Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Although the most common operative approach to unilateral groin hernia repair is the open Lichtenstein procedure, other minimally invasive techniques have been introduced and their popularity among surgeons is increasing.
The authors of this study used data from a national hernia database to compare 30-day and 1-year outcomes of laparoscopic and robotic hernia repairs with the open Lichtenstein repair. Propensity score matching was used to improve the outcome comparisons. Groups of 1,598 matched patients who underwent each type of repair were formed and outcomes were compared.
Rates of readmission, reoperation, and surgical site infection were similar for all groups; laparoscopic transabdominal preperitoneal repair was associated with an increased risk for seroma. Hernia recurrence at 1 year also was similar; robotic hernia repair had a lower overall recurrence rate, but this did not reach statistical significance. Subgroup analysis showed that robotic repair had a statistically significant lower recurrence rate in obese patients.
The authors noted that these data were recorded in the database by hernia surgeons and there is a small risk of bias in reporting; they concluded that, overall, safety profiles and recurrence rates are similar for all repair techniques, but differences may be present in subgroups of patients.
Video Laryngoscopy Should Be Preferred Technique for Endotracheal Intubation in OR
Reutzler and coauthors conducted a clustered prospective, randomized trial comparing rates of intubation success for direct versus video laryngoscopy in patients undergoing cardiac, thoracic, or vascular procedures in a single academic hospital. Patients (n = 7,736) assigned to two sets of 11 operating rooms were randomized over a 10-month interval. Outcomes of interest were the number of intubation attempts per surgical procedure and failure of intubation defined as clinician decision to switch to a different intubation technique.
85% of the procedures were elective; more than one intubation attempt was necessary in 1.7% of patients randomized to video laryngoscopy versus 7.6% of patients receiving direct laryngoscopy. Intubation failure was documented in 0.27% of video laryngoscopy patients and in 4% of direct laryngoscopy patients.
The authors concluded that the data suggest video laryngoscopy should be the preferred technique for intubating patients who require general anesthesia for surgical procedures.
Quality Assessment Is Needed Beyond Initial Colorectal Cancer Screening
Currently, quality improvement measures are applied only to the initial colorectal cancer (CRC) screening event. This study assessed the feasibility of a quality improvement measure that documented the rate of colonoscopy within 6 months of an abnormal result from a stool-based CRC screening test. Data from a national database (n = 20,581) that documented initial CRC screening and rates of colonoscopy within 6 months were used and feasibility field testing of a follow-up measure was performed.
The data analysis showed that the overall rate of colonoscopy within 6 months was low (47.9%). Rates of colonoscopy within 6x months documented by the follow-up measure were variable across the 38 healthcare organizations that were included in the study; rates were significantly lower in Black patients and patients with Medicare and Medicaid insurance. The reliability of the follow-up measure was 94.5%.
The authors concluded that a simple performance measure to determine rates of colonoscopy following a positive stool-based CRC screening test was feasible and could potentially assist in increasing rates of colonoscopy and decreasing CRC-related mortality, especially in vulnerable patient groups.
The editorial by Maratt and coauthors that accompanied this article emphasized the facts that quality assessment of CRC screening must extend beyond the initial screening procedure and that this assessment instrument could be used to identify high-performing centers; practices used by these centers could be exported to educate and improve performance in other centers.
