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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.
Trauma centers require in-house attending surgeons, but attending radiology coverage is infrequent. In-house resident radiology coverage usually is substituted. This study compared performance of in-house residents and attending radiologists participating by teleradiology in a single trauma center. Eric Yeates, MD, and co-authors compared various outcome variables such as diagnostic discrepancies, missed injuries or incidental findings, and over diagnoses (overcalls).
All trauma patients who had computed tomography scans performed between 10:00 pm and 8:00 am over a 14-month interval were included. A total of 8,226 CT scans composed the comparison group. A nationally recognized scoring system was used to facilitate the comparison. The data analysis showed that in-house radiology residents had a lower discrepancy rate and a lower turnaround time but a higher rate of overcalls. The overcalls resulted in unnecessary consultations, intensive care unit admissions, and repeat radiologic studies. Of interest was the observation that the combination of radiology resident and teleradiology interpretations resulted in the highest accuracy. The authors concluded that in-house radiology resident coverage was effective, but overcalls likely added significant cost to the diagnosis of trauma patients.
Editorial Provides Valuable Context for Recent Article on Parastomal Hernia Repair
This editorial provided relevant and valuable comments about an article by Benjamin Miller, MD, and co-authors that was reported on in the June 7, 2022 issue of ACS Brief (“Biologic vs Synthetic Mesh for Parastomal Hernia Repair: Post Hoc Analysis of a Multicenter Randomized Controlled Trial”).
The editorial noted that in the 229 years since the first colostomy was performed, parastomal hernia has been an important complication and an ongoing subject of study and stimulus for innovation. Simple suture repairs of parastomal hernias are safe but associated with a high recurrence rate, and this problem stimulated studies of mesh-based repairs. The editorialist emphasized three important issues: the safety of the mesh in a contaminated field, the risk that the mesh will erode into the adjacent intestine, and whether the mesh is in proximity to intestinal loops within the peritoneal cavity.
The principal objective of the study was comparing outcomes for procedures using synthetic mesh and a biologic mesh. The data analysis showed that synthetic mesh outperformed the biologic mesh with respect to morbidities, recurrence rates, and cost. Recurrence rates were lowest with mesh repairs using the Sugarbaker keyhole mesh opening technique. The editorialist noted that the study was performed in five institutions that had extensive experience in parastomal hernia repairs, and therefore, outcomes for other institutions and surgeons may vary.
How Often Does Ischemic Stroke Occur in Patients with Asymptomatic Severe Carotid Stenosis without Surgical Intervention?
This article reported data from a retrospective study of 3,737 patients with severe (70%−90% stenosis) but asymptomatic carotid disease. Patients were diagnosed between 2008 and 2012 and followed, without intervention so long as no symptoms occurred, until 2019. The main outcome of interest was the rate of ischemic stroke occurrence. The mean follow-up interval was 4.1 years.
The data analysis showed that the risk of ischemic stroke was 0.9% per year. The authors concluded that these data have potential value for counseling patients regarding the management of asymptomatic carotid stenosis, particularly the choice and timing of open or endovascular therapeutic interventions.
An opinion piece by Alik Farber, MD, and published in JAMA Surgery on June 22, 2022, offered valuable additional perspective and guidance regarding the best choice of therapy for patients with asymptomatic, severe carotid stenosis. Readers are encouraged to review this content in its entirety.
