyma-sparing surgery for pancreas tumors
Minimally invasive parenchyma-sparing pancreatectomy (mi-psp) decreases the risk of postoperative diabetes and exocrine insufficiency for benign pancreatic tumors. Only 9.8% of mi-psp patients developed new or worsening diabetes compared to 23% after standard minimally invasive pancreatectomy (mi-p). The 5-year cumulative incidence of new-onset diabetes was 26.7% for mi-psp vs. 38.9% for mi-p (p=0.008). Pancreatic exocrine […]
Safe Same-Day Total Thyroidectomy in High-Volume Settings
Same-day total thyroidectomy is feasible and safe for socioeconomically vulnerable patients, crucial for optimizing surgical flow. 51 out of 140 patients (36%) discharged on the same day; adoption rose from 32% to 88%. Complications were similar between same-day and overnight groups, with no hypoparathyroidism cases in same-day patients. Surgeons can confidently implement same-day discharges to […]
Surgeon-Scientist Trends Impact Research Leadership
Surgeon-scientist representation in surgical research is declining, reshaping the landscape of surgical innovation. NIH surgery funding rose 53% from $352M to $539M, but the total number of grants remained stable. MD-only principal investigators dropped from 48.9% to 40.8%, while MD-PhD investigators increased from 15.2% to 24.9%. A growing disconnect is noted; 93.2% of MD principal […]
Prehospital Whole Blood Transfusion Not Superior in Trauma
Prehospital whole-blood transfusion does not improve outcomes for major traumatic hemorrhage compared to standard blood component therapy. In a study of 616 patients, 48.7% in the whole-blood group and 47.7% in standard care experienced death or massive transfusion within 24 hours (p=0.84). Serious adverse events occurred more frequently in the standard-care group (37 vs. 31 […]
Preoperative Low-Energy Diets May Reduce Surgical Risks
Patients with obesity undergoing non-bariatric surgery who follow low-energy diets show promise for better outcomes. In a pilot study, 91 patients were randomized to a low-energy diet or standard care; adherence to the diet was 81.7%. Patients on the diet lost an average of 4.5 kg in three weeks. A meta-analysis indicated an 18% relative […]
Pre-hospital deaths dominate trauma fatalities in urban systems
Most trauma deaths happen before hospital arrival, highlighting urgent needs in trauma care. Of 3,089 adult trauma patients, 497 (16.1%) died; 77.1% died pre-hospital, typically within 12 minutes of injury. Hemorrhage and traumatic brain injury accounted for 81.9% of deaths, with 96.2% of hemorrhage deaths occurring pre-hospital. Surgeons should focus on improving pre-hospital interventions to […]
Liver Transplant Offers Hope for Colorectal Liver Metastases
Deceased donor liver transplantation (DDLT) improves survival for patients with unresectable colorectal liver metastases (CLM). Overall survival is impressive at 96.9% at one year and 84.8% at two years. Disease-free survival at one year is 62.7%; however, recurrence occurs in 42.9% of cases. Accurate patient selection is crucial; KRAS mutation significantly links to recurrence (p=0.01). […]
Timing of Necrosectomy in Infected Pancreatic Necrosis Matters
Immediate necrosectomy for infected walled-off pancreatic necrosis offers no advantages over an on-demand approach. Clinical success rates were similar: 92% (immediate) vs. 88% (on-demand), p = .5. On-demand patients required fewer necrosectomy sessions (1 vs. 2, p ≤ .01) and had fewer adverse events (24% vs. 40%, p = .2). This suggests that a selective […]