American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Videos from Tuesday's Second Edition

There’s an app for that: How technology is reshaping pre- and postoperative outpatient surgery

Jonah Stulberg, MD, PhD, MPH, FACS
Chicago, IL


Panel moderator Dr. Jonah Stulberg discusses a session on “what works?” and “what’s hype?” in the era of apps and other tools such as telemedicine to enhance patient education and engagement. Many surgeons are unaware or resist time-saving technology can be deployed to better educate patients pre-operatively, leading to pre-op compliance with medication management, bowel prep and diet restrictions. Other functions addressed include using real-time feedback to create clinical alerts, reduce readmissions, post-operative phone calls and even appointments. He likened hospitals’ acquisition of electronic medical record technology to the revolution that brought personal computers to homes – and set the stage for always-on mobile communications through the smartphone. That’s now happening to physician-patient relationships as well, pushed by explosive growth in investor-fueled innovation.

 

Lung transplant candidates receiving older donor lungs have similar survival outcome

Mohammed A. Kashem, MD, PhD
Philadelphia, PA


Dr. Mohammed A. Kashem discusses his finding no statistically significant difference in survival of single- and double-lung transplant recipients from groups of donors aged under 50 and ≥ 50. His review covered 428 single- and double-lung transplant recipients at a single center from February 2012 to August 2018. Survival for the under-50 group (n=363) was 86% (1-year), 78% (2-year) and 74% (3-year). For the ≥ 50 group (n=65) survival was 92% (1-year), 85% (2-year) and 74% (3-year). Variables such as age, gender, ethnicity, BMI, length of stay, ECMO, types of procedure were compared for significance in survival outcome, in addition to age of donor group.

View study's abstract.



Anastomotic leak rate doubled in presence of Clostridium difficile infection after colectomy

Sarah Baker, MD
New Orleans, LA


Dr. Sarah Baker discusses her recommendation to test high-risk colectomy candidates preoperatively for Clostridium difficile infection (CDI), with treatment of asymptomatic carriers before surgery. She and colleagues reviewed data on 56,631 colectomy patients in the ACS-NSQIP database, with overall incidence of CDI of 1.2% (n=673). They found a statistically significant increased risk of anastomotic leak (AL) in patients with CDI (the most common cause of healthcare-associated infections). Incidence of AL in non-CDI patients was 3.06%, vs. estimated 6.69% in patients with postoperative CDI.

View study's abstract.



Choosing Wisely® campaign against low-value breast cancer care achieves mixed results

Sarah P. Shubeck, MD, MS
Ann Arbor, MI


The Choosing Wisely® campaign against low-value practices in early stage breast cancer has not led to a reduction in the use of some low-value breast surgical procedures. Dr. Sarah P. Shubeck discusses her evaluation of rates and variation in the use of four Choosing Wisely® breast surgical oncology target metrics among adult women diagnosed with breast cancer between 2004 and 2016. Her study found rates of de-implementation varied among procedures. Although a previous study found rates of re-excision for close margins and unnecessary completion axillary lymph node dissection decreased in the post- Choosing Wisely® guideline period, the current study found rates of contralateral prophylactic mastectomy continued to increase. And the use of sentinel lymph node biopsy in women over 70 with HR+ breast cancer was flat.

View study's abstract.



Pediatric Trauma: What’s New and Improved?

Jeffrey S. Upperman, MD, FACS
Los Angeles, CA

Dr. Jeffrey Upperman discusses panel on recent updates in pediatric trauma. Panel members addressed traumatic brain injury, trauma care simulation, penetrating trauma, coagulation disorders and massive transfusion protocols.