2 Minute Medicine ® - Surgery - General

1. In this retrospective cohort study, patients with a history of depression, anxiety, or both did not have a significant increase in emergency department visits following bariatric surgery compared to those without. 2. Furthermore, patients with a history of depression and/or anxiety also did not have an increase in hospital readmissions in the first year post-bariatric surgery compared to those without. Evidence Rating Level: 2 (Good) Patients who undergo bariatric surgery have a high prevalence of preoperative mental illness...

1. In this randomized controlled trial, the elective NaV1.8 inhibitor VX-548 reduced acute pain over 48 hours following abdominoplasty and bunionectomy. 2. The main adverse events associated with VX-548 use were headaches and constipation. Evidence Rating Level: 1 (Excellent) Study Rundown: Acute pain, especially following traumas and surgical procedures, remains an area of unmet medical need. Multimodal analgesic regimens, consisting of nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, nonselective sodium-channel, and opioids can be effective approaches, but drug-related adverse events and variability in patient response translate to a high incidence of inadequately treated pain burdens...

1. In this randomized controlled trial, video laryngoscopy in the context of critically ill adults in the emergency department or intensive care unit (ICU) led to higher rates of success on first intubation attempts than direct laryngoscopy. 2. There was no significant difference in safety outcomes between groups.  Evidence Rating Level: 1 (Excellent) Study Rundown: The use both of video and direct laryngoscopy for tracheal intubation is supported by international airway management guidelines. Trials comparing the two intubation approaches have shown mixed results on patient outcomes such as a successful first attempt in intubation, an important indicator of reduced risk for life-threatening complications...

1. Mohs micrographic surgery was associated with significantly higher survival rates for patients with T1/T2 Merkel cell carcinoma with pathologically confirmed negative lymph nodes compared to other surgical modalities (i.e., wide local excision and narrow-margin excision). 2. Mohs micrographic surgery may be a more effective treatment for primary Merkel cell carcinoma than conventional wide-local excision. Evidence Rating Level: 2 (Good) Study Rundown: Merkel cell carcinoma (MCC) is a rare type of skin cancer with high mortality rates...

1. In this randomized controlled trial, isolated cleft palate surgery at six months resulted in a reduced risk of developing velopharyngeal insufficiency at five years as compared to surgery at 12 months. 2. There was no difference in speech, dentofacial, or growth development between surgery completed at six months versus 12 months. Evidence Rating Level: 1 (Excellent) Study Rundown: Isolated cleft palate is a common condition worldwide, whereby the optimal timing, technique, and number of surgeries for optimal development are debated...

1. This post-hoc analysis of the AMATERASU randomized clinical trial found that, for digestive tract cancer patients with positive p53-immunoreactivity, 2000 IU/day vitamin D3 supplementation resulted in significantly improved relapse-free survival at 5 years.  Evidence Rating Level: 1 (Excellent) Recent meta-analyses of randomized clinical trials have found that daily vitamin D3 supplementation benefited cancer mortality. In this posthoc subgroup analysis of the AMATERASU randomized, double-blind, placebo-controlled clinical trial, patients with digestive cancers were followed up for a median of 3...

1. This retrospective study found that patients undergoing gastrectomy for gastric cancer (GC) had improved five-year survival, reduced five-year tumor recurrence, less metastasis, and poorer tumour differentiation if they had ≥ 16 negative lymph nodes (NLNs) resected during gastrectomy. 2. This serves as further evidence for proportion of NLNs as a prognostic factor in cancer treatment.  Evidence Rating Level: 2 (Good) Currently one of the most common malignancies worldwide and the third most deadly cancer, gastric cancer (GC) is an important topic of research...

1. Patients with primary hepatocellular carcinoma randomized to receive primary hepatectomy versus conventional hepatectomy had less operation time, fewer complications, higher immune function post-op, and lower rates of recurrence at 3 years, amongst other advantages. Evidence Rating Level: 1 (Excellent) For patients with primary liver cancer, precision hepatectomy is a novel surgical approach that aims to decrease invasiveness and improve hepatic protection: This is done by creating a virtual 3D reconstruction of an individual patient’s liver to guide the surgical plan...

1. This phase 2, single-arm, multicenter trial found that in HER2-positive breast cancer patients demonstrating resistance to trastuzumab, the combination of pyrotinib and capecitabine improved progression-free survival and objective response rates while maintaining an adequate safety profile.  2. Results also indicate that different underlying mechanisms of trastuzumab resistance may impact disease progression and the response to treatment. Evidence Rating Level: 1 (Excellent) Approximately one-fifth of patients diagnosed with breast cancer are HER2-positive...

1. This population-based cohort study is the first to establish an evidence-based recommendation of delivery at 39 weeks for females with pregnancies conceived via infertility treatments and assisted reproductive technology (ART).  Evidence Rating Level: 2 (Good) The proportion of females between the ages of 15 to 49 receiving infertility therapies has risen over recent years. Assisted reproductive technology (ART) more specifically, although useful, is also associated with the risk for low birth weight, perinatal mortality, and stillbirth...

