Category Archives: Risk

Society for Vascular Surgery (SVS) Clinical Practice Guidelines on Popliteal Artery Aneurysms

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“Popliteal artery aneurysms (PAAs) are the most common peripheral arterial aneurysms, defined as aneurysms outside the aortoiliac system or the brain, accounting for 70% of all peripheral arterial aneurysms. They are more common in men (95%) and tend to occur in the sixth and seventh decades of life. Few modern studies have been performed on the natural history of PAAs, and many of these were retrospective reviews of surgical patients. As such, the timing and details of PAA management remain nuanced.”

“These guidelines focus on PAA screening, indications for intervention, choice of repair strategy, management of asymptomatic and symptomatic PAAs (including those presenting with acute limb ischemia), and follow-up of both untreated and treated PAAs. They offer long-awaited evidence-based recommendations for physicians taking care of these patients.”

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Timing of elective surgery and risk assessment after SARS-CoV-2 infection

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“Patients who develop symptoms of SARS-CoV-2 infection within 7 weeks of planned surgery, including on the day of surgery, should be screened for SARS-CoV-2. Elective surgery should not usually be undertaken within 2 weeks of diagnosis of SARS-CoV-2 infection. For patients who have recovered from SARS-CoV-2 infection and who are low risk or having low-risk surgery, most elective surgery can proceed 2 weeks following a SARS-CoV-2 positive test. For patients who are not low risk or having anything other than low-risk surgery between 2 and 7 weeks following infection, an individual risk assessment must be performed. This should consider: patient factors (age; comorbid and functional status); infection factors (severity; ongoing symptoms; vaccination); and surgical factors (clinical priority; risk of disease progression; grade of surgery).”

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Effects of delay of emergent transfer of patients requiring surgery.

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“Emergency general surgery (EGS) patients require greater resources and have increased rates of morbidity and mortality. Previous work has shown mortality differences in colectomy patients between direct admissions and transfers patients based on source, including emergency department, inpatient, and nursing home transfers. We hypothesize that patient transfer status negatively effects morbidity, mortality, and resource utilization in a mixed population of EGS patients.
This study demonstrates significant increases in mortality, morbidity, and resource utilization in EGS transfer patients who were not attributable to case mix, demographics, and comorbid status alone. These data point to potential financial and quality assessment challenges for tertiary referral centers.”

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Value of primary operative drain placement after major hepatectomy

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“Historically, prophylactic intraoperative peritoneal drain placement has been advocated after hepatectomy in order to identify and drain bile leaks and decrease the risk of potential perihepatic fluid collections and abscess formation postoperatively. Several small randomized trials have suggested, however, that routine abdominal drainage after elective liver resection may not be necessary.”

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Postoperative atrial fibrillation: Predictors and risk of mortality

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“Atrial fibrillation, the most common sustained dysrhythmia, is a common postoperative complication. Previous studies have shown that the incidence, prevalence, and associated morbidity and mortality increase progressively with age.
Development of POAF and mortality is dependent upon a wide range of factors not limited to age and medical comorbidities. Although a patient may be at an increased risk for POAF this does not mean they are at an increased risk for mortality.”

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Mouse study: polyphosphate administration may be an alternative approach to prevent anastomotic leak induced by collagenolytic bacteria

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“Despite decades of descriptive research, the etiology and pathogenesis of AL remains unknown. Although there is compelling evidence that microbes are the primary drivers of the pathogenesis of anastomotic leak, few efforts have been aimed at understanding and controlling the microbes that may complicated anastomotic healing.”

“A microbial cause for anastomotic leak was first proposed over 60 years ago and has been confirmed in multiple studies. The main clinical evidence for a microbial cause of anastomotic leak is indirect and is based on clinical trials in which the use of oral non-absorbable antibiotics significantly reduce the incidence of anastomotic leak”

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Damage control in penetrating duodenal trauma

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“The overall incidence of duodenal injuries in severely injured trauma patients is between 0.2 to 0.6% and the overall prevalence in those suffering from abdominal trauma is 3 to 5% 1,2. Approximately 80% of these cases are secondary to penetrating trauma, commonly associated with vascular and adjacent organ injuries. These associated injuries create a significant challenge towards the early diagnosis and appropriate management. Therefore, defining the best surgical treatment algorithm remains controversial. Mild to moderate duodenal trauma is currently manage via primary repair and simple surgical techniques. However, severe injuries have required complex surgical techniques (duodenal diverticulization, pyloric exclusion with or without gastrojejunostomy and pancreatoduodenectomy) without significant favorable outcomes and consequential increase in the rates of mortality.”

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