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Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Malignant intestinal obstruction is the most common indication for palliative surgical consultations. This study sought to determine the impact of surgical or non-surgical treatment of malignant bowel obstruction on patient quality of life and survival using patient-reported outcomes and mortality data. This prospective cohort study (n = 125) was conducted at a single cancer center.
The investigators used an accepted symptom inventory instrument—the MD Anderson Symptom Inventory-Gastrointestinal Obstruction (MDASI-GIO)—to quantify the severity of symptoms (pain) and the degree of interference in life activities due to the symptoms. In the study cohort, 37 patients underwent surgery and 88 did not. The data analysis showed that patients who underwent surgery had improved overall survival (median 15 versus 3 months) but experienced significantly more interference in areas such as work, activity, and walking. Ability to undergo surgical therapy and receive subsequent chemotherapy were predictive of survival, while palliative care consultation and use of venting gastrostomy were statistically associated with increased risk of death.
The authors concluded that these data, obtained from actual patient experiences, had potential value for improving palliative care conversations for patients with advanced cancer and gastrointestinal obstruction.
Surgery Clerkship Directors Suggest that COVID-19 Pandemic Had Significant Impact on Medical Student Education
The authors performed surveys of 164 surgical clerkship directors during the Spring of 2020 and 2021 to obtain opinions on the impact of the COVID-19 pandemic on medical student education. Response rate for the 2020 survey was 44.5% and 50.6% for the 2021 survey.
The survey data showed that more than 95% of programs adopted virtual educational platforms in 2020, and 46% had returned to pre-pandemic educational activities by 2021. Delayed student progression was observed in 12% of clerkships, and 43% of clerkship directors reported negative impact of the pandemic in 2020; however, this figure improved significantly in the 2021 survey. An encouraging observation was that the proportion of students interested in pursuing surgical training did not decrease during the study interval. A significant positive aspect of the pandemic experience was the development of virtual patient encounters; improvement in didactics, student test performance, continuous personal learning, and engagement in the clerkship were also documented.
The authors concluded that there was a significant negative impact by the pandemic on aspects of student surgical education, though some positive pandemic experiences emerged as well. Further investigation into the clinical and educational value of telehealth could potentially confirm a long-term value for these approaches.
In the editorial that accompanied the article, ACS Immediate Past-President Julie A. Freischlag, MD, FACS, DFSVS, emphasized that there were multiple features of the pandemic that harmed patients (for example, delays in diagnosis and treatment of cancer) but surgeons adapted to the crisis by developing beneficial, innovative clinical and educational solutions to the challenges presented was remarkable.
AAST Releases Consensus Document on Preventing Alcohol Withdrawal Syndrome in Surgical ICU
Alcohol withdrawal syndrome is defined as a set of symptoms, including nausea, vomiting, tremor, diaphoresis, agitation, disorientation, and others, that emerge in patients after cessation of alcohol intake. This condition is observed in up to 40% of at-risk patients admitted to surgical ICU care. In this report, the authors presented the recommendations contained in a Clinical Consensus Document created by the American Association for the Surgery of Trauma Critical Care Committee.
The consensus document recommended screening of patients with a history of alcohol use to determine risk for development of alcohol withdrawal syndrome using standard instruments such as the Alcohol Use Disorders Identification Test (AUDIT) and the Prediction of Alcohol Withdrawal Severity Scale (PAWSS). The features of the assessment instruments are clearly described in the report. Surveillance of at-risk patients using the Minnesota Detoxification Scale was recommended. Patients determined to be at high risk may be treated empirically with benzodiazepines or phenobarbital.
The consensus document provided useful discussions of alternative medications and discussed the history of intravenous alcohol use; the consensus panel recommended against the use of intravenous alcohol. Other helpful agents such as micronutrients were also discussed. Surgeons are urged to review the entire document.
