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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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Bulletin Brief

New Crucial Literature: The Science You Need to Know

Literature selections curated by Lewis Flint, MD, FACS, and reviewed by the Bulletin Brief editorial board.

January 4, 2022

From JACS

Examining Repair versus Ligation in Management of Inferior Vena Cava Injuries

Matsumoto S, Jung K, Smith A, Coimbra R. Management of IVC Injury: Repair or Ligation? A Propensity Score Matching Analysis Using the National Trauma Data Bank. J Am Coll Surg. 2018;226(5):752-759 e2.

This study queried the National Trauma Databank and compared outcomes from ligation versus repair of inferior vena cava (IVC) injuries for the interval 2007–2014. A cohort of 1,316 patients was identified; 34 percent of these underwent ligation. Propensity matching was used to identify comparison pairs. Patients who underwent ligation had more severe injuries.

After pairing, mortality rates for repair and ligation were similar but ligation was associated with increased risk of complications (especially extremity compartment syndrome and venous thromboembolism), as well as significantly longer hospital length of stay. The authors concluded that IVC ligation may be lifesaving as a component of damage-control management of severe injuries, but this approach is associated with increased risk of complications. IVC repair is preferred in stable patients.

Study Finds that Early Postoperative Telephone Visit QI Intervention Reduces Readmissions

Lovasik BP, Blair CM, Little LA, Sellers M, Sweeney JF, Sarmiento JM. Reduction in Post-Discharge Return to Acute Care in Hepatopancreatobiliary Surgery: Results of a Quality Improvement Initiative. J Am Coll Surg. 2020;231(2):231-238.

Postoperative emergency room visits and returns to acute care clinics are costly and often lead to hospital readmission. The authors reported results of a quality improvement intervention consisting of a detailed preoperative patient education initiative and a protocol-guided, early postoperative telephone visit by a healthcare professional. The quality improvement initiative was evaluated in a before-and-after study of a single surgeon's practice. The primary endpoint of interest was the number of acute care visits, emergency department visits, and readmissions before and after implementation of the intervention.

The data analysis showed that readmissions were reduced by 76 percent and emergency department visits were reduced by 46 percent after implementation of the intervention. The authors concluded that the quality improvement initiative results indicated that the protocol had potential value for reducing postoperative acute care visits, emergency department visits, and readmissions.

Other Journals

A Look at the RAGA Randomized Trial: Regional versus General Anesthesia in Elderly Hip Fracture Repair Patients

Li T, Li J, Yuan L, et al. Effect of Regional vs General Anesthesia on Incidence of Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery: The RAGA Randomized Trial. JAMA. December 20, 2021 [Epub ahead of print].

Avidan MS, Whitlock EL, Mashour GA. General Anesthesia and Postoperative Neurocognitive Outcomes. JAMA. December 20, 2021 [Epub ahead of print].

The RAGA randomized trial compared rates of postoperative delirium in elderly patients who had hip fracture surgery performed under general anesthesia or regional anesthesia. The data analysis showed that rates of postoperative delirium diagnoses were not significantly different in the two groups. Additional data on the rates of postoperative mortality, morbidity, and hospital length of stay showed similar outcomes in both comparison groups.

In the editorial that accompanied the article, Avidan and coauthors noted that rates of delirium diagnoses were lower in this study than in other reports; this observation raises the question of whether delirium was not accurately diagnosed in some patients. However, this study and others noted in the article and editorial confirm the conclusion that general anesthesia is not associated with a higher risk of delirium. It is worth noting, however, that postoperative delirium is only one outcome of interest in patients undergoing hip fracture surgery and is an unusual complication (occurring in 5 percent to 8 percent of patients). Other potential benefits of regional anesthesia as a component of an enhanced recovery pathway are worth considering. These benefits could include earlier ambulation, lower rates of opioid usage, earlier discharge, a more rapid return to normal quality of life, and earlier institution of rehabilitation protocols. While this study confirmed that general anesthesia does not increase the risk of delirium, the data should not be interpreted to mean that general anesthesia is the preferable approach in this patient group.