Aspects Of Surgical Care Research Articles

International Hepato-Pancreato-Billiary Association (IHPBA) registry study on COVID-19 infections in HPB surgery patients

BackgroundIn response to the pandemic, the International Hepato-Pancreato-Biliary Association (IHPBA) developed the IHPBA-COVID Registry to capture data on HPB surgery outcomes in COVID-positive patients prior to mass vaccination programs. The aim was to provide a tool to help members gain a better understanding of the impact of COVID-19 on patient outcomes following HPB surgery worldwide. MethodsAn online registry updated in real time was disseminated to all IHPBA, E-AHPBA, A-HPBA and A-PHPBA members to assess the effects of the pandemic on the outcomes of HPB procedures, perioperative COVID-19 management and other aspects of surgical care. ResultsOne hundred twenty-five patients from 35 centres in 18 countries were included. Seventy-three (58%) patients were diagnosed with COVID-19 preoperatively. Operative mortality after pancreaticoduodenectomy and major hepatectomy was 28% and 15%, respectively, and 2.5% after cholecystectomy. Postoperative complication rates of pancreatic procedures, hepatic interventions and biliary interventions were respectively 80%, 50% and 37%. Respiratory complication rates were 37%, 31% and 10%, respectively. ConclusionThis study reveals a high risk of mortality and complication after HPB surgeries in patient infected with COVID-19. The more extensive the procedure, the higher the risk. Nonetheless, an increased risk was observed across all types of interventions, suggesting that elective HPB surgery should be avoided in COVID positive patients, delaying it at distance from the viral infection.

Selected Research and Dramatic Surgery Fish Cases of Incisive Complete in Fish Surgical

Abstract
 Health problems which can be treated exclusively by surgical means are relatively uncommon in fish. Fish surgery feat is vital essential and inevitable for the at fish diseases treatment and fish recovery. Consequently, only a limited number of procedures have been developed and reported in the literature. Despite use of analogous surgical instruments and surgical techniques to those employed in other animals, fish are a very diverse taxon and specific anatomy and physiology should be reviewed before surgical procedures are performed. Surgical planning often requires advanced diagnostics such as ultrasonography and imaging. Essantial surgical procedures include cutaneous and intracoelomic mass excision, ophthalmic procedures, reproductive surgery, brain surgery, visceral organs surgery, gastrointestinal foreign body removal, visceral organs examples, and buoyancy concerns. This article reviews several surgical procedures that have been performed in fish and highlight various aspects of surgical care which relate specifically to fishes. In this review article, administration of sedation and anesthesia, anaesthetic agents, pain in fish, obtrusive fish cases surgery, fish cases surgery operations examples, frequently used anesthetics and preoperative considerations, underwater surgery, out of water surgery, specific surgery procedures, microsurgery techniques, laparoscopy, catheter implantation and laparotomy were discussed for fish researchers. Suggestions for appropriate postoperative management are also discussed.

The “Intern” Label: Introducing Unnecessary Confusion and Bias?

The Oxford English Dictionary defines "intern" as "a student or trainee who works, sometimes without pay, at a trade or occupation in order to gain work experience." In the medical realm, the label "intern" may introduce confusion as well as implicit and explicit bias. In this study, we sought to examine the general public's perception of the label "intern" compared to the more accurate label "first-year resident." We developed 2 forms of a 9-item survey that assessed an individual's level of comfort with surgical trainees' participation in various aspects of surgical care and knowledge of medical education and work environment. One form used the label "intern" and the other used "first-year resident." San Antonio, TX. A total of 148 adults in the general population at 3 local parks on 3 separate occasions. A total of 148 individuals completed the survey (74 per form). Respondents who did not work in the medical field reported less comfort with interns vs first-year residents participating in various aspects of their care. Only 36% of respondents were able to correctly identify which surgical team members have completed a medical degree. Directly assessing perceptual incongruity between the labels "intern" and "first-year resident," 43% of respondents said interns have a medical degree compared to 59% for first-year residents (p = 0.008), 88% stated that interns work full-time in the hospital compared to 100% for first-year residents (p = 0.041), and 82% stated that interns get paid for their work in the hospital compared to 97% for first-year residents (p = 0.047). The label "intern" may confuse patients, family members, and perhaps other healthcare professionals regarding the level of experience and knowledge of first-year residents. We advocate for abolishing the term "intern" and replacing it with "first-year resident" or simply "resident."

