Addiction Risk: No One Opioid Safer Than Other After Surgery

Posted on May 16, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Heng

Marilyn M. Heng, MD, MPH, FRCSC
Orthopaedic Trauma Surgeon
Assistant Professor of Orthopaedic Surgery
Harvard Medical School

MedicalResearch.com: What is the background for this study?

Response: The ultimate background for this study does come from the larger context of the opioid epidemic that is seen worldwide but particularly in North America. Orthopaedic surgeons should take responsibility as being among the top prescribers of opioids.

The more specific background that led to this specific study was the observation that several colleagues would insist that a drug like hydromorphone was so dangerous that they would not prescribe it but seemed okay prescribing large amounts of oxycodone. It seemed like an urban myth that the type of opioid was what made it dangerous, so that led us to do the study to see if there was evidence for that. Continue reading →

Roux-en-Y Gastric Bypass Linked to More Hip Fractures

Posted on May 15, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Elaine Yu

Elaine W. Yu, MD, MMSc
Assistant Professor, Harvard Medical School
Director, Bone Density Center
Endocrine Unit, Massachusetts General Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Roux-en-Y gastric bypass (RYGB) is a popular surgical weight loss procedure. We have previously shown that gastric bypass leads to rapid high-turnover bone loss.

Bariatric procedures are being increasingly performed in older adults, and the clinical consequences of gastric bypass-associated skeletal changes in this vulnerable population have been unclear to date. Thus, we used Medicare claims data to investigate fracture risk among older adults after gastric bypass, and in comparison to adults who received another bariatric procedure called adjustable gastric banding (AGB), which is thought to have fewer negative bone effects.

In our analysis, we found that patients undergoing Roux-en-Y gastric bypass were 73% more likely to fracture than those undergoing AGB. Importantly, we found that hip fracture risk increased nearly 180% after RYGB, and that fracture rates in patients aged 65 or older were similar to the overall group. Continue reading →

Gene Linked to Colon Cancer in Younger Patients Identified

Posted on April 22, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Nfonsam

Valentine N. Nfonsam, MD, MS, FACS
Associate Professor of Surgery
Program Director, General Surgery Residency
Colon and Rectal Surgery
Division of Surgical Oncology
University of Arizona, Tucson

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The overall incidence of colon cancer in the United states has gone down in the last few decades. However, there has been a significant increase in the incidence of sporadic colon cancer is young patients (<50 years old). The etiology of this phenomenon is likely multi-factorial.

These young patients do present with more advanced disease and with aggressive features. We demonstrated in our study that the colon cancer tumor biology was different between young and older patients. We also singled out a particular gene, Cartilage oligomeric Matrix Protein (COMP) which was significantly over-expressed in young patients and demonstrated its role in cancer proliferation and metastasis and also its potential as a prognostic biomarker since we were able to detect it in plasma.

Continue reading →

Stem Cell Therapy Improved Motor Deficit in Traumatic Brain Injury Trial

Posted on April 18, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Okonkwo

Dr. David Okonkwo, M.D., Ph.D.,
Professor of Neurological surgery
Director of the Neurotrauma Clinical Trials Center
University of Pittsburgh

Dr. Okonkwo discusses the results from the STEMTRA Phase 2 trial evaluating the efficacy and safety of SB623 in patients with chronic motor deficit from traumatic brain injury.

The results were presented at the American Association of Neurological Surgeons (AANS), April 2019

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Traumatic brain injury (TBI) is a major cause of death and disability in the US and around the globe. The effects of TBI are often long-lasting, with more than one-third of severe TBI patients displaying a neuromotor abnormality on physical examination 2 years following injury and, yet, there are no effective treatments. The public health implications are staggering: there are approximately 1.4 million new cases of TBI in the US annually, resulting in over 50,000 deaths and 80,000 disabilities; over 5 million Americans currently suffer from long-term disability caused by TBI. A successful neuroregenerative or neurorestorative therapy, such as stem cell implantation, would have significant impact.

