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Essential Surgical Knowledge

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1984 papers 1000+ followers Papers from the recent literature which are of interest to residents and practicing surgeons
https://www.readbyqxmd.com/read/28823064/preoperative-hypoalbuminemia-is-an-independent-risk-factor-for-increased-high-grade-morbidity-after-elective-rectal-cancer-resection
#1
J Hardt, L Pilz, J Magdeburg, P Kienle, S Post, R Magdeburg
PURPOSE: This study investigated the association of preoperative hypoalbuminemia and postoperative complications after elective resection for rectal cancer. METHODS: From September 2009 to December 2014, all patients who underwent elective rectal resection for adenocarcinoma of the rectum were identified using a prospective colorectal cancer database. Hypoalbuminemia was defined as a serum albumin < 35 g/L. Characteristics and outcomes of hypoalbuminemic patients were compared to those of patients with normal albumin levels...
August 19, 2017: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/28808875/ssat-state-of-the-art-conference-current-surgical-management-of-gastric-tumors
#2
Jeffrey A Norton, Teresa Kim, Joseph Kim, Martin D McCarter, Kaitlyn J Kelly, Joyce Wong, Jason K Sicklick
INTRODUCTION: The current era of gastric surgery is marked by low morbidity and mortality rates, innovative strategies to approach resections with a minimally invasive fashion or hyperthermic intraperitoneal chemotherapy (HIPEC), as well as improved understanding of the biology of sporadic and hereditary stromal, neuroendocrine, and epithelial malignancies. METHODS: In 2017, the Society for Surgery of the Alimentary Tract convened a State-of-the-Art Conference on Current Surgical Management of Gastric Tumors with both international experts and emerging leaders in the field of gastric surgery...
August 14, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/28818521/current-approach-of-the-axilla-in-patients-with-early-stage-breast-cancer
#3
REVIEW
Eleftherios P Mamounas, Thorsten Kuehn, Emiel J T Rutgers, Gunter von Minckwitz
The surgical approach of the axilla in patients with early-stage breast cancer has witnessed considerable evolution during the past 25 years. The previously undisputed gold standard of axillary-lymph-node dissection for staging has now been replaced by sentinel-lymph-node biopsy for patients with clinically negative axilla. For selected patients with limited sentinel-lymph-node involvement, completion axillary-lymph-node dissection can be omitted or replaced by axillary radiotherapy, reducing morbidity. The clinical interest of axillary staging after neoadjuvant chemotherapy is increasing and this approach might contribute to morbidity reduction, and to the further tailoring of future systemic and locoregional treatment decisions by response assessment...
August 14, 2017: Lancet
https://www.readbyqxmd.com/read/28806210/risk-stratification-for-major-postoperative-complications-in-patients-undergoing-intra-abdominal-general-surgery-using-latent-class-analysis
#4
Minjae Kim, Melanie M Wall, Guohua Li
BACKGROUND: Preoperative risk stratification is a critical element in assessing the risks and benefits of surgery. Prior work has demonstrated that intra-abdominal general surgery patients can be classified based on their comorbidities and risk factors using latent class analysis (LCA), a model-based clustering technique designed to find groups of patients that are similar with respect to characteristics entered into the model. Moreover, the latent risk classes were predictive of 30-day mortality...
August 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28754418/surgical-treatment-of-adrenal-carcinoma
#5
S Gaujoux, M Weinandt, S Bonnet, V Reslinger, J Bertherat, B Dousset
Adrenocortical carcinoma (ACC) is a rare disease with a poor prognosis. The presence of a mass syndrome or signs of hormonal hypersecretion often lead to its discovery, but more and more frequently, adrenocortical malignancy is fortuitously discovered as an incidentaloma. Cross-sectional imaging (CT and MRI) often points to the malignant character of the adrenal mass. Needle biopsy is contraindicated. Laboratory testing showing combined hypersecretion of cortisol, androgens or inactive corticosteroid precursors is highly suggestive of ACC...
July 25, 2017: Journal of Visceral Surgery
https://www.readbyqxmd.com/read/28797343/professionalism-in-surgery-crucial-skills-for-attendings-and-residents
#6
REVIEW
Mark S Hochberg, Russell S Berman, H Leon Pachter
No abstract text is available yet for this article.
September 2017: Advances in Surgery
https://www.readbyqxmd.com/read/28794797/acute-mesenteric-ischemia-guidelines-of-the-world-society-of-emergency-surgery
#7
REVIEW
Miklosh Bala, Jeffry Kashuk, Ernest E Moore, Yoram Kluger, Walter Biffl, Carlos Augusto Gomes, Offir Ben-Ishay, Chen Rubinstein, Zsolt J Balogh, Ian Civil, Federico Coccolini, Ari Leppaniemi, Andrew Peitzman, Luca Ansaloni, Michael Sugrue, Massimo Sartelli, Salomone Di Saverio, Gustavo P Fraga, Fausto Catena
Acute mesenteric ischemia (AMI) is typically defined as a group of diseases characterized by an interruption of the blood supply to varying portions of the small intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process will eventuate in life threatening intestinal necrosis. The incidence is low, estimated at 0.09-0.2% of all acute surgical admissions. Therefore, although the entity is an uncommon cause of abdominal pain, diligence is always required because if untreated, mortality has consistently been reported in the range of 50%...
