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Perioperative Durvalumab for Resectable Non–Small-Cell Lung Cancer
Patients with resectable non–small-cell lung cancer had a greater response and longer event-free survival with preoperative durvalumab plus chemotherapy and adjuvant durvalumab than with chemotherapy alone.
Journal Article
Surgical Skill and Complication Rates after Bariatric Surgery
In this preliminary study, videos of gastric bypass operations submitted by 20 bariatric surgeons were rated by peer surgeons. Surgical-skill ratings were highly correlated with complication rates (14.5% for surgeons in the bottom quartile vs. 5.2% in the top quartile).
A considerable body of research suggests that some surgeons have better results than others. Early studies of coronary-artery bypass surgery showed wide variation in risk-adjusted patient mortality across surgeons; studies of other procedures and other outcomes have shown similar variation among surgeons.
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Efforts to reduce such variation have focused primarily on improving perioperative care. For example, the Surgical Care Improvement Project and related pay-for-performance programs have provided financial incentives to increase surgeons' compliance with evidence-based practices related to prophylaxis against surgical-site infection and venous thromboembolism. As of this writing, however, there is little evidence that such initiatives have improved . . .
Journal Article
Gender and ethnic diversity in academic general surgery department leadership
Diversity in surgery has been shown to improve mentorship and patient care. Diversity has improved among general surgery (GS) trainees but is not the case for departmental leadership. We analyzed the race and gender distributions across leadership positions at academic GS programs.
Academic GS programs (n = 118) listed by the Fellowship and Residency Electronic Interactive Database Access system were included. Leadership positions were ascertained from department websites. Gender and race were determined through publicly provided data.
Ninety-two (79.3%) department chairs were white and 99 (85.3%) were men. Additionally, 88 (74.6%) program directors and 34 (77.3%) vice-chairs of education were men. A higher proportion of associate program directors were women (38.5%). Of 787 division-chiefs, 73.4% were white. Only trauma had >10% representation from minority surgeons. Women represented >10% of division chiefs in colorectal, thoracic, pediatric, and plastic/burn surgery.
Diversity among GS trainees is not yet reflected in departmental leadership. Effort is needed to improve disparities in representation across leadership roles.
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•Improvement in diversity is not reflected in departmental leadership.•More women serve as associate program directors than other leadership positions.•Only 4 specialties had >10% representation from women as division-chiefs.•Only trauma/ACS had >10% representation from minorities.•Highlights lack of diversity and need for increased representation in leadership.
Brief Summary: While general surgery trainees have become increasingly diverse, this improvement is not yet reflected in departmental leadership. Currently, more women serve as associate program directors than other leadership positions. However, only 4 specialties have >10% representation from women as division chiefs and only trauma/ACS had >10% representation from any underrepresented minorities. This highlights the lack of diversity and the need for increased representation in general surgery leadership.
Journal Article
Empire of the scalpel : the history of surgery
\"From the sixteenth-century saga of Andreas Vesalius and his crusade to accurately describe human anatomy while appeasing the clergy who clamored for his burning at the stake, to the story of late-nineteenth-century surgeons' apathy to Joseph Lister's innovation f antisepsis and how this indifference led to thousands of unnecessary surgical deaths, Empire of the Scalpel is both a history and a uniquely American tale. Readers will learn how the United States achieved surgical leadership in the twentieth century, heralded by Harvard's Joseph Murray and his Nobel Prize-winning, seemingly impossible feat of transplanting a kidney, which ushered in a new era of transplants that continues to make procedures once thought insurmountable into achievable successes.\"-- Back cover.
Book
Charitable Platforms in Global Surgery: A Systematic Review of their Effectiveness, Cost-Effectiveness, Sustainability, and Role Training
Objective
This study was designed to propose a classification scheme for platforms of surgical delivery in low- and middle-income countries (LMICs) and to review the literature documenting their effectiveness, cost-effectiveness, sustainability, and role in training. Approximately 28 % of the global burden of disease is surgical. In LMICs, much of this burden is borne by a rapidly growing international charitable sector, in fragmented platforms ranging from short-term trips to specialized hospitals. Systematic reviews of these platforms, across regions and across disease conditions, have not been performed.
Methods
A systematic review of MEDLINE and EMBASE databases was performed from 1960 to 2013. Inclusion and exclusion criteria were defined
a priori
. Bibliographies of retrieved studies were searched by hand. Of the 8,854 publications retrieved, 104 were included.
Results
Surgery by international charitable organizations is delivered under two, specialized hospitals and temporary platforms. Among the latter, short-term surgical missions were the most common and appeared beneficial when no other option was available. Compared to other platforms, however, worse results and a lack of cost-effectiveness curtailed their role. Self-contained temporary platforms that did not rely on local infrastructure showed promise, based on very few studies. Specialized hospitals provided effective treatment and appeared sustainable; cost-effectiveness evidence was limited.
Conclusions
Because the charitable sector delivers surgery in vastly divergent ways, systematic review of these platforms has been difficult. This paper provides a framework from which to study these platforms for surgery in LMICs. Given the available evidence, self-contained temporary platforms and specialized surgical centers appear to provide more effective and cost-effective care than short-term surgical mission trips, except when no other delivery platform exists.
Journal Article
Norman Bethune
Norman Bethune was a surgeon, medical inventor, tumultuous romantic, and advocate for the poor.
Book
Hazardous Postoperative Outcomes of Unexpected COVID-19 Infected Patients: A Call for Global Consideration of Sampling all Asymptomatic Patients Before Surgical Treatment
Background
In December 2019, a novel coronavirus was identified as the cause of many pneumonia cases in China and eventually declared as a pandemic as the virus spread globally. Few reports were published on the outcome of surgical procedures in diagnosed COVID-19 patients and even fewer on the surgical outcomes of asymptomatic undiagnosed COVID-19 surgical patients. We aimed to review all published data regarding surgical outcomes of preoperatively asymptomatic untested coronavirus disease 2019 (COVID-19) patients.
Methods
This report is a review on the perioperative period in COVID-19 patients who were preoperatively asymptomatic and not tested for COVID-19. Searches were conducted in PubMed April 4th, 2020. All publications, of any design, were considered for inclusion.
Results
Four reports were identified through our literature search, comprising 64 COVID-19 carriers, of them 51 were diagnosed only in the postoperative period. Synthesis of these reports, concerning the postoperative outcomes of patients diagnosed with COVID-19 during the perioperative period, suggested a 14/51 (27.5%) postoperative mortality rate and severe mostly pulmonic complications, as well as medical staff exposure and transmission.
Conclusions
COVID-19 may have potential hazardous implications on the perioperative course. Our review presents results of unacceptable mortality rate and a high rate of severe complications. These observations warrant further well-designed studies, yet we believe it is time for a global consideration of sampling all asymptomatic patients before surgical treatment.
Journal Article