Continue reading →

Home Responsibilities Encourage Physician Mothers in Procedural Specialties To Consider Career Change

Posted on April 16, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Melnitchouk

Nelya Melnitchouk, MD,MSc
Director, Program in Peritoneal Surface Malignancy, HIPEC
Dr. Melnitchouk is an associate surgeon at Brigham and Women’s Hospital (BWH) and Brigham and Women’s Faulkner Hospital (BWFH) and
instructor of surgery at Harvard Medical School.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Current literature on women in surgery show that female physicians, particularly those in procedural specialties, face many challenges in balancing responsibilities between work and home. We hypothesized that these challenges may affect career satisfaction more negatively for physician mothers in procedural specialties than those in nonprocedural specialties.

In our study, we found that physician mothers in procedural specialties who had more domestic responsibilities were more likely to report a desire to change careers than those in nonprocedural specialties. Continue reading →

Surgical Outcomes Found to be Better at ‘Brand Name’ than Affiliate Cancer Hospitals

Posted on April 12, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Boffa

Daniel J. Boffa, MD
Associate Professor of Thoracic Surgery
Yale School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Prominent cancer hospitals have been sharing their brands with smaller hospitals in the community. We conducted a series of nationally representative surveys and found that a significant proportion of the U.S. public assumes that the safety of care is the same at all hospitals that share the same respected brand. In an effort to determine if safety was in fact the same, we examined complex surgical procedures in the Medicare database.

We compared the chance of dying within 90 days of surgery between top-ranked hospitals, and the affiliate hospitals that share their brands. When taking into account differences in patient age, health, and type of procedure, Medicare patients were 1.4 times more likely to die after surgery at the affiliate hospitals, compared to those having surgery at the top-ranked cancer hospitals.

Continue reading →

Racial Disparities in Kidney Transplants Persist Despite New Allocation System

Posted on April 9, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Kulkarni

Sanjay Kulkarni, MD MHCM FACS
Associate Professor of Surgery & Medicine
Surgical Director – Kidney Transplant Program
Medical Director – Center for Living Organ Donors
Scientific Director – Yale Transplant Research
New Haven, CT 06410

MedicalResearch.com: What is the background for this study?

Response: The kidney allocation system changed in December of 2014.

The aim of the new system was to increase transplant in patients who were highly sensitized (difficult matches based on reactive antibodies) and to improve access to underserved populations. Continue reading →

Surgery Beneficial to Some HER2+ Metastatic Breast Cancer Patients

Posted on April 8, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Sharon S. Lum, MD, FACSProfessor in the Department of Surgery-Division of Surgical Oncology Medical Director of the Breast Health CenterLoma Linda University HealthLoma Linda University School of Medicine

Dr. Lum

Sharon S. Lum, MD, FACS, Professor
Department of Surgery-Division of Surgical Oncology
Medical Director of the Breast Health Center
Loma Linda University Health
Loma Linda University School of Medicine

MedicalResearch.com: What is the background for this study?

Response: Anecdotally, we observed that many patients with advanced HER2+ breast cancer have had tremendous responses to the new targeted therapies and the oncologists were referring them back to surgeons for consideration of local regional therapy.

While traditionally surgeons have avoided operating on metastatic breast cancer patients due to the patient’s likelihood of dying from their metastatic disease, these HER2+ patients seemed to be doing so well that surgery might make sense. In our surgical oncology clinic, we seemed to be operating more on these patients. Since these patients seemed to be living longer, they might survive long enough for their primary tumor to become a problem for them.

However, we did not have any data to support doing surgery in these cases. Prior studies have demonstrated mixed results regarding the survival benefit from surgery for stage IV breast cancer patients, but these were completed prior to routine use of anti-HER targeted therapies, so we wanted to further examine the role of surgery in HER2+ stage IV breast cancer patients.

Continue reading →

Is There a Risk of Bleeding With Ibuprofen After Tonsillectomy ?

Posted on April 5, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Diercks

Gillian R. Diercks, MD, MPH
Instructor in Otolaryngology, Harvard Medical School
Department of Otolaryngology
Massachusetts Eye and Ear Infirmary
Boston, Massachusetts

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Pediatric tonsillectomy is a commonly performed procedure, representing the second most common ambulatory surgery performed on children in the United States, with over half a million children undergoing the surgery annually. A major concern for surgeons, patients, and their families is the issue of postoperative pain control as pain can last up to 10-14 days after surgery, be quite severe, and result in readmission to the hospital or ED visits for medications and dehydration.

