Featured Articles in Jul 2020

How Do We Maintain Surgical Quality Standards for Enhanced Recovery Programs After Cancer Surgery During the COVID-19 Outbreak?

 

 

Author list – Alexandre Doussot, Bruno Heyd & Zaher Lakkis

 

Abstract

No Abstract

 

URL - https://rdcu.be/b4tiO

 


Virtual Learning in Surgical Education During the COVID-19 Pandemic—Shaping the Future of Surgical Education and Training

 

 

Author list – Haley Ehrlich, Mark McKenney & Adel Elkbuli

 

Abstract

No Abstract

 

URL https://rdcu.be/b4tiV

 


Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019

 

 

Author list – Emmanuel Melloul, Kristoffer Lassen, Didier Roulin, Fabian Grass, Julie Perinel, Mustapha Adham, Erik Björn Wellge, Filipe Kunzler, Marc G. Besselink, Horacio Asbun, Michael J. Scott, Cornelis H. C. Dejong, Dionisos Vrochides, Thomas Aloia, Jakob R. Izbicki & Nicolas Demartines

Abstract

Background

Enhanced recovery after surgery (ERAS) pathways are now implemented worldwide with strong evidence that adhesion to such protocol reduces medical complications, costs and hospital stay. This concept has been applied for pancreatic surgery since the first published guidelines in 2012. This study presents the updated ERAS recommendations for pancreatoduodenectomy (PD) based on the best available evidence and on expert consensus.

 

Methods

A systematic literature search was conducted in three databases (Embase, Medline Ovid and Cochrane Library Wiley) for the 27 developed ERAS items. Quality of randomized trials was assessed using the Consolidated Standards of Reporting Trials statement checklist. The level of evidence for each item was determined using the Grading of Recommendations Assessment Development and Evaluation system. The Delphi method was used to validate the final recommendations.

 

Results

A total of 314 articles were included in the systematic review. Consensus among experts was reached after three rounds. A well-implemented ERAS protocol with good compliance is associated with a reduction in medical complications and length of hospital stay. The highest level of evidence was available for five items: avoiding hypothermia, use of wound catheters as an alternative to epidural analgesia, antimicrobial and thromboprophylaxis protocols and preoperative nutritional interventions for patients with severe weight loss (> 15%).

 

Conclusions

The current updated ERAS recommendations for PD are based on the best available evidence and processed by the Delphi method. Prospective studies of high quality are encouraged to confirm the benefit of current updated recommendations.

 

URL https://rdcu.be/b4tiY

 


Surgeon Experience with Parental Leave Policies Varies Based on Practice Setting

 

 

Author list – Katherine Bingmer, Danielle S. Walsh, Nancy L. Gantt, Hilary A. Sanfey & Sharon L. Stein

Abstract

Background

The increase in female surgeons has resulted in scrutiny of widely variable parental leave policies. We hypothesized that academic and private practice surgeons have different experiences based on difference in workplace expectations.

 

Methods

A 25-question survey was disseminated via social media and through the Association of Women Surgeons social media platforms from June 1 to September 15, 2017. An analysis of attending surgeons working in the USA in an academic or private practice setting was performed.

 

Results

Of 1115 total respondents, 477 were attending surgeons practicing in the USA. Practice distribution was 34% private and 47% academic. There was no difference in marital status, work status, or the number who report having been pregnant between the groups. Compared to academic surgeons, private practice surgeons were statistically less likely to have paid leave (p < 0.001) and were more likely to continue to pay benefits while on leave (p < 0.001). Private practitioners were more likely to return to work sooner than desired due to financial (p = 0.022) and supervisor (p = 0.004) pressures and were more likely to leave a job (p = 0.01). Academic surgeons were more likely to experience a delay in job advancement (p = 0.031). On multivariate analysis, more than two pregnancies were associated with an increased risk of perception of a bias and discrimination against pregnancy in the workplace.

 

Conclusions

Parental leave policies and attitudes vary between academic and private practice, creating unique challenges for female surgeons and different issues for family planning depending on employment model.

 

URL https://rdcu.be/b4ti0

 


Sex Disparities in the Global Burden of Surgical Disease

 

 

Author list – Brittany L. Powell, Rebecca Luckett, Abebe Bekele & Tiffany E. Chao

 

Abstract

No Abstract

 

URL https://rdcu.be/b4ti3

 


Factors Associated with High Preoperative Anxiety: Results from Cluster Analysis

 

Author list – Krzysztof Jarmoszewicz, Katarzyna Nowicka-Sauer, Adam Zemła & Sebastian Beta

 

Abstract

Background

Preoperative anxiety is a common patients’ reaction related to serious adverse events post-operatively. The aim was to explore the characteristics of cardiac surgery patients experiencing high preoperative anxiety.

