One of the most exciting additions to Clinical Congress in recent years has been the Great Debates, which was introduced at Clinical Congress 2023. These dynamic panel discussions engage surgeons in collegial debate on impactful, timely issues in contemporary ORs.
After last year’s successful inaugural session, the Great Debates will return to the Clinical Congress 2024 program—but now expanded into two sessions to provide extended presentation and discussion opportunities for expert panelists.
Whole Blood Transfusion and Angioembolization
The first debate session, “The Great Debate: Whole Blood Transfusion and Angioembolization in Pediatric and Adult Trauma: Life-Saving Adjuncts, or Not Worth the Trouble,” at 9:45 am on Monday, October 21, will focus on the role of two important techniques in treating hemorrhagic trauma.
“We’ve gotten better at saving kids and adults in hemorrhagic shock, but we always have room for improvement,” according to session moderator Christopher W. Snyder, MD, MSPH, FACS, assistant professor of pediatric surgeon at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida.
Research into whole blood transfusion and angioembolization has shown benefits in recent years, but there are gaps that make this a topic worth debating.
“Whole blood and angioembolization have mainly been studied in adults, and in the setting of large, designated trauma centers, but we want to discuss whether they are applicable and beneficial in children and in less-resourced settings” Dr. Snyder said.
He explained that the expert on the pro side of the whole blood transfusion will argue that it is feasible, safe, and efficacious in pediatric trauma patients, while the con side will argue that it can be inaccessible outside of large trauma centers and has an unproven clinical benefit.
For angioembolization, the pro side will argue that it has clear clinical indications and proven benefits over other hemorrhage control techniques, while the con side will argue that it is overutilized, has unclear clinical benefit especially in children, and can have significant complications.
“We’re looking forward to a friendly but lively discussion led by national experts on both sides that will provide an opportunity to learn from each other, and to take better care of our patients—especially injured children,” Dr. Snyder said.
Rib Fracture Fixation and Specialty Complications
The wide-ranging second debate session, “The Great Debate: The Challenges of Rib Fracture Fixation and Who Should Manage Specialty Surgical Complications,” 2:30 pm on Tuesday, October 22, will explore two core topics: the different perspectives on treating rib fracture, as well as the role of general surgeons in attending to certain specialty complications.
“There is debate, especially among trauma surgeons, about the utility of using plates to repair rib fractures in trauma patients,” said session moderator Alexander R. Raines, MD, FACS, assistant professor of surgery at The University of Oklahoma in Oklahoma City. “Some are very aggressive about plating, some don’t plate at all, and some do it selectively. Because the data are mixed, we’re looking forward to an interesting debate.”
The second debate in this session is two-fold, focusing on how general surgeons should be interacting with the complications and emergencies taking place in bariatric surgery and colorectal surgery patients. When a subspecialist isn’t available, should general surgeons be taking care of patients with subspecialty diagnoses?
“For colorectal conditions like perforated diverticulitis or large bowel obstructions, there are arguments that colorectal surgeons should be managing the procedures, but others will say that colorectal issue are also in the wheelhouse of a general surgeon,” Dr. Raines said.
Similarly, managing bariatrics is a hot topic because of the increased prevalence of patients who have had bariatric surgery, which means more individuals are experiencing complications.
“For this debate, one expert will argue that a minimally invasive-trained bariatric surgeon should be the one taking care of those patients because they have unique needs, and the other is going to argue that a general surgeon can take care of them because they understand the anatomy,” he explained.
Dr. Raines said that he looks forward to the debates as fun and interactive ways to discuss some key topics of interest to surgeons—and, importantly, also as a way to highlight the multidisciplinary breadth of the ACS since the session will offer topics of interest for general, bariatrics, colorectal, trauma, and orthopaedic surgeons.
