Home Surgery American College of Surgeons, Oct. 4-8

American College of Surgeons, Oct. 4-8

The 101st Annual Clinical Congress of the American College of Surgeons

The annual meeting of the American College of Surgeons (ACS) was held from Oct. 4 to 8 in Chicago 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, post-graduate courses, scientific paper presentations, video-based education presentations, and posters focusing on the latest advances in surgical care.

In one study, Ansab Haider, M.D., of the University of Arizona in Tucson, and colleagues found that the use of helmets is still beneficial in patients who sustain an intracranial head bleed from a bicycle accident.

The investigators found that the use of a helmet reduces the severity of injury, mortality, and the likelihood of undergoing surgery for the head bleed. It also protects against facial fractures, particularly to the upper part of face, according to Haider. The investigators also found that the use of bicycle helmets in these patients was only 25 percent.

“The key conclusion is that sometimes we view bicycle helmets as devices that protect from intracranial bleeding and if they still occur we tend to imagine that the helmets didn’t help. In reality, even if the head bleeds occur, their severity is much lower and the likelihood of dying from them is low; and even the risk of facial fractures is low. So, the practice of helmet use needs to be emphasized particularly in the teenagers where it is alarmingly low,” Haider said. “For future studies, we would like to evaluate this in more detail using our own hospital database which can provide more precise details of injuries. We want to see the different types of bleeds helmets protect against in particular and if the type of helmet makes a difference.”

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In another study, Nicolas Ajkay, M.D., of the University of Louisville School of Medicine in Kentucky, and colleagues used a theoretical model to compare costs of one-sided mastectomy versus bilateral mastectomy for patients diagnosed with breast cancer in one breast and with no genetic predisposition for breast cancer.

The investigators performed a cost-effective analysis by calculating the cost of one-sided mastectomy with or without reconstruction followed by surveillance of the contralateral breast. They also analyzed the cost of a mastectomy for the breast with cancer and a contralateral prophylactic mastectomy with or without reconstruction. The costs of treating complications, the costs of finding and treating a contralateral breast cancer, and quality of life at the different health states related to the different decisions and occurrences were also calculated. The probabilities for each decision were weighted based on recent national studies.

“One-sided mastectomy with surveillance of the contralateral breast is less costly and provides a better quality of life than bilateral mastectomy for patients younger than 50 years old with sporadic unilateral breast cancer,” Ajkay said. “This is one piece of information that physicians can share with their patients as they decide on contralateral prophylactic mastectomy versus continued surveillance. Contralateral prophylactic mastectomy decreases the risk of breast cancer in the contralateral breast at 10 years — which is already an unlikely event (5 percent). No survival advantage from contralateral prophylactic mastectomy has been proven.”

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In other research, 200 people were asked to recall the date of their last colonoscopy and the findings. Their answers were compared to their health records. The patients’ last colonoscopies were either two months, one year, two years, or four years prior to the study.

The percentage of patients who remembered the date of their last colonoscopy to within one month was 94 percent after two months, 42 percent after one year, 30 percent after two years, and 28 percent after four years. The number of patients who knew whether polyps were found was 65.2, 31.6, 35.7, and 37.5 percent, respectively. The number of patients who knew the number of polyps found during their procedure was 39.1, 10.5, 7.1, and 6.25 percent, respectively.

“Patients’ personal recollections of endoscopy results can be misleading,” study author Amer Alame, M.D., a colorectal surgeon at the St. John Hospital and Medical Center in Detroit, said in an ACS news release. He added that it is important for doctors to repeat important information to patients after a colonoscopy, including what was done, the results, and recommendations for follow-up care. One helpful approach is to provide patients with a document to take home and keep in their files.

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Julie Ann Sosa, M.D., of the Duke Cancer Institute and Duke Clinical Research Institute in Durham, N.C., and colleagues conducted a large study aimed at determining the minimum number of total thyroidectomies performed by a surgeon per year that is associated with improved patient outcomes.

The investigators identified a minimum surgeon volume threshold for total thyroidectomy (25 cases per year) that is associated on average with improved patient outcomes. The investigators also found that the majority of patients undergoing total thyroidectomy in the United States are receiving the operation from low-volume surgeons, thus potentially putting them at higher risk for experiencing complications and costs.

“The study has timely implications for improving quality of surgical care in the United States, given the shift toward value-based reimbursement. Knowing the definition of high-volume surgeons based on national data is also important for identification of referral criteria for patients, primary care physicians, endocrinologists, surgeons, hospitals, and potentially payers,” Sosa said. “Future studies may need to focus on identifying any relationship of surgeon volume, skill, and experience with long-term outcomes for patients, particularly for those who undergo thyroidectomy for thyroid cancer, examining rates of disease recurrence and survival.”

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ACS: Resection Can Up Survival in Metastatic Melanoma

FRIDAY, Oct. 9, 2015 (HealthDay News) — New research suggests that surgical removal of melanoma that has metastasized may help patients live more than twice as long as those who receive only medical therapy. The study was scheduled for presentation at the annual meeting of the American College of Surgeons, held from Oct. 4 to 8 in Chicago.

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