Surgery

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.
SurgeonRatings.org 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.