Author Interviews, JAMA, Surgical Research / 30.11.2014

Hong Ryul Jin, MD Professor and Chair Department of Otorhinolaryngology-HNS Seoul National University Boramae Medical Center, Seoul, KoreaMedicalResearch.com Interview with: Hong Ryul Jin, MD Professor and Chair Department of Otorhinolaryngology-HNS Seoul National University Boramae Medical Center, Seoul, Korea Medical Research: What is the background for this study? What are the main findings? Response: Although autologous rib cartilage is a useful graft material for rhinoplasty, surgeons sometimes encounter unpleasant complication such as warping or donor-site morbidity. These complications are not infrequent, but there has been no systematic review with regarding this matter. For evidence-based practice, we aimed to assess the long-term safety of using rib cartilage by means of meta-analysis. By reviewing the 10 selected, eligible articles after extensive screening, we found that rates of warping, resorption, infection, and displacement were 3.1, 0.2, 0.6, and 0.4%, respectively. Hypertrophic scar at chest was found in 5.5%, with highest report of 23.8%. Warping and hypertrophic chest scarring showed relatively higher rates, warranting a surgeon’s attention (more…)
Author Interviews, CMAJ, Orthopedics, Surgical Research / 27.11.2014

MedicalResearch.com Interview with: NatNathan Evaniew MD Division of Orthopaedics McMaster Universityhan Evaniew MD Division of Orthopaedics McMaster University   Medical Research: What is the background for this study? Dr. Evaniew: Symptomatic cervical and lumbar spinal disc diseases affect at least 5% of the population and they cause a great deal of pain, disability, social burden, and economic impact. For carefully selected patients that fail to improve with nonsurgical management, conventional open discectomy surgery often provides good or excellent results. Minimally invasive techniques for discectomy surgery were introduced as alternatives that are potentially less destructive, but they require specialized equipment and expertise, and they may involve increased risks for technical complications. (more…)
Author Interviews, Breast Cancer, JAMA, Surgical Research, Vanderbilt / 20.11.2014

MedicalResearch.com Interview with: Dr. Kristy Lynn Kummerow MD Division of Surgical Oncology and Endocrine Surgery Vanderbilt University Medical Center Tennessee Valley Healthcare System, Veterans Affairs Medical Center Geriatric Research, Education, and Clinical Center Nashville, Tenn Medical Research: What is the background for this study? What are the main findings? Dr. Kummerow: This study looked at how we are currently treating early stage breast cancer in the US – early stage breast cancer includes small cancers with limited or no lymph node involvement and no spread to other body site – it was prompted by something we observed an our own cancer center, which is that more and more women seem to be undergoing more extensive operations than are necessary to treat their cancer.  It is helpful to understand the historical context of how we treat early breast cancer.  Prior to the 1980s, the standard of care for any breast cancer was a very extensive procedure, which involved removal of the entire breast, as well as underlying and overlying tissues and multiple levels of lymph nodes drained by that area.  Informative clinical trials were completed in the 1980s demonstrated that these extensive procedures were unnecessary, and that equivalent survival could be achieved with a much more minimal operation, by removing only the tumor, with a margin of normal breast tissue around it, and performing radiation therapy to the area; this technique is now known as breast conservation surgery, also known as lumpectomy with radiation.  In the 1990s, breast conservation was established by the national institutes of health and was embraced as a standard of care for early stage breast cancer; performance of breast conservation surgery also became a quality metric – accredited breast centers in the US are expected to perform breast conservation surgery in the majority of women who they treat for breast cancer.  However, what our research team observed at our institution didn’t fit – over time it appears more aggressive surgical approaches are being used for more women.  This has been found in other institutions as well, and is supported by smaller national studies.  We wanted to understand how surgical management of early breast cancer is changing over time at a national level using the largest data set of cancer patients in the United States. (more…)
Author Interviews, Electronic Records, Outcomes & Safety, Surgical Research, UCSD / 09.11.2014