In young children and children with sleep apnea we cannot safely administer narcotic pain medications at home. This leaves limited options for pain control, including acetaminophen and ibuprofen. However, there are concerns that ibuprofen could potentially increase bleeding risk after surgery because of its effects on platelet function in the blood. At baseline, the risk of postoperative hemorrhage within the first two weeks after tonsillectomy is around 4.5%, with about 1-1.5% of children requiring a return to the operating room to control severe bleeding. Our study set out to show that the risk of severe postoperative bleeding when ibuprofen is given for 9 days after tonsillectomy was not increased compared with the bleeding risk when acetaminophen was administered instead.

Our study could not conclude that the risk of bleeding is no different when ibuprofen is used, and was suggestive that the bleeding risk may actually be higher. Continue reading →

Cardiac Surgery: No Difference in Outcomes Between Inhaled and IV Anesthesia

Posted on March 27, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Landoni

Dr. Giovanni Landoni
Intensive Care and Anesthesia Unit
Associate professor
Università Vita-Salute San Raffaele

MedicalResearch.com: What is the background for this study?

Response: Patients undergoing cardiac surgery are still at risk for perioperative complications. Studies to improve clinical outcomes this setting are important. Inhaled anesthetics have pharmacological properties which reduce myocardial infarction size by 50% in laboratory and animal studies and which might decrease postoperative mortality according to aggregated published randomized data.

Continue reading →

Minimally Invasive Uterine Fibroid Embolization Reduces Bleeding Risk and Preserves Uterus

Posted on March 25, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Dr. Jemianne Bautista-Jia, MD
Radiology resident
Kaiser Permanente

MedicalResearch.com: What is the background for this study?

Response: There were a few patient experiences that took me by surprise. I had a patient come to clinic for an initial consultation for uterine fibroid embolization (UFE) and I asked her how she knew about the procedure. She told me that she heard about it on the radio. Another patient who came in told me she heard about it from a close friend. Why did these patients not hear about UFE from their primary physicians?

Being a woman, I know that if I had this condition I would prefer a minimally invasive option over surgery. Surgery comes with complications, and I definitely would not want an organ removed from my body if I could avoid it. Therefore I wanted to study UAE to hopefully provide additional objective data to the scientific community to support its use for the treatment of women with fibroids. Continue reading →

Lack of Patient Education as a Cause of Increased Postoperative Opioid Use

Posted on March 18, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Colvin

Dr. Alexis Colvin, MD
Associate Professor of Orthopedic Surgery
Icahn School of Medicine at Mount Sinai

MedicalResearch.com: What is the background for this study?

Response: 40% of all opioid overdose deaths involve a prescription opioid and orthopaedic surgeons are the 3rd highest prescribers of opioids. Set guidelines for post surgery opioid prescriptions have not been established. Arthroscopic knee meniscectomy is one of the most common orthopaedic procedures. The purpose of this study was to determine how many opioids were being prescribed among a group of six sports fellowship trained orthopaedic surgeons versus how many patients were actually using.

Continue reading →

Lipomas: Deoxycholic Acid (Kybella®) Can Shrink Tumors Before Removal

Posted on March 5, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Khorasani

Hooman Khorasani, M.D.
Cosmetic Surgeon & Mohs Skin Cancer Surgeon
Icahn School of Medicine at Mt. Sinai

MedicalResearch.com: What is the background for this study?

Response: Lipomas are tumors composed of mature fat cells located just beneath the skin surface. They are the most common soft tissue tumor and are estimated to occur in 1% of the population. These benign tumors are more common in overweight individuals, diabetics, patients with elevated serum cholesterol, and those suffering from familial multiple lipomatosis_. Most of these tumors are treated for cosmetic reasons; however, large lipomas can also cause significant functional impairment. Traditional treatment includes surgical removal and / or liposuction.

Deoxycholic acid is a member of the bile acid family that assists in the breakdown of fat. We investigated the use of deoxycholic acid injections to reduce the size of large lipomas prior to surgical removal.

