2 Minute Medicine ® - Surgery - General

1. After 7- and 12-year follow-ups, there was superior glycemic control after bariatric surgery for the management of type 2 diabetes (T2D) in people with obesity compared with medical and lifestyle management. 2. There was also less diabetes medication usage and higher rates of diabetes remission in the group who underwent bariatric surgery. Evidence Rating Level: 1 ( Excellent) Study Rundown: T2D is a widespread and costly condition globally . Limited evidence suggests bariatric surgery may be superior to other treatments for type 2 diabetes, but it’s typically reserved for those with a body mass index ( BMI ) of 35 or higher due to study limitations, with few opting for surgery...

1. Patients in the thrombectomy plus medical care group reported a significantly lower mRS score at the 1-year follow-up compared to those in the medical care alone group. 2. 1-year mortality in the thrombectomy group was lower than in the medical care alone group. Evidence Rating Level: 1 (Excellent) Study Rundown: Endovascular thrombectomy is known to have good clinical outcomes in patients with ischemic stroke. However, limited data exists regarding its long-term efficacy. This randomized controlled trial aimed to compare the safety and efficacy of endovascular thrombectomy plus medical care versus medical care alone in patients with large-vessel occlusion...

1. This retrospective cohort study found that in one surgeon’s practice, administration of vancomycin/tobramycin local antibiotic powder (LAP) after open treatment of fractures resulted in an 8.3% reduction in deep surgical site infections (SSIs) compared with no LAP procedures. Evidence Rating Level : 2 (Good) Conflicting data exist regarding LAP effectiveness in reducing SSIs in orthopedic surgery. While the VANCO trial showed no significant reduction in deep SSIs with vancomycin LAP, post hoc analysis suggested a decrease in gram-positive infections offset by gram-negative ones...

1. This retrospective cohort study found that the addition of hyperbaric oxygen therapy (HBOT) to surgery in patients with necrotizing soft tissue infections (NSTIs) reduced mortality, amputation and non-home discharges. 2. These effects were accompanied by longer hospital stays and higher costs. 3. In a subgroup analysis of patients with sepsis, the effects of decreased mortality, amputation, and non-home discharges persisted with no impact on length of stay and costs compared with the non-HBOT group.   Evidence Rating Level : 2 (Good) NSTIs are life-threatening, managed with early diagnosis, surgery, and antibiotics...

1. Post-ERCP pancreatitis was more common in the indomethacin alone group compared to indomethacin plus stent group. 2. The benefit of stent placement was prominent among patients at high risk for pancreatitis. Evidence Rating Level: 1 (Excellent) Study Rundown: In high-risk patients undergoing endoscopic retrograde cholangiopancreatography (ERCP), combining rectal indomethacin with prophylactic pancreatic stent placement is a recommended strategy to prevent pancreatitis. This randomized controlled trial aimed to assess the efficacy of indomethacin alone versus the combination of indomethacin plus stent placement...

1. For women with cervical intraepithelial neoplasia grade 2 (CIN2), the risk of preterm birth was similar for those who underwent active surveillance compared to immediate loop electrosurgical excision procedure (LEEP) 2. The risk of preterm birth was greater for those who underwent delayed LEEP compared to immediate LEEP.  Evidence Rating Level: 2 (Good) Cervical intraepithelial neoplasia grade 2 (CIN2) is typically managed via surgical excision. 50-60% of CIN2 cases regress spontaneously within 2 years; therefore, managing all cases with surgical excision may be over-treatment...

1. There were similar rates of ipsilateral invasive recurrence among the postoperative adjuvant radiotherapy group (group 1) and non-radiotherapy group (group 2). 2. 2% of patients in the total cohort underwent mastectomy and all of them were in the non-radiotherapy group. Evidence Rating Level: 1 (Excellent) Study Rundown: Adjuvant breast radiotherapy is a common practice in early breast cancer treatment, although some suggests it may be overtreatment. This randomized controlled trial aimed to explore whether the use of preoperative MRI can identify women with localized unifocal breast cancer who can safely avoid radiotherapy...

1. In this randomized controlled trial, the success rate of surgery was greater than that of needle fasciotomy and collagenase injection for treating Dupuytren’s contracture at two years of follow-up. 2. Initial success rates after three months were similar for surgery, needle fasciotomy, and collagenase injection. Evidence Rating Level: 1 (Excellent) Study Rundown: Dupuytren’s contracture is a hereditary fibroproliferative disorder characterized by an inability to extend one or more fingers (usually the ring and little fingers) due to progressive shortening of the palmar fascia...

1. Ketamine was non-inferior to morphine at analgesic pain reduction for out-of-hospital pain management. 2. There was, however, an increased number of adverse events in the ketamine group, though the majority of these were associated with emergence phenomenon and did not require intervention. Evidence Rating Level: 1 (Excellent) Pain is a common symptom experienced outside of the hospital, which is currently being researched to shore up inadequacies, especially for those experiencing traumatic pain. There is much discussion in this research over which analgesic is the best to prescribe for out-of-hospital pain...

1. This large retrospective cohort study found that female patients who underwent a hysterectomy with or without an adnexal surgical procedure had an increased osteoporosis risk compared with those without a hysterectomy. 2. Beyond 7 years, osteoporosis risk in the hysterectomy group without adnexal surgery was similar to the nonhysterectomy group, while the hysterectomy group with an adnexal procedure maintained an increased osteoporosis risk. 3. Despite the increased osteoporosis risk, hysterectomy with or without an adnexal surgical procedure was not associated with an increased fracture risk...

