Crohn’s Disease and Ulcerative Colitis Show Unique Cytokine Profiles

Both CD and UC specimens display upregulated transcript levels of IL-12, IL-18, Il-21 and IL-27 in both inflamed and non-inflamed intestinal areas when compared to non-IBD.

This Postop Outcome is the 3rd Leading Cause of Death in the U.S.

  • Postoperative myocardial infarction (MI) is the 3rd leading cause of death in the U.S.
  • Intraoperative hypotension, arterial occlusion and other phenomena appear to be part of the multifactorial causes.
  • Intraoperative clonidine is not protective against this phenomenon.
  • Perioperative aspirin use was not related to intraoperative or postoperative MI.

Laparoendoscopic Single-Site Varicocelectomy Significantly Superior to Conventional Lap Approach

  • Laparoendoscopic single-site varicocelectomy found to be superior surgical approach for resolution of varicocele.
  • Cochrane meta-analysis included 6 trials
  • Laparoendoscopic single-site varicocelectomy was superior to conventional laparoscopic surgery with respect to postoperative pain scores, time to convalescence, cosmetic satisfaction, and other clinical variables.
  • Operative time was shorter with CTL-V versus LESS-V.
  • There were no differences between LESS-V and CTL-V in hospital stay and postoperative complications.

New Non-Invasive Monitor May Be Able to Report Subjective Pain Experience During Surgery

  • Nociception index may provide objective measure of subjective pain experience.
  • In testing, the index mirrored physiologic responses normally observed by anesthesiologists during surgery.
  • If effective device may improve titration of analgesic and anesthetic drugs during surgery.
  • Device would be first method to objectively measure subjective pain experience.

Metabolic Disease: Candidates for Surgery Versus Drug Therapy

Philip R. Schauer, MD, is a leading authority on the use of bariatric surgery to control obesity and type 2 diabetes. View our video of him discussing the differential diagnosis for patients who need bariatric surgery versus those who would benefit from pharmacologic therapy.

Lidocaine Provides Efficient Post-Hysterectomy Analgesia

  • Both intravenous and intraperitoneal lidocaine provide effective analgesia for elective hysterectomy.
  • Intravenous and intraperitoneal lidocaine significantly reduce postop opioid requirements.
  • Double-blind placebo controlled study included 109 patients.
  • Study compared I.V and intraperitoneal lidocaine versus saline placebo.
  • Patients in the lidocaine group experienced less vomiting.
  • Trial tracked postoperative opioid analgesic requirement.

Fewer Complications, Similar Analgesia with Paravertebral vs. Thoracic Epidural Block for Thoracotomy

  • Paravertebral blockade was associated with fewer short-term complications compared to thoracic epidural blockade for thoracotomy.
  • Reduced pain was presumably associated with higher patient satisfaction.
  • Reduced short-term complications were presumably associated with reduced short-term hospital costs.
  • No differences were found in 30-day mortality, major complications, or length of hospital stay.
  • The reviewers found insufficient data on chronic pain and costs.

Coffee Significantly Speeds Recovery after Colorectal Resection

  • Postoperative consumption of coffee is a safe and effective way to accelerate the re-establishment of bowel function following colorectal resection surgery.
  • Length of hospital stay among patients receiving coffee therapy was 8.6 days on average versus 16 days for those who received tea.
  • The incidence of postoperative complications was significantly lower among patients who consumed coffee.
  • Significantly reduce overall cost of care was associated with postoperative coffee consumption.

Conservative Management of Borderline Cholelethiasis is Cost Effective, Recommended

  • Endoscopic retrograde cholangiopancreatography (ERCP) is not cost effective for treatment of borderline common bile duct stones (CBDS).
  • Conservative management of CBDS is associated with decreased length of hospital stay, fewer complications, and reduced cost.
  • Conservative management of CBDS obviates the surgical challenges associated with ERCP for borderline cholelethiasis.
  • Conservative management is equally effective as ERCP for removal of borderline common bile duct stones.
  • Post-ERCP pancreatitis occurred significantly more frequently in patients in the ERCP group.

Improve Hernia Repair Cost-Effectiveness: Use Synthetic Mesh

  • Synthetic mesh reinforcement had an expected cost of $15,776 and quality-adjusted life-year value gained of 21.03.
  • Biological mesh had an expected cost of $23,844 and quality-adjusted life-year value gained of 20.94.
  • Monte Carlo sensitivity analysis demonstrated that synthetic mesh was the preferred and most cost-effective strategy in 94 percent of simulations, supporting its overall greater cost-utility.
  • Despite varying the willingness-to-pay threshold from $0 to $100,000 per quality-adjusted life-year, synthetic mesh remained the optimal strategy across all thresholds in sensitivity analysis.

Highly Cost-Effective Pre-Op Smoking Cessation Programs Lead to Long-Term Quits

  • Smoking cessation programs are highly cost-effective; The economic cost and healthcare expenditure associated with tobacco use are estimated at $97 billion and $96 billion, respectively.
  • Results support the long-term (≥12 months) efficacy of preoperative smoking cessation programs.
  • Five million deaths are attributed to tobacco annually in the U.S, annual mortality will increase to 8 million by 2030.
  • Projections suggest that tobacco will kill more people than any single disease pathology by 2020.

Quality of VATS Lobectomies Improves Over Time

  • The adequacy and efficacy of lobectomy and lymph node clearance are crucial to the survival of patients with non-small-cell lung cancer (NSCLC).
  • Concern has been expressed as to whether patients are being understaged due to the inferior oncologic skill of these thoracic surgeons.
  • Survival and recurrence rates are improved with institutional experience with VATS lobectomy.

Google, J&J Co-Found Company to Build Surgical Robots

  • New Johnson & Johnson/Google Life Sciences spinoff will be called Verb Surgical.
  • Verb Surgical will continue to develop advanced surgical robots.
  • J&J’s Ethicon division will develop the surgical instruments for the robotic surgical platform built by Verb.
  • Verb aims to incorporate machine learning, robotic surgery, instrumentation, advanced visualization, and data analytics in order to further advance a surgical robotics platform.

Secret Data on Surgeons Made Public

  • Contents of 2 vast databases of surgeon outcomes data released to the public.
  • Information is intended to support performance-based medicine by enabling patients to search for surgeon with lowest complication rates.
  • and Surgeon Scorecard published data largely with surgeons’ cooperation.
  • Significant variations found in complication rates among surgeons.
  • Surgical complications found to vary more between surgeons than among hospitals.