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Operative Management of Emergency General Surgery Conditions Incurs Higher Long-term Costs

Research found that for emergency general surgery (EGS) conditions, operative management resulted in higher in-hospital costs compared to non-operative approaches. However, over the long term, only patients with hepatopancreaticobiliary conditions experienced cost equivalence between operative and non-operative management at 90 and 180 days. For other EGS conditions, operative management maintained higher inpatient costs that slightly narrowed with time. The study’s results underscore the importance of considering cost implications when deciding between operative and non-operative management in cases with similar clinical outcomes.

Journal Article by Kaufman EJ, Wirtalla CJ (…) Kelz RR et 8 al. in Ann Surg

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

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Innovative Smartphone App Enhances Liver Surgery Risk Assessment

Researchers have created a novel preoperative model to predict posthepatectomy liver failure (PHLF B+C) using a combination of the aspartate aminotransferase to platelet ratio (APRI) and albumin-bilirubin grade (ALBI). This APRI+ALBI-based multivariable model (MVM) demonstrated an impressive predictive accuracy with an AUC of 0.77. It also proved to be just as effective as more expensive and time-consuming liver function tests, such as ICG clearance and ALICE. To make risk assessment universally accessible, they’ve developed a smartphone app for easy calculations, offering a cost-effective solution for liver surgery candidates.

Journal Article by Santol J, Kim S (…) Starlinger P et 32 al. in Ann Surg

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

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Endoscopic Resection Proves Effective for Giant Esophageal Lesions

Researchers examined the feasibility and safety of endoscopic resection (ER) for giant esophageal subepithelial lesions (G-SELs) in a large study. They achieved a remarkable 93.3% en bloc resection rate with a low recurrence rate. Some patients experienced adverse events (9.3% intraoperatively and 17.3% postoperatively). A predictive nomogram model was developed, indicating that age, tumor size, shape, growth pattern, and the use of submucosal tunneling endoscopic resection (STER) influence the difficulty of ER. Overall, ER is a promising treatment for G-SELs, with the nomogram effectively predicting procedure difficulty.

Journal Article by Xiang AY, Wang KH (…) Zhou PH et 9 al. in Gastrointest Endosc

Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

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Sex-Related Bias in Faculty Evaluation of Surgical Residents

This study delves into the impact of the attending surgeon’s and surgical resident’s gender on evaluations in the operating room. Female attending surgeons rated female residents lower in terms of autonomy compared to their male counterparts. However, male attendings only showed a significant difference in autonomy ratings for female residents in highly complex cases. These findings highlight a gender-specific dynamic in evaluations and suggest the need for periodic evaluations to uncover and address implicit biases within surgical training programs.

Journal Article by Chang AJ, Kwon CM (…) Hoffman RL et 3 al. in Am J Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Enhanced Recovery Protocols Improve Short-Term Outcomes in Esophagectomy: Evidence from India

Esophageal cancer surgery carries significant risks, especially in low and middle-income countries. This study investigated the impact of enhanced recovery protocols (ERP) in patients undergoing esophagectomy in India. Despite ERP patients having a higher predicted risk of complications, they experienced significantly lower 30-day morbidity and shorter hospital stays compared to those receiving standard pre-protocol care. The ERP group had no 30-day deaths and fewer postoperative complications, particularly in terms of pulmonary issues and prolonged ventilation. These findings support the adoption of ERP in esophagectomy patients in India.

Journal Article by Ramakrishnan P, Saini S, Arora A and Khurana G in World J Surg

© 2023. The Author(s) under exclusive licence to Société Internationale de Chirurgie.

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Research Residents Improve Student Perceptions of Surgery Clerkship

The surgical clerkship is a pivotal part of medical education, influencing students’ views on surgery. A program at one institution enlisted research residents as junior clerkship coordinators and educators. Student feedback before and after implementing this program showed no change in overall course perception. However, students noted improved clarity in written clerkship materials and found the feedback more valuable. Qualitative analysis confirmed an overall positive shift in students’ perception of the clerkship, highlighting the benefits of this scholar program in enhancing certain aspects of the medical school clerkship experience.

Journal Article by Ladowski JM, Howell TC (…) Vatsaas CJ et 5 al. in J Surg Res

Copyright © 2023 Elsevier Inc. All rights reserved.

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Machine Learning Model Predicts Benign Anastomotic Strictures in Rectal Cancer Patients

Aiming to improve the prediction of benign anastomotic strictures (BAS) in patients who’ve undergone rectal cancer surgery, a study harnessed machine learning. Data from 1,973 patients were analyzed using multiple machine learning models, with the random forest (RF) model emerging as the best predictor of BAS. The RF model achieved an impressive area under the curve (AUC) of 0.888 and identified key factors influencing predictions. Researchers developed a user-friendly online tool that could revolutionize BAS prevention, enhancing disease management and precise medical interventions in clinical practice.

Journal Article by Su Y, Li Y (…) Liu L et 3 al. in Eur J Surg Oncol

© 2023 Published by Elsevier Ltd.

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Digestive Cancer Surgery Outcomes in Low-Mid Income Countries: A Close Look at Morbidity and Mortality

This study delves into the postoperative outcomes of digestive cancer surgeries with curative intent in a low-mid income country. Analyzing data from 76 patients, the study revealed that immediate preoperative morbidity was around 36.84%, with a mortality rate of 5.26%. At 90 days post-surgery, morbidity remained consistent, while mortality increased to 7.9%. The research identified several risk factors contributing to higher morbidity and mortality, including factors like gender, obesity, and surgical approaches. This study sheds light on the challenges and outcomes of digestive cancer surgery in low-mid income settings.

Journal Article by Sekkat H, Agouzoul H (…) Sabbah F et 9 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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Comparing Laparoscopic and Trans-Anal TME for Rectal Cancer: Insights from RCT Meta-Analysis

In a meta-analysis of randomized controlled trials, researchers evaluated two surgical approaches for rectal cancer: laparoscopic total mesorectal excision (LaTME) and trans-anal TME (TaTME). Analyzing data from 1,691 patients across six trials, they found no significant differences in morbidity, mortality, conversion to open surgery, or anastomotic leakage between the two techniques. However, TaTME patients were more likely to achieve a complete TME and had shorter hospital stays. This study highlights the value of TaTME as an effective option for rectal cancer treatment.

Review by Farooqi M, Hussain A (…) Khan A et 7 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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Antibiotics Prove Effective in Uncomplicated Diverticulitis: A Japanese Nationwide Study

Investigating the effectiveness of antibiotics in treating uncomplicated diverticulitis, this study analyzed data from 131,936 admissions. After propensity score matching, it found that initiating antibiotics within 2 days of admission significantly reduced the rates of intestinal resection and stoma creation when compared to non-antibiotic treatment. While the antibiotic approach resulted in slightly higher median costs, it showed promise in reducing the need for surgical interventions in patients with moderate to severe disease activity. Further research is recommended to explore these findings.

Journal Article by Moroi R, Tarasawa K (…) Masamune A et 9 al. in Digestion

© 2023 The Author(s). Published by S. Karger AG, Basel.

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