MedicalResearch.com Interview with: Jamie Anderson MD MPH Department of Surgery University of California, San Diego Medical Research: What is the background for this study? What are the main findings? Dr. Anderson: Risk adjustment is an important component of outcomes and quality analysis in surgical healthcare. To compare two hospitals fairly, you must take into account the “risk profile” of their patients. For example, a hospital operating on predominately very sick patients with multiple co-morbidities would be expected to have different outcomes to a hospital operating on relatively healthier patients with fewer co-morbidities. Somewhat counter-intuitively, it is possible that a hospital with a 10% mortality rate may be better than a hospital with 5% mortality rate when you adjust for the risk of the patient population. Currently, the “gold standard” database to evaluate surgical outcomes is the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), which includes a number of variables on each patient to perform risk adjustment. However, collecting these variables is costly and time consuming. There is also concern that risk adjusted benchmarking systems can be “gamed” because they include data elements that require subjective interpretation by hospital personnel. With the widespread adoption of electronic health records, the aim of this study was to determine whether a number of objective data elements already used for patient care could perform as well as a traditional, full risk adjustment model that includes other provider-assessed and provider-recorded data elements. We tested this hypothesis with an analysis of the NSQIP database from 2005-2010, comparing models that adjusted for all 66 pre-operative risk variables captured by NSQIP to models that only included 25 objective variables. These results suggest that rigorous risk adjusted surgical quality assessment can be performed relying solely on objective variables already captured in electronic health records. (more…)
Author Interviews, Pain Research, Surgical Research / 31.10.2014

Lars Peter Holst Andersen MD., Ph.d. Fellow / Læge, Ph.d. studerende Department of Surgery Herlev Hospital Gastroenheden, Herlev HospitaMedicalResearch.com Interview with: Lars Peter Holst Andersen MD., Ph.d. Fellow / Læge, Ph.d. studerende Department of Surgery Herlev Hospital Gastroenheden, Herlev Hospital Medical Research: What is the background for this study? Dr. Andersen: The sleep hormone, melatonin is diverse molecule. Several experimental animal studies have documented significant antinociceptive effects in a wide range of pain models. In perioperative medicine, administration of melatonin has demonstrated anxiolytic, analgesic and anti-oxidant effects. Optimization of the analgesic treatment in surgical patients is required due to documented inadequate analgesia and the risk of adverse effects and complications caused by commonly used NSAIDs and opioids. Our goal was to investigate if melatonin was able to reduce pain scores or analgesic use in patients undergoing laparoscopic cholecystectomy. (more…)
Outcomes & Safety, Surgical Research / 16.10.2014

Terrence Loftus, MD, MBA, FACS Medical Director, Surgical Service & Clinical Resources Banner Health Phoenix, Arizona 85006Medical Research.com Interview with: Terrence Loftus, MD, MBA, FACS Medical Director, Surgical Service & Clinical Resources Banner Health Phoenix, Arizona 85006 Medical Research: What are the main findings of the study? Dr. Loftus: This study demonstrated that a standardized safe surgery program effectively and systematically implemented across a diverse healthcare system resulted in a significant reduction in serious reportable events (SREs), thereby improving the quality of patient care and leading to significant cost avoidance.   For the purposes of the study, SREs were defined as any reported retained surgical item, wrong site, wrong patient or wrong procedure event. Following implementation of the Safe Surgery Program there was a 52% reduction in the SRE rate in the operating rooms and L&D areas in our system. The most dramatic change and greatest area of improvement was in wrong site events which demonstrated a 70% reduction for this type of serious reportable events. This was achieved through a Safe Surgery Program which consisted of three main components.
  • The first component was patient focused procedures. These are steps designed to prevent wrong site, wrong patient or wrong procedure events.
  • The second component was sponge, sharp and instrument count procedures. These are steps designed to prevent retained surgical items.
  • The final component was monthly observational audits that were performed to assess program compliance. (more…)
Surgical Research, Weight Research / 15.10.2014

