The 102nd Annual American College of Surgeons Clinical Congress
The annual meeting of the American College of Surgeons was held from Oct. 16 to 20 in Washington, D.C., and attracted approximately 14,000 participants from around the world, including surgeons, medical experts, allied health professionals, and administrators. The conference included hundreds of general and specialty sessions, postgraduate courses, scientific paper presentations, video-based education presentations, and posters focusing on the latest advances in surgical care.
In one study, Zaid Al-Qurayshi, M.D., M.P.H., of Tulane University in New Orleans, and colleagues found that performing thyroid lobectomy instead of total thyroidectomy is a cost-saving and more effective management plan in patients with a thyroid nodule that is suspicious for papillary thyroid carcinoma on fine-needle aspiration biopsy.
“Before the recent American Thyroid Association (ATA) 2015 guidelines, this population was usually treated with total thyroidectomy. Over the last few years, there has been an emergence of evidence proposing lobectomy as a clinically superior approach. This is now recommended by ATA 2015 guidelines. Our results are providing additional support to this recommendation by showing favorable effectiveness and considerable cost savings,” Al-Qurayshi said. “This study is designed as a cost-effectiveness analysis; such design is of value at the administrative and health policy-making level rather than the clinical practice and individual level. Given the high prevalence of thyroid nodules, universally adapting the ATA guidelines not only would have advantageous clinical outcomes as proven by previous investigations but also would decrease the financial burden of managing thyroid nodules.”
In another study, Luke Martin, M.D., of the University of Utah School of Medicine in Salt Lake City, and colleagues evaluated the effectiveness of a risk prediction tool, the nomogram, on intensive care unit (ICU) readmission rates for surgical patients.
“The nomogram was able to predict those at risk for surgical ICU readmission within 72 hours using seven variables that are available for virtually all ICU patients (age, blood level of urea nitrogen, level of serum chloride, blood glucose level, history of atrial fibrillation, history of renal insufficiency, and respiratory rate). The nomogram is simple to use and provides an objective measure of risk that is easily interpreted by the clinician,” Martin said. “Our findings are important because the use of the nomogram may allow clinicians to target early interventions, and thus, potentially prevent ICU readmission, which in other studies has been associated with worse patient outcomes, increased mortality, increased length of stay, and increased costs.”
Virginia Sun, Ph.D., R.N., of City of Hope in Duarte, Calif., and colleagues evaluated whether it is possible to track functional recovery, symptoms, and quality of life via wireless monitoring before and after major abdominal surgery. The investigators incorporated subjective (patient self-reported) assessments of symptoms and quality of life, along with objective measures of functional recovery via daily steps captured through physical activity wristband trackers.
“We found that functional recovery (daily steps) was slow after surgery (up to two weeks post-discharge). We found an association between the number of daily steps and complications as measured by the comprehensive complication index (CCI). Patients who had a lower number of daily steps at postoperative day seven had a higher CCI index (higher score = more risk for postoperative complications). Acceptability of the electronic monitoring system was high (as measured by patient-reported satisfaction). Adherence of wearing the physical activity tracker was also high (greater than 88 percent),” Sun said. “We conclude that a wireless monitoring system that incorporates subjective and objective assessment of functional recovery, symptoms, and quality of life is feasible, offering high adherence and satisfaction before and after major abdominal surgery.”
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