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Journal and News Scan
August 8, 2013
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This retrospective study assessed the prognostic significance of the new lung adenocarcinoma classification in patients undergoing resection for small tumors (≤2cm) comparing limited vs lobectomy resections. Histologic subtype with micropapillary component >5% was associated with an increased risk of recurrence in patients operated with limited resections but not lobectomy. This increased risk disappeared when the surgical margin was >1 cm.
August 7, 2013
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This joint statement regarding patient safety advocates a variety of systems to improve outcomes, including checklists, preoperative briefings, postoperative debriefings, and training in communication skills. Nontechnical skills are the key to improvements in safety. Anonymous event reporting and regular training in rare but significant events are also recommended.
August 7, 2013
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The surgical team at Cleveland Clinic have established a checklist, designed to become second nature to residents in training, for checking haemostasis after cardiac surgery. They have tested their process both in a trial mode and then in a service-wide implementation. This is an important part of establishing a plan for reduction of blood use and of re-opening for bleeding.
August 7, 2013
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Bouri and collegues have analysed data from multiple trials of beta blockade prior to non-cardiac surgery. Guidelines for management have been based on these findings. However, exclusion of one report, now discredited, suggests an increase in morbidity rather than a protective effect. They note the increase in the risk of mortality, the primary end-point at 30 days of 27%. These findings indicate the need for further well controlled studies into the use of beta blockers.
August 7, 2013
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In an editorial relating to a published meta-analysis ( Heart doi:10.1136/heartjnl-2013-304262), Hawkes raises the thorny but all too often repeated issue of research fraud. He estimates that in the UK, many deaths may be related to the recommendations regarding the use of β blockers during surgery, based mainly on a study by a now discredited researcher from Holland. There have been many recent and highly publicised instances of research fraud, leading to retractions of multiple peer reviewed papers, potentially impacting on our day to day clinical practice.
August 5, 2013
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This updated meta-analysis comparing bilateral internal mammary artery (BIMA) versus left internal mammary artery (LIMA) for coronary artery bypass grafting includes 27 observational studies and over 79,000 patients and demonstrates an increased long-term survival in patients receiving a BIMA operation versus a LIMA operation.
August 5, 2013
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With increasing access to online information, patients who have seen their purchasing ability decrease or have been turned down by insurance companies are increasingly turning to medical tourism as a realistic option. The article profiles patients such as Michael Shopenn who went to Belgium for his hip replacement. Implications for increasing price transparency, access and quality for patients are also touched upon in this insightful piece.
August 5, 2013
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In a remarkable large prospective study conducted in the Netherlands, patients who underwent balloon angioplasty alone in the late 1980s were followed for a median of 19.5 years. Of the total 806 patients, 287 persistent smokers after percutaneous coronoary intervention (PCI) were compared to 210 patients who quit smoking after PCI. Those who quit had at least 2.1 years life-expectancy gained compared to persistent smokers. The findings of this study reinforce the notion that interventions can be an opportunity for behavior modifications that can translate into survival benefits.
August 2, 2013
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This retrospective review evaluated combined carotid endarterectomy (CEA) and open heart surgery (OHS), staged CEA and OHS, or OHS combined with staged carotid artery stenting (CAS) using propensity score matching. Staged CAS-OHS and combined CEA-OHS had similar initial outcomes that were better than staged CEA-OHS owing to an increased risk of MI in the latter group. Staged CAS-OHS had better long-term outcomes compared to staged CEA-OHS and combined CEA-OHS. Overall, short-term and long-term outcomes appear to favor staged CAS-OHS.
August 2, 2013
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This issue focuses on total arterial revascularization, including BIMA vs LIMA, mid-term outcomes for RA vs SVG, and totally endoscopic CABGs.