MedicalResearch.com Interview with: Donna Tepper, M.D. Henry Ford Hospital Medical Research: What are the main findings of the study? Dr. Tepper: We looked at 94 patients who underwent bariatric surgery at Henry Ford from 2003 through 2013. Of those, 47 subsequently had body recontouring procedures, such as body lift, abdominoplasty (tummy tuck), arm lift, thigh lift, face lift.  We recorded the patients’ body mass index prior to bariatric surgery, and then again at 6 months, 1, 2.5, 4, and 5 years.  Of the patients who underwent contouring surgery, the average decrease in BMI was 18.24 at 2.5 years, compared to a statistically significant 12.45 at 2.5 years for those who did not have further surgery.  This is statistically significant.  This 3 point change in BMI is an 18-21 pound difference depending on patient height.  Furthermore, the BMI in the body contouring group continues to be lower at 4 and 5 years from bariatric surgery compared to the bariatric surgery alone group. (more…)
Brigham & Women's - Harvard, Infections, Surgical Research / 11.10.2014

Michael S. Calderwood, MD MPH Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston, MAMedicalResearch.com Interview with: Michael S. Calderwood, MD MPH Division of Infectious Diseases Brigham and Women's Hospital Boston, MA Medical Research: What are the main findings of the study? Dr. Calderwood: "In our study, we found that the risk of surgical site infection (SSI) following total hip arthroplasty and coronary artery bypass graft (CABG) surgery is higher for Medicare patients undergoing surgery in U.S. hospitals with lower surgical volume. This suggests that volume leads to experience, and experience leads to improved outcomes." "We found a significantly higher risk of surgical site infection in U.S. hospitals performing <100 total hip arthroplasty procedures and <50 CABG procedures per year on Medicare patients. In the lowest volume hospitals, 1 out of 3 infections following total hip arthroplasty and 1 out of 4 infections following CABG were in excess of expected outcomes based on experience in the highest volume hospitals." (more…)
Author Interviews, Surgical Research / 26.09.2014

Dennis Kim, MD Los Angeles Biomedical Research Institute Researcher MedicalResearch.com Interview with: Dennis Kim, MD Los Angeles Biomedical Research Institute Researcher Medical Research: What are the main findings of the study? Dr. Kim: Laparoscopic cholecystectomy, a minimally invasive procedure to remove the gallbladder, is one of the most common abdominal surgeries in the U.S. Yet medical centers around the country vary in their approaches to the procedure with some moving patients quickly into surgery while others wait. Our study found gallbladder removal surgery can wait until regular working hours rather than rushing the patients into the operating room at night. The gallbladder is a pear-shaped organ on the upper right side of the abdomen that collects and stores bile, a digestive fluid produced by the liver. Gallbladders may need to be removed from patients who suffer pain from gallstones that block the flow of bile. In a laparoscopic cholecystectomy, surgeons insert a tiny video camera and special surgical tools through small incisions in the abdomen to remove the gallbladder. Occasionally, surgeons may need to create a large incision to remove the gallbladder, and this is known as an open cholecystectomy. We conducted a retrospective study of 1,140 patients at two large urban referral centers who underwent gallbladder removal surgeries. We found 11% of the surgical procedures performed at night (7 a.m.-7 p.m.) were converted to the more invasive procedure, open cholecystectomies. Only 6% of those who underwent the surgery during the day required the more invasive form of surgery. (more…)
Author Interviews, Surgical Research / 10.09.2014

Achih H. Chen, MD, FACS, FAACS Georgia Center for Facial Plastic Surgery, Evans, Ga and the Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery Georgia Regents University, August, GaMedicalResearch.com Interview with: Achih H. Chen, MD, FACS, FAACS Georgia Center for Facial Plastic Surgery, Evans, Ga and the Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery Georgia Regents University, August, Ga Medical Research: What is the significance of the study? Dr. Chen : This is the first time that facial rejuvenation surgery using surgical approaches in three planes combined with ablative resurfacing has been reported in the medical literature. This approach was not previously thought possible in a single surgical setting because of the concern about disrupting the facial blood supply that may result in loss of the skin. The study demonstrates the safety of this “Total Face” approach. This approach allows simultaneous tightening of the jawline and neck, recreating the lost youthful volume of the midface region, and restoring of the smooth skin texture so characteristic of a young face. This allows for a more complete or “Total Face Rejuvenation” for patients while allowing them the flexibility for a single recovery period or downtime. (more…)
Breast Cancer, MD Anderson, Surgical Research / 05.09.2014

