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.
Retained surgical items (RSI) is a rare but important complication of operative procedures. This study used data from a large state database to determine frequencies of RSI in 2007−2017. A comprehensive training program (TeamSTEPPS) and radiofrequency detection devices were introduced in 2012 into the healthcare system that was the focus of the study.
A before and after analysis was done involving 997,237 procedures; RSI events were reduced from 11.66 to 5.80 per 100,000 operations. A major factor associated with the decrease was the use of radiofrequency detection. The authors concluded that the addition of radiofrequency detection to universal team training was an effective intervention for reducing risk of RSI.
Study Suggests Residents Can Safely Perform Laparoscopic Cholecystectomy Independently
Changes in the structure of graduate education in general surgery and attending surgeon reimbursement rules have resulted in fewer independent operative experiences for residents. Veterans Administration (VA) hospitals have traditionally been a valuable resource for resident operative experience, including opportunities to perform procedures without attending presence.
This study used data from the VA Surgical Quality Improvement Database to determine outcomes of laparoscopic cholecystectomy performed by residents with and without attending surgeon presence. Patient characteristics were matched using propensity scoring; records of 23,831 patients cared for in 2004−2019 were included, and 14% of procedures were performed without the attending surgeon scrubbed. The data analysis showed that operative time was 4 minutes longer, on average, if the attending was not scrubbed, but there was no difference in postoperative mortality or complication rates. Of interest, and a cause for concern, was the observation that the proportion of cases in which the attending was not scrubbed decreased over the study interval.
These findings suggest that development of educational programs aimed at increasing the proportion of residents who are permitted to operate independently can be done without threatening patient safety.
Hypercalcemia occurs during malignancy in up to 30% of patients. Non-small cell lung cancer, breast cancer, multiple myeloma, squamous cell cancers of the head and neck, urothelial cancers, and ovarian cancers are the most common tumors associated with hypercalcemia. Prevalence of hypercalcemia appears to be declining, possibly because of the prophylactic use of bisphosphonates.
Hypercalcemia occurs in patients with advanced cancers. Data cited in this article showed that even with current therapies, median survival after diagnosis is only 25−52 days. Increased osteolytic bone resorption is the main mechanism leading to hypercalcemia. Patients most often present with profound dehydration; aggressive management with intravenous normal saline is recommended and administration of a diuretic, such as furosemide upon rehydration, is becoming effective and may hasten reduction of serum calcium levels. Reducing bone resorption with bisphosphonates is a mainstay of treatment. Outcomes of treatment will depend on the treatment response of the underlying malignancy.
The authors provided useful illustrations of the mechanisms of hypercalcemia and a helpful table of treatment options. Readers are encouraged to review this information.
