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Local Anesthetic With Steroids for a TEP-IHR
Total extraperitoneal inguinal hernia repair (TEP-IHR) can result in significant patient discomfort in the immediate postoperative period. In a randomized clinical trial by Sakamoto et al, 75 patients received a transversus abdominis plane block, preperitoneal instillation of local anesthetic, or no regional technique. The results of the Quality of Recovery–40 questionnaire demonstrated that preperitoneal instillation of local anesthetic with dexamethasone provided patients with improved quality of recovery 24 hours postoperatively.
Trends in Choledocholithiasis Management
Wandling et al evaluate secular trends in choledocholithiasis management and compare hospital length of stay between patients with choledocholithiasis treated with endoscopic retrograde cholangiopancreatography with laparoscopic cholecystectomy (ERCP+LC) vs laparoscopic common bile duct exploration with laparoscopic cholecystectomy (LCBDE+LC). They highlight the marked decline in the use of both open and laparoscopic CBDE in the United States as well as the benefit to the length of stay LCBDE+LC has over ERCP+LC.
Cost-effectiveness in AAA Repair
Because of the similarity in clinical outcomes after elective open and endovascular repair of abdominal aortic aneurysm (AAA), cost may be an important factor in choosing a procedure. Lederle and colleagues compare total and AAA-related use of health care services, costs, and cost-effectiveness between groups randomized to open or endovascular repair and found that, with follow-up to 9 years, survival, quality of life, costs, and cost-effectiveness did not differ between elective open and endovascular repair of AAA.
Outcomes After Noncardiac Surgery in the VA
Massarweh et al provide a contemporaneous report of noncardiac postoperative outcomes in the Veterans Affairs (VA) health system using data from the VA Surgical Quality Improvement Program among veterans who underwent inpatient general, vascular, thoracic, genitourinary, neurosurgical, orthopedic, or spine surgery from 1999 to 2014. They found that morbidity, mortality, and failure to rescue have improved within the VA health system.
Confidence Crisis Among General Surgery Residents
There is concern that general surgery residents are choosing subspecialty training in large numbers because of a crisis in confidence at the end of training. Elfenbein performed a systematic review and qualitative analysis of the published literature on this topic to explore the evidence around this claim. She found that this “confidence crisis” narrative is problematic and not supported by strong evidence.
Highlights. JAMA Surg. 2016;151(12):1097. doi:10.1001/jamasurg.2015.2958
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