Assessing Early Discontinuation of Opiates After Trauma
The inappropriate use of prescription opiates is a significant public health issue throughout the United States, but little is known about patterns of use and factors associated with discontinuation of these drugs after major trauma. For a study, investigators sought to identify predictors of opiate discontinuation in patients who were discharged after experiencing a trauma. At 3 months, more than 90% had discontinued opiate use. Advanced age, marital status, and low socioeconomic status appeared to be significantly associated with a lower likelihood of discontinuation of opiates after a trauma whereas race, injury severity, and comorbid anxiety or depression were not. The findings may help surgeons identify high-risk patients and manage them accordingly.
Monitoring Functional Recovery at Home
Few studied have explored the feasibility of wearable, real-time, wireless monitoring devices and their effect on functional recovery and patient-centered outcomes after surgery. For a study, researchers had major abdominal surgery patients wear wristband pedometers that tracked their steps 3 to 7 days before their operation, during their hospitalization, and for 2 weeks after they were discharged. Web-based, self-reported symptoms and quality of life (QOL) were obtained throughout the study. Adherence rates for wearing the pedometer were above 80% before and after discharge. More than 75% of symptom and QOL assessments were completed by about 63% and 74% of patients, respectively. Patient satisfaction scores were 4 out of 5.
Predicting ICU Readmission for Surgical Patients
ICU readmission within 72 hours is an established quality measure of postoperative care, but research is lacking on predictors of these readmissions following various types of surgery. A study was conducted in which investigators evaluated more than 3,000 surgical patients admitted to an ICU. Within 72 hours, 5% of patients were readmitted after general surgery (34%), transplantation (9%), trauma (43%), and vascular surgery (14%). The study group developed a nomogram to help clinicians predict ICU readmissions. Factors in the nomogram included age, blood urea nitrogen, serum chloride, serum glucose, atrial fibrillation, renal insufficiency, and respiratory rate.
Comparing Hepatectomy Approaches
Research comparing the effectiveness of minimally invasive surgery (MIS) with the conventional open approach for major hepatectomy or challenging resections has been limited to single-institution series. For a study, researchers collected data on more than 1,000 patients who underwent major hepatectomy at 67 hospitals in 2014. Risk of serious morbidity or mortality (SMM) was significantly lower among those who underwent MIS when compared with those who underwent open surgery. However, no significant between-group differences were observed for bile leaks, liver failure, reoperation or intervention, or 30-day readmission. Also, no significant differences were observed in SMM risk among challenging resection procedures.
Maternal & Fetal Outcomes After Bariatric Surgery
With obesity potentially increasing pregnancy and postnatal complications and bariatric surgery becoming an increasingly common method of weight reduction in obese women, clinical investigations are needed to evaluate maternal and fetal outcomes for pregnant women who have previously undergone bariatric surgery. To address this research gap, investigators systematically reviewed studies published between 2000 and 2016 that compared maternal and fetal delivery outcomes following bariatric surgery with those among the general population of obese mothers. Women who had undergone bariatric surgery were significantly less likely to require Cesarean sections. The incidence of women who had babies that were large for gestational age, those with macrosomia, and those with assisted vaginal deliveries were significantly lower in the post-bariatric surgery group. Preterm delivery incidence rates were similar in both groups.
NEWS FROM ACS 2016
MORE FROM ACS 2016