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.
The authors of this study evaluated the predictive accuracy of the ACS National Surgical Quality Improvement Program (NSQIP) Surgical Risk Calculator in six Italian institutions; a total of 2,749 emergency surgical procedures (appendectomy, cholecystectomy, gastrointestinal perforation or obstruction) were included. A personal risk ratio was calculated for each procedure.
The data analysis showed that the risk calculator was more than 90% accurate in predicting mortality or discharge to a destination other than home. The personal risk ratio also was accurate with a negative predictive value of 99% for postoperative mortality. Excellent accuracy was noted for the prediction of complications such as pneumonia, cardiac complications, and renal failure. The authors concluded that the risk calculator had value for counselling patients and families and improving healthcare provider communication especially in the setting of multidisciplinary care of patients requiring emergency surgical procedures.
Can Tele-Trauma Surgery Consult Reduce Unnecessary Transfers from Rural and Community Hospitals?
Transferred patients from rural or community hospitals to trauma centers frequently are not severely injured and are discharged promptly. This phenomenon results in increased healthcare costs, stress on patient transport and trauma center resources, and patient dissatisfaction. The study authors described a pilot program to provide pre-transfer trauma surgeon consultation by telephone to rural and community hospitals that frequently transferred patients to their trauma center.
Three rural or community hospitals were involved, and an audio/video communication device was used to conduct the consultations. Training was provided to participating emergency physicians, the consultant trauma surgeon, and other healthcare professionals. Outcomes included acceptance of the process by participating caregivers and patients, rates of deaths and missed injuries, and hospital readmissions. Over 5 months, 21 patients were involved in the study; common injuries were intracranial hemorrhage and rib fractures. After the consultation, six patients were discharged from the rural or community hospital, and four were admitted. Two patients were transferred to the trauma center emergency department, and nine were transferred as direct trauma center admissions. There were no missed injuries, no unexpected deaths, and one readmission. Satisfaction with the process was high. The authors concluded that the program was feasible and associated with high satisfaction among participants.
In the editorial that accompanied the article, Caroline Park, MD, MPH, FACS, emphasized that the important contributing factors to the success of programs such as these included working with familiar institutions, standardized equipment, participant buy-in and training, and identification of appropriate patients. The editorialist noted that one program feature that is important and will require additional study is implementation of an effective medico-legal infrastructure.
Randomized Trial Results Suggest Colonoscopy Reduces Risk of Colorectal Cancer and Cancer Death
This randomized trial compared risk of colorectal cancer and colorectal cancer death in patients randomized to receive colonoscopic screening or no screening. Data were available for a total of 84,585 patients from Poland, Norway, and Sweden. Of 28,220 patients randomized to screening, 42% underwent colonoscopy. Follow-up data were recorded for 10 years following randomization.
When the data were evaluated on an intent-to-treat basis, risk of colon cancer was reduced by 18% and risk of death from colon cancer was reduced by 10%. These benefits are significantly smaller than in published studies from North America; the decreased benefit may have been due to the large number of patients in the screening group who did not undergo colonoscopy. In an adjusted analysis designed to estimate the effect if all participants in the screening group had undergone colonoscopy, the estimated risk for colorectal cancer was reduced by 30% and there was an estimated 50% reduction in risk of death from colorectal cancer.
In the editorial that accompanied this article, Jason A. Dominitz, MD, MHS, and Douglas J. Robertson, MD, MPH, emphasized that screening can be effective only if it is performed. They noted that expertise of clinicians providing screening (adenoma detection rate) was not standardized. Also, the participants were not required to provide data on pre-screening symptoms or family history of colon cancer. Increased expertise in screening clinicians and increased comfort of screening procedures for patients (gentle bowel prep, sedation) would likely increase acceptance of screening and increase adenoma detection that would result in greater patient benefit and justify the cost of screening.
