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Implementation factors significantly influence surgical care advancements

A scoping review of 3,674 citations identified 129 relevant articles on implementation science in surgical care. It highlighted major innovations in peri-operative care and safety. Six key constructs emerged as both facilitators and barriers: leadership support, surgeon and staff expertise, team building, environmental context, data availability, and resource allocation. Understanding these factors is crucial to enhancing the adoption of evidence-based practices, thereby improving the quality and equity of surgical care.

Journal Article by Lambert-Kerzner A, Myers QWO (…) Meguid RA et 8 al. in Ann Surg

Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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Patient-derived organoids enhance treatment outcomes for pancreatic cancer.

A novel approach to matching patients with pancreatic ductal adenocarcinoma (PDAC) to effective chemotherapy has shown significant promise. Patient-derived organoids (PDOs) matched 91% of patients to standard treatments, improving CA 19-9 markers and lymph node staging. Notably, those who received therapies well-aligned with their PDO chemosensitivity experienced better recurrence-free and overall survival compared to misaligned treatments. These findings suggest that PDO pharmacotyping may optimize therapeutic strategies and improve patient quality of life.

Journal Article by Nicolson NG, Tandurella JA (…) Burkhart RA et 14 al. in Ann Surg

Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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Simultaneous robot-assisted esophagectomy reduces surgery time.

A novel approach to robot-assisted cervical esophagectomy combining cervical and abdominal procedures has shown significant advantages. In a study of 30 patients, this simultaneous procedure, utilizing nerve integrity monitoring without muscle relaxants, resulted in a total operative time of 291.2 minutes, markedly shorter than the sequential group’s 453.8 minutes. No intraoperative adverse events or postoperative complications were reported, indicating both safety and feasibility of this innovative technique for thoracic esophageal carcinoma.

Journal Article by Fujita T, Sato K (…) Daiko H et 3 al. in Surg Endosc

© 2024. The Author(s).

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C-reactive protein and albumin ratio may aid cholecystitis diagnosis

An analysis of 170 patients with acute cholecystitis revealed that 37.1% had gallbladder perforation, correlated with higher rates of complications. Key biomarkers, including C-reactive protein (CRP) and the CRP/albumin ratio (CAR), demonstrated significant differences between perforated and non-perforated cases. Despite their low specificity and sensitivity, these biomarkers can assist clinicians in making timely diagnoses and planning treatment strategies for this critical condition, potentially improving patient outcomes in high-risk situations.

Journal Article by Yalcin M, Tercan M, Ozyurt E and Baysan A in Ulus Travma Acil Cerrahi Derg

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ERAS protocols significantly shorten hospital stays after colorectal surgery

Implementation of enhanced recovery after surgery (ERAS) protocols at 15 Ontario hospitals resulted in a significant 1.05-day reduction in length of stay (13.7%) for colorectal surgeries. Notably, left-sided colorectal surgeries saw an even greater decrease of 1.17 days (15.6%). This reduction remained consistent over time and was more pronounced after adjusting for various predictors. The findings suggest that ERAS protocols are an effective intervention, improving patient recovery and minimizing hospital resource use.

Multicenter Study by Bayat Z, Govindarajan A, Victor JC and Kennedy ED in BJS Open

© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.

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Stool-based surveillance reduces colonoscopies after polypectomy

Stool-based surveillance strategies may safely decrease colonoscopy demand by 15-41% following polypectomy, according to the MOCCAS study. Conducted on 3,453 individuals, the study demonstrated that multitarget stool DNA tests and fecal immunochemical tests (FIT) were effective alternatives, especially for those at lower risk. Long-term simulations indicated that while multitarget stool DNA testing incurred higher costs, FIT-based approaches proved cost-saving. These findings highlight an evolving approach to colorectal cancer surveillance with potential benefits for patients and healthcare systems.

Journal Article by Carvalho B, de Klaver W (…) Meijer GA et 34 al. in Gastroenterology

Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.

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Endoscopic Vacuum Therapy effectively treats Boerhaave’s syndrome.

A multicenter analysis demonstrates that Endoscopic Vacuum Therapy (EVT) has a high success rate for treating Boerhaave’s syndrome, yielding an 80% treatment success in 25 patients. Mortality rates were significantly lower for EVT patients (8.0%) compared to those undergoing other methods (25.0%). Moreover, treatment success with EVT was statistically superior to non-EVT approaches (43.8%). These findings suggest EVT’s effectiveness and reliability as a primary treatment for this serious condition.

Journal Article by Wannhoff A, Kouladouros K (…) Wichmann D et 7 al. in Gastrointest Endosc

Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

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Omission of drains reduces complications and hospital stays in surgery

Patients undergoing minimally invasive distal pancreatectomy without abdominal drains experienced significantly lower rates of postoperative pancreatic fistula (3.4% vs. 27.6%) and abdominal collections (3.4% vs. 31.0%), along with a shorter hospital stay (5 days vs. 9 days). These findings suggest that not using drains during this type of surgery may enhance recovery without increasing severe complications, reoperations, or readmissions.

Journal Article by Mazzola M, Benedetti A (…) Ferrari G et 6 al. in Surg Endosc

© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Multidisciplinary case conference enhances management of benign hepatopancreatobiliary disease

A study reviewing 56 cases presented at the novel benign liver and pancreas rounds highlights the effectiveness of a multidisciplinary case conference in managing benign hepatopancreatobiliary diseases. The discussions resulted in a change or adjustment in the proposed management plan for 82% of cases, with 71% of these recommendations being implemented. Most cases addressed pancreatic and biliary pathologies, showcasing the importance of interdisciplinary collaboration in refining patient treatment strategies.

Journal Article by Selznick S, Mitrou N (…) Hawel J et 6 al. in Surg Endosc

© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Endoscopic submucosal dissection proves more effective than EMR

A systematic review and meta-analysis involving 9,352 patients reveals that endoscopic submucosal dissection (ESD) outperforms endoscopic mucosal resection (EMR) in effectively treating early Barrett’s neoplasia. ESD achieved significantly higher en-bloc resection rates (odds ratio 25.96) but was associated with greater incidence of adverse events. The findings highlight the need for careful consideration of the balance between efficacy and safety when selecting treatment options for this condition.

Review by Gallegos MMM, Gomes ILC (…) de Moura EGH et 8 al. in Dig Endosc

© 2024 Japan Gastroenterological Endoscopy Society.

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