P150 UTILISATION OF OVINE REINFORCED TISSUE MATRIX IN PAEDIATRIC RECONSTRUCTIVE SURGERY

Abstract Aim Abdominal and thoracic reconstructive surgery has always been an aspect of surgical care in children for conditions such as congenital abdominal wall defects, large hiatus herniae, incisional herniae and chest wall defects following tumour surgery. Biosynthetic matrices are ideal for reconstructive surgery in the paediatric population as consideration needs to be given to future growth and potential need for reoperation. Moreover, the use of synthetic materials in this setting is known to be associated with long term issues. We present the results of our experience with ovine reinforced tissue matrix1 in paediatric reconstructive surgery. Material and Methods All patients who underwent an operation at our institution using the biosynthetic matrix from March 2019 to April 2021 were identified retrospectively by searching theatre databases. Patient demographics, diagnoses and case notes were reviewed. Results The biosynthetic matrix was used in 26 children, (15 male and 11 female). Median age at insertion was 5.1 years (2.1 – 7.1 years). Median weight at insertion was 14.0kg (11.3 – 28.1kg). Patients had a history of hiatus hernia (n = 10), exomphalos (n = 6), emergency laparotomy (n = 3), congenital diaphragmatic hernia (n = 2) sternal sarcoma (n = 1), rib sarcoma (n = 1), gastroschisis (n = 1), recurrent umbilical hernia (n = 1) and direct inguinal hernia (n = 1). There were no hernial recurrences. There was a surgical site occurrence (SSO) in 12% - skin dehiscence (n = 2) and wound infection (n = 1). Median length of follow up was 7.9 months (4.5-9.0 months). Conclusions Our series demonstrates that ovine biosynthetic matrices can be used safely in paediatric reconstructive surgery with excellent outcomes and a very low rate of SSO. 1. OviTex®-TELA Bio

The Role of Telemedicine in Surgical Specialties During the COVID-19 Pandemic: A Scoping Review.

BackgroundThe objective of this study was to evaluate the current body of evidence on the use of telemedicine in surgical subspecialties during the COVID-19 pandemic.MethodsThis was a scoping review conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). MEDLINE via Ovid, PubMed, and EMBASE were systematically searched for any reports discussing telemedicine use in surgery and surgical specialties during the first period (February 2020–August 8, 2020) and second 6-month period (August 9–March 4, 2021) of the COVID-19 pandemic.ResultsOf 466 articles screened through full text, 277 articles were included for possible qualitative and/or quantitative data synthesis. The majority of publications in the first 6 months were in orthopedic surgery, followed by general surgery and neurosurgery, whereas in the second 6 months of COVID-19 pandemic, urology and neurosurgery were the most productive, followed by transplant and plastic surgery. Most publications in the first 6 months were opinion papers (80%), which decreased to 33% in the second 6 months. The role of telemedicine in different aspects of surgical care and surgical education was summarized stratifying by specialty.ConclusionTelemedicine has increased access to care of surgical patients during the COVID-19 pandemic, but whether this practice will continue post-pandemic remains unknown.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00268-021-06348-1.

International Delphi Expert Consensus on Safe Return to Surgical and Endoscopic Practice: From the Coronavirus Global Surgical Collaborative.

