A newly developed nomogram predicts spontaneous closure in septic patients with external duodenal fistulas post-infection control, critical for surgery decisions. Spontaneous closure rates after infection control were 53.2% in the development cohort and 57% in validation. Six key factors were identified: time to infection control, infection extent, emergency surgery, fistula size, duodenal decompression, and albumin […]
Category: General Surgery
Social determinants drive 30-day mortality after elective surgery.
Patients in the lowest-income neighborhoods have a 52% higher odds of postoperative death compared to those in the highest-income areas. Increased mortality risk is dose-dependent; odds rise as income diminishes. Targeting social determinants could be crucial for improving surgical outcomes. Complexity of the procedure affects mortality risk linked to neighborhood income, with higher complexity surgeries […]
Effective Adjuvant TACE Boosts HCC Outcomes After Surgery
Postoperative adjuvant transarterial chemoembolization (pa-TACE) significantly improves survival in hepatocellular carcinoma (HCC) patients after liver resection. Patients receiving pa-TACE had 30% lower recurrence risk (HR=0.70, p=0.04) and 35% better survival rates (HR=0.65, p=0.04) compared to controls. The benefits are pronounced in microvascular invasion-positive patients, with recurrence-free survival improved by 69% (HR=0.31, p<0.001) and overall survival […]
Reassessing Lymph Node Exam Counts for Rectal Cancer Surgery
Surgeons should prioritize examining at least 7 lymph nodes in rectal cancer patients post-neoadjuvant therapy to optimize outcomes. Examining fewer than 7 lymph nodes results in a 5-year disease-free survival rate of 65.1%, compared to 76.3% with 7 or more (p=0.03). In the SEER cohort, patients with fewer than 7 lymph nodes have a 5-year […]
High Appendiceal Neoplasm Rate in Complicated Appendicitis
Patients with complicated appendicitis show a 16.1% rate of appendiceal neoplasms, necessitating careful evaluation before surgical intervention. Among 387 complicated appendicitis cases, 304 had surgery; the majority (78.6%) were surgically treated. Neoplasm rates varied: mucocele cases saw the highest at 58%, while perforated appendicitis was at 12%. Consider age, appendiceal diameter, and lymphadenopathy when assessing […]
Prehabilitation Enhances Outcomes in Oncologic Surgery Patients
Improving physical fitness before surgery can significantly enhance recovery for patients undergoing oncologic procedures. 89% of studies emphasized the need for better cardiorespiratory fitness in prehabilitation programs. Most prehabilitation interventions (41%) were supervised and typically involved three sessions per week. Surgical outcomes such as complications were the primary focus, with 42% of studies reporting them […]
Automating Surgical Quality Data Shows High Accuracy
Using electronic health record (EHR) data for surgical quality improvement matches manual abstraction accuracy, easing the burden on resources. Strong agreement for race and ethnicity variables (kappa = 98.1%). Preoperative risk factors show lower agreement (median kappa = 28.6%), indicating caution in reliance on EHR for this domain. This shift could streamline data collection, enhancing […]
Overnight Total Thyroidectomy: Safe with High Patient Satisfaction
Surgeons can confidently implement overnight discharge after total thyroidectomy without increased complication risks. No differences in complications at 24 hours, 10 days, or 30 days between patients discharged on postoperative day 1 and those on day 3. 94.6% of patients discharged on day 1 reported high satisfaction with the rapid discharge protocol. Patient selection is […]
New Insights on Anatomic Landmarks in Endoscopic Thyroidectomy
Surgeons can improve outcomes in endoscopic thyroidectomy by leveraging newly defined surgical planes and landmarks. The dissecting triangle between strap muscles and thyroid lobe ensures 100% identification of inferior thyroid vessels and middle thyroid vein. The inferior and superior parathyroid glands were located accurately in 92.5% and 90% of cases, respectively. Understanding these zones aids […]
Avoid Feeding Jejunostomy in Pancreatoduodenectomy
Feeding jejunostomy (FJT) after pancreatoduodenectomy increases complications and length of stay. Delayed gastric emptying occurred in 55% of FJT patients vs. 25% in nasojejunal tube (NJT) patients (p = 0.006). FJT led to a longer hospital stay: 11 days compared to 9 days for NJT (p = 0.007). Omit FJT to reduce postoperative complications without […]