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American College of Surgeons (ACS): Annual Clinical Congress
ACS: Loop ileostomy may give IBD colitis patients an alternative to urgent colectomy
CHICAGO – Diverting loop ileostomy may be a better option than urgent colectomy as the first surgical step for medically refractory severe ulcerative colitis and Crohn’s disease.
Investigators from the University of California, Los Angeles, have found that ileostomy gives patients a chance to recover from their acute illness – and their colons a chance to heal – so they’re in better shape for definitive surgery further down the road, if it’s even needed (J Am Coll Surg. 2015 Oct;221[4]:S37-S38).
“Urgent colectomy is standard practice for medically refractory severe ulcerative and Crohn’s colitis. However, immunosuppression and malnutrition can result in significant morbidity. This change in management strategy does not eliminate the potential need for definitive surgery, but it does allow for the more extensive procedure to be performed in an elective setting under optimized conditions, thereby improving clinical outcomes,” said the investigators, led by Dr. Amy Lightner, formerly of UCLA but now a colorectal surgery fellow at the Mayo Clinic in Rochester, Minn.
There were just eight patients in the series, so the results are tentative. Six had ulcerative colitis (UC) and two had Crohn’s disease (CD). On presentation, the patients were tachycardic, febrile, malnourished, and anemic, with severe mucosal disease confirmed by endoscopy. Steroids, immunomodulators, and biologics no longer helped. Overall, the patients were too sick to go home, but not quite sick enough for the ICU. Their average age was 29 years.
They underwent a single-incision, laparoscopic diverting loop ileostomy, which took about 45 minutes. The technique, and perhaps the thinking behind it, are similar to one gaining popularity for Clostridium difficile colitis, but without the colonic lavage.
Within 24-48 hours postop, tachycardia and fevers resolved, and patients tolerated oral intake. Narcotic use dropped, and bloody stools became less frequent, and then ceased in all but one patient. Within a month, the average hemoglobin level had climbed from a baseline of 9 g/dL to 11.5 g/dL, and average albumin from 2.5 g/dL to 4 g/dL. Within 2 months, patients’ bowels looked pink and healthy on repeat endoscopy.
“It was a remarkable turnaround. Within 48 hours, they looked markedly different. We are having very good results with this, and it’s much better for patients” than is colectomy during acute illness. “It’s a good change in management,” Dr. Lightner said.
After months of follow-up, two patients, one with UC and one with CD, haven’t needed a colectomy and are maintained on biologics. The other UC patients have had ileal pouch-anal anastomosis. The other CD patient had a subsequent ileorectal anastomosis. Patients were able to undergo those procedures laparoscopically and “have done really well,” Dr. Lightner said.
It’s unclear why loop ileostomy seems so helpful. Perhaps it has something to do with shifts in bacterial populations or decompression of the colon. Maybe it’s just about giving the colon a rest, she said.
The investigators will continue to study the approach. Since the initial report, 8 more patients have joined the series, for a current total of 16. “We are still seeing good results,” Dr. Lightner said.
Dr. Lightner has no disclosures, and there was no outside funding for the work.
These patients are challenging. Often, they are on multiple immunomodulators and are malnourished and anemic, with systemic manifestations of inflammatory disease. The abdomen may be hostile. None of these are favorable factors for doing a total abdominal colectomy, but that remains the standard even today.
This is truly a feasibility or pilot study, and as such, it’s difficult to draw definitive conclusions. Cost-effectiveness is unclear, and some patients are maintained on biologics when, in fact, they may have had a curative procedure with surgery. The follow-up isn’t long enough to look at recurrence of colitis. Nevertheless, it certainly is an intriguing and perhaps revolutionary approach to treating these patients.
Dr. Sean C. Glasgow is a colorectal surgeon and assistant professor of surgery at Washington University in St. Louis. He was not involved with the study.
These patients are challenging. Often, they are on multiple immunomodulators and are malnourished and anemic, with systemic manifestations of inflammatory disease. The abdomen may be hostile. None of these are favorable factors for doing a total abdominal colectomy, but that remains the standard even today.
This is truly a feasibility or pilot study, and as such, it’s difficult to draw definitive conclusions. Cost-effectiveness is unclear, and some patients are maintained on biologics when, in fact, they may have had a curative procedure with surgery. The follow-up isn’t long enough to look at recurrence of colitis. Nevertheless, it certainly is an intriguing and perhaps revolutionary approach to treating these patients.
Dr. Sean C. Glasgow is a colorectal surgeon and assistant professor of surgery at Washington University in St. Louis. He was not involved with the study.
These patients are challenging. Often, they are on multiple immunomodulators and are malnourished and anemic, with systemic manifestations of inflammatory disease. The abdomen may be hostile. None of these are favorable factors for doing a total abdominal colectomy, but that remains the standard even today.
This is truly a feasibility or pilot study, and as such, it’s difficult to draw definitive conclusions. Cost-effectiveness is unclear, and some patients are maintained on biologics when, in fact, they may have had a curative procedure with surgery. The follow-up isn’t long enough to look at recurrence of colitis. Nevertheless, it certainly is an intriguing and perhaps revolutionary approach to treating these patients.
Dr. Sean C. Glasgow is a colorectal surgeon and assistant professor of surgery at Washington University in St. Louis. He was not involved with the study.
CHICAGO – Diverting loop ileostomy may be a better option than urgent colectomy as the first surgical step for medically refractory severe ulcerative colitis and Crohn’s disease.
Investigators from the University of California, Los Angeles, have found that ileostomy gives patients a chance to recover from their acute illness – and their colons a chance to heal – so they’re in better shape for definitive surgery further down the road, if it’s even needed (J Am Coll Surg. 2015 Oct;221[4]:S37-S38).
“Urgent colectomy is standard practice for medically refractory severe ulcerative and Crohn’s colitis. However, immunosuppression and malnutrition can result in significant morbidity. This change in management strategy does not eliminate the potential need for definitive surgery, but it does allow for the more extensive procedure to be performed in an elective setting under optimized conditions, thereby improving clinical outcomes,” said the investigators, led by Dr. Amy Lightner, formerly of UCLA but now a colorectal surgery fellow at the Mayo Clinic in Rochester, Minn.
There were just eight patients in the series, so the results are tentative. Six had ulcerative colitis (UC) and two had Crohn’s disease (CD). On presentation, the patients were tachycardic, febrile, malnourished, and anemic, with severe mucosal disease confirmed by endoscopy. Steroids, immunomodulators, and biologics no longer helped. Overall, the patients were too sick to go home, but not quite sick enough for the ICU. Their average age was 29 years.
