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Excessive Testing in Elective Surgery: Major Savings Potential

Preoperative testing often exceeds guidelines, leading to unnecessary costs and patient burden.

  • 89% of 501 patients underwent at least one unnecessary test, primarily full blood counts and chest X-rays.
  • Potential cost savings of ZAR 857,987 annually if NICE guidelines were followed.

This highlights a critical opportunity for surgeons to reassess preoperative testing protocols and reduce waste.

  • Over-testing was notably higher in general surgery, ASA 2 patients, and those over 35 years old.

Journal Article by Wronski SV and Venter S in S Afr Med J

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Trauma Scoring Systems Help Predict Transfusion Needs and Mortality

Rapid assessment tools can enhance early trauma management and improve patient outcomes.

  • Massive transfusion was needed in 19.7% of trauma patients, primarily due to firearm injuries.
  • The shock index showed the best predictive accuracy for transfusion needs (AUC=0.911).
  • The trauma-related injury severity score (TRISS) was the most effective for predicting in-hospital mortality (AUC=0.975).

These findings underscore the importance of using validated scoring systems to guide therapeutic decisions in trauma surgery.

Journal Article by Türkoğlu B, Karakaş B (…) Ünlü A et 5 al. in Ulus Travma Acil Cerrahi Derg

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Prunes cut low anterior resection syndrome risk in rectal cancer patients

Prune consumption significantly lowers the risk of low anterior resection syndrome (LARS) after surgery.

  • LARS incidence dropped from 74.6% to 27.3% with daily prune intake (p<0.001).
  • Major LARS occurrence decreased from 61.9% to 18.2% (p<0.001).

Consider recommending prunes to enhance recovery and improve patient quality of life post-surgery.

  • Patients consuming prunes reported fewer symptoms like constipation and sleep disturbances.

Journal Article by Pyo DH, Shin JK (…) Cho YB et 5 al. in Ann Coloproctol

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High Trauma Volume Hospitals Cut Delays in Blunt Intestinal Injuries

Patients with blunt intestinal injuries benefit from surgery in high-volume trauma centers, reducing delays and complications.

  • Patients in low-volume hospitals had an average surgery wait of 18 hours, compared to 15 hours in high-volume centers (p<0.001).
  • High-volume facilities saw a 42% lower risk of post-injury sepsis (aOR 0.58).

Surgeons should prioritize referral to high-volume centers to enhance patient outcomes in these complex cases.

  • Similar trends were noted with high blunt trauma and overall trauma volumes linked to reduced delays in surgery.

Journal Article by Arda Y, Panossian VS (…) Kaafarani HMA et 8 al. in Ann Surg

Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.

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Optimizing Fistula Prevention in Pancreatoduodenectomy

Identifying effective strategies for preventing postoperative pancreatic fistula (POPF) can significantly impact patient outcomes after pancreatoduodenectomy (PD).

  • Overall POPF rate was 15.1%; drains alone showed no association with POPF.
  • For moderate fistula risk score patients, drains alone reduced POPF from 19.8% to 13.1%.
  • High-risk patients benefited most from a drain combined with a stent, lowering POPF from 38.5% to 23.7%.

Emphasizing these optimal strategies could cut fistula rates by a third, and up to half when early drain removal is applied.

Journal Article by Judish MM and Vollmer CM in Ann Surg

Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.

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New tool predicts esophageal stricture risk after ESD

Surgeons can now better predict the risk of esophageal stricture following extensive endoscopic submucosal dissection (ESD) for early esophageal cancer.

  • A nomogram developed from a study of 1,043 patients categorizes stricture risk as low (2.3%), intermediate (48.8%), or high (75%).
  • In a matched cohort of 44 patients, a combination of glucocorticoids and functional exercise reduced stricture rates to 31.8% versus 63.6% with glucocorticoids alone (p=0.035).

Consider using the nomogram for personalized patient management and to implement glucocorticoids with exercise for high-risk individuals.

Journal Article by Tian S, Shi L and Jiang J in Surg Endosc

© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Increase in Laparoscopic Surgery for Small Bowel Obstruction

Minimally invasive surgery (MIS) for adhesive small bowel obstruction (SBO) has surged and leads to better outcomes than open surgery.

  • MIS usage rose from 27% to 45% from 2011 to 2021.
  • Complications dropped significantly with MIS (15.2% vs. 27.7% for open, p < 0.001).
  • Patients had shorter hospital stays with MIS (4 days vs. 8 days, p < 0.001).

Adoption of MIS is supported by these outcomes, but careful patient selection based on age and comorbidities is essential for optimal results.

Journal Article by La Riva A, Perez-Soto RH (…) Romero-Velez G et 8 al. in Surg Endosc

© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Effective Tourniquet Management Could Save Limbs

Prolonged tourniquet use in combat can lead to serious complications like limb loss; reassessment is crucial.

  • Current practices often overlook timely reassessment, increasing risk of avoidable morbidity.
  • Data shows that tourniquet conversion and optimization are rarely implemented in the field.

Emphasizing these skills as essential for all personnel can drastically improve patient outcomes.

  • Recommendations include updating training protocols to ensure reassessment occurs within 2 hours of application.

Editorial by Beerbaum M, White J and Henderson J in J Spec Oper Med

2025.

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Novel Methylation Test Identifies Lymph Node Metastasis in Colorectal Cancer

A new ctDNA methylation-based model shows promise for preoperatively identifying lymph node metastasis in colorectal cancer, influencing surgical decisions.

  • Sensitivity of 82.6% and specificity of 73.3% for identifying lymph node metastasis.
  • Outperforms traditional CT imaging (77.2% vs. 66.5%, p = 0.019).

This could help refine the need for D3 lymphadenectomy in surgical planning.

  • The new nomogram also predicts D3 metastasis with accuracy of 82.6%, compared to 67.4% with traditional methods (p < 0.001).

Journal Article by Ji H, Xu M (…) Yan J et 4 al. in Dis Colon Rectum

Copyright © The ASCRS 2025.

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Vulnerable Patients in ED Risk Higher Mortality, ICU Admissions

Identifying vulnerability markers at triage can improve outcomes for emergency department patients.

  • Cognitive impairment increases 30-day mortality odds by 2.24 times.
  • ICU admission is more likely for patients with immunosuppression (4.13 times), substance use disorder (1.82 times), and diabetes (1.73 times).

Surgeons should consider these vulnerability factors when making surgical decisions post-ED assessment.

  • Hospital admission is linked to cognitive impairment, immunosuppression, substance use disorder, diabetes, recent surgery, and psychiatric issues.

Journal Article by Hilpert F, Riedel HB (…) Espejo T et 2 al. in Postgrad Med J

© The Author(s) 2025. Published by Oxford University Press on behalf of the Fellowship of Postgraduate Medicine.

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