Featured Articles in Dec 2021

The World Journal of Surgery is Pleased to Announce that Dr. Michelle de Oliveira Will Join Our Editorial Team as Our Associate Editor for Liver Surgery

 

Author list:  Julie Ann Sosa

Abstract: NA

Free link: https://rdcu.be/cBYpr

 


The World Journal of Surgery Announces Two New Assistant Editors for Visual Abstracts and Social Media

 

Author list:  Julie Ann Sosa

Abstract: NA

Free link: https://rdcu.be/cBYpH

 


Inspiring Women in Surgery: Professor Barbara K. Kinder MD, USA

 

 

Title: Professor Barbara K. Kinder MD, USA

Author list:  Sanziana Roman

Abstract: NA

Free link: https://rdcu.be/cBYpP

 


Surgical Symposium: Pushing the Surgical Envelope

 

Author list:  Rifat Latifi

Abstract: NA

Free link: https://rdcu.be/cBYpT

 


We Asked the Experts: One Size Does Not Fit All: The Option to Go Flat Following Mastectomy

 

Author list:  Kari M. Rosenkranz

Abstract: NA

Free link:  https://rdcu.be/cBYrk


My First Paper: The Direct Medical Cost of Acute Appendicitis Surgery in a Resource-Limited Setting of Papua New Guinea

 

Author list:  Ian Umo & Kennedy James

Abstract:

Background

Acute appendicitis is a common surgical emergency, and challenges in access to surgery in a low middle-income country can direct cost implications.

Methods

A prospective cost of illness study was conducted at Alotau Provincial Hospital (APH) from October 14, 2019, to June 1, 2020. A bottom-up approach of microcosting was used to estimate the direct medical cost of consecutive patients with acute appendicitis undergoing surgery.

Results

The mean cost of acute appendicitis surgery for each patient was K39,517.66 (US$11,460.12) for uncomplicated appendicitis, K45,873.99 (US$13,303.46) for complicated appendicitis and K38,838.80 (US$ 11,263.25) for a normal appendix. In total, the direct medical cost for acute appendicitis in this study was K4,562,625.29 (US$ 1,323,161.33) with the majority of expenditure incurred by surgical ward expenses.

Conclusion

This study demonstrates that direct medical costs for uncomplicated appendicitis surgery in a resource-limited hospital are less expensive. As the pathology progresses, the cost also exponentially increases. Policy makers and clinicians must establish appropriate curative surgical services at secondary (NOM of acute appendicitis and laparoscopic surgery) and primary health-care levels to address acute appendicitis surgery as this can reduce costs.

Free link:  https://rdcu.be/cBYrk

 


Original Scientific Reports: Management of Adult Intussusception—A Case Series Experience from a Tertiary Center

 

 

Author list:  Mariya Neymark, Roi Abramov, Maria Dronov & Hayim Gilshtein

Abstract:

Background

The management of intussusception is controversial. Clinical presentation, with the aid of imaging modalities, enables a better selection of patients for the appropriate treatment algorithm. Conservative management versus surgical intervention with bowel resection is considered accordingly.

Methods

Retrospective review of a computerized database of patients who were admitted with intussusception between January 1, 2010, and December 31, 2020, in a single tertiary center in Israel. Patients who were treated conservatively were compared to those who underwent surgery. Patients who underwent bowel resection were compared to those that had surgery without a resection.

 

Results

A total of 76 patients were diagnosed with intussusception, and 49 were operated. Bowel resection was performed in 32 cases. 20/76(26%) were successfully managed conservatively. Patients with a lead point (OR = 5.59) and colonic involvement (OR = 13.72) had a higher likelihood for resection. The likelihood of bowel resection was found to be significantly lower with proximal small bowel intussusception (OR = 0.071).

Conclusion

Young patients presenting with intussusception may be treated conservatively when adequate criteria are met in order to avoid unnecessary surgical interventions.

Free link:  https://rdcu.be/cBYti

 


The Impact of Obesity on Renal Trauma Outcome: An Analysis of the National Trauma Data Bank

 

Author list:  Nizar Hakam, Behnam Nabavizadeh, Michael J. Sadighian, Jordan Holler, Patrick Shibley, Kevin D. Li, Patrick Low, Gregory Amend, Deborah M. Stein & Benjamin N. Breyer

Abstract:

Background

The obesity paradox has been recently demonstrated in trauma patients, where improved survival was associated with overweight and obese patients compared to patients with normal weight, despite increased morbidity. Little is known whether this effect is mediated by lower injury severity. We aim to explore the association between body mass index (BMI) and renal trauma injury grade, morbidity, and in-hospital mortality.

Methods

A retrospective cohort of adults with renal trauma was conducted using 2013–2016 National Trauma Data Bank. Multiple regression analyses were used to assess outcomes of interest across BMI categories with normal weight as reference, while adjusting for relevant covariates including kidney injury grade.