They underwent a single-incision, laparoscopic diverting loop ileostomy, which took about 45 minutes. The technique, and perhaps the thinking behind it, are similar to one gaining popularity for Clostridium difficile colitis, but without the colonic lavage.
Within 24-48 hours postop, tachycardia and fevers resolved, and patients tolerated oral intake. Narcotic use dropped, and bloody stools became less frequent, and then ceased in all but one patient. Within a month, the average hemoglobin level had climbed from a baseline of 9 g/dL to 11.5 g/dL, and average albumin from 2.5 g/dL to 4 g/dL. Within 2 months, patients’ bowels looked pink and healthy on repeat endoscopy.
“It was a remarkable turnaround. Within 48 hours, they looked markedly different. We are having very good results with this, and it’s much better for patients” than is colectomy during acute illness. “It’s a good change in management,” Dr. Lightner said.
After months of follow-up, two patients, one with UC and one with CD, haven’t needed a colectomy and are maintained on biologics. The other UC patients have had ileal pouch-anal anastomosis. The other CD patient had a subsequent ileorectal anastomosis. Patients were able to undergo those procedures laparoscopically and “have done really well,” Dr. Lightner said.
It’s unclear why loop ileostomy seems so helpful. Perhaps it has something to do with shifts in bacterial populations or decompression of the colon. Maybe it’s just about giving the colon a rest, she said.
The investigators will continue to study the approach. Since the initial report, 8 more patients have joined the series, for a current total of 16. “We are still seeing good results,” Dr. Lightner said.
Dr. Lightner has no disclosures, and there was no outside funding for the work.
CHICAGO – Diverting loop ileostomy may be a better option than urgent colectomy as the first surgical step for medically refractory severe ulcerative colitis and Crohn’s disease.
Investigators from the University of California, Los Angeles, have found that ileostomy gives patients a chance to recover from their acute illness – and their colons a chance to heal – so they’re in better shape for definitive surgery further down the road, if it’s even needed (J Am Coll Surg. 2015 Oct;221[4]:S37-S38).
“Urgent colectomy is standard practice for medically refractory severe ulcerative and Crohn’s colitis. However, immunosuppression and malnutrition can result in significant morbidity. This change in management strategy does not eliminate the potential need for definitive surgery, but it does allow for the more extensive procedure to be performed in an elective setting under optimized conditions, thereby improving clinical outcomes,” said the investigators, led by Dr. Amy Lightner, formerly of UCLA but now a colorectal surgery fellow at the Mayo Clinic in Rochester, Minn.
There were just eight patients in the series, so the results are tentative. Six had ulcerative colitis (UC) and two had Crohn’s disease (CD). On presentation, the patients were tachycardic, febrile, malnourished, and anemic, with severe mucosal disease confirmed by endoscopy. Steroids, immunomodulators, and biologics no longer helped. Overall, the patients were too sick to go home, but not quite sick enough for the ICU. Their average age was 29 years.
They underwent a single-incision, laparoscopic diverting loop ileostomy, which took about 45 minutes. The technique, and perhaps the thinking behind it, are similar to one gaining popularity for Clostridium difficile colitis, but without the colonic lavage.
Within 24-48 hours postop, tachycardia and fevers resolved, and patients tolerated oral intake. Narcotic use dropped, and bloody stools became less frequent, and then ceased in all but one patient. Within a month, the average hemoglobin level had climbed from a baseline of 9 g/dL to 11.5 g/dL, and average albumin from 2.5 g/dL to 4 g/dL. Within 2 months, patients’ bowels looked pink and healthy on repeat endoscopy.
“It was a remarkable turnaround. Within 48 hours, they looked markedly different. We are having very good results with this, and it’s much better for patients” than is colectomy during acute illness. “It’s a good change in management,” Dr. Lightner said.
After months of follow-up, two patients, one with UC and one with CD, haven’t needed a colectomy and are maintained on biologics. The other UC patients have had ileal pouch-anal anastomosis. The other CD patient had a subsequent ileorectal anastomosis. Patients were able to undergo those procedures laparoscopically and “have done really well,” Dr. Lightner said.
It’s unclear why loop ileostomy seems so helpful. Perhaps it has something to do with shifts in bacterial populations or decompression of the colon. Maybe it’s just about giving the colon a rest, she said.
The investigators will continue to study the approach. Since the initial report, 8 more patients have joined the series, for a current total of 16. “We are still seeing good results,” Dr. Lightner said.
Dr. Lightner has no disclosures, and there was no outside funding for the work.
AT THE ACS CLINICAL CONGRESS
Key clinical point: Patients with refractory inflammatory bowel disease may benefit from loop ileostomy in lieu of urgent colectomy as a first surgical step.
Major finding: Within 24-48 hours after diverting loop ileostomy, tachycardia and fevers resolved, and patients tolerated oral intake. Narcotic use dropped, and bloody stools became less frequent, then ceased.
Data source: Pilot study in eight patients with refractory inflammatory bowel disease
Disclosures: The lead investigator has no disclosures, and there was no outside funding for the work.
VIDEO: A better option for C. difficile toxic megacolon
CHICAGO – Last-minute colectomy isn’t the way to go for Clostridium difficile–induced toxic megacolon; outcomes are better with a timely loop ileostomy and colonic lavage.
University of Pittsburgh surgery professor Dr. Brian Zuckerbraun, a pioneer of the technique, explained the procedure and its benefits in an interview at the annual Clinical Congress of the American College of Surgeons.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
CHICAGO – Last-minute colectomy isn’t the way to go for Clostridium difficile–induced toxic megacolon; outcomes are better with a timely loop ileostomy and colonic lavage.
University of Pittsburgh surgery professor Dr. Brian Zuckerbraun, a pioneer of the technique, explained the procedure and its benefits in an interview at the annual Clinical Congress of the American College of Surgeons.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
CHICAGO – Last-minute colectomy isn’t the way to go for Clostridium difficile–induced toxic megacolon; outcomes are better with a timely loop ileostomy and colonic lavage.
University of Pittsburgh surgery professor Dr. Brian Zuckerbraun, a pioneer of the technique, explained the procedure and its benefits in an interview at the annual Clinical Congress of the American College of Surgeons.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
EXPERT ANALYSIS FROM THE ACS CLINICAL CONGRESS
ACS: Less pneumonia, fewer deaths with ketamine for rib fracture pain
CHICAGO – Ketamine is a safe and simple alternative to epidural anesthesia for pain control in the setting of multiple rib fractures, investigators from the Jacobi Medical Center in the Bronx (N.Y.) concluded after reviewing their experience with the drug.