The aim of this work is to formulate recommendations based on global expert consensus to guide the surgical community on the safe resumption of surgical and endoscopic activities. The COVID-19 pandemic has caused marked disruptions in the delivery of surgical care worldwide. A thoughtful, structured approach to resuming surgical services is necessary as the impact of COVID-19 becomes better controlled. The Coronavirus Global Surgical Collaborative sought to formulate, through rigorous scientific methodology, consensus-based recommendations in collaboration with a multidisciplinary group of international experts and policymakers. Recommendations were developed following a Delphi process. Domain topics were formulated and subsequently subdivided into questions pertinent to different aspects of surgical care in the COVID-19 crisis. Forty-four experts from 15 countries across 4 continents drafted statements based on the specific questions. Anonymous Delphi voting on the statements was performed in 2 rounds, as well as in a telepresence meeting. One hundred statements were formulated across 10 domains. The statements addressed terminology, impact on procedural services, patient/staff safety, managing a backlog of surgeries, methods to restart and sustain surgical services, education, and research. Eighty-three of the statements were approved during the first round of Delphi voting, and 11 during the second round. A final telepresence meeting and discussion yielded acceptance of 5 other statements. The Delphi process resulted in 99 recommendations. These consensus statements provide expert guidance, based on scientific methodology, for the safe resumption of surgical activities during the COVID-19 pandemic.

Analysis of hidradenitis suppurativa hospitalizations: A report from the National Inpatient Sample database

Analysis of hidradenitis suppurativa hospitalizations: A report from the National Inpatient Sample database

The effect of implementing an aseptic practice bundle for anaesthetists to reduce postoperative infections, the Anaesthetists Be Cleaner (ABC) study: protocol for a stepped wedge, cluster randomised, multi-site trial

BackgroundPostoperative infection is a serious problem in New Zealand and internationally with considerable human and financial costs. Also, in New Zealand, certain factors that contribute to postoperative infection are more common in Māori and Pacific populations. To date, most efforts to reduce postoperative infection have focussed on surgical aspects of care and on antibiotic prophylaxis, but recent research shows that anaesthesia providers may also have an impact on infection transmission. These providers sometimes exhibit imperfect hand hygiene and frequently transfer the blood or saliva of their patients to their work environment. In addition, intravenous medications may become contaminated whilst being drawn up and administered to patients. Working with relevant practitioners and other experts, we have developed an evidence-informed bundle to improve key aseptic practices by anaesthetists with the aim of reducing postoperative infection. The key elements of the bundle are the filtering of compatible drugs, context-relevant hand hygiene practices and enhanced maintenance of clean work surfaces.MethodsWe will seek support for implementation of the bundle from senior anaesthesia and hospital leadership and departmental “champions”. Anaesthetic teams and recovery room staff will be educated about the bundle and its potential benefits through presentations, written material and illustrative videos. We will implement the bundle in operating rooms where hip or knee arthroplasty or cardiac surgery procedures are undertaken in a five-site, stepped wedge, cluster randomised, quality improvement design. We will compare outcomes between approximately 5000 cases before and 5000 cases after implementation of our bundle. Outcome data will be collected from existing national and hospital databases. Our primary outcome will be days alive and out of hospital to 90 days, which is expected to reflect all serious postoperative infections. Our secondary outcome will be the rate of surgical site infection. Aseptic practice will be observed in sampled cases in each cluster before and after implementation of the bundle.DiscussionIf effective, our bundle may offer a practical clinical intervention to reduce postoperative infection and its associated substantial human and financial costs.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12618000407291. Registered on 21 March 2018.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P72. Influence of racial disparities on short- and long-term perception of health status and patient-reported satisfaction after elective lumbar spine surgery

