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Privilege Disparities Shape Access to Cancer Surgery

A study of 25,070 cancer surgery patients reveals that community privilege significantly influences access to high-volume surgical centers. Residents in less privileged areas (lower income, non-white) faced longer travel distances and were less likely to choose high-volume hospitals. Individuals in the least privileged communities had over 70% greater odds of bypassing high-volume centers. The findings underscore privilege as a crucial social determinant impacting patient access to and utilization of complex oncologic surgical care resources.

Journal Article by Munir MM, Endo Y (…) Pawlik TM et 10 al. in Ann Surg

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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Resident Autonomy: A Vital Key to Wellness in Surgical Training

In a survey of 7,233 residents across 324 programs, 82.2% reported appropriate autonomy, linking to lower burnout, suicidality, and thoughts of leaving. Female residents were less likely to report adequate autonomy. Satisfaction with workload, work-life balance, faculty engagement, camaraderie, and resources correlated with perceived autonomy. Qualitative insights highlighted autonomy’s crucial role in residency, identified barriers, and emphasized the need for residents to “earn” autonomy. The study calls for equitable resource allocation to support autonomy and well-being in surgical training.

Journal Article by Abahuje E, Smith KS (…) Hu YY et 12 al. in Ann Surg

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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Major Surgery, Silent Threat: Myocardial Injury’s Hidden Impact

In a global study of 22,552 major general surgery patients, 16.3% experienced myocardial injury after noncardiac surgery (MINS). Shockingly, 89.9% of MINS cases showed no symptoms, emphasizing the hidden danger. Those with MINS faced a nearly 5-fold increase in 30-day mortality (6.8% vs. 1.2%), underlining its prognostic importance. This exposes the need for routine postoperative troponin monitoring to unveil asymptomatic MINS, potentially saving lives after major surgery.

Journal Article by Jacka MJ, Youngson E (…) Devereaux PJ et 11 al. in Ann Surg

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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Gastric Bypass: A Shield Against Esophageal Adenocarcinoma in Obesity

In a Nordic cohort study, researchers explored if bariatric surgery lowers esophageal and cardia adenocarcinoma risks linked to obesity. Of 748,932 participants, mainly undergoing gastric bypass, the surgery showed a significant decrease in esophageal adenocarcinoma risk over time, suggesting it may counteract its development in morbidly obese individuals. The study implies gastric bypass as a potential preventive measure against esophageal adenocarcinoma in the long term for those struggling with obesity.

Journal Article by Hardvik Åkerström J, Santoni G (…) Lagergren J et 7 al. in Ann Surg

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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Revolutionizing Surgeon Onboarding: A Success Story in Community Hospitals

Surgeons often face inadequate introductions to new practice settings. This study, implementing a tailored onboarding program in an academic-affiliated community hospital, showed outstanding process adherence, user satisfaction, and improved readiness to practice. Results affirm the feasibility and effectiveness of local teams implementing robust onboarding, ensuring smooth transitions for surgeons practicing across diverse settings in the evolving landscape of academic-community hospital collaborations.

Journal Article by Etheridge JC, Goldstone RN (…) Haas S et 4 al. in Ann Surg

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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Assessing Pouch Function After Ileal Pouch Anal Anastomosis: Beyond Manometry

In evaluating post-proctocolectomy patients with ileal pouch anal anastomosis (IPAA), anopouch manometry (APM) highlights defecatory symptoms. Less than 10% of symptomatic IPAA patients undergo APM. Dyssynergic defecation, prevalent in 47.0% to 100% of cases, associates with fecal incontinence. APM alone proves imperfect for pouch function assessment, prompting the need for confirmatory dynamic imaging. This study emphasizes expanding diagnostic approaches, recognizing dyssynergic defecation and fecal incontinence in symptomatic IPAA patients.

Journal Article by Luo Y, Schmidt N (…) Kayal M et 2 al. in Inflamm Bowel Dis

© The Author(s) 2022. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
© The Author(s) 2022. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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Balancing Act: Bariatric Surgery and Anticoagulation’s Bleeding Dilemma

In a study spanning 2008–2022, researchers delved into the post-bariatric bleeding risks for patients on chronic anticoagulation (CAT). Examining 132 cases (82 Roux-en-Y gastric bypass, 50 sleeve gastrectomy), the incidence of long-term bleeding was significantly higher in the Roux-en-Y group (18.3%) than the sleeve gastrectomy group (4%). Notably, bleeding marginal ulcer (MU) prevailed in the Roux-en-Y group (13.4%). The study urges informed counseling on bleeding risks for CAT patients considering metabolic and bariatric surgery.

Journal Article by Abi Mosleh K, Belluzzi A (…) Ghanem OM et 4 al. in Obes Surg

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Novice Surgeons’ Success in Laparoscopic Sleeve Gastrectomy

In South Korea’s non-tertiary hospitals, where bariatric surgery lacks specialized training, researchers examined outcomes of laparoscopic sleeve gastrectomy (LSG). Analyzing data from a novice surgeon’s cases before and after the learning curve, they found comparable safety and efficacy. Post-learning curve, operation time significantly decreased (118.4 to 61.9 minutes), showcasing that LSG can be proficiently performed by novice surgeons in non-tertiary settings with careful patient selection, challenging assumptions about the procedure’s complexity.

Journal Article by Lee S and Mun S in Asian J Surg

Copyright © 2023 Asian Surgical Association and Taiwan Robotic Surgery Association. Published by Elsevier B.V. All rights reserved.

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Liquid Biopsy in Cancer Care: A Game Changer for Surgical Patients

This review delves into the evolving realm of liquid biopsy, a groundbreaking tool with the potential to transform cancer care. Researchers explored its clinical applications in the context of surgical patients. While circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA) have been studied extensively, their practical use in surgical settings is not yet fully defined. They show promise in detecting disease progression, guiding systemic therapy, and predicting recurrence, particularly for early-stage cases. However, there is still much to learn, and surgeons need to actively engage in clinical trials to advance this game-changing technology.

Journal Article by Mahuron KM and Fong Y in JAMA Surg

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Early Discharge Proves Safe After Uncomplicated Colectomy

This retrospective study explored the relationship between postoperative discharge timing and complications in patients who underwent uncomplicated elective colectomy. Findings from over 113,000 patients revealed that early discharge (≥3 days for laparoscopic/robotic, or ≥5 days for open surgery) after minimally invasive colectomy significantly lowered the odds of post-discharge complications. The same benefit wasn’t observed in open surgery. Importantly, there were no notable differences in the risk of return to the operating room. This suggests that early discharge is a safe option for select patients, especially in minimally invasive approaches.

Journal Article by Balas M, Quereshy F, Bohnen J and Jung JJ in J Am Coll Surg

Copyright © 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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