Fluorescence image-guided surgery with indocyanine green (ICG) enhances precision for gastrointestinal procedures. Strong recommendations for using ICG in detecting non-regional metastases and identifying primary cancers. Supported use for lymph node identification in GI cancers and assessing anastomosis quality in esophageal and left-sided colorectal surgeries. Consider integrating ICG into practice where evidence supports its use to […]
Category: General Surgery
Prediction Tool for Timing of Cholecystectomy After PTGBD
A new machine learning tool helps surgeons determine the optimal timing for cholecystectomy after transcutaneous gallbladder drainage in elderly acute cholecystitis patients, improving surgical outcomes. Random forest model achieved an AUC of 0.914, outperforming other models for predicting surgery delays. Key predictors for delayed surgery include age, gallbladder wall thickness, and white blood cell count. […]
Increased Postoperative Delirium Risk in Prior COVID-19 Patients
Older adults with a history of COVID-19 face higher rates of postoperative delirium after major surgery, impacting surgical outcomes. Patients with prior COVID-19 have a 3.09 times greater risk of delirium (p = 0.02). Acute postsurgical pain increases the risk of delirium (odds ratio of 1.51; p = 0.02) while vaccination significantly reduces this risk […]
Rising Early-Onset Pancreatic Cancer Burden in Asia
Early-onset pancreatic cancer is surging, demanding attention from surgeons. In 2021, there were 31,531 new cases and 26,996 deaths worldwide. Asia, particularly East Asia, accounts for the highest burden, with developing nations like China and India leading. Risk factors differ; high fasting plasma glucose is not a primary risk for early-onset cases. Surgeons should prioritize […]
Preventing Acute Kidney Injury Cuts Complications After Major Surgery
A preventive care strategy can significantly reduce the risk of acute kidney injury (AKI) in high-risk surgical patients. Moderate or severe AKI occurred in 14.4% of patients receiving the intervention versus 22.3% in the control group (odds ratio 0.57, p=0.0002). Number needed to treat to prevent one case of AKI is 12. Adverse event rates […]
Transforming HCC Surgery with Biology-Driven Approaches
Surgeons need to adapt to evolving strategies for hepatocellular carcinoma (HCC) that prioritize biological insights and dynamic eligibility criteria. Curative treatments offer optimal long-term outcomes, yet 5-year recurrence rates remain at about 70%. New methods in immunogenomic profiling and liquid biopsy enhance patient selection beyond traditional staging. These advances enable personalized surgical strategies and improve […]
Effective Oral Care Cuts Surgical Site Infections
Perioperative oral management significantly reduces surgical site infections (SSIs) and shortens hospital stays. Oral care interventions lowered SSI risk by 36% in experimental studies (RR=0.64) and 51% in observational studies (OR=0.49). Modest effects were noted in patients with cardiovascular disease (OR=0.72) and non-oncology patients (OR=0.66). Implement tailored oral management plans to optimize preoperative care. Protocols […]
Postoperative Analgesia: Emphasizing Oral Over IV
A study reveals a major disconnect in postoperative analgesia practices, highlighting a need for surgeons to consider oral routes for efficiency and cost savings. Intravenous (IV) analgesia was used in 86% of non-opioid patients and 39% for opioids, while the oral route was utilized in only 1%. Transitioning to oral analgesia can cut costs per […]
Guided Classification Improves Outcomes in Pancreatic Surgery
A new intraoperative classification system enhances pancreatic surgery for benign and low-grade tumors. 122 patients underwent robotic resections with IPDECT; type I defects had a 10.6% overall complication rate including 8.5% for postoperative pancreatic fistula. Type IV defects had longer operations (mean 127.6 min) yet only 5.9% complications. Standardizing decision-making may enhance patient outcomes and […]
NSAID Timing Impacts Early Leak Risk in Rectal Surgery
Early use of NSAIDs post-proctectomy increases the risk of early anastomotic leaks. 8.7% overall rate of anastomotic leaks, with early NSAID use linked to higher rates (7.7% vs. 4.7%, p = 0.030). Non-selective NSAIDs and multiple doses significantly heighten early leak risk (OR 1.717, p = 0.012; OR 1.687, p = 0.016). Consider timing and […]