sabelle Bedrosian, M.D., F.A.C.S. Associate Professor, Department of Surgical Oncology, Division of Surgery Medical Director, Nellie B. Connelly Breast Center The University of Texas MD Anderson Cancer Center, Houston, TXMedicalResearch.com: Interview with: Isabelle Bedrosian, M.D., F.A.C.S. Associate Professor, Department of Surgical Oncology, Division of Surgery Medical Director, Nellie B. Connelly Breast Center The University of Texas MD Anderson Cancer Center, Houston, TX Medical Research: What are the main findings of the study? Dr. Bedrosian: •       National BCT (breast conserving therapy) rates have increased during the last two decades. •       Disparities based on age, geographic facility location and type of cancer treatment facility have lessened over time. •       Insurance type and travel distance remain persistently associated with underutilization of breast conserving therapy. •       Annual income of less than $35K may be emerging as a new association with underutilization of breast conserving therapy. (more…)
Author Interviews, Mayo Clinic, Surgical Research / 03.09.2014

Dr. Juliane Bingener-Casey, M.D. Mayo Clinic in Rochester, Minn.MedicalResearch.com Interview with: Dr. Juliane Bingener-Casey, M.D. Mayo Clinic in Rochester, Minn Medical Research: What are the main findings of the study? Dr. Bingener: Other investigators have shown that preoperative quality of life is a predictor for postoperative survival in colon and pancreas cancer surgery. In this study we looked as preoperative quality of life as a predictor for postoperative complications. The main findings of the study were that patients who had a deficit in their quality of life before surgery had a 3 times higher risk of a serious complication before leaving the hospital than patients who had normal quality of life (16% vs 6 %), independent of gender, race, tumor stage or laparoscopic or open colectomy. Patients with serious complications before leaving the hospital also were older and had more other medical problems than patients without complications. Further, patients who had a complication stayed in the hospital longer and their postoperative quality of life was worse (more…)
Author Interviews, Heart Disease, JAMA / 31.08.2014

Massimo Imazio. MD, FESC Dipartimento di Cardiologia/Cardiology Department Maria Vittoria Hospital and University of Torino Torino, ItaliaMedicalResearch.com Interview with: Massimo Imazio on behalf of the COPPS-2 Investigators Massimo Imazio. MD, FESC Dipartimento di Cardiologia/Cardiology Department Maria Vittoria Hospital and University of Torino Torino, Italia Medical Research: What is the background for this investigation? Dr. Imazio: Post-pericardiotomy syndrome, post-operative atrial fibrillation (AF), and post-operative effusions may be responsible for increased morbidity and healthcare costs after cardiac surgery. Postoperative use of colchicine prevented these complications in a single trial (the COPPS trial published on EHJ in 2010). Here all events occurred within 3 months and colchicine was given after cardiac surgery starting from postoperative day 3 for 1 month. However most postoperative AF events are reported in the first 3 days and thus pre-treatment with colchicine may give better outcomes. Thus we performed the COPPS-2 giving colchicine 48 to 72 hours before surgery for 1 month without a loading dose and weight adjusted doses (i.e. 0.5 mg twice daily for patients >70kg or 0.5 mg once for patients <70Kg) in order to improve patients compliance.The Colchicine for Prevention of the Post-pericardiotomy Syndrome and post-operative atrial fibrillation (COPPS-2 trial) is an investigator-initiated, double-blind, placebo-controlled, randomized clinical trial. A total of 360 consecutive candidates for cardiac surgery, 180 for each arm, were enrolled in 11 Italian centers between March 2012 and March 2014. Main exclusion criteria were absence of sinus rhythm at enrollment, cardiac transplantation, and contraindications to . (more…)
Anesthesiology, Author Interviews, Pain Research, Surgical Research / 30.08.2014

