Current Literature

Literature selections curated by Lewis Flint, MD, FACS, and reviewed by the ACS Brief editorial board. 

Low-Titer Group O Whole Blood Is Safe for Use Across Blood Types

Brill JB, Mueck KM, Tang B., et al. Is Low-Titer Group O Whole Blood Truly a Universal Blood Product? J Am Coll Surg. 2022, in press.

Low-titer group O blood (LTOWB) is an important component of massive transfusion protocols that are activated for management of severely injured patients in the prehospital and/or early hospital phases of care. These protocols may also be used for management of intraoperative hemorrhage encountered during elective or emergent non-trauma procedures. Massive transfusion protocols emphasize early blood replacement and blood component infusions in a 1:1:1 ratio.

This study evaluated the effectiveness of LTOWB based on the blood type of the recipient. Data were prospectively gathered on 1,075 patients cared for in a single trauma center. Patients were classified according to blood type; other variables were collected such as injury severity, serum lactate, arrival systolic blood pressure, and volume of blood products received. Endpoints of interest included mortality and complications such as acute kidney injury, respiratory complications, and infection.

After logistic regression analysis, the data showed that there was no difference in mortality or rates of complications based on blood type. For reasons that are not clear from the analysis, patients with type AB blood had lower admission systolic blood pressure and higher lactate levels than other patient groups. Despite this, there was no increased rate of complications in the AB group after statistical adjustment. The authors concluded that LTOWB was safe for use across all blood types.

Gastric Ultrasound Potentially Valuable for Identification of Patients at Risk for Delayed Bowel Function

Lamm R, Collins M, Bloom J, et al. Postoperative Hand-Held Gastric Point-of-Care Ultrasound and Delayed Bowel Function. J Am Coll Surg. 2022, in press.

This study evaluated the potential value of detection of a full stomach by point-of-care ultrasound on postoperative day 1 as a predictor of delayed return of bowel function in surgical patients. Patients who had undergone abdominal surgical procedures (n = 50) comprised the study cohort; the end points of interest were time to tolerance of diet and flatus or bowel movement occurrence. The responsible surgeons were blinded to the results of the ultrasound examination.

Full stomach was documented on 18 of the 50 examined patients. This group had significantly delayed recovery of bowel function, longer length of hospital stay, more episodes of emesis, and increased rates of nasogastric tube placement. The authors concluded that gastric ultrasound has potential value for identification of patients at risk for delayed bowel function. Use of this technique could provide evidence to support early preemptive intervention to reduce the adverse effects of delayed bowel function.

Genomic Screening May Have Value for Early Detection and Treatment of Thyroid Malignancy

Pichardo PFA, Hellums RN, Hao J, et al. Thyroidectomy Outcomes in Patients Identified with RET Pathogenic Variants through a Population Genomic Screening Program. JAMA Otolaryngol Head Neck Surg. Jan 5 2023;doi:10.1001/jamaoto.2022.4195

Priscilla F. A. Pichardo, DO, and coauthors assessed treatments used and patient outcomes in a group of patients (n = 75) who had identification of pathogenic/likely pathogenic RET variants that are associated with increased risk of medullary thyroid carcinoma. The variants were identified because the patients were participating in a population genomic screening program.

Total thyroidectomy was performed in 20 of the patients with identified variants, and 13 of the 20 had a central neck dissection. Pathologic findings confirmed medullary thyroid cancer in 12 patients and papillary thyroid carcinoma in 2 patients; Stage 1 medullary thyroid carcinoma was diagnosed in 10 patients. One patient had stage II disease and one patient had stage III disease. The authors concluded that genomic screening may have value for early detection and treatment of thyroid malignancy.

Editorial

Davies L, Angelos P. Medullary Thyroid Carcinoma and Population Screening—The Promise and Pitfalls of Genetic Testing. JAMA Otolaryngol Head Neck Surg. Jan 5 2023;doi:10.1001/jamaoto.2022.4196

In the editorial that accompanied the article, Louise Davies, MD, MS, and Peter Angelos, MD, PhD, noted that the value of genomic screening for medullary thyroid cancer as a public health intervention is questionable because the disease is not common and, in this study cohort, only 20 patients chose to undergo surgery. They noted that similar findings had been observed in studies of breast cancer and familial hypercholesterolemia discovered in genomic testing programs. Greater patient education could potentially increase the number of patients who choose to undergo treatment. Careful follow up of patients who choose to refuse treatment for diseases discovered in these programs will be necessary to reduce the risk of progression of the conditions.