Epidural analgesia has been the standard for controlling pain after multiple rib fractures, but epidurals are sometimes contraindicated in trauma, especially with back and neck injuries. There’s also a bleeding risk, and the need for an on-call anesthesia team to place them, something not all hospitals have.
Those problems – and the success Jacobi surgeons reported with ketamine pain control after thoracotomy – led the hospital to switch to a ketamine-based rib fracture protocol in 2007.
“As far as we know, we are the only people doing this routinely for multiple rib fractures,” Dr. Joelle Getrajdman, a second-year surgery resident at the medical center, said at the annual clinical congress of the American College of Surgeons.
Patients there with two or more rib fractures get a low-dose peripheral intravenous infusion of ketamine 0.05 mg/kg per hour while in the ICU and step-down unit, along with other pain medications as indicated. The hospital discontinues ketamine once patients leave the step-down unit to prevent diversion for illicit use.
To see how well the protocol has worked, the investigators reviewed all 128 adult trauma patients who received ketamine for multiple rib fractures from 2007 to 2014.
These patients were 60 years old on average, with a median of six rib fractures, many of them bilateral. Almost half had injury severity scores above 15, and most had chest Abbreviated Injury Scores of at least 3. Pneumo- and hemothoraces were common. Patients spent a mean of 6 days in the surgical ICU and 13 days in the hospital.
Along with ketamine, almost all had a morphine or hydromorphone (Dilaudid) patient-controlled analgesia (PCA) pumps, more than half received IV ketorolac (Toradol), and about 40% IV Tylenol. Only 14% had paravertebral or intercostal blocks.
Fourteen patients (10.9%) developed pneumonia, and four (3.1%) died, which compares favorably with outcomes in patients receiving epidurals. Historically, epidural analgesia for multiple traumatic rib fractures has been associated with about an 18% pneumonia rate, and about 9% mortality.
Ketamine side effects were minimal; none of the patients had hallucinations or tachycardia, and three (2.3%) were hypotensive on the drug.
Jacobi’s database did not record how many times patients used their PCA pumps, so the study did not have a direct measure of pain control. The investigators plan to look into this question prospectively.
Even so, when patients hurt from rib fractures, they breathe shallowly, which puts them at risk for pneumonia and death. “We have lower rates” of both than with epidurals, “so you could extrapolate that we must be controlling pain better,” Dr. Getrajdman said.
Ketamine at high doses is an anesthetic, but at lower doses it’s an antagonist of N-methyl-D-aspartate (NMDA), and a mild opioid receptor agonist, “so we can give patients the same amount of morphine but achieve a higher analgesic effect,” she said.
Ketamine had been the subject of intense interest in recent years for pain control in a wide variety of settings, as well as for psychiatric and other problems. Clinicaltrials.gov currently lists 138 open investigations of the drug.
Among them is a randomized trial from the Medical College of Wisconsin pitting ketamine against placebo for rib fracture pain following blunt trauma.
Dr. Getrajdman has no disclosures, and there was no outside funding for the work.
CHICAGO – Ketamine is a safe and simple alternative to epidural anesthesia for pain control in the setting of multiple rib fractures, investigators from the Jacobi Medical Center in the Bronx (N.Y.) concluded after reviewing their experience with the drug.
Epidural analgesia has been the standard for controlling pain after multiple rib fractures, but epidurals are sometimes contraindicated in trauma, especially with back and neck injuries. There’s also a bleeding risk, and the need for an on-call anesthesia team to place them, something not all hospitals have.
Those problems – and the success Jacobi surgeons reported with ketamine pain control after thoracotomy – led the hospital to switch to a ketamine-based rib fracture protocol in 2007.
“As far as we know, we are the only people doing this routinely for multiple rib fractures,” Dr. Joelle Getrajdman, a second-year surgery resident at the medical center, said at the annual clinical congress of the American College of Surgeons.
Patients there with two or more rib fractures get a low-dose peripheral intravenous infusion of ketamine 0.05 mg/kg per hour while in the ICU and step-down unit, along with other pain medications as indicated. The hospital discontinues ketamine once patients leave the step-down unit to prevent diversion for illicit use.
To see how well the protocol has worked, the investigators reviewed all 128 adult trauma patients who received ketamine for multiple rib fractures from 2007 to 2014.
These patients were 60 years old on average, with a median of six rib fractures, many of them bilateral. Almost half had injury severity scores above 15, and most had chest Abbreviated Injury Scores of at least 3. Pneumo- and hemothoraces were common. Patients spent a mean of 6 days in the surgical ICU and 13 days in the hospital.
Along with ketamine, almost all had a morphine or hydromorphone (Dilaudid) patient-controlled analgesia (PCA) pumps, more than half received IV ketorolac (Toradol), and about 40% IV Tylenol. Only 14% had paravertebral or intercostal blocks.
Fourteen patients (10.9%) developed pneumonia, and four (3.1%) died, which compares favorably with outcomes in patients receiving epidurals. Historically, epidural analgesia for multiple traumatic rib fractures has been associated with about an 18% pneumonia rate, and about 9% mortality.
Ketamine side effects were minimal; none of the patients had hallucinations or tachycardia, and three (2.3%) were hypotensive on the drug.
Jacobi’s database did not record how many times patients used their PCA pumps, so the study did not have a direct measure of pain control. The investigators plan to look into this question prospectively.
Even so, when patients hurt from rib fractures, they breathe shallowly, which puts them at risk for pneumonia and death. “We have lower rates” of both than with epidurals, “so you could extrapolate that we must be controlling pain better,” Dr. Getrajdman said.
Ketamine at high doses is an anesthetic, but at lower doses it’s an antagonist of N-methyl-D-aspartate (NMDA), and a mild opioid receptor agonist, “so we can give patients the same amount of morphine but achieve a higher analgesic effect,” she said.
Ketamine had been the subject of intense interest in recent years for pain control in a wide variety of settings, as well as for psychiatric and other problems. Clinicaltrials.gov currently lists 138 open investigations of the drug.
Among them is a randomized trial from the Medical College of Wisconsin pitting ketamine against placebo for rib fracture pain following blunt trauma.
Dr. Getrajdman has no disclosures, and there was no outside funding for the work.
