American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

New Crucial Literature: The Science You Need to Know

Evaluating the Unique Needs of Geriatric Surgical Patients

Tang VL, Jing B, Boscardin J, et al. Association of Functional, Cognitive, and Psychological Measures With 1-Year Mortality in Patients Undergoing Major Surgery. JAMA Surg. 2020.

McDonald SR, Barbeito A, Lagoo-Deenadayalan SA. Reframing Surgical Risk Using Geriatric Assessment Measures. JAMA Surg. 2020.

Tang and coauthors report data from a retrospective cohort study of elderly patients (mean age 76) who underwent major surgical procedures. All included patients had been enrolled in a national study of functional variables in elderly patients. The overall one-year mortality was 17 percent. Mortality was closely related to impaired activities of daily living, walking limitation, dementia, and depression. The authors stressed the fact that these factors can be evaluated preoperatively and can be potentially improved. In the accompanying editorial, the authors stressed the importance of preoperative assessment that can identify opportunities for improvement of risk factors and also can identify patients who might benefit from palliative care.

Three Articles Explore Crucial Aspects of Surgical Education across the Lifelong Learning Continuum

Sachdeva AK. Acquiring and maintaining lifelong expertise in surgery. Surgery. 2020;167(5):787-792.

Huffman EM, Martin JR, Stefanidis D. Teaching technical surgery. Surgery. 2020;167(5):782-786.

Cheun T, Davies MG. Improving ABSITE scores—A meta-analysis of reported remediation models. The American Journal of Surgery. 2020 (in press).

These three articles provide valuable information and guidance on critical aspects of surgical education. The first article deals with the need for a disciplined approach to acquisition and maintenance of surgical expertise. Achieving the best outcomes of surgical care requires knowledge, technical skill, emotional intelligence, leadership skills, and the ability to recognize and adapt to unexpected events. Contemporary approaches to acquiring and maintaining expertise are clearly presented; the need for continuing self-assessment, a commitment to improvement, and review of outcomes data are emphasized.

The second article, by Huffman and colleagues, describes a potentially valuable approach to teaching and evaluating technical skills. The authors stress the importance of dedicated teaching and learning of mental skills; use of simulation-based training; and coaching before, during, and after a surgical procedure. A clear description of their approach to teaching laparoscopic cholecystectomy is provided in the article.

In the final article, Cheun and coauthors report findings of a systemic review of the literature. Their analysis shows that multimodality educational programs that use an individualized study plan, structured reading, conference attendance, and a learning management system to document progress and task completion were associated with improved scores on the American Board of Surgery In-Training Examination.

Study Weighs the Value of Fluorescence versus X-Ray Cholangiography

Lehrskov LL, Westen M, Larsen SS, Jensen AB, Kristensen BB, Bisgaard T. Fluorescence or X-ray cholangiography in elective laparoscopic cholecystectomy: A randomized clinical trial. Br J Surg. 2020;107(6):655-661.

This randomized trial was performed to determine noninferiority of fluorescence cholangiography versus conventional X-ray cholangiography. The trial included 120 patients and results were assessed by a single surgeon. Fluorescence cholangiography was noninferior to conventional cholangiography. Of interest is the finding that the junction of the cystic duct and common bile duct was not visualized in 15 percent of the conventional group but was visualized in all of the fluorescence group. Right and left hepatic ducts were not visualized well in the fluorescence group as a result of difficulty in transmission of images through hepatic tissue. The authors note that the fluorescence cholangiography approach is limited because it cannot be used when choledocholithiasis is suspected and because of the long learning curve required for surgeons to effectively use fluorescence cholangiography; but safer dissection, especially in cases of acute cholecystitis, may be realized with use of fluorescent cholangiography.

Additional Readings

JAMA Internal Medicine, Assessment of Deaths from COVID-19 and from Seasonal Influenza