Continue reading →

When Evaluating Teens for Surgery, Check Family Opioid Use

Posted on February 27, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Harbaugh

Calista Harbaugh, MD
House Officer, General Surgery
Clinician Scholar, National Clinician Scholars Program
Research Fellow
Michigan Opioid Prescribing Engagement Network
University of Michigan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Nonmedical prescription opioid use and prescription opioid-related overdose remain significant concerns among adolescents and young adults. Among adolescents and young adults prescribed an opioid after surgery, prior work found that 4.8% of opioid-naïve patients develop new persistent use, filling additional opioid prescriptions at 3-6 months after surgery. This work found associations of persistent use with diagnoses such as chronic pain disorders, depression, anxiety, and prior substance use disorder. It is likely that for young patients, family members may also play an important role in development of new persistent use, but this has not previously been explored. We performed this study to evaluate whether long-term opioid use among family members was associated with prescription opioid fills among adolescents and young adults perioperatively – and we found that opioid-naïve adolescents and young adults who have 1 or more family members with long-term opioid use are more likely to fill at the time of surgery, during recovery, and in the long-term with a near-doubling of rates of new persistent use.

Continue reading →

Hip Fracture in Elderly: Longer Surgery and General Anesthesia Linked to Greater Risk of Post-Op Delirium

Posted on February 25, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Ravi

Bheeshma Ravi, MD, PhD, FRCSC
Scientist
Sunnybrook Health Sciences Centre
Holland Centre
Toronto, ON

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Delirium is an acute change in mental status characterized by fluctuating disturbances of consciousness and attention. Elderly patients are prone to delirium after surgery; this contributes significantly to post-operative morbidity and can also lead to long-term disability.

Our study found that among older adults undergoing hip fracture surgery, both an increased duration of surgery and a general anesthetic are associated with an increased risk for post-operative delirium.

Continue reading →

Bariatric Surgery Could be a Cost-Effective Intervention in Patients with NASH Cirrhosis who are Overweight or Obese.

Posted on February 24, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Jagpreet Chhatwal

Jagpreet Chhatwal PhD
Assistant Professor, Harvard Medical School
Senior Scientist, Institute for Technology Assessment
Massachusetts General Hospital

Dr. Chin Hur

Chin Hur, MD
Associate Professor of Medicine
Harvard Medical School

MedicalResearch.com: What is the background for this study?

Response: Nonalcoholic steatohepatitis (NASH), a severe form of nonalcoholic fatty liver disease, is one of the leading causes of liver transplantation. Because of increasing prevalence of obesity in the United States, NASH-related cirrhosis cases are expected to increase in the near future. Unfortunately, there are few pharmacological treatments for NASH, and none with proven long-term benefit. Weight loss can be effective in managing NASH but not many patients can lose the sufficient weight necessary to impact NASH and/or maintain long-term weight loss. In contrast, bariatric surgery can provide long-term weight loss and thus potentially reverse liver damage in cirrhosis. However, bariatric surgery is associated with mortality and morbidity associated with the procedure.

Continue reading →

Accredited Hospitals Linked to Better Rectal Cancer Surgical Outcomes

Posted on February 22, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Alexis G. Antunez

Alexis G. Antunez MS
University of Michigan Medical School, Ann Arbor
Center for Healthcare Outcomes and Policy
University of Michigan, Ann Arbor

MedicalResearch.com: What is the background for this study?

Response: The American College of Surgeons Commission on Cancer is implementing a National Accreditation Program for Rectal Cancer (NAPRC), aiming to improve and standardize the quality of rectal cancer care in the United States. While this is a commendable goal, previous accreditation programs in other specialties have faced controversy around their uncertain impact on access to care. Furthermore, it is well established that the quality of rectal cancer care is associated with patients’ socioeconomic position. So, the NAPRC could have the unintended consequence of widening disparities and limiting access to high quality rectal cancer care for certain patient populations. Continue reading →

Aortic Stenosis Staging Helps Predict TAVR Outcomes

Posted on February 15, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
JOÃO L. CAVALCANTE, MD, FASE, FACC, FSCCT, FSCMR
Director, Cardiac MRI and Structural CT Labs
Director, Cardiovascular Imaging Research Core Lab
Minneapolis Heart Institute
Abbott Northwestern Hospital
Minneapolis, MN, 55407

MIHO FUKUI MD
Division of Cardiovascular Diseases, Department of Internal Medicine, Heart & Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota

MedicalResearch.com: What is the background for this study?

