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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.
Perioperative venous thromboembolism (VTE) is a significant complication of surgical procedures; data cited in this article indicate that more than 60,000 VTE-related deaths are documented in US hospitals each year.
In 2008, the authors reviewed NSQIP data from their institution and discovered that VTE events were occurring three times more often than expected. They implemented a VTE risk assessment model that was integrated into the electronic medical record (EHR). The risk model was based on the Caprini VTE score.
Once risk calculation data were entered, the model suggested a VTE prevention intervention (early ambulation, compression stockings, prophylactic anticoagulation) based on risk assessment. The EHR also provided reminders and recorded surgeon compliance with the risk assessment and intervention protocol.
The article reported data obtained 11 years after implementation of the model. The data analysis showed that the rate of perioperative VTE had decreased to less than 1%. The reported data also showed that the interval needed to reach this reduction was 3 years from implementation of the protocol.
A helpful illustration of the EHR protocol is provided in the article. Of note is the fact that no data on patient or caregiver reactions to the protocol were provided.
Retromuscular Sugarbaker versus Keyhole Mesh Placement for Parastomal Hernia Repair: Which Is Superior?
Parastomal hernia is a notable complication occurring after surgical procedures that require fecal diversion. Repair of these hernias using the Sugarbaker retromuscular mesh repair or the keyhole technique has been associated with hernia recurrence rates of up to 45%. The Sugarbaker technique has been touted as the superior approach because of reported lower hernia recurrence rates.
This article reported results of a randomized prospective trial (n = 150) comparing recurrence rates at 2 years after Sugarbaker or keyhole repair. Hernia recurrence was documented in 17% of patients following Sugarbaker repair and 24% of patients following keyhole repair. The difference was not statistically significant.
Other outcomes such as rates of reoperation, mesh-related complications, patient-reported pain, and quality of life were similar, as well. The authors concluded that both procedures were associated with significant risk for hernia recurrence, which was similar after both procedures.
In the editorial that accompanied the article, Kannappan and Ramaswamy noted that the methods used to choose the operation that was performed were not reported; also, the rates of stoma repositioning were 63% for the keyhole technique and 31% for the Sugarbaker technique. The influence of this factor on outcomes is not known.
Robotic-Assisted Hernia Repair Shows Increased Risk of Long-Term Recurrence versus Other Treatments
Fry and coauthors reported a retrospective analysis of Medicare claims data (n = 161,415) to compare long-term hernia recurrence rates in patients who underwent robotic-assisted, laparoscopic, or open ventral, incisional, or umbilical hernia repair over the interval 2010–2020.
Instrumental variable analysis was used to adjust for unmeasured patient factors. The data showed that usage of robotic-assisted repair techniques increased significantly over the study interval. The 10-year risk of hernia recurrence was significantly higher (13.43%) for patients undergoing robotic-assisted repairs, compared to laparoscopic repairs (12.33%), and open repairs (12.74%). Statistical significance of the difference in recurrence rates may have been influenced by the large sample size.
Data on the clinical significance of this difference (long-term patient-reported outcomes, rates of reoperation) are not reported. The authors concluded that additional research to document the advantages and disadvantages of each approach is needed.
In the editorial that accompanied the article, Sadaka and Itani noted that this study adds to other published data showing a two-fold increase in risk of hernia recurrence following a robotic-assisted repair. Risk-adjusted prospective randomized comparison studies are needed. Patients should be counselled regarding the risk of recurrence when robotic-assisted hernia repair is planned.
