2 Minute Medicine ® - Surgery - General

1. In this randomized controlled trial, in patients undergoing cardiopulmonary bypass, continuous intravenous (IV) administration of amino acids was found to be associated with lower rates of acute kidney injury (AKI). 2. There was no significant difference in adverse outcomes in the IV amino acid group as compared to the placebo control group.  Evidence Rating Level: 1 (Excellent) Study Rundown: AKI is a common complication of cardiac surgery, often resulting from reduced renal blood flow. While it is associated with long-term morbidity and kidney dysfunction, there is currently no standardized protocol to prevent the occurrence of AKI in cardiac surgery patients...

1. In patients with difficult biliary cannulation in the setting of benign disease, endoscopic ultrasound-guided rendezvous and precut sphincterotomy had similar technical success rates. 2. Both techniques exhibited similar procedure times and rate of adverse events, although radiation exposure was significantly higher in patients who underwent ultrasound-guided rendezvous. Evidence Rating Level: 1 (Excellent) Study Rundown: Endoscopic retrograde cholangiopancreatography (ERCP) combines endoscopy and fluoroscopy to diagnose and treat diseases involving the biliary and pancreatic ducts...

1. Sarcopenia is associated with an increased risk of adverse postoperative outcomes in older adults with inflammatory bowel disease (IBD). Evidence Rating Level: 2 (Good) A considerable fraction of individuals living with IBD will undergo IBD-related surgery soon after diagnosis, presenting a point of concern for older adults living with IBD who are at a greater risk of postoperative complications. In many studies of populations of non-IBD older adults, sarcopenia has been shown to be an important risk factor for adverse postoperative outcomes...

1.In a cohort of adults who underwent cardiac surgery, men were more likely to develop postoperative atrial fibrillation (poAF) than women, but among those women, there was an increased risk of long-term mortality compared to men who developed poAF. Evidence Rating Level : 2 (Good)  Women are at a higher risk of postoperative complications and mortality after open heart surgery compared to men. However, it is unclear if there is an association between sex and postoperative atrial fibrillation (poAF), the most common complication after cardiac surgery...

1. Low-volume local anesthetic with intravenous dexamethasone reduced the incidence of diaphragmatic paresis and provided equivalent analgesic duration compared to the conventional volume of local anesthetic in arthroscopic shoulder surgery Evidence Rating Level: 1 (Excellent) Severe postoperative pain is common in patients undergoing arthroscopic shoulder surgery. Therefore, appropriate analgesia and rehabilitation are key for recovery. Interscalene brachial plexus block provides effective analgesia after arthroscopic shoulder surgery but carries a high risk of diaphragmatic paresis...

1. Dose-dense adjuvant chemotherapy involving sequential epirubicin/cyclophosphamide and docetaxel showed improved breast cancer recurrence-free survival and event-free survival compared to standard adjuvant chemotherapy involving docetaxel.  Evidence Rating Level: 1 (Excellent) Study Rundown: A dose-dense sequential adjuvant chemotherapy regimen involving an anthracycline and a taxane has been shown to confer survival benefit in previous studies. However, such studies used paclitaxel once every 3 weeks as the control regimen which is inferior to other currently available regimens...

1. Fewer anti-VEGF intravitreal injections were required in the SRT group over 2 years. 2. Change in visual acuity was non-inferior in the SRT group compared to the sham group. Evidence Rating Level: 1 (Excellent) Study Rundown: Neovascular age-related macular degeneration (nAMD) is a major cause of blindness, often treated with anti-vascular endothelial growth factor (anti-VEGF) agents through intravitreal injections. Ionizing radiation, such as stereotactic radiotherapy (SRT), may offer therapeutic benefits by targeting key pathogenic processes in nAMD...

1. Patients who underwent burr-hole drainage with subdural irrigation had fewer reoperation rates with comparable functional outcomes than those without subdural irrigation. 2. Functional outcomes were similar between groups. Evidence Rating Level: 1 (Excellent) Study Rundown: Chronic subdural hematoma is an emergency that is often treated with burr-hole drainage surgery. While using a subdural drain is known to be beneficial, the impact of subdural irrigation has not been fully explored. This randomized controlled trial aimed to determine whether subdural irrigation is necessary for burr-hole drainage surgery...

1. Patients in the early weight-bearing group showed better recovery than those in the delayed weight-bearing group at 4 months post-randomization. 2. Early weight-bearing was more cost-effective with comparable adverse outcomes. Evidence Rating Level: 1 (Excellent) Study Rundown: Patients recovering from ankle surgery have traditionally been advised to avoid walking for 6 weeks, a strategy known as delayed weight-bearing. An alternative approach, early weight-bearing, allows walking 2 weeks post-surgery and may offer better rehabilitation outcomes...

1. Patients in the sintilimab group reported a significantly greater event-free survival at 36 months compared to the standard therapy group. 2. Grade 3-4 adverse events were slightly more common in the sintilimab group. Evidence Rating Level: 1 (Excellent) Study Rundown: Anti-PD-1 therapy is used to treat metastatic and refractory nasopharyngeal carcinoma, yet its role in locoregionally advanced disease remains unclear. Sintilimab, a novel PD-1 inhibitor, has shown some promise when added to the standard chemoradiotherapy regimen, although further evidence is needed...

