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.
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.
Traumatic hemothorax is frequently encountered in patients with blunt and penetrating thoracic injuries; tube thoracostomy is the most common initial treatment for these patients. Complications are common in patients who sustain traumatic hemothorax, including retained hemothorax, empyema, and respiratory failure. A significant proportion of complications are related to thoracostomy tube placement, recognition of which has stimulated interest in observing small volume hemothoraces without tube thoracostomy.
This article presented results of a retrospective study of patients (n = 210) with small volume hemothorax (300 mL or less as determined by CT imaging) treated with observation according to an institutional thoracic trauma management guideline. Outcomes were compared with patients (n = 147) treated prior to implementation of the guideline. Thoracostomy tube placement occurred in 42% of the post-guideline cohort and 57% of the pre-guideline cohort.
Patients in the post-guideline cohort had significantly shorter ICU and hospital lengths of stay. No increase in pulmonary complications, rates of 30-day readmission, or 30-day mortality were observed in the post-guideline cohort.
The authors concluded that implementation of the guideline resulted in decreased use of tube thoracostomy with no increase in morbidity or mortality risk.
Patient-Reported Outcomes Critical in Determining Successful Long-Term Follow Up after Pancreatoduodenectomy
Patient-reported outcomes can provide valuable data on long-term success of surgical procedures. The authors of this study gathered preoperative and postoperative (out to 6 months) patient-reported data on patients (n = 116) who underwent pancreatoduodenectomy in a single institution over a 2-year interval.
Patient clinical status (preoperative and postoperative) was graded using standard scales and patient-reported outcomes were obtained using accepted questionnaires. Complications were documented. The main outcomes of interest were patient opinions regarding “full recovery” in groups with and without complications.
Complications occurred in 28% of patients. Only 7% of patients reported “full recovery” at 30 days postoperatively, but this proportion rose to 55% at 6 months. In the patient group with complications, 62% reported “not fully recovered” at 6 months while 38% of patients without complications classified themselves as “not fully recovered.” The most common complication associated with failure to recover was delayed gastric emptying.
Of interest were the observations that pancreatic fistula was not associated with reports of incomplete recovery and healthier patients (based on preoperative assessment) were more likely to report incomplete recovery at 6-month follow-up.
The authors concluded that recovery failure is not observed solely in patients with complications and patient-reported outcomes are critical to determine treatment success over long-term follow-up.
Negative Emotional Responses Are Common among Trainees and Faculty following Adverse Patient Events
This article reported results of surveys and interviews that sought to characterize responses of surgical faculty and trainees who had experienced a recent adverse patient event. Survey instruments were offered to 216 trainees and 93 completed the survey; interviews were offered to 29 faculty and 23 completed interviews.
Trainees had been involved in at least one recent event; they commonly reported embarrassment, post-event rumination, and fear of attempting future procedures. A significant proportion of trainees (35.9%) reported that they had considered quitting the training program. Women trainees and trainees reporting race/ethnicity other than non-Hispanic white were more likely to experience negative emotional reactions. Faculty reported feelings of guilt and shame, loss of confidence, and distraction.
The most desired form of post-event management reported from trainees was the opportunity to discuss the event with a senior, experienced faculty member; faculty desired these conversations, as well, although some faculty expressed unwillingness to discuss the incident.
The authors concluded that negative emotional responses are common among trainees and faculty following an adverse patient event. Formal programs to provide support are needed. The article supplied clear descriptions of negative emotional reactions and valuable listings of descriptive statements obtained from trainees and faculty. Surgeons are encouraged to review the entire article content.