Ian Gilron, MD, MSc, FRCPC Director of Clinical Pain Research Professor of Anesthesiology & Perioperative Medicine, Biomedical & Molecular Sciences, and Center for Neuroscience Studies Queen's University Kingston General Hospital, Kingston, Ontario, CanadaMedicalResearch.com Interview with: Ian Gilron, MD, MSc, FRCPC Director of Clinical Pain Research Professor of Anesthesiology & Perioperative Medicine, Biomedical & Molecular Sciences, and Center for Neuroscience Studies Queen's University Kingston General Hospital, Kingston, Ontario, Canada Medical Research: What are the main findings of the study? Dr. Gilron: Pain is the most common symptom which prevents recovery from surgery. Even with the best available treatments today, many patients still suffer from moderate to severe pain after surgery. Antidepressants - drugs used to treat depression - are also proven effective for treating chronic pain due to nerve disease and fibromyalgia. However, there has been much less research on the effects of antidepressant drugs on pain after surgery. Our group conducted a systematic review of all published clinical trials of antidepressant for post surgical pain. Slightly more than half of these studies suggested some benefit of these drugs but the details of this review led us to conclude that there is not yet enough evidence to recommend these medications for post surgical pain treatment. Given the possibility that these medications could be useful treatments for pain after surgery, we believe that future studies of higher scientific quality and which involve larger numbers of patients should be carried out in the hopes of finding safer and more effective treatments for pain after surgery. (more…)
Author Interviews, Hospital Acquired, JAMA, Surgical Research / 28.08.2014

Christopher Mantyh, M.D. Associate Professor of Surgery Chief of Colorectal Surgery NSQIP Surgical Champion Duke University Medical CenterMedicalResearch.com Interview with: Christopher Mantyh, M.D. Associate Professor of Surgery Chief of Colorectal Surgery NSQIP Surgical Champion Duke University Medical Center Medical Research: What are the main findings of the study?  Dr. Mantyh: Specific perioperative bundles can drastically reduce surgical site infections in colorectal surgery patients. (more…)
Author Interviews, Frailty, Geriatrics, JAMA / 22.08.2014

Dr. Bellal Joseph MD FACS Associate Professor of Surgery Medical Director, Southern Arizona Telemedicine and Telepresence (SATT) Program Program Director, International Research Fellowship Liaison, Multi-Specialty Surgery Clinic at UAMCMedicalResearch.com Interview with Dr. Bellal Joseph MD FACS Associate Professor of Surgery Medical Director, Southern Arizona Telemedicine and Telepresence (SATT) Program Program Director, International Research Fellowship Liaison, Multi-Specialty Surgery Clinic at UAMC Medical Research: What are the main findings of the study? Dr. Joseph: Chronologic age is frequently used as the determinant of outcomes when treating elderly and treatments are tailored accordingly. However, the findings of our study challenge this dogma and suggest that it’s not the chronologic age rather frailty status of the individual that determines outcomes. We found frailty Index (quantitative measure of frailty) as a better predictor of in-hospital complications and discharge disposition in elderly compared to the chronologic age. (more…)
Author Interviews, JAMA, Karolinski Institute, Surgical Research / 20.08.2014

MedicalResearch.com Interview with: Mats Möller MD Department of Surgery, Ersta Hospital Department of Clinical Sciences Karolinska Institutet Danderyds Hospital, Stockholm, Sweden Medical Research: What are the main findings of the study? Dr. Möller: The natural course of common bile duct stones seem not as favorable as previous studies have suggested. Leaving stones with no measures taken has in our study a less favorable outcome compared to removing the stones. (more…)
Author Interviews, JAMA, Surgical Research / 13.08.2014

Dr. Thomas M. Scalea, MD R. Adams Cowley Shock Trauma Center, Program in Trauma University of Maryland School of Medicine, BaltimoreMedicalResearch.com Interview with: Dr. Thomas M. Scalea, MD R. Adams Cowley Shock Trauma Center, Program in Trauma University of Maryland School of Medicine, Baltimore Medical Research: What are the main findings of this study? Dr. Scalea:  The main findings of the study was that putting this financial incentive program in place had immediate and dramatic effects on first cases starting on time and turnaround times decreasing in our operating room. (more…)
Author Interviews, BMJ, Clots - Coagulation, Surgical Research / 13.08.2014