CHICAGO – Ketamine is a safe and simple alternative to epidural anesthesia for pain control in the setting of multiple rib fractures, investigators from the Jacobi Medical Center in the Bronx (N.Y.) concluded after reviewing their experience with the drug.
Epidural analgesia has been the standard for controlling pain after multiple rib fractures, but epidurals are sometimes contraindicated in trauma, especially with back and neck injuries. There’s also a bleeding risk, and the need for an on-call anesthesia team to place them, something not all hospitals have.
Those problems – and the success Jacobi surgeons reported with ketamine pain control after thoracotomy – led the hospital to switch to a ketamine-based rib fracture protocol in 2007.
“As far as we know, we are the only people doing this routinely for multiple rib fractures,” Dr. Joelle Getrajdman, a second-year surgery resident at the medical center, said at the annual clinical congress of the American College of Surgeons.
Patients there with two or more rib fractures get a low-dose peripheral intravenous infusion of ketamine 0.05 mg/kg per hour while in the ICU and step-down unit, along with other pain medications as indicated. The hospital discontinues ketamine once patients leave the step-down unit to prevent diversion for illicit use.
To see how well the protocol has worked, the investigators reviewed all 128 adult trauma patients who received ketamine for multiple rib fractures from 2007 to 2014.
These patients were 60 years old on average, with a median of six rib fractures, many of them bilateral. Almost half had injury severity scores above 15, and most had chest Abbreviated Injury Scores of at least 3. Pneumo- and hemothoraces were common. Patients spent a mean of 6 days in the surgical ICU and 13 days in the hospital.
Along with ketamine, almost all had a morphine or hydromorphone (Dilaudid) patient-controlled analgesia (PCA) pumps, more than half received IV ketorolac (Toradol), and about 40% IV Tylenol. Only 14% had paravertebral or intercostal blocks.
Fourteen patients (10.9%) developed pneumonia, and four (3.1%) died, which compares favorably with outcomes in patients receiving epidurals. Historically, epidural analgesia for multiple traumatic rib fractures has been associated with about an 18% pneumonia rate, and about 9% mortality.
Ketamine side effects were minimal; none of the patients had hallucinations or tachycardia, and three (2.3%) were hypotensive on the drug.
Jacobi’s database did not record how many times patients used their PCA pumps, so the study did not have a direct measure of pain control. The investigators plan to look into this question prospectively.
Even so, when patients hurt from rib fractures, they breathe shallowly, which puts them at risk for pneumonia and death. “We have lower rates” of both than with epidurals, “so you could extrapolate that we must be controlling pain better,” Dr. Getrajdman said.
Ketamine at high doses is an anesthetic, but at lower doses it’s an antagonist of N-methyl-D-aspartate (NMDA), and a mild opioid receptor agonist, “so we can give patients the same amount of morphine but achieve a higher analgesic effect,” she said.
Ketamine had been the subject of intense interest in recent years for pain control in a wide variety of settings, as well as for psychiatric and other problems. Clinicaltrials.gov currently lists 138 open investigations of the drug.
Among them is a randomized trial from the Medical College of Wisconsin pitting ketamine against placebo for rib fracture pain following blunt trauma.
Dr. Getrajdman has no disclosures, and there was no outside funding for the work.
AT THE ACS CLINICAL CONGRESS
Key clinical point: Patients with multiple rib fractures treated with ketamine for pain control had less risk of pneumonia and death than did patients receiving epidural for pain.
Major finding: Overall, 14 ketamine patients (10.9%) developed pneumonia, and four (3.1%) died.
Data source: Review of 128 rib fracture patients.
Disclosures: The lead investigator has no disclosures, and there was no outside funding for the work.
VIDEO: Tranexamic acid didn’t increase postop infections
CHICAGO – Tranexamic acid was not independently associated with any infection within 30 days of injury in U.S. soldiers undergoing trauma surgery, a case-control study showed.
The antifibrinolytic has been used for years to reduce morbidity and the risk of death associated with hemorrhage in the military setting. Tranexamic acid (TXA) made its way into the civilian setting after the 2010 provocative CRASH-2 trial in adult trauma patients.
Because TXA (Cyklokapron, Lysteda) also has anti-inflammatory properties, Dr. Clayton Lewis of Brooke Army Medical Center in San Antonio and his colleagues decided to evaluate the effect of TXA on the development of posttraumatic infections, including time to first infection, in combat casualties.
The findings were presented at the annual clinical congress of the American College of Surgeons, where we caught up with Dr. Lewis for an interview.
Dr. Lewis reported having no relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
CHICAGO – Tranexamic acid was not independently associated with any infection within 30 days of injury in U.S. soldiers undergoing trauma surgery, a case-control study showed.
The antifibrinolytic has been used for years to reduce morbidity and the risk of death associated with hemorrhage in the military setting. Tranexamic acid (TXA) made its way into the civilian setting after the 2010 provocative CRASH-2 trial in adult trauma patients.
Because TXA (Cyklokapron, Lysteda) also has anti-inflammatory properties, Dr. Clayton Lewis of Brooke Army Medical Center in San Antonio and his colleagues decided to evaluate the effect of TXA on the development of posttraumatic infections, including time to first infection, in combat casualties.
The findings were presented at the annual clinical congress of the American College of Surgeons, where we caught up with Dr. Lewis for an interview.
Dr. Lewis reported having no relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
CHICAGO – Tranexamic acid was not independently associated with any infection within 30 days of injury in U.S. soldiers undergoing trauma surgery, a case-control study showed.
The antifibrinolytic has been used for years to reduce morbidity and the risk of death associated with hemorrhage in the military setting. Tranexamic acid (TXA) made its way into the civilian setting after the 2010 provocative CRASH-2 trial in adult trauma patients.
Because TXA (Cyklokapron, Lysteda) also has anti-inflammatory properties, Dr. Clayton Lewis of Brooke Army Medical Center in San Antonio and his colleagues decided to evaluate the effect of TXA on the development of posttraumatic infections, including time to first infection, in combat casualties.
The findings were presented at the annual clinical congress of the American College of Surgeons, where we caught up with Dr. Lewis for an interview.
Dr. Lewis reported having no relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT THE ACS CLINICAL CONGRESS
VIDEO: Tomosynthesis soon to be standard of care for breast cancer screening
CHICAGO – The uptake of tomosynthesis has been fairly brisk among the nation’s breast cancer screening centers.
