Featured Articles in Jan 2018

The World Journal of Surgery Announces Julie Ann Sosa, MD MA FACS, as Editor-in-Chief

 

Author list: John G. Hunter

 

Abstract:

As the 5th Editor-in-Chief of the World Journal of Surgery, I am excited to introduce Julie Ann Sosa, MD MA FACS, as the 6th Editor-in-Chief of the World Journal of Surgery. Dr. Sosa was chosen by the International Association of Endocrine Surgeons (IAES) as an Associate Editor of the WJS in 2013 and has served the WJS admirably in this capacity. Dr. Sosa is Professor of Surgery and Medicine (Oncology) at Duke University, where she serves as Chief of Endocrine Surgery and Director of the Surgical Center for Outcomes Research, as well as Leader of the Endocrine Neoplasia Diseases Group and the Solid Tumor Therapeutics Program at the Duke Cancer Institute. Her clinical interest is in endocrine surgery, with a focus in thyroid cancer. She is an NIH-funded investigator and author of more than 270 peer-reviewed publications and 50 book chapters, largely focused on outcomes research, healthcare delivery, hyperparathyroidism, and thyroid cancer, with a focus on clinical trials. Dr. Sosa is Treasurer of the American Thyroid Association and serves on the Board of Directors/Executive Council of the ATA, International Thyroid Oncology Group, and Society for Surgical Oncology, as well as practice guidelines committees for the ATA and the NCCN. Dr. Sosa was born in Montreal and raised in upstate New York. She received her AB at Princeton, MA at Oxford, and MD at Johns Hopkins University, where she completed the Halsted surgery residency and a fellowship in surgical oncology. I have been honored to serve the ISS/SIC and the World Journal of Surgery for the past 13 years, and am looking forward to the new heights that Dr. Sosa will take the World Journal of Surgery. Please join me in welcoming Dr. Sosa as our new Editor in Chief. Congratulations!

 

URL: http://rdcu.be/AHpC


Effects of Pre-operative Psychological Status on Post-operative Recovery: A Prospective Study

 

Author list: Ajay Raghunath Aspari, K. Lakshman

 

Abstract:

Background

Often in clinical practice, a spectrum of outcomes from surgery may be observed ranging from a quick and comfortable recovery to a recovery punctuated by persistent pain and decreased quality of life. While there has been a fast pace of advances made in the field of operative surgery, surgeons seldom pay attention to factors such as the psychological profile of a patient that can affect recovery from surgery.

 

Methods

Consecutive patients undergoing laparoscopic surgeries at Sagar Hospitals, Jayanagar, were recruited. All patients were assessed for psychological status using the screening for illness behaviour questionnaire (SIBQ) and pain catastrophizing scale (PCS). Following surgery, they were followed up for a period of 3 months—on post-operative day 1, post-operative day 7, 1 month and 3 months from the date of surgery. Post-operative pain was measured using the visual analogue scale (Wong–Baker’s), return to work was documented in days and quality of life was measured using the Short Form-36 version 2 (SF-36v2) Health Survey. The Pearson’s correlation coefficients were used to compare variables with continuous data and Chi-square and Fisher’s tests were used to test categorical data for significance.

 

Results

In a total of 98 patients recruited, 50 patients had a complete follow-up of 3 months. Significant correlations existed between the pre-operative markers and markers of recovery. The Chi-square test and Fisher’s exact tests showed significant differences in the scores of pre-operative markers between the groups of patients who developed chronic pain and those who did not. Difference in scores with regard to quality of life was also noted.

Conclusion

Psychological status does play a role in post-operative recovery. This result opens up scope for counselling patients towards a healthy and comfortable recovery from surgery.

 

URL: http://rdcu.be/AHqr


Are American Surgical Residents Prepared for Humanitarian Deployment?: A Comparative Analysis of Resident and Humanitarian Case Logs

 

Author list: Yihan Lin, James S. Dahm, Adam L. Kushner, John P. Lawrence, Miguel Trelles, Lynette B. Dominguez, David P. Kuwayama

 

Abstract:

Background

Effective humanitarian surgeons require skills in general surgery, OB/GYN, orthopedics, and urology. With increasing specialization, it is unclear whether US general surgery residents are receiving exposure to these disparate fields. We sought to assess the preparedness of graduating American surgical residents for humanitarian deployment.

 

Methods

We retrospectively analyzed cases performed by American College of Graduate Medical Education general surgery graduates from 2009 to 2015 and cases performed at select Médecins Sans Frontières (MSF) facilities from 2008 to 2012. Cases were categorized by specialty (general surgery, orthopedics, OB/GYN, urology) and compared with Chi-squared testing. Non-operative care including basic wound and drain care was excluded from both data sets.