Response: Recent study by Généreux et al (1), using the Placement of Aortic Transcatheter Valves (PARTNER) 2A and 2B data, provided the first framework of a staging system for severe aortic stenosis (AS) that quantifies the extent of structural and functional cardiac change associated with AS and importantly its association with 1-year mortality in patients receiving either surgical or transcatheter AVR (TAVR):

Stage 0: No other cardiac damage;
Stage 1: LV damage as defined by presence of LV hypertrophy, severe LV diastolic, or LV systolic dysfunction;
Stage 2: Left atrium or mitral valve damage or dysfunction;
Stage 3: Pulmonary artery vasculature or tricuspid valve damage or dysfunction; and
Stage 4: right ventricular damage.

Continue reading →

Does EEG Brain Monitoring During Surgery Reduce Post-Op Delirium?

Posted on February 7, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Avidan

Michael Avidan, MBBCh, FCA SA
Dr. Seymour and Rose T. Brown Professor of Anesthesiology
Chief of the Division of Clinical and Translational Research
Director of the Infrastructure of Quality Improvement, Research and Informatics
Washington University School of Medicine
St Louis, MO

MedicalResearch.com: What is the background for this study?

Response: Postoperative delirium, a temporary state of confusion and inattention, is common in older adults after major surgery. Delirium can be distressing to patients, family members and clinicians. It is associated with longer hospital stays, other medical complications, cognitive decline, and death.

Some previous studies have found that using electroencephalography (EEG) monitoring of the brain during general anesthesia decreases the occurrence of delirium following surgery.

Therefore we conducted a rigorous study to determine whether using information from the EEG to guide the safe reduction of inhaled anesthetic drugs would prevent postoperative delirium and improve other outcomes in older adults following major surgery.

Continue reading →

Gastric Bypass Surgery Linked to Diabetes Remission

Posted on February 7, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Lene Ring Madsen, MD, Ph.d.
Medicinsk Afdeling Herning
Hospitalsenheden Vest

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We know from previous studies that there is a significant chance of diabetes remission following Roux-en-Y gastric bypass, but most studies evaluate smaller cohorts of selected patients (e.g. from a single center or only patients covered by a specific type of insurance). By using Danish registries, which hold information on all Danish Citizens independent of social- or economic status and have complete follow-up, we wanted to evaluate the Roux-en-Y gastric bypass surgery (RYGB) in a real-world setting.

The main findings are that more than 70 % of patients with obesity (BMI>35 kg/m2) and type 2 diabetes treated by RYGB had their diabetes go into remission or every 6-month period in the first 5 years after the procedure. Out of those who were in remission within the first year of follow-up 27% had undergone relapse at 5 years.

The most important predictor of a patient not going into remission was if they required insulin to control their disease. Other factors included older age and higher starting HbA_1c level. During the more than five years of follow-up, the risk of microvascular complications was 47% lower in the RYGB group than in the control population, with largest decreases in the risk of diabetic retinopathy and diabetic kidney disease. There was a smaller impact on the risk of macrovascular events, which were 24% lower among patients who had received bariatric surgery; however, this difference was not large enough to achieve statistical significance. The 90-day mortality was very low (<0.5%).

Continue reading →

How Functional Are Frail Adults After Aortic Valve Replacement?

Posted on February 5, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Dae Hyun Kim

Dae Hyun Kim, MD, MPH, ScD
Assistant Professor of Medicine, Harvard Medical School
Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital
Division of Gerontology, Department of Medicine,
Beth Israel Deaconess Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The number of older adults undergoing aortic valve replacement is increasing. Since these patients are at high risk for complications and functional decline due to preexisting multimorbidity and frailty, the latest guideline (Otto et al. J Am Coll Cardiol 2017;69:1313–46) emphasizes shared decision-making based on patient-centered outcomes. Despite this recommendation, we witness many decision-making processes are cardio-centric—mainly informed by expected benefit in terms of cardiac-specific measures. Many patients are not adequately informed about what their daily life would be like after the procedure.

