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Journal and News Scan
The Society of Thoracic Surgeons (STS), the Society of Cardiovascular Anesthesiologists (SCA), the American Society of ExtraCorporeal Technology (AmSECT), and the Society for the Advancement of Blood Management (SABM) published an update to the "2011 Update to The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Blood Conservation Clinical Practice Guidelines."
Data from the Esodata project used more than 8,000 patients undergoing esophagectomy for cancer to develop a risk prediction score for 90-day mortality. Development and validation groups were used. There were 10 variables that emerged as significant predictors, and weighted values were developed into the model. The model identified 5 risk levels for 90-day mortality, which may help in patient selection and in informed discussions.
Fascinating confirmation of null hypotheses including bleeding complications and survival in a Pennsylvanian cohort study, despite the easily predictable previous PCI, hock, and IABP prevalence in the emergency group. The statistical model is elaborate and complex. Perhaps a randomized trial could now be justified!
A useful detailed review (or state-of-the-art article) on revascularisation in extracardiac vascular stenoocclusive atheromatosis.
A glimpse of what could be a future for surgery..........
This examination of readmission rates is based on data from nearly 40,000 patients from the STS Database having undergone elective pulmonary lobectomy. Readmission was driven by complications during the index operation, notably pulmonary embolism, empyema, pleural effusion, and pneumothorax. Improved pleural space management may offer a means to mitigate readmission rates.
Over 30% of lung resection patients in the STS Database had prior exposure to opioid use. They experienced longer length of postoperative stay, more frequent visits to the ED, and a higher incidence of readmission within 90 days. Athough there is growing interest in standardized enhanced recovery pathways after lung resection, this challenging subset of patients appears to require unique targeted postoperative interventions.
Chyle leak remains a challenging postoperative complication to manage, and avoidance is always easier than mitigation. The only predisposing factor identified in this study was low BMI. Although ICU stay was longer in affected patients, operative mortality, hospital LOS, and survival were not negatively impacted by the presence of a leak.
A good discussion on the concepts of:
1. aortic true lumen and false lumen behavior after repair of acute Type A aortic dissection
2. distal anastomotic new entry tear after hemiarch repair
3. impact of above on clinical outcomes
4. strategies on preventing distal anastomotic entry tear
The authors communicate that improved understanding of these hemodynamic conditions may serve to improve surgical technique, guide creation of novel devices toward new therapeutic targets, reduce surgical risk, and ultimately improve patient outcomes.