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Sequential bundles significantly reduce surgical site infections.

In a multicentre cohort study involving 32,205 patients, two sequential preventive bundles led to a 50% reduction in surgical site infection rates, decreasing from 18.16% to 8.19%. Bundle-2 notably reduced both superficial and deep surgical site infections but was ineffective for organ/space infections in rectal surgery. Compliance with preventive measures improved with the addition of new protocols. Furthermore, length of hospital stay and mortality rates decreased significantly, suggesting enhanced patient outcomes.

Pragmatic Clinical Trial by Flores-Yelamos M, Gomila-Grange A (…) Juvany M et 7 al. in BJS Open

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

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Enhanced recovery protocols promote better outcomes after emergency laparotomy

A systematic review and meta-analysis of six randomized clinical trials involving 509 patients evaluated the effects of enhanced recovery after surgery (ERAS) protocols following emergency laparotomy. Findings indicated that ERAS significantly reduced postoperative nausea and vomiting (odds ratio: 0.32), time to ambulation (mean difference: 1.67 days), length of stay (mean difference: -2.92 days), and various complications such as pulmonary issues and surgical site infections. The study recommends widespread use of ERAS in this context.

Journal Article by Amir AH, Davey MG and Donlon NE in Am J Surg

Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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Three-day antibiotic regimen shows non-inferiority to seven-day regimen

A study involving 256 patients undergoing left-sided colorectal surgery assessed the effectiveness of a three-day versus a seven-day selective digestive decontamination (SDD) regimen. Results indicated anastomotic leakage rates of 1.2% for the three-day group compared to 5.2% for the seven-day group, and surgical site infections were 3.6% and 5.8%, respectively. The shortened three-day regimen was found to be non-inferior to the seven-day regimen in preventing infectious complications.

 

Journal Article by Ulrich W, Josefine S (…) Bettina R et 7 al. in J Gastrointest Surg

Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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Indicators for Predicting Pathological Complete Response in Rectal Cancer

Key findings indicate that flattening of marginal tumor swelling is a strong independent predictor of pathological complete response (PCR) in rectal cancer patients post-neoadjuvant therapy (p < 0.001, odds ratio = 100.605). Additionally, lower preoperative carcinoembryonic antigen and erythrocyte sedimentation rates also correlate with PCR, with cutoffs established at 2.15 ng/ml and 19.0 mm/h, respectively. These predictive factors could aid in identifying candidates for conservative treatment approaches.

Journal Article by Hadizadeh A, Kazemi-Khaledi H (…) Parsaei M et 8 al. in Int J Colorectal Dis

© 2024. The Author(s).

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Optimizing the peri-operative patient journey enhances surgical outcomes.

A narrative review highlights key opportunities to improve peri-operative care, emphasizing timely alternative treatments to reduce unnecessary surgeries. Risk assessment during surgical listing is crucial for optimizing comorbidities. Enhanced recovery after surgery (ERAS) protocols lead to fewer complications and shorter hospital stays but require clinician collaboration. Effective monitoring of at-risk patients ensures proactive management. Early access to rehabilitation services significantly promotes recovery and patient experience, emphasizing streamlined communication across healthcare providers for better outcomes and value.

Review by Watters DA, Scott DA (…) Ludbrook GL et 2 al. in ANZ J Surg

© 2024 The Author(s). ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.

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Robotic training pathway integrates safely into surgical practice

The integration of the “Robotic Curriculum for young Surgeons” (RoCS) into clinical practice did not compromise patient outcomes, according to a comparative study of two cohorts. Key results demonstrated no significant differences in in-hospital, 30-, or 90-day morbidity and mortality rates between groups. Surgical efficiency improved with reduced surgery duration and blood loss in colorectal cases, along with decreased conversion rates for hepatopancreaticobiliary operations. RoCS presents a robust training model for robotic surgery novices.

Journal Article by Stockheim J, Andriof S (…) Croner RS et 8 al. in J Robot Surg

© 2024. The Author(s).

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Standardized application of complication metrics guides surgical reporting

The study reviewed the increasing integration of the Clavien-Dindo Classification (CDC) and Comprehensive Complication Index (CCI®) in 1,327 randomized controlled trials (RCTs), revealing a rise of over 200 new RCTs annually. However, only one-third of the published RCTs included the entire CDC grading scale. A survey among 163 surgeons resulted in a consensus for improved guidelines on reporting complications, emphasizing that separate counts for interconnected complications should be standardized for better outcomes.

Journal Article by Abbassi F, Pfister M (…) Clavien PA et 3 al. in Ann Surg

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

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Age impacts the explanatory power of trauma mortality models.

Findings indicate that the explanatory power of trauma mortality models decreases linearly with age, significantly affecting objective comparisons of outcomes. Among 317,136 patients analyzed, the relative utility of covariates like Glasgow Coma Scale and Injury Severity Score varies across age groups, highlighting limitations in current adjustment models for older adults. Researchers emphasize the need for additional studies to identify effective covariates that improve model performance for all age groups.

Journal Article by Shen Y, Orlando A and Fakhry SM in J Surg Res

Copyright © 2024 Elsevier Inc. All rights reserved.

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HAIC treatment shows potential benefits over Sorafenib for HCC

Analysis of 26 studies involving 6456 hepatocellular carcinoma (HCC) patients demonstrated that hepatic artery infusion chemotherapy (HAIC) consistently outperformed Sorafenib in overall survival (OS) outcomes, except for those refractory to trans-arterial chemoembolization. Key risk factors for reduced OS included larger tumor size and heavier tumor burden, while HAIC treatment and lower BCLC stage acted as protective factors. The study reveals the robust correlation between one-year OS and progression-free survival, guiding future research in HCC treatment.

Journal Article by Si T, Shao Q (…) Heaton N et 2 al. in Int J Surg

Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

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Textbook outcomes enhance survival for pancreatic cancer patients.

A retrospective analysis of 111 pancreatic cancer patients undergoing pancreaticoduodenectomy revealed that 62.2% achieved textbook outcomes, significantly improving overall survival (OS) [p=0.03; HR=0.60]. Cox regression identified achievement of these outcomes as a protective factor for OS [p=0.04; HR=4.08]. Key barriers to achieving textbook outcomes included high amylase levels, prolonged surgery duration, and soft pancreatic texture, underscoring their importance in surgical quality control measures.

Journal Article by Wang H, Hu X (…) Zhang H et 4 al. in Transl Gastroenterol Hepatol

2024 Translational Gastroenterology and Hepatology. All rights reserved.

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