MedicalResearch.com Interview with Stavros G. Memtsoudis, MD, PhD, FCCP Clinical Professor of Anesthesiology and Public Health Weill Cornell Medical College Senior Scientist and Attending Anesthesiologist Hospital for Special SurgeryMedicalResearch.com Interview with Stavros G. Memtsoudis, MD, PhD, FCCP Clinical Professor of Anesthesiology and Public Health Weill Cornell Medical College Senior Scientist and Attending Anesthesiologist Hospital for Special Surgery Medical Research: What are the main findings of the study? Dr. Memtsoudis: In this large population based study we found that perioperative tranexamic acid administration significantly reduced the need for blood transfusions in joint arthroplasty patients, while not increasing the risk of major complications, including thromboembolic, cardiac and renal events. (more…)
Author Interviews, JAMA, Surgical Research / 06.08.2014

MedicalResearch.com Interview Cristina B. Geltzeiler, MD Knight Cancer Institute Oregon Health & Science University Portland, OR 97239-3098 Medical Research: What are the main findings of the study? Dr. Geltzeiler: The main findings of the study are that implementing an Enhanced Recovery After Surgery (ERAS) program at a community hospital can be successfully implemented and can allow patients to recover quicker from their surgery with ongoing safety. (more…)
Author Interviews, Urology / 29.07.2014

MedicDavid C. Johnson, MD, MPH Department of Urology University of North Carolina School of MedicinealResearch.com Interview with: David C. Johnson, MD, MPH Department of Urology University of North Carolina School of Medicine   Medical Research: What are the main findings of the study? Dr. Johnson: The first main finding from this study is that the likelihood of benign pathology after surgical removal of a renal mass suspected to be malignant based on pre-operative is inversely proportionate to size. This concept is well-established, however we systematically reviewed the literature for surgical series that published rates of benign pathology stratified by size and combined these rates to determine a single pooled estimate of benign pathology of pre-operatively suspicious renal masses for each size strata. Using benign pathology rates from US studies only, we found that 40.4% of masses < 1 cm, 20.9% of masses 1-2 cm, 19.6% of masses 2-3 cm, 17.2% of masses 3-4 cm, 9.2% of masses 4-7 cm, and 6.4% of masses >7 cm are benign. The more novel finding from this study was the quantification of a previously unmeasured burden of over treatment in kidney cancer. By combining the above mentioned rates of benign pathology with epidemiological data, we estimated that the overall burden of benign renal masses surgically removed in the US to approach 6,000 per year in 2009. This represented an 82% increase over the course of a decade. Most importantly, we found an overwhelmingly disproportionate rise in the surgical treatment of renal masses in the smallest size categories – those which were most likely to be benign. We found a 233%, 189% and 128% increase in surgically removed benign renal lesions < 1 cm, 1-2 cm, and 2-3 cm, respectively from 2000 – 2009 in the US. (more…)
Author Interviews, Education, JAMA, Surgical Research, UC Davis / 23.07.2014

  Erin Brown, MD General Surgery PGY6 UC Davis Medical CenterMedicalResearch.com Interview with: Erin Brown, MD General Surgery PGY6 UC Davis Medical Center Medical Research: What are the main findings of the study? Dr. Brown: This study sought to determine with childrearing during training put residents at increased risk of quiting.  We looked at both male and female surgical residents who chose to have children during residency and found that residents having children during training were not more likely to quit than those who did not have children.  We also found that there childrearing had no negative impact on surgical training based on total surgical case numbers, board pass rates, and annual exam scores.  Main findings of the study were that neither female gender nor childrearing during training were associated with residents quitting. (more…)
Author Interviews, JAMA, Stroke, Surgical Research / 17.07.2014

Mads E. Jørgensen, M.B. University of Copenhagen, DenmarkMedicalResearch.com Interview with: Mads E. Jørgensen, M.B. University of Copenhagen, Denmark Medical Research: What are the main findings of the study? Answer: We included all patients undergoing non-cardiac surgery in 2005-2011, which were then categorized by time elapsed between stroke and surgery. Patients with a very recent stroke, i.e. less than 3 months prior to surgery, had a significant 14 times higher relative risk of 30-day MACE following surgery, compared with patients without prior stroke. Patients with a more distant stroke had a 2-5 fold higher risk of MACE following surgery, and still significantly higher than risks in patients without prior stroke. An additional model including time between stroke and surgery as a continuous measure showed a steep decrease in risks of perioperative MACE during the first 9 months. After 9 months, an increase in time between stroke and surgery did not further reduce the risks. The results for 30-day all-cause mortality showed similar patterns, although estimates were not as dramatic as for 30-day MACE. When analyzing the MACE components individually, we found that recurrent strokes were the main contributor to the high risk of MACE. A history of stroke any time prior to surgery was associated with a 16 fold increased relative risk of recurrent stroke, compared with patients without prior stroke. We also performed analyses stratified by surgery risk as low- (OR for stroke anytime, 3.97; 95% CI, 2.79-5.66), intermediate- (OR for stroke anytime, 4.46; 95% CI, 2.87-5.13) and high-risk (OR for stroke anytime, 1.98; 95% CI, 1.20-3.27), which were somewhat challenged in power. However, results indicated that stroke associated relative risk was at least as high in low and intermediate-risk surgery as in high risk surgery. (more…)
Author Interviews, Rheumatology, Surgical Research / 30.06.2014

