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Surgical Duration and Risk of Venous Thromboembolism
There is a paucity of data assessing the effect of increased surgical duration on the incidence of venous thromboembolism (VTE). Kim et al examine the association between surgical duration and the incidence of VTE by exploring 30-day VTE rates using a retrospective cohort of 1 432 855 patients undergoing surgery under general anesthesia at 315 US hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2011. They find that an increase in surgical duration was directly associated with an increase in the risk for VTE.
Continuing Medical Education
Early Laparoscopic Cholecystectomy
There is growing evidence in support of performing early laparoscopic cholecystectomy (LC) for acute cholecystitis. However, the definition of early LC varies from 0 through 10 days depending on the research protocol. The optimum time to perform early LC is still unclear. Using the Nationwide Inpatient Sample that included 95 523 adults (18 years and older) who underwent LC within 10 days of presentation for acute cholecystitis, Zafar et al determine the optimal time of surgery, with the lowest rates of mortality and morbidity, to be within the first 48 hours of presentation.
The Faculty Practice Solution Center is a national benchmarking tool for academic medical centers to accurately characterize physician productivity. Mostaedi et al queried this extensive database to evaluate the annual mean procedure frequency per surgeon (specifically bariatric surgery) in each calendar year from 2006 through 2011. They discovered that the laparoscopic Roux-en-Y gastric bypass was consistently among the top 10 procedures in each year and generated the highest number of work relative value units. The growth of complex laparoscopic gastrointestinal procedures has significant implications for general surgery residency training.
Tracking Early Readmission After Pancreatectomy
Readmission after pancreatectomy is common, but few data compare patterns of readmission to index and nonindex hospitals. Using statewide data, Tosoian et al observed a 30-day readmission rate of 21.5% among 623 patients who underwent pancreatectomy at a tertiary care referral center between January 1, 2005, and December 2, 2010. On multivariable analysis, factors independently associated with readmission included age 65 years or older, preexisting liver disease, distal pancreatectomy, and postoperative drain placement. Surprisingly, more than 1 in 5 readmissions occurred at nonindex hospitals.
Subtotal cholecystectomy (SC) is a procedure that removes portions of the gallbladder when structures of the Calot triangle cannot be safely identified in “difficult gallbladders.” Elshaer et al conduct a systematic review and meta-analysis to evaluate current studies and present an evidence-based assessment of the outcomes for the techniques available for SC. Subtotal cholecystectomy is an important tool for use in difficult gallbladders and achieves morbidity rates comparable to those reported for total cholecystectomy in simple cases. The various technical differences appear to influence outcomes only for the laparoscopic approach.
Highlights. JAMA Surg. 2015;150(2):93. doi:10.1001/jamasurg.2014.2488
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