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Diverticulitis Episodes Before Resection and Earlier Interventions
In this nationwide retrospective cohort study evaluating inpatient, outpatient, and antibiotic prescription claims of 87 461 patients, Simianu et al found that 56.3% of elective resections for uncomplicated diverticulitis occurred after fewer than 3 episodes of diverticulitis. Earlier surgery was not explained by younger patient age, laparoscopy, time between the last 2 episodes preceding surgery, or financial risk-bearing for patients.
Author Audio Interview and CME
Hospital Competition and Use of Robotic-Assisted Surgery
Despite the lack of efficacy data, robotic-assisted surgery has diffused rapidly into practice. Marketing to physicians, hospitals, and patients has been widespread, but how this marketing has contributed to the diffusion of the technology remains unknown. Wright and colleagues examined the effect of regional hospital competition and hospital financial status on the use of robotic-assisted surgery for 5 commonly performed procedures. They found that patients undergoing surgery in a hospital in a competitive regional market were more likely to undergo a robotic-assisted procedure.
Comparative Effectiveness of Surgical Safety Checklists
The appropriately coached implementation of surgical safety checklists (SSCs) reduces the incidence of perioperative complications and 30-day mortality of patients undergoing surgery. However, the association of the introduction of SSCs with 90-day mortality remains unclear. Bock et al assessed the association between the implementation of SSCs and all-cause 90- and 30-day mortality rates among 10 741 patients. They found that the implementation of SSCs was associated with a 27% reduction of the adjusted risk for all-cause death within 90 days but not within 30 days.
Clinical Review & Education
Users’ Guide to the Medical Literature
Because surgical procedures require clinicians to develop and maintain procedural expertise and because blinding in randomized clinical trials of such therapies is often challenging, their critical appraisal raises unique issues. To address these issues, this Users’ Guide to the Medical Literature reviews the use of remote randomization systems, blinding, sham-controlled trials, split-body trials, expertise-based trials, and mechanistic vs practical trials.
Molecular-Directed Treatment of Differentiated Thyroid Cancer
The diagnosis and surgical treatment of thyroid cancer is challenging when preoperative biopsy results are cytologically indeterminate. In a review by Yip and Sosa, molecular marker tests, such as gene expression classifier analysis and evaluation for somatic mutations or rearrangements, can be used to differentiate benign from malignant nodules. Preoperative genotyping may also correlate with tumor phenotype and may be used to tailor the extent of the initial surgery.
Highlights. JAMA Surg. 2016;151(7):597. doi:10.1001/jamasurg.2015.2928
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