 

Results

US general surgery residents performed 41.3% MSF relevant general surgery cases, 1.9% orthopedic cases, 0.1% OB/GYN cases, and 0.3% urology cases; the remaining 56.4% of cases exceeded the standard MSF scope of care. In comparison, MSF cases were 30.1% general surgery, 21.2% orthopedics, 46.8% OB/GYN, and 1.9% urology. US residents performed fewer OB/GYN cases (p < 0.01) and fewer orthopedic cases (p < 0.01). Differences in general surgery and urology caseloads were not statistically significant. Key procedures in which residents lacked experience included cesarean sections, hysterectomies, and external bony fixation.

 

Conclusion

Current US surgical training is poorly aligned with typical MSF surgical caseloads, particularly in OB/GYN and orthopedics. New mechanisms for obtaining relevant surgical skills should be developed to better prepare American surgical trainees interested in humanitarian work.

 

URL: http://rdcu.be/AHsK


How Safe is Performing Cholecystectomy in the Oldest Old? A 15-year Retrospective Study from a Single Institution

 

Author list: Matteo Novello, Davide Gori, Solomone Di Saverio, Matteo Bianchin, Lorenzo Maestri, Francesco Vito Mandarino, Giuseppe Cavallari, Bruno Nardo

 

Abstract:

Background

Globally, the number of people aged 80 years or over, the “oldest old,” is the fastest growing population group. Because of the strong association between age and gallstone disease, both prevalence and incidence of this disease are increasing. The feasibility of the cholecystectomy in octogenarians has been evaluated in several studies that confirmed the safety of the operation. However, the safety of this procedure in nonagenarians is still controversial. The aim of this study was to evaluate the safety of cholecystectomies in nonagenarians and identify related predictors for postoperative hospital length of stay (LOS) and in-hospital mortality up to 30 days postoperatively.

 

Methods

More than 500 cholecystectomies, both open and laparoscopic, were performed between January 2000 and September 2015 at our institution in patients 80 years and older. These statistics include both elective and emergent admissions. A retrospective review of charts over the last 15 years was conducted to compare mortality and length of postoperative stay among two patient groups: 319 octogenarians and 36 nonagenarians. Parameters evaluated include demographics, surgical presentation, American Society of Anesthesiologists (ASA) score, main diagnosis, comorbidities, type of surgery performed, LOS and in-hospital mortality. All data were analyzed with STATA (v.13) software, using a multivariate logistic regression after determining the statistically significant variables through a stepwise regression.

 

Conclusions

We found out that being nonagenarian, compared to octogenarian, is not a significant risk factor in terms of LOS and in-hospital mortality within 30 days postoperatively. Despite that, the mortality rate among nonagenarians is still remarkably high as almost every patient was admitted in an emergent setting. The most remarkable predictor for mortality among the two groups was an “afternoon/night emergency” surgical presentation (OR 25.5, CI 1.53–42.35, p = 0.02). Thus, the surgical emergency management for gallbladder disease at our institution should be critically reevaluated. Performing the procedure in laparoscopy predicted a significant reduction (−5 days, CI −8.5 to −1.4, p = 0.006) of LOS, while presenting with “gallbladder and bile duct stones” (+6.3 days, CI 1.5–11.1, p = 0.01) or “acalculous cholecystitis” (+4.7 days, CI 0.4–9.2, p = 0.03) had the opposite effect. Despite the remarkable mortality rate of our series, being nonagenarian should not be considered as a reason to avoid gallbladder surgery in case of need. Our study suggests that nonagenarians are more suitable surgical candidates than may have previously expected.

 

URL: http://rdcu.be/AHtI


Hospital Workload for Weapon-Wounded Females Treated by the International Committee of the Red Cross: More Work Needed than for Males

 

Author list: Peter Andersson, Mans Muhrbeck, Harald Veen, Zaher Osman, Johan von Schreeb

 

Abstract:

Background

Civilians constitute 33–51% of victims in armed conflicts. Several reports on civilian injuries exist, but few have focused on injuries afflicting females. We analyzed routinely collected data on weapon-related injuries from the International Committee of the Red Cross (ICRC) hospital in northwestern Pakistan in order to define injury patterns and types of surgical treatment for females.

 

Methods

A total of 3028 patient files (376 females) from consecutively admitted patients to the ICRC-hospital in Peshawar from February 2009 to May 2012 were included. Information regarding injury-mechanism, time since injury, vital parameters at admission, type of injury, treatment and basic outcome was extracted from the files and analyzed. Comparisons between gender and age-groups were done by cross-table analyses or nonparametric tests.

 

Results

Females were younger than males (20 vs. 25 years), arrived sooner after injury (24 vs. 48 h) (p < 0.001 for both) and were victims of bombs and missiles more frequently (64.4 vs. 54.6%) (p < 0.001). Vital parameters such as systolic blood pressure (110 vs. 113 mmHg) and pulse rate (100 vs. 86) were more affected at admission (p < 0.001 for both). Females were subjected to surgery (83.0 vs. 77.4%) (p < 0.05) and were given blood transfusions more often (18.8 vs. 13.6%) (p < 0.01). No differences in amputations or in-hospital mortality were found.

