Current Literature

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

Bariatric Surgery Improves Obesity-Associated Pulmonary Hypertension, Linked to Decrease in Inflammation

Valera RJ, Fonnegra CB, Cogollo VJ, et al. Impact of Rapid Weight Loss after Bariatric Surgery in Systemic Inflammatory Response and Pulmonary Hemodynamics in Severely Obese Subjects with Pulmonary Hypertension. J Am Coll Surg. 2022, in press.

Pulmonary hypertension in patients with severe obesity is mediated, in part, by an enhanced systemic inflammatory response. The objective of this study was to document changes in pulmonary hypertension and systemic inflammation in patients with obesity and pulmonary hypertension who had undergone bariatric surgery. The retrospective study compared 20 patients who had undergone bariatric surgery with 20 patients who did not. Right ventricular systolic pressure was used to record changes in pulmonary hypertension and red blood cell distribution width was recorded to quantify the systemic inflammatory response.

The data analysis showed that there was a decrease in both pulmonary systolic pressure and red blood cell distribution width following bariatric surgery. There was a correlation in these changes for both comparison groups, but this did not reach statistical significance. The authors concluded that these findings suggested that bariatric surgery improves obesity-associated pulmonary hypertension, and that this improvement may be linked to a decrease in systemic inflammation.

Editorial

Ghanem OM. The Anti-inflammatory Effects of Metabolic Surgery. J Am Coll Surg. 2022, in press.

In the editorial that accompanied the article, Omar Ghanem, MD, FACS, noted that these findings, added to other available research, serve to reinforce the role of upregulated inflammation in producing the cellular and cardiovascular changes that occur with severe obesity. Additional research that focuses on the role of bariatric surgery as a means of modulating the abnormal inflammatory response is needed.

Predictive value of routine white blood cell count prior to discharge for organ space infection in children with complicated appendicitis: results from the Eastern Pediatric Surgery Network

Study Suggests Predischarge White Blood Cell Count Not Useful in Select Pediatric Surgery Patients

Cramm SL, Graham DA, Allukian M, et al. Predictive Value of Routine White Blood Cell Count Prior to Discharge for Organ Space Infection in Children with Complicated Appendicitis: Results from the Eastern Pediatric Surgery Network. J Am Coll Surg. 2022, in press.

The authors used data from a 14-hospital database to investigate the potential value of a predischarge white blood cell count (RPD-WBC) for prediction of postoperative organ space infection in children who had been treated for complicated appendicitis. The study cohort (n = 1,264) included 348 patients who had a pre-discharge white blood cell count. Logistic regression was used to calculate predictive values that were adjusted for patient age, appendicitis severity, and use of post-discharge antibiotics.

The data analysis showed that median RPD-WBC counts were similar for patients who did and did not develop organ space infection. Leucocytosis was absent in 50% of patients who were diagnosed with this complication. The authors concluded that RPD-WBC was not useful for prediction of postoperative organ space infection in pediatric patients with complicated appendicitis.

Examining Postoperative Surveillance Imaging After Mastectomy

Smith D, Sepehr S, Karakatsanis A, Strand F, Valachis A. Yield of Surveillance Imaging After Mastectomy With or Without Reconstruction for Patients With Prior Breast Cancer: A Systematic Review and Meta-analysis. JAMA Netw Open. 2022;5(12).

Daniel Smith, PhD, and coauthors noted that breast-conserving therapy is the recommended and most common approach for patients with early breast cancer, but many patients still undergo mastectomy and guidelines for postoperative surveillance using imaging do not provide clear guidance for clinicians caring for this patient group. This article described a systematic review of the literature to determine the value of postoperative imaging surveillance for detection of cancer recurrence in patients who had undergone mastectomy with or without reconstruction.

The systematic review included 16 studies that met inclusion criteria. Data from the included studies showed that rates of detection of recurrent cancer were low for all imaging modalities (mammography, ultrasonography, MR imaging) when rates of detection of clinically occult lesions were assessed. The authors concluded that evidence to support the value of routine imaging surveillance following mastectomy for breast cancer was weak and did not support the use of this approach for detecting cancer recurrence. The authors recommended additional prospective studies that focus on the clinically occult cancer detection rate to determine the best approach for postoperative surveillance of patients undergoing mastectomy.