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Frailty and Healthcare Utilization Before and After Major Surgery

A study analyzed healthcare utilization patterns before and after major surgery and their association with pre-operative frailty. The results showed that frail patients had worse post-operative outcomes and higher costs during the surgical period. Four distinct utilization trajectories were identified, with a subgroup of patients experiencing a transition from low to high healthcare utilization after surgery. The study suggests the need for tailored care processes for this subgroup. The risk analysis index (RAI) alone was not effective in predicting this transition, but a multivariable model with other preoperative variables was successful.

Journal Article by Tarnasky A, Ludwig J (…) Hall D et 4 al. in Ann Surg

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

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Comparison of Robotic and Laparoscopic Pancreatoduodenectomy: Perioperative Advantage of Robotic Surgery and Similar Oncological Outcomes

Robotic pancreatoduodenectomy (RPD) was compared to laparoscopic pancreatoduodenectomy (LPD) in terms of operative and oncologic outcomes in a multicenter study involving 2,255 patients. After propensity score matching, 1,006 patients were included in each group. RPD had shorter operative time, lower blood transfusion and conversion rates, and higher vascular reconstruction rate compared to LPD. No significant differences were found in blood loss, postoperative length of stay, complications, and mortality. Both procedures had similar safety and feasibility, but RPD showed perioperative advantages, especially in vascular reconstruction. For pancreatic ductal adenocarcinoma patients, RPD and LPD had similar oncological and survival outcomes.

Journal Article by Zhang XP, Xu S (…) Liu R et 13 al. in Ann Surg

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

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High Mortality and Morbidity Rates in Patients at High Risk for Postoperative Pancreatic Fistula

Researchers analyzed nationwide outcomes after pancreatoduodenectomy in patients at very high risk for postoperative pancreatic fistula (POPF). The study found a 4.1% in-hospital mortality rate and observed major morbidity in 45.9% of patients. POPF occurred in 30% of patients, leading to increased major morbidity and mortality rates. Prophylactic total pancreatectomy (TP) was performed in only 2.1% of patients. The study suggests that while mortality rates remain significant, future trials should focus on preventing and managing POPF in this high-risk patient category.

Journal Article by Theijse RT, Stoop TF (…) Besselink MG et 23 al. in Ann Surg

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

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Development of Prediction Models for Major Morbidity and Endocrine Dysfunction after Central Pancreatectomy

A retrospective multicenter study aimed to develop prediction models for major morbidity and endocrine dysfunction following central pancreatectomy (CP). The study included 838 patients from 51 centers in 19 countries. The risk model for major morbidity identified male sex, age, BMI, and ASA score ≥3 as significant factors. The risk model for endocrine dysfunction revealed higher BMI and male sex as predictors. These models aid in tailoring the use of CP for patients with benign and premalignant lesions in the pancreas.

Journal Article by van Bodegraven EA, Lof S (…) Dokmak S et 45 al. in Ann Surg

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

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Sterile Gloves Are Not Superior to Nonsterile Gloves for Wound and Laceration Repair

This systematic review and meta-analysis compared the use of sterile and nonsterile gloves for wound and laceration repair. The analysis found no significant difference in the rates of infection or wound healing between the two types of gloves. These results suggest that nonsterile gloves are equally effective in preventing complications during wound and laceration repair, which has implications for reducing healthcare costs and improving efficiency.

Journal Article by Hamam Y, Ayesh H (…) Albarqouni L et 4 al. in JAMA Surg

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Supraclavicular Lymph Node Metastases in Esophageal Squamous Cell Carcinoma: Limited Impact on OS After Three-Field Dissection

The study aimed to determine the impact of clinically suspicious and pathologically confirmed supraclavicular lymph node (SCN) metastasis on survival outcomes in esophageal squamous cell carcinoma (ESCC) patients who underwent esophagectomy with three-field lymph node dissection. Analysis of 611 patients revealed that the presence of SCN metastasis did not significantly affect overall survival, regardless of clinical suspicion or confirmation. Although univariable analysis showed associations between SCN metastasis and poorer survival, multivariable analysis did not support these findings.

Journal Article by Park SY, Lee J (…) Shim YM et 5 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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Sacral Neuromodulation Shows Promise in Relieving Symptoms of Low Anterior Resection Syndrome

Sacral neuromodulation may be effective in relieving symptoms of low anterior resection syndrome after rectal cancer surgery, according to the SANLARS randomized clinical trial. The trial involved 46 patients, of whom 78% experienced a ≥50% reduction in symptoms after testing. During the crossover phase, all patients showed a reduction in symptoms, with better results when the generator was active. At 6- and 12-month follow-up, significant reductions in symptom scores and improvements in quality of life were observed.

Journal Article by Marinello FG, Fraccalvieri D (…) Espín-Basany E et 5 al. in Dis Colon Rectum

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Colon and Rectal Surgeons.

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Psychological Safety and Leadership in Operating Room Debriefing: Insights from Frontline Workers

The study conducted interviews with 40 operating room staff in a tertiary children’s hospital to explore effective debriefing policies. The findings revealed three key themes: commitment to learning, the importance of creating a safe space for debriefing, and the valuable role of leadership. It was found that psychological safety is both a prerequisite for and a outcome of debriefing, and that collective responsibility in leadership could help dismantle existing hierarchies. The study suggests that well-implemented debriefing can enhance psychological safety, promote team learning, reduce errors, and improve patient safety.

Journal Article by McElroy C, Skegg E (…) Hamill J et 4 al. in J Surg Res

Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

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Classification of GIST and Other Benign Gastric Tumors for Minimally Invasive Surgery

The study aimed to propose a new surgical classification for non-malignant gastrointestinal mesenchymal tumors (GMTs) based on their location and guide minimally invasive surgical strategies. The classification divided the tumors into two groups (exophytic and transmural/intragastric) and further subdivided them based on location. The study included 42 patients distributed into each subgroup. Encouraging perioperative outcomes were observed, with only two minor complications and one patient requiring reintervention. Further research with a larger sample is needed to confirm these findings and draw definitive conclusions.

Journal Article by Morales-Conde S, Socas M (…) Balla A et 3 al. in Langenbecks Arch Surg

© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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An Operative Time Threshold for Safety in Robotic Pancreaticoduodenectomy

Robotic pancreaticoduodenectomy (RPD) is a safe and effective procedure, although it often takes longer than open pancreaticoduodenectomy (OPD). A study analyzed elective, low-risk RPD and OPD cases to determine the operative time threshold (OTT) for safety in RPD patients. The OTT was identified as 7.7 hours, and patients whose RPD exceeded this threshold had higher rates of major morbidity and 30-day mortality compared to the OPD cohort. Risk factors for prolonged RPD included preoperative obstructive jaundice and a pancreatic duct size of less than 3mm or 3-6mm. The study suggests using the OTT to improve patient selection for RPD and as a competency-based quality benchmark.

Journal Article by Delman AM, Whitrock JN (…) Wilson GC et 6 al. in HPB (Oxford)

Copyright © 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

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