2017: World Journal of Emergency Surgery: WJES
https://www.readbyqxmd.com/read/28792873/acute-respiratory-distress-syndrome
#8
B Taylor Thompson, Rachel C Chambers, Kathleen D Liu
New England Journal of Medicine, Volume 377, Issue 6, Page 562-572, August 2017.
August 10, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28792589/early-definitive-treatment-rate-as-a-quality-indicator-of-care-in-acute-gallstone-pancreatitis
#9
R Green, S C Charman, T Palser
BACKGROUND: Early definitive treatment (cholecystectomy or endoscopic sphincterotomy in the same admission or within 2 weeks after discharge) of gallstone disease after a biliary attack of acute pancreatitis is standard of care. This study investigated whether compliance with early definitive treatment for acute gallstone pancreatitis can be used as a care quality indicator for the condition. METHODS: A retrospective cohort study was conducted using the Hospital Episode Statistics database...
August 9, 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/28794243/malpractice-claims-related-to-diagnostic-errors-in-the-hospital
#10
Ashwin Gupta, Ashley Snyder, Allen Kachalia, Scott Flanders, Sanjay Saint, Vineet Chopra
BACKGROUND: Little is known about the incidence or significance of diagnostic error in the inpatient setting. We used a malpractice claims database to examine incidence, predictors and consequences of diagnosis-related paid malpractice claims in hospitalised patients. METHODS: The US National Practitioner Database was used to identify paid malpractice claims occurring between 1 January 1999 and 31 December 2011. Patient and provider characteristics associated with paid claims were analysed using descriptive statistics...
August 9, 2017: BMJ Quality & Safety
https://www.readbyqxmd.com/read/28704232/laparoscopic-transcystic-stenting-and-postoperative-ercp-for-the-management-of-common-bile-duct-stones-at-laparoscopic-cholecystectomy
#11
David Gomez, Michael R Cox
No abstract text is available yet for this article.
July 12, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28772222/hyperlactatemia-in-icu-patients-incidence-causes-and-associated-mortality
#12
Mireia Ferreruela, Joan Maria Raurich, Ignacio Ayestarán, Juan Antonio Llompart-Pou
PURPOSE: To describe the incidence, causes and associated mortality of hyperlactatemia in critically ill patients and to evaluate the association between lactate clearance and in-hospital survival. METHODS: Retrospective cohort study of patients with hyperlactatemia admitted to the ICU. Hyperlactatemia was defined as a blood lactate concentration ≥5mmol/L and high-grade hyperlactatemia a lactate level ≥10mmol/L. Lactate clearance was calculated as the percentage of decrease in lactate concentration from the peak value...
July 24, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28762168/the-role-of-computed-tomography-in-the-diagnosis-of-necrotizing-soft-tissue-infections
#13
Myriam Martinez, Thomas Peponis, Aglaia Hage, Daniel D Yeh, Haytham M A Kaafarani, Peter J Fagenholz, David R King, Marc A de Moya, George C Velmahos
BACKGROUND: The exact role of IV contrast-enhanced computed tomography (CT) in the diagnosis of necrotizing soft tissue infections (NSTIs) has not yet been established. We aimed to explore the role of CT in patients with clinical suspicion of NSTI and assess its sensitivity and specificity for NSTI. METHODS: The medical records of patients admitted between 2009 and 2016, who received IV contrast-enhanced CT to rule out NSTI, were reviewed. CT was considered positive in case of: (a) gas in soft tissues, (b) multiple fluid collections, (c) absence or heterogeneity of tissue enhancement by the IV contrast, and (d) significant inflammatory changes under the fascia...
July 31, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28768325/estimating-risk-of-postsurgical-general-and-geriatric-complications-using-the-vespa-preoperative-tool
#14
Lillian Min, Karen Hall, Emily Finlayson, Michael Englesbe, William Palazzolo, Chiao-Li Chan, Hechuan Hou, Ashley Miller, Kathleen M Diehl
Importance: As greater numbers of older patients seek elective surgery, one approach to preventing postoperative complications is enhanced assessment of risks during preoperative evaluation. Objective: To determine whether a geriatric assessment tool can be implemented in a preoperative clinic and can estimate risk of postoperative complications. Design, Setting, and Participants: In this prospective cohort study, patients 70 years of age or older were assessed in a preoperative clinic for elective surgery from July 9, 2008, to January 5, 2011...