Results

We analyzed 15181 renal injuries. Increasing BMI above normal progressively decreased the risk of high-grade renal trauma (HGRT). Subgroup analysis showed that this relationship was maintained in blunt injury, but there was no association in penetrating injury. Overweight (OR 1.02, CI 0.83–1.25, p = 0.841), class I (OR 0.92, CI 0.71–1.19, p = 0.524), and class II (OR 1.38, CI 0.99–1.91, p = 0.053) obesity were not protective against mortality, whereas class III obesity (OR 1.46, CI 1.03–2.06, p = 0.034) increased mortality odds. Increasing BMI by category was associated with a stepwise increase in odds of acute kidney injury, cardiovascular events, total hospital length of stay (LOS), intensive care unit LOS, and ventilator days.

Conclusions

Increasing BMI was associated with decreased risk of HGRT in blunt trauma. Overweight and obesity were associated with increased morbidity but not with a protective effect on mortality. The obesity paradox does not exist in kidney trauma when injury grade is accounted for.

Free link:  https://rdcu.be/cBYtE

 


Operative Approach Does Not Impact Radial Margin Positivity in Distal Rectal Cancer

Author list:  George Q. Zhang, Rebecca Sahyoun, Miloslawa Stem, Brian D. Lo, Ashwani Rajput, Jonathan E. Efron, Chady Atallah & Bashar Safar

Abstract:

Background

Robotic surgery is attractive for resection of low rectal cancer due to greater dexterity and visualization, but its benefit is poorly understood. We aimed to determine if operative approach impacts radial margin positivity (RMP) and postoperative outcomes among patients undergoing abdominoperineal resection (APR).

Methods

This was a retrospective cohort study of patients from the National Surgical Quality Improvement Program who underwent APR for low rectal cancer from 2016 to 2019. Patients were stratified by operative approach: robotic, laparoscopic, and open APR (R-APR, L-APR, and O-APR). Emergent cases were excluded. The primary outcome was RMP. 30-day postoperative outcomes were also evaluated, using logistic regression analysis.

Results

Among 1,807 patients, 452 (25.0%) underwent R-APR, 474 (26.2%) L-APR, and 881 (48.8%) O-APR. No differences regarding RMP (13.5% R-APR vs. 10.8% L-APR vs. 12.3% O-APR, p = 0.44), distal margin positivity, positive nodes, readmission, or operative time were observed between operative approaches. Adjusted analysis confirmed that operative approach did not predict RMP (p > 0.05 for all). Risk factors for RMP included American Society of Anesthesiologists (ASA) classification III (ASA I-II ref; OR 1.46, p = 0.039), pT3-4 stage (T0-2 ref, OR 4.02, p < 0.001), pN2 stage (OR 1.98, p = 0.004), disseminated cancer (OR 1.90, p = 0.002), and lack of preoperative radiation (OR 1.98, p < 0.01).

Conclusions

No difference in RMP was observed among R-APR, L-APR, and O-APR. Postoperatively, R-APR yielded greater benefit when compared to O-APR, but was comparable to that of L-APR. Minimally invasive surgery may be an appropriate option and worthy consideration for patients with distal rectal cancer requiring APR.

Free link:  https://rdcu.be/cBYup


Systematic Reviews and Meta-Analyses: Trauma Training Courses and Programs in Low- and Lower Middle-Income Countries: A Scoping Review

 

 

Author list:  Rachel J. Livergant, Selina Demetrick, Xenia Cravetchi, Janice Y. Kung, Emilie Joos, Harvey G. Hawes & Abdullah Saleh

Abstract:

Background

Injury is the leading cause of morbidity and mortality in low- and lower middle-income countries (LMICs). Trauma training is a cost-effective way to improve injury outcomes. Several trauma programs have been implemented in LMICs; however, their scope and effectiveness remain unclear. In this review, we sought to describe and assess the current state of trauma training in LMICs.

Methods

We searched MEDLINE, Embase, Global Health, Cochrane Library, and ProQuest Dissertations & Theses Global for trauma training courses in LMICs. An additional gray literature search was conducted on university, governmental, and non- governmental organizations’ websites to identify trauma-related postgraduate medical education (PGME) opportunities.

Results

Most studies occurred in sub-Saharan Africa and participants were primarily physicians/surgeons, medical students/residents, and nurses. General and surgical trauma management courses were most common, followed by orthopedic trauma or plastic surgery trauma/burn care courses. 32/45 studies reported on participant knowledge and skills, 27 of which had minimal follow-up. Of the four studies commenting on cost of courses, only one demonstrated cost-effectiveness. Three articles evaluated post-course effects on patient outcomes, two of which failed to demonstrate significant improvements. Overall, 43.0% of LMICs have PGME programs with defined trauma competency requirements.

Conclusions

Current studies on trauma training in LMICs do not clearly demonstrate sustainability, cost-effectiveness, nor improved outcomes. Trauma training programs should be in response to a need, championed locally, and work within a cohesive system to demonstrate concrete benefits. We recommend standardized and contextualized trauma training with recertifications in LMICs for lasting and improved trauma care.

Free link:  https://rdcu.be/cBYuR


 

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