Pain and opioid use after colorectal resection for benign versus malignant disease: A single institution analysis.

Background: Studies comparing opioid needs between benign and malignant colorectal diseases are inconclusive.

Methods: Single institution analysis of prospectively maintained colorectal surgery database. Multiple regression analyses done on perioperative numeric pain scores (NPS) and opioids prescribed at discharge.

Health-care expenditures are less for minimally invasive than open colectomy for colon cancer: A US commercial claims database analysis.

Background: Most studies comparing surgical platforms focus on short-term outcomes. In this study, we compare the expanding societal penetration of minimally invasive surgery (MIS) with open colectomy by assessing payer and patient expenditures up to one year for patients undergoing surgery for colon cancer.

Methods: We analyzed the IBM MarketScan Database for patients who underwent left or right colectomy for colon cancer between 2013 and 2020.

Follow-up Blood Cultures in Gram-negative Bacteremia: How Do They Impact Outcomes?

Introduction: Several studies have questioned the utility of obtaining follow-up blood cultures in Gram-negative bacteremia, but the impact of this practice on clinical outcomes is not fully understood.

Methods: A retrospective cohort study of adult patients admitted with Gram-negative bacteremia over a two year period, to compare outcomes in those with and without follow-up blood cultures obtained. Data collected included demographics, comorbidities and presumed source of bacteremia.

Approach considerations for the management of strangulation in the emergency department.

Patients with a history of strangulation present to the emergency department with a variety of different circumstances and injury patterns. We review the terminology, pathophysiology, evaluation, management, and special considerations for strangulation injuries, including an overview of forensic considerations and legal framework for strangulation events.

Characterization of amniotic fluid sludge in preterm and term gestations.

Objective: To describe the characteristics of amniotic fluid sludge obtained from patients in term and preterm gestations.

Methods: This cross-sectional study included patients with dense aggregates of particulate matter detected in amniotic fluid, observed with transvaginal sonography. All patients were in labor and had an impending delivery, either preterm or at term.

Comparison of health-care utilization and expenditures for minimally invasive vs. open colectomy for benign disease.

Background: Adoption of minimally invasive approaches continues to increase, and there is a need to reassess outcomes and cost. We aimed to compare open versus minimally invasive colectomy short- and long-term health-care utilization and payer/patient expenditures for benign disease.

Methods: This is a retrospective analysis of IBM MarketScan Database patients who underwent left or right colectomy for benign disease between 2013 and 2018.

Locally advanced perforated appendiceal cancer: Case report and review.

Appendiceal cancers may be difficult to diagnose even after comprehensive investigation. This report of locally advanced perforated appendiceal adenocarcinoma attached to the terminal ileum, cecum, and rectosigmoid illustrates the management challenges that require comprehensive knowledge of pathologic variations and range from simple appendectomy to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

Examining the Public's Most Frequently Asked Questions Regarding COVID-19 Vaccines Using Search Engine Analytics in the United States: Observational Study.

Background: The emergency authorization of COVID-19 vaccines has offered the first means of long-term protection against COVID-19-related illness since the pandemic began. It is important for health care professionals to understand commonly held COVID-19 vaccine concerns and to be equipped with quality information that can be used to assist in medical decision-making.

Objective: Using Google's RankBrain machine learning algorithm, we sought to characterize the content of the most frequently asked questions (FAQs) about COVID-19 vaccines evidenced by internet searches.

A national database propensity score-matched comparison of minimally invasive and open colectomy for long-term opioid use.

Background: Opioid dependence is a public health crisis and surgery is a risk factor for long-term opioid use. Though minimally invasive surgery (MIS) is associated with less perioperative pain, demonstrating an association with less long-term opioid use would be another reason to justify adoption of minimally invasive techniques. We compared the rates for long-term opioid prescriptions among patients in a large national database who underwent minimally invasive and open colectomy.

A proposal for selective resuscitation of adult cardiac arrest patients in a pandemic.

Allocation of limited resources in pandemics begs for ethical guidance. The issue of ventilator allocation in pandemics has been reviewed by many medical ethicists, but as localities activate crisis standards of care, and health care workers are infected from patient exposure, the decision to pursue cardiopulmonary resuscitation (CPR) must also be examined to better balance the increased risks to healthcare personnel with the very low resuscitation rates of patients infected with coronavirus disease 2019 (COVID-19). A crisis standard of care that is equitable, transparent, and mindful of both human and physical resources will lessen the impact on society in this era of COVID-19.