August 2, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28766197/predicting-nodal-positivity-in-women-70%C3%A2-years-of-age-and-older-with-hormone-receptor-positive-breast-cancer-to-aid-incorporation-of-a-society-of-surgical-oncology-choosing-wisely-guideline-into-clinical-practice
#15
Jessemae L Welsh, Tanya L Hoskin, Courtney N Day, Elizabeth B Habermann, Matthew P Goetz, Judy C Boughey
PURPOSE: One of the Society of Surgical Oncology Choosing Wisely guidelines recommends avoiding routine sentinel lymph node (SLN) surgery in clinically node-negative women ≥70 years of age with hormone receptor-positive (HR+) breast cancer. We sought to assess the impact of tumor stage and grade on nodal positivity, and to develop a model to identify patients at low-risk of nodal positivity to aid adoption of the guideline. METHODS: We identified women ≥70 years of age with HR+ cN0 invasive breast cancer in the National Cancer Database (NCDB; 2010-2013) and examined the impact of tumor stage and grade on nodal positivity to identify low-risk combinations...
August 1, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/28679416/management-of-frailty-a-protocol-of-a-network-meta-analysis-of-randomized-controlled-trials
#16
Ahmed M Negm, Courtney C Kennedy, Lehana Thabane, Areti-Angeliki Veroniki, Jonathan D Adachi, Julie Richardson, Ian D Cameron, Aidan Giangregorio, Alexandra Papaioannou
BACKGROUND: Frailty is a common syndrome affecting 5-17% of community-dwelling older adults. Various interventions are used to prevent or treat frailty. Given the diversity of singular and multi-faceted frailty interventions, not all of them have been compared in head-to-head studies. Network meta-analyses provide an approach to simultaneous consideration of the relative effectiveness of multiple treatment alternatives. This systematic review and network meta-analysis of RCTs aims to determine the comparative effect of interventions targeting the prevention or treatment of frailty...
July 5, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/28742709/prospective-evaluation-of-precision-multimodal-gallbladder-surgery-navigation-virtual-reality-near-infrared-fluorescence-and-x-ray-based-intraoperative-cholangiography
#17
Michele Diana, Luc Soler, Vincent Agnus, Antonio D'Urso, Michel Vix, Bernard Dallemagne, Vanina Faucher, Catherine Roy, Didier Mutter, Jacques Marescaux, Patrick Pessaux
OBJECTIVE: We aimed to prospectively evaluate NIR-C, VR-AR, and x-ray intraoperative cholangiography (IOC) during robotic cholecystectomy. BACKGROUND: Near-infrared cholangiography (NIR-C) provides real-time, radiation-free biliary anatomy enhancement. Three-dimensional virtual reality (VR) biliary anatomy models can be obtained via software manipulation of magnetic resonance cholangiopancreatography, enabling preoperative VR exploration, and intraoperative augmented reality (AR) navigation...
July 24, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28742711/readiness-of-us-general-surgery-residents-for-independent-practice
#18
Brian C George, Jordan D Bohnen, Reed G Williams, Shari L Meyerson, Mary C Schuller, Michael J Clark, Andreas H Meier, Laura Torbeck, Samuel P Mandell, John T Mullen, Douglas S Smink, Rebecca E Scully, Jeffrey G Chipman, Edward D Auyang, Kyla P Terhune, Paul E Wise, Jennifer N Choi, Eugene F Foley, Justin B Dimick, Michael A Choti, Nathaniel J Soper, Keith D Lillemoe, Joseph B Zwischenberger, Gary L Dunnington, Debra A DaRosa, Jonathan P Fryer
OBJECTIVE: This study evaluates the current state of the General Surgery (GS) residency training model by investigating resident operative performance and autonomy. BACKGROUND: The American Board of Surgery has designated 132 procedures as being "Core" to the practice of GS. GS residents are expected to be able to safely and independently perform those procedures by the time they graduate. There is growing concern that not all residents achieve that standard. Lack of operative autonomy may play a role...
July 24, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28746154/anastomotic-leakage-and-chronic-presacral-sinus-formation-after-low-anterior-resection-results-from-a-large-cross-sectional-study
#19
Wernard A A Borstlap, Emma Westerduin, Tjeerd S Aukema, Willem A Bemelman, Pieter J Tanis
OBJECTIVES: Little is known about late detected anastomotic leakage after low anterior resection for rectal cancer, and the proportion of leakages that develops into a chronic presacral sinus. METHODS: In this collaborative snapshot research project, data from registered rectal cancer resections in the Dutch Surgical Colorectal Audit in 2011 were extended with additional treatment and long-term outcome data. Independent predictors for anastomotic leakage were determined using a binary logistic model...
July 25, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28728882/variation-in-the-cost-of-5-common-operations-in-the-united-states
#20
Elliot Wakeam, George Molina, Neel Shah, Stuart R Lipsitz, David C Chang, Atul A Gawande, Alex B Haynes
BACKGROUND: Health care costs are an important policy focus in the United States. The magnitude and drivers of variation in the costs of common operative procedures are not well understood. We sought to characterize variation in costs across hospitals. METHODS: We used data from the Nationwide Inpatient Sample from 2001-2011 for 5 elective operations: colectomy, coronary artery bypass graft, total knee arthroplasty, cesarean section, and lung resection. Hospitals were benchmarked for each using hierarchical risk- and reliability-adjustment methods to generate an observed-to-expected cost ratio, which was adjusted for patient demographics, comorbidity, wage index, and procedure complexity...
September 2017: Surgery
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