BACKGROUND CONTEXT In spine surgery, racial disparities have been shown to impact various aspects of surgical care. Previous studies have associated racial disparities with inferior surgical outcomes, including increased complication and 30-day readmission rates after spine surgery. Recently, patient reported outcomes (PROs) and satisfaction measures have been proxies for overall quality of care and hospital reimbursements. However, the influence racial disparities have on short- and long-term PROs and satisfaction after spine surgery is relatively unknown. PURPOSE The aim of this study was to investigate the impact racial disparities have on three-month and one-year PROs and satisfaction after elective lumbar spine surgery. STUDY DESIGN/SETTING This was a retrospectively analyzed study from a maintained prospective database. PATIENT SAMPLE The medical records of 345 adult (≥18years old) patients who underwent elective lumbar spine surgery for spondylisthesis (Grade 1), disc herniation, or stenosis at a major academic institution. OUTCOME MEASURES Patient reported outcomes instruments (ODI, VAS-Back Pain, and VAS Leg-Pain) were completed before surgery, then at 3- and 12-months after surgery along with patient satisfaction measures. METHODS This was a retrospectively analyzed study from a maintained prospective database. The medical records of 345 adult (≥18years old) patients who underwent elective lumbar spine surgery for spondylisthesis (Grade 1), disc herniation, or stenosis at a major academic institution were included in this study. We identified 53 (15.4%) African-American patients and 292 (84.6%) Caucasian patients. Patient demographics, comorbidities, postoperative complication and 30-day readmission rates were collected. Patients had prospectively collected outcome and satisfaction measures. Patient reported outcomes instruments (ODI, VAS-Back Pain, and VAS Leg-Pain) were completed before surgery, then at 3 and 12 months after surgery along with patient satisfaction measures. RESULTS Baseline patient demographics and comorbidities were similar between both cohorts, with AA patients having increased BMI (33.1±6.6 kg/m2 vs. 30.2±6.4 kg/m2, p=.0005) and diabetes (35.9% vs. 16.1%, p=.0008). Surgical indications, operative variables, and postoperative variables were similar between both cohorts. Baseline and follow-up PRO measures were worse in the AA cohort, with patients having a greater ODI (p CONCLUSIONS Our study suggests that there is a significant difference in perception of health, pain and disability between African-American and Caucasian patients at baseline, short- and long-term follow up which may influence overall patient satisfaction. Further studies are necessary to identify patient specific factors associated with racial disparities that may be influencing outcomes in order to adequately measure and assess overall PROs and satisfaction after elective lumbar spine surgery.

An Incision Closure Bundle for Colorectal Surgery: 2.0 www.aornjournal.org/content/cme.

Surgical site infections (SSIs) are among the most common and expensive of all health care–associated infections, and as many as 50% are considered preventable. Surgical care bundles, which involve a small set of reliably performed evidence-based practices, may effectively reduce SSI rates. However, closure of the surgical incision is one aspect of surgical care that is not well described in current SSI prevention bundles; this presents an opportunity for perioperative professionals to improve care by identifying and implementing evidence-based incision closure practices for high-risk procedures (eg, colorectal surgery). We propose and review the evidence supporting a colorectal incision closure bundle composed of a glove and sterile instrument set change, irrigation with 0.05% chlorhexidine solution, use of triclosan-coated sutures, removal of surgical drapes after applying postoperative dressings, use of topical skin adhesive or an antiseptic dressing, and distribution of comprehensive postoperative patient instructions.

Influence of racial disparities on patient-reported satisfaction and short- and long-term perception of health status after elective lumbar spine surgery.

