A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy

“Despite advancements in operative technique and improvements in postoperative outcomes, pancreatic fistula is widely considered to be the most common and
troublesome complication after pancreatic resection. It represents the factor most often linked with postoperative mortality, certain complications such as delayed gastric emptying, longer hospital stays, readmissions, and increased costs. Furthermore, it frequently delays
timely delivery of adjuvant therapies, and reduces overall patient survival. Placement of pancreatic duct stents, the use of somatostatin analogs or adhesive sealants, or modifications in reconstruction technique have done little to change the incidence or alter the impact of postoperative pancreatic fistulas (POPF).”

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Development of Diabetes after Pancreaticoduodenectomy

“The association with new-onset impaired glucose tolerance (or pre-diabetes) and diabetes has been observed since the inception of and subsequent popularization of pancreaticoduodenectomy (PD) the gold-standard surgical treatment for resectable pancreatic head pathologies. Standardization of surgical techniques, advancements in peri-operative care, and improved understanding of inflicting pathologies have led to drastic reductions in mortality and morbidity across all indications. Despite these advancements, the relationship between diabetes development and parenchymal resection, pathology, and
comorbid states remains understudied.”

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Advantages of routine intraoperative cholangiography in a teaching hospital

“The role of routine IOC during cholecystectomy has been controversial. Opponents to routine IOC assert that this procedure increases operating times and exposes caregivers and patients to radiation. In addition, there is the possibility of detection of indolent CBD stones with consequently unnecessary removal. On the other hand, advocates in favor
of routine IOC state that intraoperative visualization of the bile duct anatomy may decrease either the rate of complications such as CBD injury, or hospital readmissions for subsequent removal of retained CBD stones. Despite lacking strong evidence for not performing IOC vs. routine IOC vs. selective IOC, fitting in one of these three groups can depend on training, technical experience, and surgical habit. If a surgeon never performs IOC in their daily practice, they are not eager to change their habits, even though literature may suggest otherwise.”

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Acute Kidney Injury within an Enhanced Recovery after Surgery (ERAS) Program for Colorectal Surgery

“Acute kidney injury (AKI) is a common complication following major abdominal surgery and is associated with increased length of hospital stay, the progression of chronic kidney disease (CKD), and increased long-term mortality. The rate of AKI amongst patients within different enhanced recovery programs (ERP) is reported to be between 3 and 23%. Patient-related risk factors for AKI include age, comorbidities such as hypertension and diabetes, a history of CKD, and use of angiotensin-converting enzyme inhibitors. Procedure-related factors that may impact on the prevalence of AKI include open surgery, the requirement for blood products, the use of intraoperative vasopressors, and a restrictive perioperative fluid regimen. The original guidelines published by the Enhanced Recovery After Surgery (ERAS) Society for colorectal surgery (CRS) as well as their recent update (2018 guidelines) promote a number of measures which aim to maintain near euvolaemia such as preoperative carbohydrate loading, avoidance of bowel preparation, minimisation of fasting times, minimally invasive surgery, and early resumption of oral fluid therapy.”

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Long-term symptom resolution following the surgical management of chronic pancreatitis

“Chronic pancreatitis is characterized by recurrent inflammation and fibrosis, resulting in pervasive symptoms of abdominal pain, early satiety, nausea, malnutrition, and pancreatic insufficiency. Though there are limited data on the true prevalence of chronic pancreatitis, an
estimated 5 to 14 per 100,000 patients are diagnosed annually in the US. While the overall incidence and prevalence of chronic pancreatitis remain relatively low, it contributes a significant morbidity and financial burden, with an annual healthcare cost exceeding $3 billion, largely due to increased utilization and symptom palliating efforts. Furthermore,
disability secondary to chronic pancreatitis symptoms creates a substantial personal burden, with increased work absenteeism and reducedquality of life. Treatment efforts initially focus on symptom management and reversal of instigating factors, consisting primarily of medical
and endoscopic techniques; however, up to 50 % of all cases of chronic pancreatitis eventually require surgical intervention due to persistent symptoms, most commonly debilitating abdominal pain. Additionally, current data suggest that surgery is superior to endoscopy in maintaining symptom resolution and preserving pancreatic function.”

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Risk Factors and Outcomes for Postoperative Delirium after Major Surgery in Elderly Patients

“The number of people over 65 years is increasing and will continue to do so over the coming decades. Similarly, the number of elderly patients requiring surgery is expected to increase.
Delirium is a common and serious problem in hospitalized patients, especially in the elderly.
Postoperative delirium is associated with an increase in postoperative complications, a decrease in functional capacity, a prolonged hospital stay and a direct increase of healthcare costs.
Early identification of patients at risk for delirium is important because adequate well timed
interventions could prevent occurrence of delirium and the related detrimental outcome.
Several prediction models have been developed, including multiple risk factors for postoperative delirium. However, these studies are of varying quality and each with a heterogeneous population.
Measuring frailty may be a more sensitive marker of determining post-operative delirium. However, to this date, there is no consensus on a clear definition and quantification of
frailty. Several assessment instruments have been developed for frailty during the last decades.
The most evidence based process to identify frail patients at this moment is comprehensive
geriatric assessment. However, this is a resource intensive, time consuming process and therefore not suitable for clinical practice”

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Comparing Outcomes Between “Pull” Versus “Push” Percutaneous Endoscopic Gastrostomy in Acute Care Surgery: Under-Reported Pull Percutaneous Endoscopic Gastrostomy Incidence of Tube Dislodgement

“Percutaneous endoscopic gastrostomy (PEG) tube placement is a commonly performed procedure in trauma patients.Since the establishment of the acute care surgery (ACS)
model, the role of ACS in PEG tube placement in many institutions has expanded. The incidence of PEG tube complications has been under-reported in the literature and varies
widely among the patient populations studied and the definition of complications utilized. Major and minor complications may range from 3% to 26%. Our institution, under an ACS model, has previously reported an overall 25% complication rate with 10% major and 14% minor complications associated with pull PEG.”

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