A new definition of major trauma that combines injury severity with urgent trauma-team interventions identified more high-risk patients and deaths than injury scoring alone. In 2.68 million National Trauma Data Bank patients, 22.4% met the combined definition, versus 17.8% with Injury Severity Score above 15. The combined definition had the best discrimination for 24-hour mortality […]
Category: General Surgery
IVC Filter Use Varies Widely in Trauma Care
In severely injured trauma patients, higher hospital use of inferior vena cava filters did not improve survival and was linked to more thromboembolic events. Among 2.28 million patients at 427 level I and II trauma centers, 0.81% received a filter. Use fell from 1.15% in 2017 to 0.59% in 2024, but rates ranged from 0% […]
Prophylactic Insulin Improves Glycemia in Major Surgery
In nondiabetic patients undergoing major abdominopelvic surgery, prophylactic glucose-insulin-potassium infusion was feasible and improved perioperative glucose control without severe hypoglycemia. In this pilot trial, 103 patients were randomized; 97% completed treatment, with no severe hypoglycemic episodes. Euglycemia occurred in 42% with prophylactic insulin versus 27% with placebo. Hyperglycemia occurred in 37% versus 48%, and treatment […]
Antireflux surgery holds up in severe obesity
In 2,388 patients undergoing fundoplication or magnetic sphincter augmentation for reflux disease, body mass index of 35 or higher did not worsen symptom relief, medication independence, or five-year durability. Obese patients had larger hiatal hernias and more severe reflux before surgery. At 1 year, satisfaction was 81.6% versus 83.3%, and proton-pump inhibitor independence was 85.1% […]
Conversion drainage matches primary in acute cholecystitis
For high-risk patients with acute cholecystitis, conversion to endoscopic ultrasound-guided gallbladder drainage after percutaneous drainage achieved outcomes comparable to primary drainage. Multicenter study of 141 patients: technical success was 95.8% after conversion versus 98.3% with primary drainage. Results remained comparable after adjustment, despite more cancer and greater comorbidity in the conversion group. Clinical success, adverse […]
New Hepatocellular Carcinoma Treatment Framework
A new consensus framework for hepatocellular carcinoma (HCC) could transform surgical decision-making and patient outcomes. The BEACON-HCC system integrates clinical features like tumor burden and vascular invasion for more precise treatment options. In a pilot with 29 cases, expert decisions matched BEACON-HCC recommendations 96.6% of the time, compared to 72.4% for current standards. This framework […]
Impact of 2023 CPT Changes on Hernia Repair Reimbursement
The 2023 CPT changes on hernia repair coding significantly boost reimbursement for academic surgeons dealing with larger hernias. Academic centers saw a quarterly increase of 1.98 work relative value units (WRVUs) after the revisions, while nonacademic centers remained stable. For large repairs (>10 cm), WRVUs increased by 1.80. Smaller hernias (<3 cm) showed no change. […]
Robotic Abdominal Wall Reconstruction Matches Open Repair Efficiency
Robotic abdominal wall reconstruction (RAW) offers comparable outcomes to traditional methods while enhancing recovery. RAW provides reduced hospital stays (1 day vs. 3-4 days for open surgery) and lower readmission rates. Similar long-term recurrence rates across open, laparoscopic, and robotic techniques, with early outcomes influenced by surgical experience. Surgeons should consider RAW for complex repairs, […]
Standardizing Intraoperative Nerve Monitoring in Endocrine Surgery
Inconsistent practices in intraoperative nerve monitoring (IONM) hinder surgical outcomes in endocrine procedures. Key variability exists in techniques, signal interpretation, and outcome documentation. Essential standardization areas include defining signal loss and reporting technical settings. Implementing these consensus recommendations can enhance data quality and outcome evaluation in endocrine surgery. Improved comparisons across studies could support stronger […]
Robotic Cholecystectomy Reduces Bile Duct Injury Risks
Robot-assisted cholecystectomy shows lower bile duct injury rates compared to laparoscopic procedures in complex cases of acute cholecystitis. Bile duct injury rates: 0.65% for robotic vs. 1.02% for laparoscopic. Adjusted odds of bile duct injury were 71% lower for robotic cholecystectomy (AOR 0.29). This suggests that robotic-assisted approaches can enhance surgical safety and outcomes even […]