Daniel L. Riddle, PT, Ph.D., F.A.P.T.A. Otto D. Payton Professor Assistant department chair Department of Physical Therapy Virginia Commonwealth UniversityMedicalResearch.com Interview with: Daniel L. Riddle, PT, Ph.D., F.A.P.T.A. Otto D. Payton Professor Assistant department chair Department of Physical Therapy Virginia Commonwealth University MedicalResearch: What are the main findings of the study? Dr. Riddle: We used a classification system developed by researchers in Spain in the late 1990s and found that classifications of appropriate, inappropriate and inclusive ratings for persons undergoing knee replacement surgery were  44.0%, 21.7%, and 34.3%, respectively. We studied 175 persons who underwent unilateral total knee replacement in the Osteoarthritis Initiative study, an NIH and privately funded multi-year cohort study of persons with are at high risk for knee osteoarthritis. These findings need to be considered cautiously because the classification system was developed more than 15 years ago and was designed to place greatest priority on persons with end stage knee osteoarthritis and severe pain and functional loss. (more…)
Author Interviews, JAMA, Pediatrics, Surgical Research / 26.06.2014

Frank H. Morriss, Jr., MD, MPH Professor of Pediatrics - Neonatology University of Iowa Carver College of MedicineMedicalResearch.com Interview with: Frank H. Morriss, Jr., MD, MPH Professor of Pediatrics  - Neonatology University of Iowa Carver College of Medicine   MedicalResearch: What are the main findings of the study? Dr. Morriss: Our aim was to assess the association between surgery performed during the initial hospitalization of very low- birth-weight infants and subsequent death or neurodevelopmental impairment at 18-22 months’ corrected age. We conducted a retrospective cohort analysis of patients who were prospectively enrolled in the National Institute of Child Health and Human Development Neonatal Research Network Generic Database from 1998 to 2009. Surgery was classified by the expected anesthesia type as either major surgery that likely would have been performed under general anesthesia; or minor surgery, that is, procedures that could have been performed under non-general anesthesia and in general were shorter in duration. There were 2,186 major surgery patients and 784 minor surgery patients and more than 9,000 patients who did not undergo surgery. We found that any surgical procedure  increased the adjusted risk of death or neurodevelopmental impairment in low birth weight infants by about 30%. Not all surgical procedures were associated with increased risk, however. Compared with those who did not undergo surgery, patients  who were classified as having major surgery had a risk-adjusted odds ratio of death or neurodevelopmental impairment of 1.52 (95% confidence interval 1.24-1.87). However, those who were classified as having minor surgery had no increased adjusted risk. Among survivors who had major surgery compared with those who did not undergo surgery the risk-adjusted odds ratio for neurodevelopmental impairment was 1.56 (95% confidence interval 1.26-1.93), and the risk-adjusted mean Bayley II Mental Developmental Index and mean Psychomotor Developmental Index values were significantly lower. (more…)
Author Interviews, Hospital Readmissions, JAMA, Surgical Research / 24.06.2014