Conclusions

Females treated at the ICRC-hospital in northwestern Pakistan are markedly affected by indiscriminate weapons such as bombs and missiles. Their average consumption of surgery is greater than for males, and this might be relevant in planning for staffing and facility needs in similar contexts.

 

URL: http://rdcu.be/AHuC


A Novel Lateral Approach to the Assessment of Vocal Cord Movement by Ultrasonography

 

Author list: Takahiro Fukuhara, Ryohei Donishi, Eriko Matsuda, Satoshi Koyama, Kazunori Fujiwara, Hiromi Takeuchi

 

Abstract:

Background

Ultrasonography is a non-invasive technique that is commonly used by endocrinologists and endocrine surgeons to examine the thyroid region and could be useful for the assessment of vocal cord movement by these specialists. However, previous studies reported a low rate of successful visualization of vocal cord movement by ultrasonography. To address this issue, we devised a novel ultrasonographic procedure for assessing vocal cord movement indirectly by observing the arytenoid movement from a lateral view.

 

Methods

Subjects were 188 individuals, including 23 patients with vocal cord paralysis and 13 with vocal cord paresis. We performed ultrasonographic assessment of vocal cord movement using two different procedures: the conventional middle transverse procedure and the novel lateral vertical procedure.

 

Results

The rate of visualization of vocal cords with the middle transverse procedure was 70.2% and that of the arytenoid cartilage with the lateral vertical procedure was 98.4%. The lateral vertical procedure enabled visualization of all patients with vocal cord paresis/paralysis and detected all 23 patients with vocal paralysis; only one of 13 patients with vocal cord paresis was positively identified. The conventional procedure enabled visualization of 21 of 36 patients with vocal cord paresis/paralysis with high accuracy. There was no false-positive case in either procedure.

 

Conclusions

The proposed lateral vertical procedure improved the rate of visualization of vocal cord movement by ultrasonography, suggesting that it is a useful technique to screen for vocal cord paralysis by ultrasonography.

 

URL: http://rdcu.be/AHvT


Association of Elevated Pre-operative Hemoglobin A1c and Post-operative Complications in Non-diabetic Patients: A Systematic Review

 

Author list: Negar Karimian, Petru Niculiseanu, Alexandre Amar-Zifkin, Francesco Carli, Liane S. Feldman

 

Abstract:

Background

The systematic review summarizes the evidence pertaining to the association of suboptimal pre-operative HbA1c on post-operative outcomes in adult surgical patients with no history of diabetes mellitus.

 

 

 

Results

Six observational studies met all the eligibility criteria and were included in the review. Four studies reported a significant association between pre-operative HbA1c levels and post-operative complications in non-diabetic patients. Two studies reported increased post-operative infection rates, and two reported no difference. Of four studies assessing the length of stay, three did not observe any association with HbA1c level and only one study observed a significant impact. Only one study found higher mortality rates in patients with suboptimal HbA1c.

 

Conclusions

Based on the limited available evidence, suboptimal pre-operative HbA1c levels in patients with no prior history of diabetes predict post-operative complications and represent a potentially modifiable risk factor.

 

URL: http://rdcu.be/AHxi


Systematic Review and Meta-Analysis of Epidural Analgesia Versus Different Analgesic Regimes Following Oesophagogastric Resection

 

Author list: Michael Hughes, Ivan Yaim, D. A. Christopher Deans, Graeme W. Cooper, Peter J. Lamb, Richard J. E. Skipworth

 

Abstract:

Background

Effective analgesia following open oesophagogastric (OG) resection is considered a key determinant of recovery. This review aimed to compare epidural to alternative analgesic techniques in patients undergoing major open resection for OG cancer.

 

Methods

A systematic review and meta-analysis was conducted of randomized controlled trials comparing epidural with alternative analgesic methods in open OG surgery. Primary outcome was the overall post-operative morbidity rate. Secondary outcomes included pulmonary complication rates, length of stay (LOS) and pain scores at 24 h.

 

Results

Six trials which comprised of 249 patients were identified (3 following gastrectomy and 3 following oesophagectomy). Following gastrectomy, secondary outcomes including pulmonary complications and dynamic pain scores at 24 h were improved in the epidural groups. No difference was observed in overall morbidity rates or LOS. Following oesophagectomy, overall morbidity rates were not reported at all. LOS was not shortened, and rest pain was not significantly different in the epidural group, but dynamic pain scores were reported to be improved.

 

Conclusions

Few trials of analgesic regimen have been performed following open OG resection. In those trials that have been performed, epidural analgesia has not been shown to reduce overall morbidity. Epidural is associated with reduced pulmonary complications after gastrectomy, but no benefit has been shown after oesophagectomy. Whilst widespread investigation of minimally invasive OG techniques currently takes place, it is clear that the most effective patient pathway following open OG surgery, particularly oesophagectomy, is still not proven. Further trials are required.

 

URL: http://rdcu.be/AHyE


 

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