There are good reasons for that. In an interview at the annual clinical congress of the American College of Surgeons, Dr. Sarah Friedewald, division chief of breast and women’s imaging at Northwestern University, Chicago, explained the procedure; its pluses and minuses; and why it’s likely to be the standard of care for breast cancer screening within 5 years.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
CHICAGO – The uptake of tomosynthesis has been fairly brisk among the nation’s breast cancer screening centers.
There are good reasons for that. In an interview at the annual clinical congress of the American College of Surgeons, Dr. Sarah Friedewald, division chief of breast and women’s imaging at Northwestern University, Chicago, explained the procedure; its pluses and minuses; and why it’s likely to be the standard of care for breast cancer screening within 5 years.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
CHICAGO – The uptake of tomosynthesis has been fairly brisk among the nation’s breast cancer screening centers.
There are good reasons for that. In an interview at the annual clinical congress of the American College of Surgeons, Dr. Sarah Friedewald, division chief of breast and women’s imaging at Northwestern University, Chicago, explained the procedure; its pluses and minuses; and why it’s likely to be the standard of care for breast cancer screening within 5 years.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
EXPERT ANALYSIS FROM THE ACS CLINICAL CONGRESS
VIDEO: Immediate breast reconstruction results reassuring in select patients
CHICAGO – Immediate breast reconstruction did not dramatically increase adverse outcomes in women undergoing mastectomy, a SCOAP database analysis found.
The popularity of immediate breast reconstruction is on the rise. Uptake rates, however, vary considerably across the country, prompting some to question whether concerns about adverse outcomes may be putting some surgeons and patients off the procedure.
Using the Surgical Clinical Outcomes Assessment Program database, researchers examined three key outcomes – 30-day readmissions, surgical complications, and surgical site infections – in 757 women who did or did not undergo breast reconstruction within 30 days of mastectomy for stage 0-3 breast cancer.
The results were reassuring, but should be interpreted within the context that those undergoing immediate reconstruction were a select group of women who were more likely to be nonsmokers and less likely to be obese or to be diagnosed with invasive cancer, observed study author Dr. Meghan Flanagan of the University of Washington in Seattle.
Click here to hear our interview with Dr. Flanagan at the annual clinical congress of the American College of Surgeons, where the data were formally presented.
Dr. Flanagan reported no relevant conflicts of interest.
CHICAGO – Immediate breast reconstruction did not dramatically increase adverse outcomes in women undergoing mastectomy, a SCOAP database analysis found.
The popularity of immediate breast reconstruction is on the rise. Uptake rates, however, vary considerably across the country, prompting some to question whether concerns about adverse outcomes may be putting some surgeons and patients off the procedure.
Using the Surgical Clinical Outcomes Assessment Program database, researchers examined three key outcomes – 30-day readmissions, surgical complications, and surgical site infections – in 757 women who did or did not undergo breast reconstruction within 30 days of mastectomy for stage 0-3 breast cancer.
The results were reassuring, but should be interpreted within the context that those undergoing immediate reconstruction were a select group of women who were more likely to be nonsmokers and less likely to be obese or to be diagnosed with invasive cancer, observed study author Dr. Meghan Flanagan of the University of Washington in Seattle.
Click here to hear our interview with Dr. Flanagan at the annual clinical congress of the American College of Surgeons, where the data were formally presented.
Dr. Flanagan reported no relevant conflicts of interest.
CHICAGO – Immediate breast reconstruction did not dramatically increase adverse outcomes in women undergoing mastectomy, a SCOAP database analysis found.
The popularity of immediate breast reconstruction is on the rise. Uptake rates, however, vary considerably across the country, prompting some to question whether concerns about adverse outcomes may be putting some surgeons and patients off the procedure.
Using the Surgical Clinical Outcomes Assessment Program database, researchers examined three key outcomes – 30-day readmissions, surgical complications, and surgical site infections – in 757 women who did or did not undergo breast reconstruction within 30 days of mastectomy for stage 0-3 breast cancer.
The results were reassuring, but should be interpreted within the context that those undergoing immediate reconstruction were a select group of women who were more likely to be nonsmokers and less likely to be obese or to be diagnosed with invasive cancer, observed study author Dr. Meghan Flanagan of the University of Washington in Seattle.
Click here to hear our interview with Dr. Flanagan at the annual clinical congress of the American College of Surgeons, where the data were formally presented.
Dr. Flanagan reported no relevant conflicts of interest.
AT THE ACS ANNUAL CONGRESS
VIDEO: Take steps now to keep gram-negative resistance at bay
CHICAGO – Gram-negative bacteria are the new frontier of antimicrobial resistance.
Resistant Escherichia coli, Klebsiella, and other organisms are increasingly common in Asia, South America, and southern Europe, but haven’t quite established themselves yet in the United States.
In an interview at the annual clinical congress of the American College of Surgeons, Dr. John Mazuski, a professor of surgery at Washington University in St. Louis, explained what’s known so far, and the steps to take now to keep the organisms in check.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
CHICAGO – Gram-negative bacteria are the new frontier of antimicrobial resistance.
Resistant Escherichia coli, Klebsiella, and other organisms are increasingly common in Asia, South America, and southern Europe, but haven’t quite established themselves yet in the United States.
In an interview at the annual clinical congress of the American College of Surgeons, Dr. John Mazuski, a professor of surgery at Washington University in St. Louis, explained what’s known so far, and the steps to take now to keep the organisms in check.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
CHICAGO – Gram-negative bacteria are the new frontier of antimicrobial resistance.
Resistant Escherichia coli, Klebsiella, and other organisms are increasingly common in Asia, South America, and southern Europe, but haven’t quite established themselves yet in the United States.
In an interview at the annual clinical congress of the American College of Surgeons, Dr. John Mazuski, a professor of surgery at Washington University in St. Louis, explained what’s known so far, and the steps to take now to keep the organisms in check.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
EXPERT ANALYSIS FROM THE ACS CLINICAL CONGRESS
Sleeve gastrectomy cut biochemical cardiac risk factors
CHICAGO – Many traditional and novel biochemical cardiac risk markers show dramatic and stable improvements following sleeve gastrectomy, a prospective, observational study shows.
C-reactive protein (CRP) levels were elevated in 78% of patients preoperatively, but they fell early in the preoperative course at 3 months (median 6.6 mg/L vs. 4.5 mg/L; P less than .0001) and continued to decline throughout the 12-month follow-up (median 5.8 mg/L vs. 2.4 mg/L; P less than .0001).
“This gradual improvement and normalization of this inflammatory marker may reflect the slower resolution of the chronic inflammatory burden that obesity brings along with it,” Ms. Tara Mokhtari said at the American College of Surgeons Clinical Congress.