 

Methods

A total of 127 patients (mean age 64.48 years; 34.6% women) assessed their level of anxiety while waiting for surgery, need for information, depression and illness perception with the use of Amsterdam Preoperative Anxiety and Information Scale, Visual Analogue Scale, Hospital Anxiety and Depression Scale and Brief Illness Perception Questionnaire, respectively. Clinical and socio-demographic data were gathered using structured interview and medical files review. K-means and hierarchical cluster analyses were performed. α 0.05 was considered significant.

 

Results

The analysis revealed two different clusters: Cluster 1 involved 46 patients (36.2%; mean age 58.91); Cluster 2 involved 81 patients (63.8%; mean age 67.65). Patients from Cluster 2 had significantly higher anxiety on the day prior to surgery (12.09 vs. 7.93), at a decision stage (6.16 vs. 3.85) and during prehospitalization week (8.01 vs. 4.41). These patients also had more negative illness perception (43.84 vs. 28.35), depressive symptoms (4.9 vs. 2.5) and higher information desire (6.68 vs. 5.54) than patients from Cluster 1. Female sex and planned combined surgery were additional contributors to higher anxiety.

 

Conclusions

Patients scheduled for cardiac surgery experienced high anxiety throughout the presurgery period. Early intervention addressing not only anxiety but also illness perception and depressive symptoms seems vital. The results can be helpful in planning tailored, needs-based psycho-educational intervention which might improve patients’ preoperative psychological state.

 

URL https://rdcu.be/b4tjc

 


Defining Major Surgery: A Delphi Consensus Among European Surgical Association (ESA) Members

 

Author list – David Martin, Styliani Mantziari, Nicolas Demartines, Martin Hübner the ESA Study Group

 

Abstract

Background

Major surgery is a term frequently used but poorly defined. The aim of the present study was to reach a consensus in the definition of major surgery within a panel of expert surgeons from the European Surgical Association (ESA).

 

Methods

A 3-round Delphi process was performed. All ESA members were invited to participate in the expert panel. In round 1, experts were inquired by open- and closed-ended questions on potential criteria to define major surgery. Results were analyzed and presented back anonymously to the panel within next rounds. Closed-ended questions in round 2 and 3 were either binary or statements to be rated on a Likert scale ranging from 1 (strong disagreement) to 5 (strong agreement). Participants were sent 3 reminders at 2-week intervals for each round. 70% of agreement was considered to indicate consensus.

 

Results

Out of 305 ESA members, 67 (22%) answered all the 3 rounds. Significant comorbidities were the only preoperative factor retained to define major surgery (78%). Vascular clampage or organ ischemia (92%), high intraoperative blood loss (90%), high noradrenalin requirements (77%), long operative time (73%) and perioperative blood transfusion (70%) were procedure-related factors that reached consensus. Regarding postoperative factors, systemic inflammatory response (76%) and the need for intensive or intermediate care (88%) reached consensus. Consequences of major surgery were high morbidity (>30% overall) and mortality (>2%).

 

Conclusion

ESA experts defined major surgery according to extent and complexity of the procedure, its pathophysiological consequences and consecutive clinical outcomes.

 

URL https://rdcu.be/b4tjm


Effectiveness and Safety of Mesh Repair for Incarcerated or Strangulated Hernias: A Systematic Review and Meta-Analysis

 

 

Author list – Yu-Te Lin, Tzu-Yu Weng & Ka-Wai Tam

 

Abstract

Background

Hernia repair with mesh in patients with incarcerated or strangulated hernias is controversial. Moreover, the use of mesh for hernia repair with concomitant bowel resection poses a great dilemma. This study compared the outcomes of mesh and anatomic repairs in patients with acutely incarcerated or strangulated hernias.

 

Methods

PubMed, Embase, and Cochrane databases were searched for studies published before November 2019. Randomized controlled trials (RCTs) and prospective studies were included. We conducted meta-analyses using a random-effects model. The treatment outcome was measured by the incidence of surgical site infection (SSI), seroma formation, and hernia recurrence postoperatively.

 

Results

Two RCTs and six prospective studies with 978 patients were included. No significant difference in SSI incidence was observed between patients with incarcerated hernia from the mesh and anatomic repair groups. Recurrence was significantly lower in mesh repair group than in anatomic repair group (odds ratio, 0.08; 95% confidence interval, 0.01–0.45). Only two patients needed to have mesh explantation due to mesh infection. In the setting of hernia repair with concomitant bowel resection, the SSI rate with mesh repair was slightly higher, but most cases of infections were well controlled with conservative antibiotic therapy.

 

Conclusions

Mesh repair for incarcerated or strangulated hernias was feasible with a great benefit of lower recurrence rates. However, due to limited data, drawing conclusions regarding the use of mesh for hernia repair with concomitant bowel resection was difficult. Further studies with preset criteria for evaluating patients undergoing concomitant bowel resection may help elucidate this issue.

 

URL  https://rdcu.be/b4tjp


 

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