1. Best practices centred around supportive decisions and ultrasound evaluation of risk significantly reduced perinatal and maternal morbidity. 2. No difference in perinatal or maternal morbidity was seen between groups among patients who underwent elective Caesarean delivery. Evidence Rating Level: 1 (Excellent) Study Rundown : Women with a prior cesarean section face the dilemma of choosing between a repeat elective cesarean or attempting vaginal delivery, each associated with potential complications. This randomized controlled trial aimed to evaluate whether a multifaceted intervention, promoting patient-centred decision-making and best practices, could reduce major perinatal morbidity in women with a previous cesarean...

1. A joint Inpatient palliative Care (IPC) approach was effective at reducing patients’ time in the intensive care unit (ICU) and hospital overall. Evidence Rating Level: 2 (Good) Patients in the intensive care unit (ICU) would benefit from having an Inpatient Palliative Care (IPC) team to help them through this difficult chapter in their lives. An IPC team usually help patients manage their symptoms and pain along with providing support to them and their families and assisting with communication to ensure realistic expectations...

1. Diabetes remission was achievable for participants through weight loss by surgery or lifestyle changes. 2. At a median follow-up of 3.1 years, two thirds of patients who achieved remission returned to a hyperglycemic state. Evidence Rating Level: 2 (Good) A commonly held belief is that there is no cure for type 2 diabetes. Optimistically, recent clinical trials have shown that remission is possible through sustained weight loss in overweight or obese individuals. Early weight control, especially within the first year after diagnosis, is extremely important in those with type 2 diabetes as it can prevent diabetes-related complications while also improving outcomes in the long term...

1. The Atezolizumab group demonstrated significantly greater progression-free and overall survival among patients with metastatic, persistent, or recurrent cervical cancer. 2. Grade 3 or worse adverse events were comparable in both groups. Evidence Rating Level: 1 (Excellent) Study Rundown: A previous large-scale trial has shown improved overall survival among patients with cervical cancer treated with bevacizumab and chemotherapy. Other studies have shown similar results using chemotherapy and PD-L1 monoclonal antibodies, such as pembrolizumab...

1. Women with non-screen detected ductal carcinoma in situ had worse outcomes for the 25 years following their diagnosis. 2. When compared with surgery, mastectomies had better results at lowering the risks of invasive breast cancer. Evidence Rating Level: 2 (Good) A breast screening program developed by the National Health Service has contributed to the increased incidence of ductal carcinoma in situ. However, not all women with this type of cancer have been diagnosed through the screening program. A study examining outcomes of a population of 27543 women in England who had been diagnosed with non-screen detected ductal carcinoma in situ as their first cancer diagnosis...

1. There was no procedure-related mortality or life-threatening events reported. 2. At the 6-month follow-up, improved valve function was noted with increased mean aortic valve area and decreased mean pressure gradient. Evidence Rating Level: 2 (Good) Study Rundown : Calcific aortic stenosis is often challenging to treat with conventional interventions given the burden of comorbidities among many patients. This has led to the exploration of non-invasive therapies for high-risk patients. This prospective, single-arm series assessed the safety and efficacy of trans-thoracically delivered non-invasive ultrasound therapy in patients with severe symptomatic aortic valve stenosis...

1. In this randomized controlled trial, for patients with chronic limb-threatening ischemia (CLTI) due to infrapopliteal artery disease (IAD), a drug-eluting resorbable scaffold was superior to angioplasty in reducing the risk of vascular events.  2. There was no significant difference in the adverse events between the drug-eluting resorbable scaffold and angioplasty groups.  Evidence Rating Level: 1 (Excellent) Study Rundown: Peripheral artery disease is an epidemic, and its incidence is increasing alongside other cardiovascular diseases...

1. In patients with distal femoral periprosthetic fractures (DFPF), patients treated with dual plating (DP) were more likely to be weight-bearing in the twelve-week postoperative period, compared with those treated with distal femoral locking plates (DFLP). 2. Compared with the DFLP group, the DP patients were more likely return to their baseline ambulatory status. Evidence Rating Level : 3 (Average) With an aging population and increasing rates of knee arthroplasty, the incidence of DFPF is expected to grow...

1. In this randomized crossover trial, intravenous levothyroxine, given to hemodynamically unstable brain-dead potential heart donors, did not improve the heart transplant success rates compared to placebo.  2. Levothyroxine resulted in more severe hypertension and tachycardia as compared to placebo. Evidence Rating Level: 1 (Excellent) Study Rundown: The majority of transplanted hearts come from brain-dead donors. Less than half of potential donor hearts are fit for transplantation, which might be due to neurohormonal derangements, including thyroid hormone deficiency...

1. There was no significant increase in mortality between the paclitaxel-coated and control devices in both the intention-to-treat and as-treated analyses groups. Evidence Rating Level: 1 (Excellent) Study Rundown: The safety of paclitaxel-coated devices for femoropopliteal disease has been well-studied; however, a 2018 meta-analysis raised concerns about increased mortality risk with paclitaxel. This meta-analysis aimed to provide updated insights on data from ten different trials comparing mortality rates between paclitaxel-coated and control (non-paclitaxel-coated) devices...