Journal of the American College of Surgeons
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Comparative Study
Normal alcohol metabolism after gastric banding and sleeve gastrectomy: a case-cross-over trial.
Severe obesity remains the leading public health concern of the industrialized world, with bariatric surgery as the only current effective enduring treatment. In addition to gastric bypass, gastric banding and sleeve gastrectomy have emerged as viable treatment options for the severely obese. Occasionally, poor postoperative psychological adjustment has been reported. It has been previously demonstrated that breath alcohol content (BAC) levels and time to sober were increased in postoperative gastric bypass patients. The aim of this study was to examine whether alcohol metabolism in patients undergoing restrictive-type bariatric procedures is also altered. ⋯ Patients undergoing LAGB and LSG do not share the same altered alcohol metabolism as seen in gastric bypass patients. However, all bariatric surgery patients should be counseled regarding alcohol use.
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Comparative Study
Intraoperative pathologic examination in the era of molecular testing for differentiated thyroid cancer.
Diagnostic thyroidectomy is typically indicated for indeterminate thyroid cytology results. Traditionally, intraoperative pathologic examination (IOPE) helped to guide the extent of initial surgery. Preoperative molecular testing (MT) of fine needle aspiration cytology has emerged as another diagnostic adjunct, is highly specific for thyroid cancer, and can lead to appropriate initial total thyroidectomy. We hypothesized that preoperative MT obviates the need for routine IOPE during lobectomy. ⋯ Together with the Bethesda cytologic criteria, preoperative MT allows for an increased rate of initial definitive total thyroidectomy and eliminates the need for routine intraoperative pathologic examination during diagnostic lobectomy.
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In an effort to improve the quality of care in bariatric surgery, 2 accreditation programs based on volume have been initiated. The aim of this study was to analyze the perioperative outcomes of bariatric surgery performed at accredited vs nonaccredited centers. ⋯ Within the context of academic centers, accreditation status was associated with lower in-hospital mortality. The lower mortality rate associated with accredited centers may be attributed to their ability to recognize and rescue complications.
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Simulation-based training can improve technical and nontechnical skills in surgery. To date, there is no consensus on the principles for design, validation, and implementation of a simulation-based surgical training curriculum. The aim of this study was to define such principles and formulate them into an interoperable framework using international expert consensus based on the Delphi method. ⋯ The Delphi methodology allowed for determination of international expert consensus on the principles for design, validation, and implementation of a simulation-based surgical training curriculum. These principles were formulated into a framework that can be used internationally across surgical specialties as a step-by-step guide for the development and validation of future simulation-based training curricula.
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Duration of femoral-popliteal bypass is based on multiple patient-specific, system-specific, and surgeon-specific factors, and is subject to considerable variability. We hypothesized that shorter operative duration is associated with improved outcomes and might represent a potential quality-improvement measure. ⋯ Longer duration of femoral-popliteal bypass with autogenous vein was associated with a significantly higher risk of perioperative surgical site infection and longer hospital length of stay. Surgeon-specific parameters that lead to faster operative time might lead to improved clinical outcomes and more efficient hospital resource use.