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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.
Research reported by military and civilian trauma surgeons has supported the benefits of low-titer type O Rh positive whole blood (LTOWB) for massive transfusion protocols used in the prehospital and in-hospital phases of care to treat hemorrhagic shock in severely injured patients. This treatment is often withheld in females of childbearing age because of fear of alloimmunization and potential damaging effects to the woman and an unborn fetus.
The estimated risk of alloimmunization has traditionally been thought to be as high as 40%. This study carefully examined the available data and determined that the risk of alloimmunization is 3% to 6% due to the immunosuppression that accompanies hemorrhagic shock.
One study cited in the article reported data from 124 female patients at increased risk for Rh negative blood type seen over a 30-month interval; only one Rh negative female patient was discovered in the cohort resulting in a risk of alloimmunization of less than 0.12%.
Given the significant improvements in treatment of alloimmunization in Rh negative women exposed to Rh positive blood, the authors concluded that the benefits of resuscitation with LTOWB in women of childbearing age far outweigh the risks. They concluded that LTOWB should be administered to women of childbearing age who are candidates for treatment with massive transfusion protocols.
In the editorial that accompanied the article, Jason L. Sperry, MD, MPH, FACS, and Mark H. Yazer, MD, cited additional data supporting these recommendations and noted that ongoing prospective trials are underway that include women of childbearing age, and these data will hopefully provide definitive guidance for massive transfusion protocols.
Aggressive Neoadjuvant Therapy and Resection Approach to Pancreatic Cancer Improves Survival in Young and Older Patients
This study provided data from a retrospective patient cohort analysis comparing outcomes in patients older than 75 years with patients younger than 75 years with resectable or borderline resectable pancreatic cancer who were treated with FOLFORINOX. A second comparison group received neoadjuvant therapy (NAT) followed by resection, and a final group of only older patients who received NAT plus resection was compared with patients who received up-front resection.
The outcomes of interest were postoperative complications, overall survival, and time to recurrence. Propensity score matching was used to facilitate accurate comparisons of patients within the three comparison groups.
The data analysis showed that older patients were less likely to complete a full course of FOLFORINOX compared with younger patients, but similar proportions of each group underwent surgery. There was no difference in rates of postoperative complications in the second comparison group, but younger patients had significantly higher rates of overall survival. Time to recurrence was similar in younger and older patients.
In the final comparison group, overall survival and time to recurrence data favored use of NAT followed by resection rather than up-front resection. The authors concluded that an aggressive approach including NAT and surgical resection was safe and effective in older patients.
Acute Care Surgeon-Guided Protocol for Treating Choledocholithiasis Could Shorten LOS and Lower Costs
The authors hypothesized that a treatment protocol for management of patients with choledocholithiasis that relied on early laparoscopic cholecystectomy with Seldinger catheter-assisted common bile duct exploration under fluoroscopic guidance (LCBDE) performed by acute care surgeons would provide improved results compared with a protocol that relied on endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy.
The study included 180 patients (71 LCBDE); a significant reduction in hospital length of stay (LOS) (48.8 hours versus 84.3 hours) was observed in the LCBDE group. Successful duct clearance occurred in 70.4% of LCBDE patients. Using an “intent to treat” approach, outcomes for patients who did not have successful duct clearance and required ERCP after LCBDE were included in the LCBDE data analysis, which suggests that the effect of the LCBDE approach on hospital length of stay may be larger than reported.
The authors concluded that the acute care surgeon-guided protocol was feasible and provided shortened hospital length of stay and probable cost savings.
A clear, detailed description of the proposed protocol is provided in the article, and surgeons are encouraged to review this content.
