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Journal and News Scan
A must-read position paper.
The authors analyzed the effectiveness of left atrial appendage closure with AtriClip in 43 patients. In all patients, the absence of blood flow in the excluded appendage was confirmed. In 31 patients, no residual stump was observed. In only one patient, there was a significant (>10 mm) stump. In 11 patients, the residual stump was less than 10 mm. The authors concluded that the left atrial appendage closure with AtriClip is effective and the definition of clinical significant left atrial appendage stump should be further evaluated.
Persistent opioid use (>90 days postoperatively) in this Medicare database study identified modifiable factors, including prescription size and preoperative prescription refills, among other features, that could be targeted in order to reduce opioid dependency.
The authors review the growing suspicion that fluoroquinolone antibiotic (FQ) use may be related to the occurrence of thoracic aortic aneurysms and acute aortic dissection. The proposed mechanism is through an increase in matrix metalloproteinases (MMPs), which degrade collagen, a precursor to aortic injury. At least one international agency has recommended modifying the product package insert to warn users of this risk.
Identification of Anonymous MRI Research Participants with Face-Recognition Software: The authors demonstrated the ability to use facial recognition software to identify individuals undergoing head MR, highlighting the risk of loss of anonymity when seemingly de-identified data are available to others.
The National Cancer Database was queried regarding esophageal squamous cancer cases from 2004-2013, and over 11,000 patients were identified. Definitive chemoradiotherapy was used in 79%, whereas resection was employed in 21% at some phase of therapy. Resection alone and definitive chemoradiotherapy were associated with increased mortality compared to neoadjuvant therapy followed by resection. Higher volume centers (>20/year) had better survival than other centers regardless of therapy.
This multiinstitutional study including advocates of robotic lung resection identified a 1.9% incidence of intraoperative castrophes, most commonly pulmonary arterial bleeding. Patients at risk had lower FEV1%, higher clinical stage, and more frequent preoperative radiation therapy. Interestingly, they were also undergoing a different surgical approach than what the authors normally used. The hospital mortality in these patients was 10-fold higher than among patients who did not suffer catastrophes.
This analysis of data from the JCOG0201 trial identified factors that place patients at increased risk for recurrence after lobectomy for stage I adenocarcinoma. They include visceral pleural invasion, vascular invasion, or an invasive component measuring >2 cm.
A federal court in Minnesota has dismissed over 5000 lawsuits against 3M Bair Hugger, disagreeing with assertions by plaintiffs that forced-air warming contributes to surgical site infections (SSI). A fallout between the inventor and the company he founded contributed to the acrimony and disparate recommendations surrounding this therapy. Ultimately, the judge agreed with a preponderance of published evidence, the FDA, and independent organizations such as ECRI in concluding the benefits of forced-air warming systems outweigh potential but unproven risks of SSI due to disruption of air currents.
A new multidisciplinary guideline for surgical attire has been issued that replaces controversial 2014 recommendations from the Association of periOperative Registered Nurses (AORN). The new standard, written by the American Society of Anesthesiologists (ASA), American College of Surgeons (ACS), AORN, and others has reversed prior mandates regarding head and arm covering, and clothing worn under scrubs, due to lack of evidence. It is anticipated that The Joint Commission and other regulatory bodies will follow these new guidelines which state, “No recommendation can be made” for the type of head covering worn, wearing long sleeves, or clothing worn underneath scrubs. The author notes significant cost savings from elimination of disposable jackets, and encourages anesthesiologists to have greater input in future policy decisions. A resurgence of the skull cap is warranted based on evidence. A key lesson from this 5-year distraction is the need for multidisciplinary collaboration by ALL stakeholders impacted by a national policy of this scope.