In this single-center prospective cohort study, we examined functional status trajectories via assessments of global functional status at 1, 3, 6, 9, and 12 months in 246 patients who underwent transcatheter and surgical aortic valve replacement. We identified 5 clinically meaningful functional trajectories, ranging from high baseline function-early complete recovery to low baseline function-large and persistent decline. We were able to predict most likely trajectory as well as best possible and worse possible trajectories using the preoperative frailty index. Delirium and postoperative complications were also strongly associated with undesirable functional trajectories. Continue reading →

Midurethral Sling Complications May Be Associated with Psychological Stress, esp in Young Women

Posted on January 14, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Welk

Blayne Welk MD, MSc, FRCSC
Associate Professor of Surgery
St. Joseph’s Hospital
Western University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: I found that when I was referred women with midurethral sling complications, they were often quite emotional and described a significant period of time when they struggled with the complications before they were referred to someone to assess them.

The study looked at the rate of depression and self-harm behavior of women who had surgery for midurethral sling complications compared to women who did not have midurethral sling complications.

I found that there was an increased risk of both of these outcomes among women who had surgery for complications, however this risk was primarily present in younger women.

Continue reading →

Esophageal Cancer: HMIE Procedure Reduces Morbidity Without Sacrificing Efficacy

Posted on January 11, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Prof. Piessen

Guillaume Piessen, MD, PhD
University Hospital Centre
Lille, Franc

MedicalResearch.com: What is the background for this study?

Response: Patients requiring surgery for esophageal cancer fare better after undergoing a hybrid minimally invasive esophagectomy (HMIE) with a combined laparoscopy+thoracotomy procedure compared to an open esophagectomy (OE), according to results of the MIRO trial published in the last issue of the New England Journal Of Medicine (link article).

This French prospective multi-center randomized controlled study was funded by the French National Cancer Institute (Grant n° 1907). The study was conducted by Pr Mariette who sadely passed away in 2017 and Pr Piessen (Department of Digestive and Oncological Surgery, CHU Lille), under the hauspice of FRENCH (Fédération de Recherche EN Chirurgie) and FREGAT (French Eso-Gastric Tumors) working group (https://www.fregat-database.org/fr/).

Postoperative morbidity, especially pulmonary complications, affects more than half of patients after open esophagectomy for esophageal cancer.

Hybrid minimally invasive esophagectomy (HMIE) combines a laparoscopic abdominal phase with an open thoracotomy, which may have specific advantages including lower rate of pulmonary complications, without laparoscopic tumor dissection limiting potential tumor spillage and easier reproducibility of the technique [12].

Postoperative morbidity, especially pulmonary complications, affects more than half of patients after open esophagectomy for esophageal cancer.

Continue reading →

New Intestinal Microbiome Changes After Bariatric Surgery

Posted on January 11, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Morrow

Casey Morrow, Ph.D.
Leader of the research team and professor emeritus
Department of Cell, Developmental and Integrative Biology
University of Alabama at Birmingham

MedicalResearch.com: What is the background for this study?

Response: The human gastrointestinal tract (GIT) contains several distinct physical environments within the stomach, small intestine (duodenum, jejunum, ileum) and colon that harbor complex microbial communities.

Changes in the fecal microbe composition have been described for Roux-en-Y gastric bypass (RYGB), the most effective and durable treatment for morbid obesity, and sleeve gastrectomy (SG). Continue reading →

What are the Patient Preferences that Determine Chose of Bariatric Surgery?

Posted on November 28, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Rozier

Michael Rozier, S.J., Ph.D.
Assistant Professor, Health Management and Policy
College for Public Health and Social Justice
St. Louis University

MedicalResearch.com: What is the background for this study?

Response: Patients considering surgery for weight loss have several options, which differ in significant ways, such as expected weight loss, risk of complication, modification of diet, effect on other medical conditions, and more. Previous studies have asked patients why they chose one procedure over another.

Instead, we quantified the relative importance of the key characteristics of surgical options. Using a discrete choice experiment, potential patients were given profiles of two weight loss options. They were asked to select one profile based on key characteristics such as out-of-pocket costs, total weight loss, risk of complication, and five other factors.