1. In postoperative patients randomized to receive either 30% FiO 2 and 60% FiO 2 via mechanical ventilation while under general anesthesia, there was no difference in the incidence of postoperive alectasis between the two groups.  Evidence Rating Level: 1 (Excellent) A sizeable proportion of patients undergoing surgery with mechanical ventilation under general anesthesia develop postoperative atelectasis, which itself lends to longer hospital stays and increased 90-day mortality. The literature investigating which amount of inspired oxygen fraction (FiO 2 ) is optimal for patients under general anesthesia has been conflicting...

1. The pathological complete response rate for the experimental group was improved compared to the control group. 2. Progression-free survival and overall survival at 24 months were also improved in the experimental group with HR 0.47 and 0.43 respectively. Evidence Rating Level: 1 (Excellent) Study Rundown: The optimal treatment for non-small-cell lung cancer (NSCLC) diagnosed at stage IIIA or IIIB remains uncertain. Recent trials (NADIM, CheckMate 816) demonstrated the benefits of combining chemotherapy and immunotherapy, prompting this study (NADIM II) to compare nivolumab-platinum chemotherapy neoadjuvant treatment followed by adjuvant nivolumab, against standard neoadjuvant chemotherapy in resectable stage IIIA/IIIB NSCLC patients...

1. Mean pain score at 6 weeks was not statistically different between the opioid and placebo groups. 2. Risk of opioid misuse after 52 weeks was higher in the opioid group compared to the placebo group. Evidence Rating Level: 1 (Excellent) Study Rundown: Opioid analgesics are commonly used for acute low back and neck pain, despite limited efficacy. Aside from the questionable efficacy, a major concern of regular opioid use is the risk of serious adverse events which could increase mortality and healthcare costs...

1. Deep surgical site infection at 90 days was 1.7% in the single-antibiotic group versus 1.2% in the dual-antibiotic loaded cement group, with no significant differences between groups. 2. Quality of life, mobility, and mortality at 120 days were comparable between both groups. Evidence Rating Level: 1 (Excellent) Study Rundown: Hip fracture is a common injury in the elderly that necessitates hospital, and often operative, management. Although surgical site infections are common, mixed evidence exists regarding the use of antibiotic-loaded bone cement in hemiarthroplasty...

1. Double-balloon enteroscopy (DBE) has a high diagnostic yield for small-bowel strictures in Crohn’s disease (CD) patients, with no difference in accuracy depending on low or high symptom severity. Evidence Rating Level: 2 (Good) Strictures occur in an estimated 15-30% of Crohn’s Disease (CD) patients within the first 10 years after diagnosis. Several methods have been developed for evaluating small-bowel strictures, including computed tomography enterography (CTE) and double-balloon enteroscopy (DBE)...

1. Postoperative enhanced recovery after surgery (ERAS) protocols for cardiac surgeries were found to improve outcomes such as decreasing the length of stay (LOS) and incidences of postoperative infections. 2. There was a significantly reduced 30-day mortality for patients who underwent open aortic surgeries after the implementation of ERAS protocols, compared to the pre-implementation cohort. Evidence Rating Level : 2 (Good) ERAS protocols provide guidelines for standardized perioperative pathways that aim to optimize patient care...

1. In a large Taiwanese cohort, it was found that patients with hyperlipidemia had higher risk of developing stenosing tenosynovitis, otherwise known as trigger finger, compared to controls.  Trigger finger, also referred to as stenosing tenosynovitis, is a common condition in those aged 50 to 60 years. The disease is characterized by pain and locking of fingers, particularly the thumb and fourth finger. The etiology of trigger finger is poorly understood, with female sex, obesity, carpal tunnel syndrome, and rheumatoid arthritis being reported as possible risk factors...

1. A theoretical risk of opioid addiction following surgery may affect patients’ choice of pain medications and thus, it is important to involve patients in decision-making discussions to determine their optimal pain control plan. 2. Higher opioid addiction risks resulted in patients favouring over-the-counter medication rather than opioid prescription, regardless of pain levels. Evidence Rating Level: 1 (Excellent) Study Rundown: Mohs micrographic surgery (MMS) is a procedure used to treat skin cancer, often leading to patients fulfilling short-term opioid use prescriptions for pain control...

1. In this retrospective cohort study, patients younger than 50 with metastatic colorectal cancer (mCRC) had significantly shorter progression-free survival and overall survival rates compared with those aged 50 to 65 years old. 2. The younger cohort of patients also had unique treatment-related adverse events and distinct genomic profiles compared with their older counterparts. Evidence Rating Level: 2 (Good) Study Rundown: Colorectal cancer (CRC) is the third most common cancer and the second deadliest cancer worldwide...

1. Combination therapy with gemcitabine and docetaxel for patients with metastatic or locally advanced synovial sarcoma met the primary endpoint of 3-month progression-free survival.  Evidence Rating Level: 3 (Average) Synovial sarcoma (SS) accounts for 5-10% of all soft tissue sarcomas. SS carries a high risk for local recurrence and metastasis. The median 5-year overall survival of metastatic SS is only 10%. Anthracyclines are the standard of first-line care advanced SS. Combination therapy with gemcitabine and docetaxel has not been prospectively studied...