OBJECTIVE In spine surgery, racial disparities have been shown to impact various aspects of surgical care. Previous studies have associated racial disparities with inferior surgical outcomes, including increased complication and 30-day readmission rates after spine surgery. Recently, patient-reported outcomes (PROs) and satisfaction measures have been proxies for overall quality of care and hospital reimbursements. However, the influence that racial disparities have on short- and long-term PROs and patient satisfaction after spine surgery is relatively unknown. The aim of this study was to investigate the impact of racial disparities on 3- and 12-month PROs and patient satisfaction after elective lumbar spine surgery. METHODS This study was designed as a retrospective analysis of a prospectively maintained database. The medical records of adult (age ≥ 18 years) patients who had undergone elective lumbar spine surgery for spondylolisthesis (grade 1), disc herniation, or stenosis at a major academic institution were included in this study. Patient demographics, comorbidities, postoperative complications, and 30-day readmission rates were collected. Patients had prospectively collected outcome and satisfaction measures. Patient-reported outcome instruments-Oswestry Disability Index (ODI), visual analog scale for back pain (VAS-BP), and VAS for leg pain (VAS-LP)-were completed before surgery and at 3 and 12 months after surgery, as were patient satisfaction measures. RESULTS The authors identified 345 medical records for 53 (15.4%) African American (AA) patients and 292 (84.6%) white patients. Baseline patient demographics and comorbidities were similar between the two cohorts, with AA patients having a greater body mass index (33.1 ± 6.6 vs 30.2 ± 6.4 kg/m2, p = 0.005) and a higher prevalence of diabetes (35.9% vs 16.1%, p = 0.0008). Surgical indications, operative variables, and postoperative variables were similar between the cohorts. Baseline and follow-up PRO measures were worse in the AA cohort, with patients having a greater baseline ODI (p < 0.0001), VAS-BP score (p = 0.0002), and VAS-LP score (p = 0.0007). However, mean changes from baseline to 3- and 12-month PROs were similar between the cohorts for all measures except the 3-month VAS-BP score (p = 0.046). Patient-reported satisfaction measures at 3 and 12 months demonstrated a significantly lower proportion of AA patients stating that surgery met their expectations (3 months: 47.2% vs 65.5%, p = 0.01; 12 months: 35.7% vs 62.7%, p = 0.007). CONCLUSIONS The study data suggest that there is a significant difference in the perception of health, pain, and disability between AA and white patients at baseline and short- and long-term follow-ups, which may influence overall patient satisfaction. Further research is necessary to identify patient-specific factors associated with racial disparities that may be influencing outcomes to adequately measure and assess overall PROs and satisfaction after elective lumbar spine surgery.

Racial Disparities in 30-Day Readmission Rates After Elective Spine Surgery: A Single Institutional Experience.

Retrospective cohort review. The aim of this study is to investigate whether patient race is an independent predictor of unplanned 30-day hospital readmission after elective spine surgery. Racial disparities are known to exist for many aspects of surgical care. However, it is unknown if disparities exist in 30-day readmissions after elective spine surgery, an area that is becoming a prime focus for clinical leaders and policymakers. Records of 600 patients undergoing elective spine surgery at a major academic medical center were reviewed. We identified all unplanned readmissions within 30 days of discharge. Unplanned readmissions were defined to have occurred as a result of either a surgical or a nonsurgical complication. Patient's records were reviewed to determine the cause of readmission and the length of hospital stay. The main outcome measure was risk-adjusted odds of all-cause 30-day readmission. We used multivariate logistic regression to determine if Black patients had an increased likelihood of 30-day readmission compared with White patients. Baseline characteristics were similar between both groups. Black patients had higher readmission rates than White patients (10.56% vs. 7.86%, P = 0.04). In a univariate analysis, race, body mass index, sex, patient age, smoking, diabetes, and fusion levels were associated with increased 30-day readmission rates. However, in a multivariate logistic regression model, race was an independent predictor of 30-day readmission after elective spine surgery. In addition, no significant differences in baseline, 1-year and 2-year patient reported outcomes measures were observed between both groups. This study suggests that Black patients are more likely to be readmitted within 30-days of discharge after elective spine surgery. Efforts at reducing disparities should focus not only on race-based measures but also effective post discharge care. 3.

