Current Literature

Angioembolization Increases Risk of Significant Complications in Management of Abdominal Trauma

Deville PE, Marr AB, Cone JT, et al. Multicenter Study of Perioperative Hepatic Angioembolization as an Adjunct for Management of Major Operative Hepatic Trauma. J Am Coll Surg. 2023, in press.

Nonoperative management of solid organ injuries has continued evolving and has increasingly employed radiologic and endovascular interventions as parts of efforts to improve outcomes. Available data have reported benefits of techniques such as angioembolization when used as a component of nonoperative management of liver and spleen injuries as well as pelvic fractures.

Data cited in this article remind readers that evidence supporting the use of angioembolization added to operative management of liver injury is not strong. This study sought to determine the potential value of angioembolization in patients with liver injury who required an open operation for achieving initial bleeding control. Data were gathered from 13 Level 1 and Level 2 trauma centers over a 9-year interval. Patients with Grade 3 or 4 liver injuries (n = 442) were divided according to use (n = 90) or non-use of angioembolization.

The data analysis showed that patients undergoing angioembolization had increased risk for biloma formation, intra-abdominal abscess, pneumonia, acute respiratory distress syndrome, deep vein thrombosis, and acute renal failure. The authors acknowledge that patients requiring angioembolization were likely more severely injured and this factor may help explain the higher rates of morbidity; however, the increased complication rates persisted after adjustments for injury severity.

Editorial

Dilday J, Martin MJ. Angioembolization and Adding Insult to Operative Hepatic Injury. J Am Coll Surg. 2023, in press.

In the editorial that accompanied the article, Joshua Dilday, DO, and Matthew J. Martin, MD, FACS, noted that the data presented provided convincing evidence that in the group of patients who require operative control of bleeding due to liver injury, angioembolization should be reserved for situations in which control of bleeding cannot be completely achieved by operative maneuvers. Additional prospective studies to further refine the indications for various hemostatic maneuvers were recommended.

Formal Ethics Education May Help Prepare Surgeons for Challenges of Daily Practice

Char S, Prager K, Dugdale L, Fischkoff K. Surgeon Perspectives on Daily Presentation of Ethical Dilemmas: A Qualitative Study. J Am Coll Surg. 2023, in press.

Steven Char, MD, and coauthors noted that surgeons face ethical dilemmas daily in clinical practice. The ACS has identified six core ethical issues commonly encountered in surgical practice and has provided educational resources to assist surgeons in managing them.

In this study, the authors conducted in-depth interviews with surgeons from multiple specialty fields (n = 30) to determine the most common ethical dilemmas encountered in contemporary practice and obtain perspectives from surgeons regarding needed skills for improving management of these dilemmas. Data obtained from the interviews showed that four ethical issues from the ACS list were most often encountered; these included professional obligations, competition of interests, truth-telling, and end-of-life care.

The surgeons interviewed noted that pressure from colleagues and surrogate caregivers to provide care that was not medically indicated was a common ethical challenge not included in the list provided by the ACS. They also stressed the importance of formal ethics education to prepare surgeons for these challenges.

Editorial

Angelos, P. Surgeon Perspectives on Ethical Dilemmas: The Importance of a National Surgical Ethics Curriculum. J Am Coll Surg. 2023, in press

In the editorial that accompanied the article, Peter Angelos, MD, FACS, noted that the differences in the ethical challenges encountered by interviewed surgeons and the list of core principles promulgated by the ACS is an indication of the changing nature of surgical practice. These changes make formal, continuing education of surgeons in ethics a necessary component of safe and effective surgical practice.

Examining Incidence and Risk Factors Associated with Postoperative Urinary Retention after Inguinal Hernia Repair

Croghan SM, Mohan HM, Breen KJ, et al. Global Incidence and Risk Factors Associated with Postoperative Urinary Retention Following Elective Inguinal Hernia Repair: The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) Study. JAMA Surg 2023 doi: 10.1001/jamasurg.2023.2137 [published Online First: 20230705]

Postoperative urinary retention (POUR) is a recognized complication of hernia repair procedures. This article reported an international study of hernia repairs (n = 4,151) performed with any surgical technique and using local, neuraxial, regional, or general anesthesia. The objective of the study was to document the rate of POUR in hernia repair surgery and identify risk factors that could stimulate research to develop interventions to reduce this complication.

The data showed that most patients underwent open hernia repairs (82.2%) and most received general or neuraxial anesthesia. POUR occurred in 5.8% of men and 2.97% of female patients; POUR was diagnosed in 9.5% of men over 65 years of age. Risk factors for POUR included older age, use of anticholinergic medication, history of urinary retention, constipation, performance of surgery outside of normal hours, involvement of the bladder in the hernia, intraoperative bladder catheterization, and increased operative duration.

The importance of this complication was confirmed by the observation that POUR was the cause of 27.8% of same-day admissions and 51.8% of 30-day readmissions. The authors noted that interventions to prevent POUR such as treatment of constipation, altering anticholinergic medications, encouraging preoperative urination and/or leaving the inserted bladder catheter for 24 hours if perioperative catheterization is necessary, as well as restriction of intravenous fluids, could potentially reduce the frequency of POUR.

Editorial

Economopoulos KP, Greenberg JA. Minimizing the Risk of Postoperative Urinary Retention After Inguinal Hernia Repair-2 Myths and an Opportunity. JAMA Surg 2023 doi: 10.1001/jamasurg.2023.2147 [published Online First: 20230705]

The accompanying editorial by Konstantinos P. Economopoulos, MD, PhD, MEng, and Jacob A. Greenberg, MD, EdM, recommended including these and other interventions in comprehensive preoperative and intraoperative protocols for prevention of POUR.

Current Literature

Angioembolization Increases Risk of Significant Complications in Management of Abdominal Trauma

Formal Ethics Education May Help Prepare Surgeons for Challenges of Daily Practice

Examining Incidence and Risk Factors Associated with Postoperative Urinary Retention after Inguinal Hernia Repair

In This Issue

Dr. Paul Friedrichs Will Head New White House Pandemic Response Office

Submit High-Impact Clinical Trials & Studies by August 1 for Clinical Congress

Apply for OGB Resident Scholarship for Clinical Congress 2023

What Surgeons Look Forward to at Clinical Congress 2023

Read July Bulletin Viewpoint Article on the Potential and Implications of ChatGPT for Surgeons

Advocating for the Ensuring Lasting Smiles Act (ELSA) to Cover of Congenital Anomalies

Attend the ACS Introduction to Simulation-Based Training Course

Participate in YFA Annual Mentor Program as Mentor or Mentee

Clinical Congress Lecturer Discusses How CoC Addresses Cancer Care Disparities