1. Tumor response rate at 25 weeks was significantly greater in vimseltinib than placebo. 2. Most adverse events were mild-to-moderate with no treatment-related fatalities. Evidence Rating Level: 1 (Excellent) Study Rundown: Tenosynovial giant cell tumour (TGCT) is an aggressive neoplasm of the tendon sheath with limited treatment options. Vimseltinib, an oral CSF1R inhibitor, has shown promise for symptomatic TGCT patients, although further research is needed. This randomized controlled trial aimed to assess the safety and efficacy of vimseltinib compared to placebo among patients with TGCT not amenable to surgery...

1. In this randomized controlled trial involving critically ill adults undergoing tracheal intubation, those who were preoxygenated with bilevel-positive airway pressure had a lower incidence of hypoxemia than those who received preoxygenation with an oxygen mask alone. 2. Noninvasive ventilation appeared to have greater benefit among patients with a higher body-mass index. Evidence Rating Level: 1 (Excellent) Study Rundown: Hypoxemia occurs in up to twenty percent of tracheal intubations in critically ill patients...

1. Dual antiplatelet therapy with ticagrelor and asprin led to a significantly lower risk of major adverse cardiovascular events over 5 years compared to ticagrelor or asprin monotherapy 2. Bleeding and other adverse events were similar between dual antiplatelet, ticagrelor monotherapy, and asprin monotherapy  Evidence Rating Level: 1 (Excellent) Typically, asprin monotherapy is recommended after a coronary artery bypass graft surgery to reduce the risk of adverse cardiovascular events and improve graft patency...

1. Total knee arthroplasty (TKA) using a MAKO robot improves short-term efficacy and can assist in planning while maintaining high safety.  Evidence Rating Level: 3 (Average) Traditional total knee arthroplasties (TKA) are done using cutting guides for osteotomy. The precision of osteotomy and soft tissue balancing can significantly affect the postoperative alignment and prosthetic positioning. The MAKO surgical robot can help plan correction and balance ligament tension during surgery. This study aimed to compare the efficacy of TKA assisted by the MAKO robot and conventional TKA through retrospective analysis...

1. Treating intracerebral hemorrhage (ICH) with endoscopic evacuation or stereotactic aspiration results in more favourable outcomes 2. Stratifying outcomes by location of hemorrhage shows endoscopy and aspiration are preferred for supratentorial deep hemorrhages whereas no significant difference is seen in supratentorial lobar hemorrhages Evidence Rating Level: 1 (Excellent) Intracerebral hemorrhage (ICH) is the deadliest type of acute stroke. It is treated with small-bone flap craniotomy, endoscopic evacuation, or stereotactic aspiration...

1 . In this decision model analysis, biparametric MRI (bpMRI) testing led to an increased rate of overdiagnosis and false positives compared to a first-line prostate-specific antigen (PSA) test for prostate cancer (PCa). 2. There were more life years saved when using bpMRI compared to other screening techniques. Evidence Rating Level: 2 (Good) Study Rundown: Many cancer screenings employ imaging-based techniques; however, PCa screening typically involves first-line biomarker testing and PSA. First-line bpMRI is a screening technique that has been proposed as an alternative to previously used tools...

1 . In this randomized controlled trial, a self-expanding supra-annular valve was superior to a balloon-expandable valve for bioprosthetic-valve dysfunction among patients with severe aortic stenosis (AS) and a small aortic annulus. 2. The self-expanding valve was noninferior to the balloon-expandable valve for a composite of death, disabling stroke, or rehospitalization for heart failure. Evidence Rating Level: 1 (Excellent) Study Rundown: AS, a thickening and narrowing of the aortic valve, is associated with significant mortality and morbidity, especially when characterized by symptoms of heart failure, syncope, or angina...

1. Significantly more patients in the bimekizumab group than placebo reported improved clinical response at week 16. 2. Treatment-related adverse events were infrequent with one fatality across both treatment groups. Evidence Rating Level: 1 (Excellent) Study Rundown: Hidradenitis suppurativa (HiS) is a chronic inflammatory disease with limited therapeutic options. Bimekizumab, a monoclonal IgG1 antibody that inhibits interleukin (IL)-17F and IL-17A, has shown potential in treating this condition. This randomized controlled trial aimed to assess the safety and efficacy of bimekizumab in patients with moderate-to-severe HiS...

1. In this randomized controlled trial, it was found that those who received transcatheter aortic valve replacement (TAVI) did not have an increased risk of stroke and all-cause mortality compared to those who received surgical replacement (SAVR). 2. Those who underwent a transcatheter procedure had significantly fewer major bleeding events compared to those who underwent surgical replacement. Evidence Rating Level: 1 (Excellent) Study Rundown: TAVI has largely replaced SAVR as the first-line treatment for patients with severe, symptomatic aortic stenosis who are at high surgical risk...

1. Fewer patients in the decompressive craniectomy group had an mRS score of 5-6 compared to medical treatment alone, although this difference was not statistically significant. 2. Severe adverse events were comparable between both groups. Evidence Rating Level : 1 (Excellent) Study Rundown: Spontaneous intracerebral hemorrhage is commonly associated with strokes worldwide. Although decompressive craniectomy reduces mortality in people with large vessel infarction, its role in the management of severe deep supratentorial intracerebral hemorrhage remains unclear...