Though prior studies have shown that gastric bypass and adjustable gastric banding improved biochemical cardiac risk factors (BCRFs), this is the first prospective study to detail such improvements following sleeve gastrectomy.
The study evaluated 10 BCRFs (total cholesterol (TC), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides (TG), TC/HDL ratio, hemoglobin A1c, TG/HDL ratio, homocysteine, lipoprotein A, and CRP) in 334 morbidly obese patients undergoing laparoscopic sleeve gastrectomy during 2006-2015. Their mean age was 45 years, 76.4% were women, 55% were hypertensive, 29.4% had diabetes, 9.6% had known coronary artery disease, and 26.4% were on a lipid-lowering medication.
Many patients had abnormal cardiac risk factors prior to surgery, the most striking being the 78% of patients with elevated CRP levels (at least 3 mg/L), according to Ms. Mokhtari of Stanford (Calif.) University.
One-third also had abnormal HDL levels, total cholesterol, and triglyceride/HDL ratio and 20% had LDL levels above the 130 mg/dL threshold. Statin use was discontinued in all patients following surgery, per hospital protocol.
After sleeve gastrectomy, body mass index declined from 43.5 preoperatively to 36.6 at 3 months, 34.3 at 6 months, and 33.1 at 12 months, according to the study authors, led by Dr. John M. Morton, also of Stanford.
Similar to the early changes observed in CRP, there were significant changes from baseline at 3 months in triglycerides (116.5 mg/dL vs. 98.5 mg/dL; P less than .0001) and HbA1c (5.8% vs. 5.5%; P less than .0001).
Six months after sleeve gastrectomy, significant improvements were seen in these same risk factors as well as HDL cholesterol (47 mg/dL vs. 51 mg/dL; P less than .0001), TG/HDL ratio, a surrogate marker for metabolic syndrome (2.5 vs. 1.9; P less than .0001), and lipoprotein A (8.9 mg/dL vs. 5.4 mg/dL; P = .016), Ms. Mokhtari said.
By 12 months, all cardiac risk factors except LDL cholesterol (median preop 101.5 mg/dL vs. 102.5 mg/dL; P = .062) were significantly improved. Notably, HDL increased to a median of 54 mg/dL, triglycerides continued to decline to 93 mg/dL, and HgA1c held steady at 5.5%.
“Triglycerides fell dramatically and remained stable, which in combination with the increase in HDL, reflects a much healthier overall lipid profile for our post-sleeve patients,” Ms. Mokhtari said. “It’s important to recall that all of these improvements were seen without the use of a statin drug.”
Improvement in these cardiac biomarkers may further represent improvements in other obesity-related diseases, as evidenced by improvements in the markers for type II diabetes and metabolic syndrome, she said.
“Such risk factors are useful in determining baseline risk for our sleeve patients and also can be followed very easily in the postoperative period,” Ms. Mokhtari added.
Discussant Dr. Aurora D. Pryor of State University of New York at Stony Brook, congratulated the authors on their research and asked how sleeve gastrectomy stacks up to gastric bypass or banding as a procedure for metabolic disease and whether the biomarker improvements will translate into improved mortality.
There are several published reports on cardiac risk factors and gastric banding and Roux-en-Y gastric bypass, but many do not include the newer biomarkers of lipoprotein A, homocysteine, or CRP, Ms. Mokhtari observed. A 2006 study by the Stanford investigators, however, suggests that “overall, Roux-en-Y allowed for a more significant improvement in these risk factors compared to sleeve,” she said.
Ms. Mokhtari went on to say that the SOS study reported a decrease in cardiovascular events after Roux-en-Y bypass, but that no such solid evidence exists for sleeve gastrectomy. However, studies have shown comparable improvements in Framingham risk scores at 1 year between sleeve and Roux-en-Y.
CHICAGO – Many traditional and novel biochemical cardiac risk markers show dramatic and stable improvements following sleeve gastrectomy, a prospective, observational study shows.
C-reactive protein (CRP) levels were elevated in 78% of patients preoperatively, but they fell early in the preoperative course at 3 months (median 6.6 mg/L vs. 4.5 mg/L; P less than .0001) and continued to decline throughout the 12-month follow-up (median 5.8 mg/L vs. 2.4 mg/L; P less than .0001).
“This gradual improvement and normalization of this inflammatory marker may reflect the slower resolution of the chronic inflammatory burden that obesity brings along with it,” Ms. Tara Mokhtari said at the American College of Surgeons Clinical Congress.
Though prior studies have shown that gastric bypass and adjustable gastric banding improved biochemical cardiac risk factors (BCRFs), this is the first prospective study to detail such improvements following sleeve gastrectomy.
The study evaluated 10 BCRFs (total cholesterol (TC), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides (TG), TC/HDL ratio, hemoglobin A1c, TG/HDL ratio, homocysteine, lipoprotein A, and CRP) in 334 morbidly obese patients undergoing laparoscopic sleeve gastrectomy during 2006-2015. Their mean age was 45 years, 76.4% were women, 55% were hypertensive, 29.4% had diabetes, 9.6% had known coronary artery disease, and 26.4% were on a lipid-lowering medication.
Many patients had abnormal cardiac risk factors prior to surgery, the most striking being the 78% of patients with elevated CRP levels (at least 3 mg/L), according to Ms. Mokhtari of Stanford (Calif.) University.
One-third also had abnormal HDL levels, total cholesterol, and triglyceride/HDL ratio and 20% had LDL levels above the 130 mg/dL threshold. Statin use was discontinued in all patients following surgery, per hospital protocol.
After sleeve gastrectomy, body mass index declined from 43.5 preoperatively to 36.6 at 3 months, 34.3 at 6 months, and 33.1 at 12 months, according to the study authors, led by Dr. John M. Morton, also of Stanford.
Similar to the early changes observed in CRP, there were significant changes from baseline at 3 months in triglycerides (116.5 mg/dL vs. 98.5 mg/dL; P less than .0001) and HbA1c (5.8% vs. 5.5%; P less than .0001).
Six months after sleeve gastrectomy, significant improvements were seen in these same risk factors as well as HDL cholesterol (47 mg/dL vs. 51 mg/dL; P less than .0001), TG/HDL ratio, a surrogate marker for metabolic syndrome (2.5 vs. 1.9; P less than .0001), and lipoprotein A (8.9 mg/dL vs. 5.4 mg/dL; P = .016), Ms. Mokhtari said.