Continue reading →

Staged vs One-Time Multivessel Revascularization in Multivessel CAD

Posted on November 22, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Peter T. Hu MD
Department of Cardiology
Cleveland Clinic

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Among patients with blockages in multiple coronary vessels, we studied predictors and outcomes of having a staged versus one-time multivessel percutaneous coronary intervention. By “staged” we mean performing coronary intervention only on one vessel, letting the patient recover, and fixing the other blockages at a later date. We know that multivessel coronary artery disease is very common – present in up to 2/3 of patients who require coronary interventions. Previous studies in patients with STEMI (ST-elevation myocardial infarction) suggested that staged multivessel PCI was associated with lower risk of death compared with one-time multivessel revascularization. Outside of STEMI patients, very little data exist in a broader group of patients who undergo coronary interventions to multiple vessels.

In our study, we found an association between doing a staged PCI and lower long-term mortality benefit compared with fixing multiple blockages at once. What was surprising was there seemed to be a correlation with the degree of benefit from staged PCI based on the symptoms and signs the patient presented with.

The association with improved outcomes was strongest in patients with STEMI, followed by those with NSTEMI, unstable angina, and stable angina, respectively. We also found that the decision to perform staged PCI was driven by patient and procedural characteristics, as well as other unmeasured site variation. Continue reading →

Comparison of the Evolut R™TAVR Valve with the Evolut PRO™

Posted on November 20, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Shazia Afzal MD
University Hospital Düsseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany

MedicalResearch.com: What is the background for this study?

Response: Since its introduction in 2002, transcatheter aortic valve replacement (TAVR) emerged to an increasingly important interventional procedure in the field of structural heart disease. Widespread use in Europe, the USA and Canada lead to continuous technological development and improved patient’s safety, procedural success and clinical outcome.

In 08/2017 one of the market leaders introduced its latest generation valve model -the CoreValve Evolut PRO^TM– which was especially designed to mitigate paravalvular leakage after valve deployment. We conducted the first prospective study which directly compares the Evolut PRO^TM with its direct predecessor the Evolut R^TM as a head-to-head analysis especially focusing on hemodynamic performance and clinical outcome in a real-world setting. To ensure comparability between groups, we performed propensity score matching with special interest in CT-derived data to guarantee equitable anatomical conditions.

Since both valves are on the market but sold at different prices the pivotal question is whether the Evolut PRO^TM reaches its target. In a highly budget restricted health care system with limited refunding cost-effectiveness evolves to a substantial discussion point in daily clinical practice. Our results may not be marketing friendly but we think of relevance for the interventional community. Continue reading →

Cost-effectiveness of Humanitarian Pediatric Cardiac Surgery

Posted on November 17, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Marcelo G. Cardarelli, MD A member of Inova Medical Group

Dr. Cardarelli

Marcelo G. Cardarelli, MD
Inova Children’s Hospita
Fairfax, Falls Church, Virginia

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Global Humanitarian Medical efforts consume a large amount of resources (nearly $38B in 2016) and donors (Countries, International organizations, WHO, Individuals) make the decisions as to where their funds should be allocated based on cost-effectiveness studies. Most resources go to prevent/treat infectious diseases, sanitation efforts and maternal/child care issues. An insignificant amount of resources is directed to satisfy the surgical needs of the populations in low and middle income countries (LMICs).

The idea behind our project was to find out if it was cost-effective to perform a tertiary surgical specialty (pediatric cardiac surgery) in this context and the answer (at $171 per DALY averted) was an overwhelming yes!

But most importantly, we believe, as many others do, that judging the cost/effectiveness of an intervention in order to decide resources allocation is valid for diseases that can be prevented, but not relevant when it comes to surgical problems that are not preventable.

Instead, we propose the use of another measure of effectiveness, what we call “The Humanitarian Footprint”.

The Humanitarian Footprint represents the long term benefits, as measured by changes in the life expectancy, extra years of schooling and potential lifetime earnings of patients treated surgically during humanitarian interventions.

