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Factors distinguishing higher-performing hospitals in implementing enhanced recovery pathways

Implementing enhanced recovery pathways in hospitals varies widely. This qualitative study analyzed interviews with perioperative leaders, clinicians, and staff from eight US hospitals to identify factors that distinguished hospitals with greater success in implementing these pathways. The study found that information-sharing practices, planning, engaging, positive knowledge and beliefs among clinicians, and strong leadership support were consistently positive factors associated with successful implementation. Conversely, factors such as pathway complexity, hospitals’ infrastructure, and challenges in altering electronic health record systems were consistently negative barriers to implementation success.

Journal Article by Yuan CT, Wu J (…) Rosen MA et 5 al. in Ann Surg

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

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Glucose Control Improves Survival in Pancreatic Cancer Patients with Low CA19-9 Levels

Researchers examined pancreatic cancer patients with long-term survival and found that a subgroup with normal levels of the biomarker CA19-9 had a significantly higher overall survival rate and 5-year survival compared to patients with high CA19-9 levels. This subgroup also had lower levels of circulating glucose and increased insulin expression. Glucose control was shown to decrease CA19-9 levels and improve overall survival in animal models and a clinical trial. The study suggests that glucose control could be a promising therapeutic strategy for pancreatic cancer.

Journal Article by Zhu X, Xiao Z (…) Yu X et 8 al. in Ann Surg

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

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Surgical Care in the Criminal Justice Health Care System: Comparable Mortality and Readmission Rates, but Higher Morbidity in Incarcerated Patients

Patients who are incarcerated within the Texas Department of Criminal Justice (TDCJ) receive similar rates of mortality and readmission compared to the general nonincarcerated population when undergoing surgical procedures. However, incarcerated patients have significantly higher rates of morbidity. These findings highlight the need for further research to understand the factors contributing to perioperative morbidity and to explore long-term surgical outcomes in the incarcerated population.

Journal Article by Mao RD, Williams TP (…) Tyler DS et 6 al. in JAMA Surg

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Crafting Surgical Leadership: A Comprehensive Toolkit for Integrated Strategic Plans

Developing an integrated strategic plan in surgical leadership requires a variety of tools. The most common tool is a strengths, weaknesses, opportunities, and threats analysis, which evaluates internal and external factors. Various additional tools, such as the political, economic, social, technological, legal, and environmental analysis, mission-objective-strategy-tactics analysis, blue ocean strategy, scenario planning, Ansoff matrix, Porter’s five forces, six sigma, and balanced scorecard, can also be used for future planning and measurable advancements. This study offers clinicians and researchers a comprehensive overview of these tools for developing successful leadership plans.

Journal Article by DuCoin C and Kuo PC in BMC Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Pre-operative risk factors predict post-operative pancreatic leak after pancreatectomy

A novel combined pre-operative risk score composed of radiologic main pancreatic duct diameter (mpd), body mass index (bmi), and comorbidity-polypharmacy score (cps) was found to be an independent predictor of post-operative pancreatic fistula (popf) occurrence after pancreatectomy. Patients with mpd diameter <4 mm and BMI ≥25 had a higher likelihood of developing pancreatic leak. The combined score, called cplps, can aid clinicians in surgical decision-making and counseling patients.

Journal Article by Clements NA, Philips P (…) Martin RCG et 3 al. in Surg Endosc

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

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Prehabilitation in Colorectal Cancer Surgery Reduces Complications, Length of Stay, and Hospital Costs

Implementation of a multimodal prehabilitation program in colorectal surgery reduces postoperative complication rates, length of stay, and hospital costs. A study conducted in a regional Dutch hospital included 196 patients who completed prehabilitation and 390 patients who received standard care. The prehabilitation group had lower overall complication rates (31% vs. 40%) and severe complication rates (20% vs. 31%), as well as a shorter length of stay (5.80 days vs. 6.71 days). Hospital cost savings were €1109 per patient, outweighing the investment for prehabilitation (€969).

Journal Article by Sabajo CR, Ten Cate DWG (…) Slooter GD et 3 al. in Eur J Surg Oncol

© 2023 Published by Elsevier Ltd.

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New Study Finds Early CT Scan Accuracy for Diagnosing Anastomotic Leakage After Colorectal Surgery

A retrospective study evaluated the efficacy of early contrast-enhanced CT scans for diagnosing anastomotic leakage (AL) after colorectal surgery in patients with elevated CRP levels. The study included 661 patients, with an overall AL rate of 7.4%, and found that early CT scans had an accuracy of 83.7% in diagnosing AL. The accuracy was lower for grade C AL and varied depending on the type of resection and anastomosis. However, the study concluded that early CT scans are not a perfect method for early AL diagnosis.

Journal Article by Leourier P, Pellegrin A, Regimbeau JM and Sabbagh C in Int J Colorectal Dis

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

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Anesthetic Parameters in Hepatectomy with Inferior Vena Cava Clamping

The study aimed to analyze the hemodynamic and surgical effects of using the inferior vena cava (IVC) partial clamp (PC) in combination with the Trendelenburg position (TP) during anatomical hepatectomy. Twenty-six patients were divided into three groups based on the use of IVC-PC and TP. The results showed that IVC-PC combined with TP can be an alternative procedure to control intrahepatic venous bleeding during hepatectomy without significantly affecting operating time and procedures.

Journal Article by Nanashima A, Hiyoshi M (…) Tsuneyoshi I et 6 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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A Review of Cognitive Support Systems in the Operating Room: Improved Surgical Performance and Reduced Workload

Implementing cognitive support technologies (CSTs) in the operating room has been found to enhance surgical performance compared to traditional methods. Findings from 37 studies demonstrated decreased error rates and increased efficiency with the use of CSTs. Most CSTs achieved over 90% accuracy in identifying anatomical markers with minimal error margins. Additionally, there was a general trend of reduced surgical time. However, the limited ergonomic design of current CSTs hampers their widespread adoption, calling for more clinical data before widespread implementation.

Review by Zhang ZS, Wu Y and Zheng B in Surg Innov

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Pancreatic Ductal Adenocarcinoma Resection: A 5.3-Year Journey to 95% Cure Probability

According to a multi-institutional analysis of 2554 patients, the probability of achieving the same life expectancy as the general population, with no tumor recurrence, after pancreatic surgery for pancreatic ductal adenocarcinoma (PDAC) was found to be 20.4%. Furthermore, the study revealed that the likelihood of cure reached 95% certainty after 5.3 years. Preoperative and postoperative models were developed, considering various factors such as tumor stage, size, chemotherapy response, and surgical variables, to predict patient outcomes. An online calculator was also provided for easily assessing cure probabilities.

Journal Article by Crippa S, Malleo G (…) Cucchetti A et 12 al. in Ann Surg

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