By 12 months, all cardiac risk factors except LDL cholesterol (median preop 101.5 mg/dL vs. 102.5 mg/dL; P = .062) were significantly improved. Notably, HDL increased to a median of 54 mg/dL, triglycerides continued to decline to 93 mg/dL, and HgA1c held steady at 5.5%.
“Triglycerides fell dramatically and remained stable, which in combination with the increase in HDL, reflects a much healthier overall lipid profile for our post-sleeve patients,” Ms. Mokhtari said. “It’s important to recall that all of these improvements were seen without the use of a statin drug.”
Improvement in these cardiac biomarkers may further represent improvements in other obesity-related diseases, as evidenced by improvements in the markers for type II diabetes and metabolic syndrome, she said.
“Such risk factors are useful in determining baseline risk for our sleeve patients and also can be followed very easily in the postoperative period,” Ms. Mokhtari added.
Discussant Dr. Aurora D. Pryor of State University of New York at Stony Brook, congratulated the authors on their research and asked how sleeve gastrectomy stacks up to gastric bypass or banding as a procedure for metabolic disease and whether the biomarker improvements will translate into improved mortality.
There are several published reports on cardiac risk factors and gastric banding and Roux-en-Y gastric bypass, but many do not include the newer biomarkers of lipoprotein A, homocysteine, or CRP, Ms. Mokhtari observed. A 2006 study by the Stanford investigators, however, suggests that “overall, Roux-en-Y allowed for a more significant improvement in these risk factors compared to sleeve,” she said.
Ms. Mokhtari went on to say that the SOS study reported a decrease in cardiovascular events after Roux-en-Y bypass, but that no such solid evidence exists for sleeve gastrectomy. However, studies have shown comparable improvements in Framingham risk scores at 1 year between sleeve and Roux-en-Y.
CHICAGO – Many traditional and novel biochemical cardiac risk markers show dramatic and stable improvements following sleeve gastrectomy, a prospective, observational study shows.
C-reactive protein (CRP) levels were elevated in 78% of patients preoperatively, but they fell early in the preoperative course at 3 months (median 6.6 mg/L vs. 4.5 mg/L; P less than .0001) and continued to decline throughout the 12-month follow-up (median 5.8 mg/L vs. 2.4 mg/L; P less than .0001).
“This gradual improvement and normalization of this inflammatory marker may reflect the slower resolution of the chronic inflammatory burden that obesity brings along with it,” Ms. Tara Mokhtari said at the American College of Surgeons Clinical Congress.
Though prior studies have shown that gastric bypass and adjustable gastric banding improved biochemical cardiac risk factors (BCRFs), this is the first prospective study to detail such improvements following sleeve gastrectomy.
The study evaluated 10 BCRFs (total cholesterol (TC), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides (TG), TC/HDL ratio, hemoglobin A1c, TG/HDL ratio, homocysteine, lipoprotein A, and CRP) in 334 morbidly obese patients undergoing laparoscopic sleeve gastrectomy during 2006-2015. Their mean age was 45 years, 76.4% were women, 55% were hypertensive, 29.4% had diabetes, 9.6% had known coronary artery disease, and 26.4% were on a lipid-lowering medication.
Many patients had abnormal cardiac risk factors prior to surgery, the most striking being the 78% of patients with elevated CRP levels (at least 3 mg/L), according to Ms. Mokhtari of Stanford (Calif.) University.
One-third also had abnormal HDL levels, total cholesterol, and triglyceride/HDL ratio and 20% had LDL levels above the 130 mg/dL threshold. Statin use was discontinued in all patients following surgery, per hospital protocol.
After sleeve gastrectomy, body mass index declined from 43.5 preoperatively to 36.6 at 3 months, 34.3 at 6 months, and 33.1 at 12 months, according to the study authors, led by Dr. John M. Morton, also of Stanford.
Similar to the early changes observed in CRP, there were significant changes from baseline at 3 months in triglycerides (116.5 mg/dL vs. 98.5 mg/dL; P less than .0001) and HbA1c (5.8% vs. 5.5%; P less than .0001).
Six months after sleeve gastrectomy, significant improvements were seen in these same risk factors as well as HDL cholesterol (47 mg/dL vs. 51 mg/dL; P less than .0001), TG/HDL ratio, a surrogate marker for metabolic syndrome (2.5 vs. 1.9; P less than .0001), and lipoprotein A (8.9 mg/dL vs. 5.4 mg/dL; P = .016), Ms. Mokhtari said.
By 12 months, all cardiac risk factors except LDL cholesterol (median preop 101.5 mg/dL vs. 102.5 mg/dL; P = .062) were significantly improved. Notably, HDL increased to a median of 54 mg/dL, triglycerides continued to decline to 93 mg/dL, and HgA1c held steady at 5.5%.
“Triglycerides fell dramatically and remained stable, which in combination with the increase in HDL, reflects a much healthier overall lipid profile for our post-sleeve patients,” Ms. Mokhtari said. “It’s important to recall that all of these improvements were seen without the use of a statin drug.”
Improvement in these cardiac biomarkers may further represent improvements in other obesity-related diseases, as evidenced by improvements in the markers for type II diabetes and metabolic syndrome, she said.
“Such risk factors are useful in determining baseline risk for our sleeve patients and also can be followed very easily in the postoperative period,” Ms. Mokhtari added.
Discussant Dr. Aurora D. Pryor of State University of New York at Stony Brook, congratulated the authors on their research and asked how sleeve gastrectomy stacks up to gastric bypass or banding as a procedure for metabolic disease and whether the biomarker improvements will translate into improved mortality.
There are several published reports on cardiac risk factors and gastric banding and Roux-en-Y gastric bypass, but many do not include the newer biomarkers of lipoprotein A, homocysteine, or CRP, Ms. Mokhtari observed. A 2006 study by the Stanford investigators, however, suggests that “overall, Roux-en-Y allowed for a more significant improvement in these risk factors compared to sleeve,” she said.
Ms. Mokhtari went on to say that the SOS study reported a decrease in cardiovascular events after Roux-en-Y bypass, but that no such solid evidence exists for sleeve gastrectomy. However, studies have shown comparable improvements in Framingham risk scores at 1 year between sleeve and Roux-en-Y.
AT THE AMERICAN COLLEGE OF SURGEONS CLINICAL CONGRESS
Key clinical point: Sleeve gastrectomy provided 12-month improvements in biochemical cardiovascular risk factors as well as weight and diabetes.