Unexpected Gifts

Unexpected Gifts

Disparities in Surgical 30-Day Readmission Rates for Medicare Beneficiaries by Race and Site of Care

To determine whether black patients have higher odds of readmission than white patients after major surgery, and to ascertain whether these disparities are related to where black patients receive care. Racial disparities are known to exist for many aspects of surgical care. However, it is unknown if disparities exist in readmissions after a surgical procedure, an area which is becoming a prime focus for clinical leaders and policymakers. Using national Medicare data from 2007 to 2010, we examined 30-day readmissions for patients undergoing coronary artery bypass grafting, pulmonary lobectomy, endovascular abdominal aortic aneurysm repair, open abdominal aortic aneurysm repair, colectomy, and hip replacement. The main outcome measure was risk-adjusted odds of all-cause 30-day readmission. We used multivariate logistic regression to determine if black patients had higher readmission rates than white patients, and if so, whether this effect was mediated by the hospitals at which patients received care, or by poverty. Black patients had higher readmission rates than white patients (14.8% vs 12.8%, odds ratio [OR] 1.19; 95% confidence interval [CI], 1.16-1.22; P < 0.001). Patients undergoing major surgery at minority-serving hospitals also had higher readmission rates (14.3% vs 12.8%, OR 1.14, 95% CI 1.09-1.19; P < 0.001). In multivariate analyses, black patients at minority-serving hospitals had the highest overall odds of readmissions (OR 1.34). White patients at minority-serving hospitals (OR 1.15) and black patients at non-minority-serving hospitals (OR 1.20) also had higher odds of readmission than the reference group of white patients at non-minority-serving hospitals. Racial disparities were mediated in part by poverty. Among Medicare beneficiaries, black patients were more likely to be readmitted after hospitalization for surgical procedures. Since racial disparities in readmission rates are mediated both by patients' race and the hospital at which care is delivered, efforts at reducing disparities should focus not only on race-based measures but also on improving outcomes of care at minority-serving hospitals.

Understanding Variation in the Quality of the Surgical Treatment of Prostate Cancer

More than 80% of men with prostate cancer undergo active treatment, which can be associated with significant morbidity. Outcomes of surgical treatment vary widely depending on who treated the patient and where the patient was treated, implying that there is room for improvement. Factors influencing outcomes include patient characteristics as well as some measure of procedure volume. Although relationships between volume and outcomes for prostatectomy can most likely be explained by differences between surgeons (e.g., experience, technical skill), the hospital environment (e.g., team communication, safety culture) has the potential to either amplify or dampen the effects. Although most patient factors are immutable, these other aspects of surgical care and the delivery environment provide opportunities for quality improvement. Collaborative quality improvement initiatives may prove to be an important vehicle for achieving better prostate cancer care. These grass roots organizations, driven largely by urologists dedicated to providing prostate cancer care, have had initial successes in improving some aspects of quality in prostate cancer care, including reducing unwarranted use of imaging and perioperative morbidity. However, much of the variation in functional outcomes after prostate cancer surgery arises from differences in technical skill. Evaluating and improving intraoperative surgeon performance will inevitably be challenging, as they require acquisition and interpretation of data collected in the operating room. To this end, several methods have been described to objectively assess what happens in the operating room.

The Road Map to Better Knowledge? Care Pathways as an Educational Tool During Surgical Internship

Changes in medical practice have promoted a culture of standardized care. Care pathways have been proven to raise the quality of clinical care. Their effect as an educational tool has not been evaluated to date. To examine the educational role of care pathways in elective surgical admissions during surgical internship and the effect of their introduction on interns' confidence in performing tasks. A questionnaire survey was filled in by interns to determine their confidence in performing different tasks during elective surgical admission and postoperative care. Care pathways were then formulated for the commonest procedures within the Department of Colorectal Surgery. The same interns then repeated the same questionnaire after they were exposed to the care pathways. Thirty interns participated in the study with a 100% response rate. There was statistically significant improvement in tasks performed confidently in 20 out of 21 areas surveyed after the introduction of the care pathways. The percentage of tasks performed with no confidence decreased from 25% to 1% (p<0.001). Care pathways are an effective method to improve the efficiency and confidence of interns in different aspects of surgical care, thereby improving patient safety. They also function as a valuable educational tool to aid interns in the management of patients with complex surgical issues.