Benjamin S. Brooke, M.D., Ph.D. Assistant Professor of Surgery Division of Vascular Surgery University of Utah School of MedicineMedicalResearch.com Interview with: Benjamin S. Brooke, M.D., Ph.D. Assistant Professor of Surgery Division of Vascular Surgery University of Utah School of Medicine MedicalResearch: What are the main findings of the study? Dr. Brooke: This study was designed to evaluate whether high-risk surgical patients who visit a primary care provider (PCP) during the early period following hospital discharge are less likely to be readmitted within 30-days.  We examined this question by performing a retrospective cohort analysis of Medicare beneficiaries (2003-2010) who underwent a high risk surgery (open thoracic aortic aneurysm repair) as well as a control group of patients who underwent a lower risk surgical procedure (open ventral hernia repair), and then determining whether there was evidence of early PCP follow-up. In risk-adjusted analyses, we found that early primary care provider-follow-up was associated with a significant lower likelihood of 30-day readmission for high-risk patients undergoing open thoracic aortic aneurysm repair, particularly if a post-operative complication had occurred.  In comparison, early primary care provider follow-up did not have a significant effect on lowering readmissions in uncomplicated patients and those undergoing lower-risk operations such as ventral hernia repair. (more…)
Author Interviews, Breast Cancer, MD Anderson, Surgical Research / 11.06.2014

Dr. Benjamin D. Smith MD Associate Professor Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston, TX 77030 MedicalResearch.com Interview with: Dr. Benjamin D. Smith MD Associate Professor Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston, TX 77030 MedicalResearch: What are the main findings of the study? Dr. Smith: Although use of needle biopsy to diagnose breast cancer increased during the time period we studied, it remained lower than targeted benchmarks. The patient’s surgeon seemed to exert a major influence on use of needle biopsy. (more…)
Author Interviews, JAMA, Kidney Stones, Urology / 21.05.2014

Charles D. Scales, Jr MD MSHS Assistant Professor of Surgery Division of Urologic Surgery Duke University Medical CenterMedicalResearch Interview with: Charles D. Scales, Jr MD MSHS Assistant Professor of Surgery Division of Urologic Surgery Duke University Medical Center   MedicalResearch: What are the main findings of the study? Dr. Scales: When it comes to treating kidney stones, less invasive is not always better. We used the best method short of a randomized trial to balance out patients in terms of factors that might influence the success of treatment.  In other words, we achieved a “statistical toss-up” for factors that could influence the outcome of the procedure. When we balanced out all of the factors that might influence the chance of a repeat procedure, we found that about 11% of patients treated with non-invasive SWL had a repeat procedure, as compared to <1% with minimally invasive URS. (more…)
Mayo Clinic, Urology / 20.05.2014

MedicalResearch.com Interview with: Sarah P. Psutka, MD Fellow in Urologic Oncology Department of Urology, Mayo Clinic MedicalResearch: What are the main findings of each study?  Dr. Psutka: In this study, we analyzed 1335 patients who underwent radical cystectomy at the Mayo clinic between 1996 and 2006. We categorized patients who stayed in the hospital longer than 10 days, putting them in the top 25th percentile of the length of stay, as having a prolonged hospital stay. We noted that prolonged hospital stay was associated with adverse postoperative outcomes, including serious complications and early postoperative death. Patients who had a prolonged length of stay had a higher burden of comorbidities, American Society of Anesthesiologist score, and their Eastern Cooperative Oncology Group Score. A multivariable analysis, holding these factors and other clinically relevant potential confounders constant, revealed that only the ECOG performance score independently predicted whether or not a patient had a prolonged hospital course following radical cystectomy. (more…)
Author Interviews, Cancer Research, JAMA, Surgical Research / 10.05.2014

Dr. Carlo Riccardo Rossi, MD Melanoma and Sarcoma Unit, Veneto Institute of Oncology Surgery Branch, Department of Surgery Oncology, and Gastroenterology, University of Padova, Padova, ItalyMedicalResearch.com Interview with: Dr. Carlo Riccardo Rossi, MD Melanoma and Sarcoma Unit, Veneto Institute of Oncology Surgery Branch, Department of Surgery Oncology, and Gastroenterology, University of Padova, Padova, Italy MedicalResearch: What are the main findings of the study? Dr. Rossi: A total of 90% patients undergone lymph node dissection for melanoma had 12, 7, 14, 6 and 13 excised lymph nodes (10th percentile of the distribution) after 3 level axillary, 3 level or less neck, 4 level or more neck, inguinal, or ilio-inguinal dissections, respectively. (more…)