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Bariatric Surgery vs Lifestyle Intervention for T2DM
Questions remain about the role and durability of bariatric surgery for type 2 diabetes mellitus (T2DM). Courcoulas and colleagues randomly assigned and treated 61 adults with a body mass index between 30 and 40 with either gastric bypass, adjustable gastric banding, or an intensive lifestyle intervention. Partial or complete T2DM remission at 3 years was achieved by 40% of adults who underwent a gastric bypass, 29% of adults who underwent adjustable gastric banding, and 0% of adults who underwent the intensive lifestyle intervention.
Continuing Medical Education
Caprini VTE Risk Assessment Model
Appropriate risk stratification for venous thromboembolism (VTE) is essential to providing appropriate thromboprophylaxis and avoiding morbidity and mortality. Obi and colleagues performed a retrospective cohort study of 4844 adults (≥18 years old) admitted to a 20-bed surgical intensive care unit in a large tertiary care academic hospital during a 5-year period (July 1, 2007, through June 30, 2012) and found that the Caprini VTE risk assessment model was valid.
Surveillance and Long-term Outcomes After EVAR
It is unknown whether adherence to national surveillance guidelines improves long-term outcomes after endovascular aortic aneurysm repair (EVAR). In an observational study using Medicare claims data, Garg et al examined surveillance patterns and long-term outcomes for 9503 patients. They found no overall survival advantage or aneurysm-related survival advantage for those who adhered to surveillance guidelines, which suggests that frequent surveillance may not be required for all patients.
Interhospital Variation in Mortality for Patients With Severe TBI
It is unclear whether compliance with evidence-based guidelines can be used as a marker of hospital quality. Dawes et al studied all adult patients who presented to a regional consortium of 14 hospitals from January 1, 2009, through December 31, 2010, with severe traumatic brain injury (TBI) and calculated the hospitals’ compliance with 2 national guidelines. Despite face validity, they found no association between guideline compliance and risk-adjusted mortality.
THR and Prosthetic Survivorship
Total hip replacement (THR) is successful in treating hip arthritis. Prosthetic survivorship may depend on characteristics of the implant, notably THR fixation technique and bearing surface type. In a cohort study of 100 191 French patients aged 40 years or older who received implants between April 2010 and December 2011, Colas et al assessed whether THR fixation technique and bearing surface were related to early prosthetic revision. Antibiotic-impregnated cemented THRs have a better prognosis; metal-on-metal THRs have a slightly worse one.
Highlights. JAMA Surg. 2015;150(10):925. doi:10.1001/jamasurg.2014.2528
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