Understanding Variation in the Quality of the Surgical Treatment of Prostate Cancer

More than 80% of men with prostate cancer undergo active treatment, which can be associated with significant morbidity. Outcomes of surgical treatment vary widely depending on who treated the patient and where the patient was treated, implying that there is room for improvement. Factors influencing outcomes include patient characteristics as well as some measure of procedure volume. Although relationships between volume and outcomes for prostatectomy can most likely be explained by differences between surgeons (e.g., experience, technical skill), the hospital environment (e.g., team communication, safety culture) has the potential to either amplify or dampen the effects. Although most patient factors are immutable, these other aspects of surgical care and the delivery environment provide opportunities for quality improvement. Collaborative quality improvement initiatives may prove to be an important vehicle for achieving better prostate cancer care. These grass roots organizations, driven largely by urologists dedicated to providing prostate cancer care, have had initial successes in improving some aspects of quality in prostate cancer care, including reducing unwarranted use of imaging and perioperative morbidity. However, much of the variation in functional outcomes after prostate cancer surgery arises from differences in technical skill. Evaluating and improving intraoperative surgeon performance will inevitably be challenging, as they require acquisition and interpretation of data collected in the operating room. To this end, several methods have been described to objectively assess what happens in the operating room.

Mayo Clinic Consensus Recommendations for the Depth of Excision in Primary Cutaneous Melanoma

Currently, no data from randomized controlled clinical trials are available to guide the depth of resection for intermediate-thickness primary cutaneous melanoma. Thus, we hypothesized that substantial variability exists in this aspect of surgical care. We have summarized the literature regarding depth of resection and report the results of our survey of surgeons who treat melanoma. Most of the 320 respondents resected down to, but did not include, the muscular fascia (extremity, 71%; trunk, 66%; and head and neck, 62%). However, significant variation exists. We identified variability in our own practice and have elected to standardize this common aspect of routine surgical care across our institution. In light of the lack of evidence to support resection of the deep muscular fascia, we have elected to preserve the muscular fascia as a matter of routine, except when a deep primary melanoma or thin subcutaneous tissue dictates otherwise.

The emergence of radiofrequency identification tags: applications in surgery

Radiofrequency identification (RFID) is a wireless method of automatic identification. Currently, RFID tags are emerging into our environment in many aspects of our lives. Applications are being developed in a variety of fields, including health care. Aspects of surgical care will lend themselves to this approach. This technology could provide large amounts of data that not only carry the promise of improving health care, but also may have an impact on personal aspects of our daily lives. Each of us must become familiar with the risks and benefits of RFID use.

Surgical Management of Pancreatic Cancer

The overall prognosis after resection for adenocarcinoma of the pancreas remains poor; however, considerable progress has been made in terms of preoperative patient selection and radiographic staging, refinements in the technical aspects of surgical care, and investigations into the role of multimodality care for patients with potentially curable, resected cancers. Improvements in endoscopic decompression of malignant biliary obstruction have decreased the need for palliative bypass operations and have focused current surgical issues on ways to improve clinical outcomes after potentially curative resections. Controversies such as whether or not to perform extended lymph node dissections and standard versus pylorus-preserving resections have been addressed by randomized, prospective clinical trials. Major venous resections secondary to local tumor extension are now performed without an increase in morbidity or mortality and with survival rates comparable to standard resections. The impact of surgical specialization and regionalization of referrals to tertiary care centers is evident in markedly improved perioperative mortality rates. Neoadjuvant therapy is an area of current clinical investigation. This article describes the current preoperative, intraoperative, and postoperative issues in the surgical management of pancreatic cancer.