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Prescribing Guideline Cuts Postoperative Opioid Use in Emergency Surgery

In emergency general surgery (EGS), there’s often no standardized approach to prescribing opioids for postoperative pain, raising concerns about overprescription. To address this, researchers introduced an opioid prescribing guideline. After implementation, they observed a significant reduction in prescribed opioid dosages at discharge. The proportion of patients receiving high-dose opioid prescriptions (≥50 morphine milligram equivalents per day) decreased from 75% to 25%. Importantly, this reduction in opioid use didn’t lead to an increase in post-discharge refills, demonstrating the guideline’s effectiveness in curbing opioid prescriptions for EGS patients.

Journal Article by Biesboer EA, Al Tannir AH (…) Trevino C et 7 al. in J Surg Res

Copyright © 2023 Elsevier Inc. All rights reserved.

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Shaping the Role of Surgical Vice Chairs of Education

In response to evolving medical education needs, the role of Vice Chair of Education (VCE) in a Department of Surgery (DoS) is emerging. However, this role’s specifics aren’t well-defined. This study engaged 13 faculty members and 13 VCEs to explore this novel position. Stakeholders welcomed the VCE role, albeit with some questions about its impact. Four themes emerged among stakeholders, including support for education and balancing clinical, research, and educational responsibilities. VCEs highlighted leveraging experience, establishing frameworks, and leading in education. This study informs the development of VCE roles in academic DoS, offering a blueprint for other institutions.

Journal Article by Whaley Z, Palenzuela D (…) Phitayakorn R et 4 al. in J Surg Res

Copyright © 2023 Elsevier Inc. All rights reserved.

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2023 AABB Guidelines: A Fresher Approach to Red Blood Cell Transfusion

The 2023 AABB International Guidelines on red blood cell transfusion are here. They provide recommendations for adults and children based on extensive research. For adults, the guidelines suggest a restrictive transfusion strategy with a hemoglobin concentration less than 7 g/dl for stable patients, which was found to be safe. For children, similar strategies are recommended, taking into account specific cardiac conditions and surgical stages. Overall, these guidelines encourage clinicians to consider clinical context and alternative therapies when making transfusion decisions for patients, promoting a more tailored and cautious approach.

Journal Article by Carson JL, Stanworth SJ (…) Pagano MB et 24 al. in JAMA

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Aggressive Treatment Approach Beneficial for Elderly Pancreatic Cancer Patients

This study examined whether administering neoadjuvant therapy (nat) followed by surgical resection is safe and effective in pancreatic ductal adenocarcinoma (PDAC) patients aged 75 and older. In a comprehensive three-part analysis, the research found that this aggressive treatment approach appears to be both safe and effective for older patients. Notably, it led to improved outcomes in terms of overall survival (OS) and time to recurrence (TTR) compared to upfront surgical resection, supporting the idea that older adults with PDAC should be offered this multimodal treatment approach.

Journal Article by Qiao G, Fong ZV (…) Qadan M et 16 al. in Ann Surg

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

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Comparing Gastric Ischemic Conditioning Techniques for Safer Esophagectomy

This study delves into techniques used to reduce complications in esophagectomy, where blood flow issues often lead to problems. They compared three methods: one-step esophagectomy, laparoscopic gastric ischemic conditioning (lapgic), and angioembolization (angiogic). Results from 14 studies involving 1760 patients indicate that both lapgic and angiogic significantly reduced the risk of postoperative anastomotic leaks and stenosis compared to the one-step procedure. Interestingly, there were no differences in other complications or mortality rates among the techniques, suggesting potential benefits for lapgic and angiogic in enhancing patient safety during esophagectomy.

Journal Article by Aiolfi A, Bona D (…) Zehetner J et 13 al. in Ann Surg

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

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Validation of Fistula Risk Scores for Postoperative Pancreatic Fistula After Surgery

Researchers have successfully validated the accuracy of two fistula risk scores, “distal fistula risk scores” and “dispair,” in predicting postoperative pancreatic fistula (POPF) after distal pancreatectomy. These scores are based on various patient factors like body mass index, diabetes, and pancreatic characteristics. With a 19.3% incidence of clinically relevant POPF in their cohort, the study confirmed the reliability of these models. This validation provides surgeons with valuable tools to assess and reduce the risk of POPF, enhancing surgical decision-making and patient care.

Journal Article by Xu Y, Jin C, Fu D and Yang F in BMC Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Gender Bias Persists in the Operating Room: Implications for the Medical Workforce

In a survey involving 440 surgeons and anesthesiologists, 55.2% of participants reported experiences of gender bias. Women faculty members, in particular, expressed the need to continually prove themselves, experienced less respect, had fewer opportunities and resources, faced more assumptions about their abilities, and felt the necessity to adjust their demeanor to connect with their teams, all compared to their male colleagues. These findings emphasize the presence of gender bias in the perioperative environment, highlighting the importance of creating a more equitable workplace.

Journal Article by Staub M, Han B (…) Eckhouse SR et 8 al. in Am J Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Common Channel Length and Type II Diabetes Remission after Duodenal Switch

Exploring the impact of common channel (CC) length in duodenal switch (DS) surgeries on Type II diabetes mellitus (DM) remission, this study analyzed 341 DM patients with varying CC lengths (100 cm, 150 cm, and 200 cm). When stratified by insulin dependence, patients with shorter CC lengths exhibited improved glycemic control and greater DM remission in the insulin-dependent group. Milder DM cases responded well to all CC lengths. Importantly, shorter CC lengths didn’t affect nutritional status or necessitate more revisions for malnutrition.

Journal Article by Sharp LS, Sharp WT and Ng P in Obes Surg

© 2023. The Author(s).

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Factors Influencing Readmissions After Sleeve Gastrectomy

In the quest to understand 30-day readmission rates following laparoscopic sleeve gastrectomy, a study involving 235,563 patients identified several influential factors. These factors included age, gender, body mass index (BMI), payment source, length of hospital stay, comorbidities, and hospital characteristics. Older age, male gender, higher BMI, Medicare as the primary payer, and certain comorbidities were associated with higher readmission rates. Additionally, hospital factors like size and ownership played a role. Recognizing these influences is crucial for decision-making around readmission penalties.

Journal Article by Dubchuk C, Afifi AM (…) Nazzal M et 6 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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Gender Disparity in Penetrating Trauma Outcomes: Insights from a Single-Center Study

While penetrating trauma occurs less often in females, a study delving into this specific demographic reveals some intriguing findings. Females, on average, had less severe injuries than males, but the mortality rates were similar. Surprisingly, females underwent fewer surgical or interventional radiology interventions. After accounting for age and injury severity, the study found no significant differences in mortality rates, hospital stays, or complications between the genders. This research calls for further investigation into the factors contributing to these outcomes in penetrating trauma.

Journal Article by Zwemer CH, Mohamed T (…) Kartiko S et 3 al. in J Surg Res

Copyright © 2023 Elsevier Inc. All rights reserved.

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