March 21, 2023
Amundson JR, Kuchta K, VanDruff VN, et al. Experience with Impedance Planimetry for Surgical Foregut Disease in 1,097 Cases. J Am Coll Surg. 2023, in press.
Precise information concerning the geometry and compliance of esophageal sphincters can assist surgeons in achieving long-term success with treatments of patients suffering from GERD or achalasia. This article provided data from a retrospective, single-institution study of the use of a functional lumen imaging probe (FLIP) to provide information on the geometry and compliance of esophageal sphincters.
The study reported data on 1,097 procedures. Intraoperative FLIP was used in 573 antireflux procedures and 272 endoscopic myotomies. FLIP findings altered the operative approach in 77 of the procedures; changes in the procedure included adding or removing crural sutures, adjusting fundoplication tightness, and adjusting the choice of full or partial wraps. After examining outcomes of procedures altered based on FLIP information, complete resolution of symptoms was reported by most patients.
The authors conclude that the data suggested that use of FLIP was potentially effective as a means of improving outcomes in patients undergoing foregut surgical procedures for GERD or achalasia.
Sakran JV, Bornstein SS, Dicker R, et al. Proceedings from the Second Medical Summit on Firearm Injury Prevention, 2022: Creating a Sustainable Healthcare Coalition to Advance a Multidisciplinary Public Health Approach. J Am Coll Surg. 2023, in press.
This article describes the proceedings of the 2022 ACS-hosted multiorganizational consensus conference convened to outline an updated, evidence-based approach to reduction of firearm injuries. The authors noted that the first such conference was held in 2019, and the list of approaches to this challenging public health problem listed after the conference included recommendations for research initiatives focused on the root causes of firearm violence; recommendations for funding of such research, engaging firearm owners in the effort to reduce firearm injury; and including hospitals and healthcare systems in an effort to engage communities in research and interventions to address the firearm injury problem.
Despite a well-organized consensus-based approach, firearm deaths and injuries have increased. There were nearly 50,000 firearm-related deaths in 2021, and firearm injuries increased by 23% since 2019. Research published by the RAND corporation was described in the article; this evidence showed that reduction of child access to firearms could potentially reduce deaths. Other findings included evidence supporting background checks, mandatory waiting periods between firearm purchase and delivery, limiting “stand your ground” laws, and restricting concealed carry permits as potentially effective ways to reduce firearm injuries.
The results of the 2022 consensus conference are reviewed in the article and presented as a table; the recommendations emphasized support for hospital violence intervention programs, specific efforts to engage high-risk members of communities, and formation of collaborative groups (marginalized community members, law enforcement, concerned citizens) to promote firearm injury prevention efforts. Several other short, medium, and long-term goals are listed. Surgeons are encouraged to review the entire article.
Herridge MS, Azoulay E. Outcomes after Critical Illness. N Engl J Med. 2023;388(10):913-924.
Authors Margaret S. Herridge, MD, MPH, and Elie Azoulay, MD, PhD, presented a clear and very helpful review article on long-term morbidities encountered in patients who survive critical illness. As early as 1998, evidence was available confirming the significant incidence of post-traumatic stress disorder in survivors of acute respiratory distress syndrome.
Additional research since that time has shown that nearly one-third of this patient group suffer from neurocognitive and psychological dysfunction. Other disorders affecting critical care survivors include muscle weakness, tooth loss, tracheal stenosis, vocal cord dysfunction, and incontinence resulting from rectal and urethral trauma. Adverse long-term effects are also observed in critical illness caregivers, including increased long-term mortality risk due to stress, depression, and panic disorder.
The authors recommended focused efforts to provide long-term care for patients, their families, and critical care providers. In addition, data collection for at least 1 year after the index episode of critical illness was recommended to provide guidance for specific interventions to improve quality of life.