Impact of Biopsy Technique on Clinically Important Outcomes for Cutaneous Melanoma: A Systematic Review and Meta-analysis.

We performed a systematic review and meta-analysis to examine the relationship between the type of biopsy technique employed in the diagnosis of cutaneous melanoma and 4 clinically important outcomes: melanoma-specific mortality, all-cause mortality, Breslow tumor depth, or melanoma recurrence. Our database was obtained by searching PubMed, Ovid MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Library from inception until December 6, 2019. Studies were identified that compared biopsy techniques used to diagnose cutaneous melanoma with any of our study outcomes.

Colon and Rectal Surgery Robotic Training Programs: An Evaluation of Gender Disparities.

Background: Female surgeons are subjected to implicit bias throughout their careers. The evaluation of gender bias in training is warranted with increasing numbers of female trainees in colon and rectal surgery.

Objective: This study aimed to evaluate gender bias in colon and rectal surgery training program operative experience.

Incorporating a Detailed Case Log System to Standardize Robotic Colon and Rectal Surgery Resident Training and Performance Evaluation.

Objective: This study was designed to evaluate a novel case log used as part of a standardized robotic colon and rectal surgery resident training program.

Design: This observational study describes a detailed procedure log developed to standardize training of residents in robotic colorectal surgery. The procedure log tracks resident total case numbers and execution of specific steps of eleven colorectal procedures.

Controversies in Surgical Oncology: Does the Minimally Invasive Approach for Rectal Cancer Provide Equivalent Oncologic Outcomes Compared with the Open Approach?

Background: Compared with open surgery, minimally invasive surgery for colon cancer has been shown to improve short-term outcomes and yield equivalent long-term oncologic results. It remains to be seen if oncologic outcomes for the minimally invasive approach for rectal cancer are equivalent to traditional open rectal resection.

Methods: We conducted a systematic review of Medline, SCOPUS, and Cochrane databases.

Unplanned Robotic-Assisted Conversion-to-Open Colorectal Surgery is Associated with Adverse Outcomes.

Background: Laparoscopic conversion-to-open colorectal surgery is associated with worse outcomes when compared to operations completed without conversion. Consequences of robotic conversion have not yet been determined. The purpose of this study is to compare short-term outcomes of converted robotic colorectal cases with those that are completed without conversion, as well as with cases done by the open approach.

Statin medications are associated with decreased risk of sepsis and anastomotic leaks after rectal resections.

Background: This study was designed to determine the effect of statins on colorectal postoperative complications related to sepsis. Previous studies have reported conflicting results.

Methods: This is a retrospective propensity score analysis of postoperative outcomes from a large regional database of patients who underwent elective colorectal resection from June 2012-July 2015.

The Effect of Formal Robotic Residency Training on the Adoption of Minimally Invasive Surgery by Young Colorectal Surgeons.

Objective: The minimally invasive approach to colorectal surgery is still underused. Only 50% to 60% of colectomies and 10% to 20% of rectal resections for cancer are performed laparoscopically. The increasing adoption of the robotic platform for colorectal surgery warrants re-evaluation of minimally invasive surgery (MIS) training techniques.

The cost of conversion in robotic and laparoscopic colorectal surgery.

Background: Conversion from minimally invasive to open colorectal surgery remains common and costly. Robotic colorectal surgery is associated with lower rates of conversion than laparoscopy, but institutions and payers remain concerned about equipment and implementation costs. Recognizing that reimbursement reform and bundled payments expand perspectives on cost to include the entire surgical episode, we evaluated the role of minimally invasive conversion in total payments.

Ketamine: 50 Years of Modulating the Mind.

Ketamine was introduced into clinical practice in the 1960s and continues to be both clinically useful and scientifically fascinating. With considerably diverse molecular targets and neurophysiological properties, ketamine's effects on the central nervous system remain incompletely understood. Investigators have leveraged the unique characteristics of ketamine to explore the invariant, fundamental mechanisms of anesthetic action.