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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.

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Literature Selections

Current Literature

January 23, 2024

Prehospital Blood Transfusion before Airway Control Shows Decreased Mortality in Patients with Severe Hemorrhage

Ritondale J, Piehl M, Caputo S, et al. The Impact of a Prehospital “x-ABC” Resuscitation Sequence in Patients with Severe Hemorrhage. J Am Coll Surg. 2024, in press.

There is increasing recognition of the reduction in mortality risk for injured patients with hemorrhagic shock treated with early transfusion and efforts to control hemorrhage rather than initial airway control. This article reported results from a prospective study of early prehospital transfusion of packed red blood cells (prior to endotracheal intubation) in patients with penetrating torso injuries and severe hemorrhagic shock (x-ABC group, n = 62).

Patients included in the study group were identified according to a prehospital care protocol developed by a consensus group of emergency medical services professionals and trauma surgeons. The x-ABC group received two units of packed red blood cells, two grams of intravenous calcium chloride, and two grams of tranexamic acid. Controls were chosen from an institutional trauma registry; propensity matching was used to create a matched control group (n = 31, ABC group). The outcome of interest was in-hospital mortality.

The data analysis showed that mortality in the x-ABC group was 13% compared to 47% in the ABC group. This study was presented at the plenary session of the 2023 meeting of the Southern Surgical Association.

In the discussion that occurred after the presentation, discussants noted that Glasgow Coma scores were low in both patient groups even though patients with head injury were excluded. The authors hypothesized that this was due to the severity of shock since none of the x-ABC group had received sedation or paralyzing drugs. Discussants agreed that the x-ABC approach has value for management of severely injured patients. 

The results also align with other research recently featured in JACS.

Pregnant Patients with Acute Cholecystitis Show Improved Outcomes after Cholecystectomy

Hantouli MN, Droullard DJ, Nash MG, et al. Operative vs Nonoperative Management of Acute Cholecystitis During the Different Trimesters of Pregnancy. JAMA Surg. 2024;159(1):28-34.

Clinical practice guidelines promulgated by national professional organizations recommend cholecystectomy for management of acute cholecystitis (AC) in all trimesters of pregnancy; despite these recommendations, available evidence cited in this article show that rates of cholecystectomy in pregnant patients who develop AC are less than 35%.

The authors used data from a national medical database to compare rates of adverse pregnancy outcomes (preterm birth, early live birth, and pregnancy loss) in pregnant women who developed AC (n = 5,759) with a propensity matched group of pregnant patients without AC (N=23,036). Cholecystectomy was performed in 34.5% of the AC group.

Rates of adverse pregnancy outcomes were higher in all patients who developed AC, but patients who underwent cholecystectomy had significantly lower risk for adverse pregnancy outcomes compared with AC patients who did not have cholecystectomy, regardless of pregnancy trimester.

The authors concluded that additional efforts to increase adherence to available clinical practice guidelines are needed to improve rates of cholecystectomy in pregnant patients with AC.

Laser Epilation Significantly Lowers Recurrence of Pilonidal Disease

Minneci PC, Gil LA, Cooper JN, Asti L, Nishimura L, Lutz CM, Deans KJ. Laser Epilation as an Adjunct to Standard Care in Reducing Pilonidal Disease Recurrence in Adolescents and Young Adults: A Randomized Clinical Trial. JAMA Surg. 2024;159(1):19-27.

Recurrence of pilonidal disease (acute inflammatory flares, chronic wounds, and fistulas) is a significant cause of reduced quality of life. Recurrent disease is thought to be the result of hair in the gluteal cleft, sedentary lifestyle, and chronic irritation of the gluteal cleft area. Available evidence has confirmed recurrence rates after standard treatment (improved hygiene and mechanical or chemical depilation of hair) of up to 66%.

The authors reported results of a randomized trial that compared laser epilation (applied with different energy levels according to skin type determined by the Fitzpatrick classification system) and standard care (n = 96) with a control group (n = 134) that received standard care alone. Laser epilation removes the hair shaft, follicle, and bulb using selective thermolysis. The outcome of interest was the rate of recurrence at 1 year of follow-up.

Recurrence rate of pilonidal disease was significantly lower in the laser epilation group (10.4% versus 33.6%). The authors concluded that laser epilation should be recommended as standard therapy for patients with pilonidal disease.