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Journal and News Scan
This single center, open RCT compared patients’ satisfaction with local (LA) or general anesthesia (GA) for video-assisted thoracoscopy. Fifty patients were allocated to GA and 57 to LA. Patient satisfaction did not differ significantly for anesthesiology care, general perioperative care, or recovery after surgery. Surgeons and anesthesiologists were both less satisfied with feasibility in the LA group. LA patients had significantly shorter hospital stays, averaging 3.9 vs. 6.0 days, with P < 0.01. The authors conclude that patients should be offered LA as an alternative to GA whenever medically appropriate and feasible.
Although there are proportionate numbers of women and men in Canadian medical schools, women still only make up 33 percent of the surgeon population. The top paid specialties, cardiac and thoracic surgery, are only 9.4 and 10.9 percent women, respectively. This is despite the fact that surveys confirm more women are aspiring to become surgeons. The article details the microaggressions, pay differences, and other factors that may have led to this outcome, and ways that change can be made.
A strike by trainees in the UK is scheduled for April 11 through April 15 because of a pay dispute with the government and NHS. This ongoing conflict, which took junior doctors out of care settings in March as well, has caused a backup in appointments for patients. There has been no move by the government to settle pay disputes and a way forward remains up for discussion.
In the first analysis to validate observed clinical outcomes, two trials compared transcatheter aortic valve replacement (TAVR) to surgical aortic valve replacement (AVR). Valve dysfunction was found to be less common after five years in TAVR. Long-term performance is a critical consideration in patients who undergo TAVR, especially when they are younger and lower risk. These promising results were driven by lower rates of valve deterioration and prothesis-patient mismatch.
This retrospective cohort study aimed to document the detection of anastomotic leak after esophagectomy. It was concluded that early postoperative esophagrams often miss leaks, leading to greater clinical consequences than leaks that are detected upon the first esophagram. These findings suggest that the team must be aware of potential leaks even after a normal esophagram result and be wary of advancing postoperative steps before a leak is completely ruled out.
Since granular single-center data is lacking for the SynCardia total artificial heart, this study reported outcomes in 100 TAH recipients in a single high-volume center. The study found that 61 percent of patients underwent successful transplant while 39 percent died on TAH support. Overall, the study reaffirmed that the TAH is an effective bridge to transplantation in qualifying patients.
In a study meant to review outcomes in patients less than 5 kg supported by the Berlin Heart pulsatile ventricular assist device (VAD), it was found that the device is an affective bridge to transplant in small children. However, survival is less in patients with univentricular circulation in comparison to those with biventricular circulation.
Based on survey results of 31,000 physicians, physician compensation declined by 2.4 percent in 2022. Neurosurgeons received the highest average salary, followed by thoracic surgeons and orthopedic surgeons. In addition, the gender pay gap has narrowed, but remains substantial with women physicians compensated 26 percent less than their colleagues who are men.
Dr. Irene Cybulsky is being compensated by Hamilton Health Sciences, where she was the first woman head of cardiac surgery in Canada from 2009 to 2016, for discrimination against her based on her gender. The case also stipulates that the hospital must consult with an external specialist to ensure bias is addressed and provide education on discrimination.
Lung transplantation in COVID-19 patients with end-stage lung disease has proven to improve quality of life and be a viable treatment option. This study confirmed that by comparing a group of COVID-associated transplant patients with a group of patients needing transplants for other reasons. Although they had longer hospital stays, the COVID-related cases had a similar one-year survival rate to the other cohort.