To our surprise and based on the results, the effects on society of at least this particular surgical intervention were greater than we expected. We suspect this measure can be used in many other surgical humanitarian interventions as well. Continue reading →

Advanced Prostate Cancer: Risk of Mortality with Surgery vs Radiotherapy

Posted on November 16, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. D’Amico

Anthony Victor D’Amico, MD, PhD
Professor and Chief,
Genitourinary Radiation Oncology
Harvard Medical School

MedicalResearch.com: What is the background for this study?

Response: This study investigated whether surgery followed by the use of adjuvant low dose radiation and short course hormonal therapy as compared to high dose radiation and hormonal therapy could provide an equivalent low risk of death from prostate cancer amongst men presenting with aggressive and not infrequently fatal Gleason score 9 or 10 prostate cancer.

It has been shown previously (https://jamanetwork.com/journals/jama/fullarticle/2673969) and validated in the current study that surgery alone in such cases leads to a more then 2.5-fold increase in the risk of death from prostate cancer as compared to high dose radiation and hormonal therapy. Continue reading →

Who Does Better After Bariatric Surgery?

Posted on November 14, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Field

Alison E. Field, ScD
Professor and Chair of Epidemiology
Brown University School of Public Heath
Providence, RI

MedicalResearch.com: What is the background for this study?

Response: In the United States, approximately 40% of adults are obese. There are a range of treatment options, but relatively few people are able to lose weight and maintain the loss. The most effective treatment is bariatric surgery, but even among patients who have undergone bariatric surgery, there is a range in weight change patterns after surgery. This suggests that not all people with obesity are similar. There may be different causes and optimal treatment plans that vary by obesity subgroup. Our goal was to identify subgroups and to examine if they differed in terms of weight loss after bariatric surgery.

Continue reading →

MedicalResearch.com

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Category Archives: Surgical Research

Addiction Risk: No One Opioid Safer Than Other After Surgery

Roux-en-Y Gastric Bypass Linked to More Hip Fractures

Gene Linked to Colon Cancer in Younger Patients Identified

Stem Cell Therapy Improved Motor Deficit in Traumatic Brain Injury Trial

Home Responsibilities Encourage Physician Mothers in Procedural Specialties To Consider Career Change

Surgical Outcomes Found to be Better at ‘Brand Name’ than Affiliate Cancer Hospitals

Racial Disparities in Kidney Transplants Persist Despite New Allocation System

Surgery Beneficial to Some HER2+ Metastatic Breast Cancer Patients

Is There a Risk of Bleeding With Ibuprofen After Tonsillectomy ?

Cardiac Surgery: No Difference in Outcomes Between Inhaled and IV Anesthesia

Minimally Invasive Uterine Fibroid Embolization Reduces Bleeding Risk and Preserves Uterus

Lack of Patient Education as a Cause of Increased Postoperative Opioid Use

Lipomas: Deoxycholic Acid (Kybella®) Can Shrink Tumors Before Removal

When Evaluating Teens for Surgery, Check Family Opioid Use

Hip Fracture in Elderly: Longer Surgery and General Anesthesia Linked to Greater Risk of Post-Op Delirium

Bariatric Surgery Could be a Cost-Effective Intervention in Patients with NASH Cirrhosis who are Overweight or Obese.

Accredited Hospitals Linked to Better Rectal Cancer Surgical Outcomes

Aortic Stenosis Staging Helps Predict TAVR Outcomes

Does EEG Brain Monitoring During Surgery Reduce Post-Op Delirium?

Gastric Bypass Surgery Linked to Diabetes Remission

How Functional Are Frail Adults After Aortic Valve Replacement?

Midurethral Sling Complications May Be Associated with Psychological Stress, esp in Young Women

Esophageal Cancer: HMIE Procedure Reduces Morbidity Without Sacrificing Efficacy

New Intestinal Microbiome Changes After Bariatric Surgery

What are the Patient Preferences that Determine Chose of Bariatric Surgery?

Staged vs One-Time Multivessel Revascularization in Multivessel CAD

Comparison of the Evolut R™TAVR Valve with the Evolut PRO™

Cost-effectiveness of Humanitarian Pediatric Cardiac Surgery

Advanced Prostate Cancer: Risk of Mortality with Surgery vs Radiotherapy

Who Does Better After Bariatric Surgery?