Major finding: CRP showed significant improvement within 3 months (median, 6.6 mg/L vs. 4.5 mg/L; P less than .0001).
Data source: Prospective, observational study in 334 morbidly obese patients undergoing sleeve gastrectomy.
Disclosures: Dr. Morton reported serving as a consultant for Ethicon and Medtronic.
VIDEO: Dialysis-dependent patients face rocky road after colorectal surgery
CHICAGO – The odds of emergency surgery were sevenfold higher in dialysis-dependent patients undergoing colorectal surgery than patients with renal insufficiency not on dialysis or those with normal renal function.
Dialysis patients were also far less likely to undergo laparoscopic surgery and to be rescued from death if they experienced a complication.
These are just some of the results of a retrospective study involving 156,645 elective colorectal surgery cases selected as a poster of exceptional merit here at the annual clinical congress of the American College of Surgeons.
Dialysis patients are known to be at high risk for postoperative complications, but few studies have evaluated outcomes after colorectal surgery in these patients or distinguished them from patients with non–dialysis dependent renal insufficiency (NDDRI) or normal renal function (NRF), observed study author Dr. Isibor Arhuidese of Johns Hopkins University in Baltimore.
Indeed, when the researchers compared these three groups, perioperative mortality and morbidity after elective colorectal surgery was the worst in dialysis patients.
Absolute perioperative mortality was highest for dialysis patients vs. NDDRI and NRF patients after open (13.4% vs. 4.8% vs. 2%; P less than .001) and laparoscopic (8% vs. 2% vs. 0.6%; P less than .001) surgery.
Three complications were significantly associated with death in dialysis patients: myocardial infarction (adjusted odds ratio, 48.6; P = .027), bleeding (aOR, 14.5; P = .025), and sepsis or septic shock (aOR, 8.7; P = .001).
It is not enough to simply identify dialysis dependence as a predictor of poor outcomes, but one must identify targets for improvement in surgical care, Dr. Arhuidese stressed.
Dr. Arhuidese reported having no relevant conflicts of interest.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @pwendl
CHICAGO – The odds of emergency surgery were sevenfold higher in dialysis-dependent patients undergoing colorectal surgery than patients with renal insufficiency not on dialysis or those with normal renal function.
Dialysis patients were also far less likely to undergo laparoscopic surgery and to be rescued from death if they experienced a complication.
These are just some of the results of a retrospective study involving 156,645 elective colorectal surgery cases selected as a poster of exceptional merit here at the annual clinical congress of the American College of Surgeons.
Dialysis patients are known to be at high risk for postoperative complications, but few studies have evaluated outcomes after colorectal surgery in these patients or distinguished them from patients with non–dialysis dependent renal insufficiency (NDDRI) or normal renal function (NRF), observed study author Dr. Isibor Arhuidese of Johns Hopkins University in Baltimore.
Indeed, when the researchers compared these three groups, perioperative mortality and morbidity after elective colorectal surgery was the worst in dialysis patients.
Absolute perioperative mortality was highest for dialysis patients vs. NDDRI and NRF patients after open (13.4% vs. 4.8% vs. 2%; P less than .001) and laparoscopic (8% vs. 2% vs. 0.6%; P less than .001) surgery.
Three complications were significantly associated with death in dialysis patients: myocardial infarction (adjusted odds ratio, 48.6; P = .027), bleeding (aOR, 14.5; P = .025), and sepsis or septic shock (aOR, 8.7; P = .001).
It is not enough to simply identify dialysis dependence as a predictor of poor outcomes, but one must identify targets for improvement in surgical care, Dr. Arhuidese stressed.
Dr. Arhuidese reported having no relevant conflicts of interest.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @pwendl
CHICAGO – The odds of emergency surgery were sevenfold higher in dialysis-dependent patients undergoing colorectal surgery than patients with renal insufficiency not on dialysis or those with normal renal function.
Dialysis patients were also far less likely to undergo laparoscopic surgery and to be rescued from death if they experienced a complication.
These are just some of the results of a retrospective study involving 156,645 elective colorectal surgery cases selected as a poster of exceptional merit here at the annual clinical congress of the American College of Surgeons.
Dialysis patients are known to be at high risk for postoperative complications, but few studies have evaluated outcomes after colorectal surgery in these patients or distinguished them from patients with non–dialysis dependent renal insufficiency (NDDRI) or normal renal function (NRF), observed study author Dr. Isibor Arhuidese of Johns Hopkins University in Baltimore.
Indeed, when the researchers compared these three groups, perioperative mortality and morbidity after elective colorectal surgery was the worst in dialysis patients.
Absolute perioperative mortality was highest for dialysis patients vs. NDDRI and NRF patients after open (13.4% vs. 4.8% vs. 2%; P less than .001) and laparoscopic (8% vs. 2% vs. 0.6%; P less than .001) surgery.
Three complications were significantly associated with death in dialysis patients: myocardial infarction (adjusted odds ratio, 48.6; P = .027), bleeding (aOR, 14.5; P = .025), and sepsis or septic shock (aOR, 8.7; P = .001).
It is not enough to simply identify dialysis dependence as a predictor of poor outcomes, but one must identify targets for improvement in surgical care, Dr. Arhuidese stressed.
Dr. Arhuidese reported having no relevant conflicts of interest.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @pwendl
AT THE ACS CLINICAL CONGRESS
VIDEO: When to use MRI in breast cancer
CHICAGO – For most women, there’s little role for MRI in screening for and treating breast cancer
However, there are important exceptions. In an interview at the American College of Surgeons Clinical Congress, Dr. Monica Morrow, chief of breast surgery at Memorial Sloan-Kettering Cancer Center in Manhattan, explained what those exceptions are, and how she uses MRI in her practice.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
CHICAGO – For most women, there’s little role for MRI in screening for and treating breast cancer
However, there are important exceptions. In an interview at the American College of Surgeons Clinical Congress, Dr. Monica Morrow, chief of breast surgery at Memorial Sloan-Kettering Cancer Center in Manhattan, explained what those exceptions are, and how she uses MRI in her practice.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
CHICAGO – For most women, there’s little role for MRI in screening for and treating breast cancer
However, there are important exceptions. In an interview at the American College of Surgeons Clinical Congress, Dr. Monica Morrow, chief of breast surgery at Memorial Sloan-Kettering Cancer Center in Manhattan, explained what those exceptions are, and how she uses MRI in her practice.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
EXPERT ANALYSIS FROM THE AMERICAN COLLEGE OF SURGEONS CLINICAL CONGRESS
