Journal of the American College of Surgeons
-
Randomized Controlled Trial
Hernia Prevention Using Biologic Mesh and/or Small Bites: A Multispecialty 2 × 2 Factorial Randomized Controlled Trial.
Ventral incisional hernias are the most common complication after abdominal operation. Randomized trials have shown efficacy of prophylactic synthetic mesh and small bites. Adoption of these practices has been limited due to concerns with placement of synthetic mesh in contaminated cases and small bites in an overweight population. We sought to assess the efficacy of prophylactic biologic mesh and small bites to prevent postoperative major complications: ventral incisional hernias, surgical site infection, reoperation, and death. ⋯ In this trial, biologic mesh and small bites appear to have no benefit. Further randomized trials are needed among high-risk patients before widespread adoption of prophylactic biologic mesh or small bites.
-
Randomized Controlled Trial
Real-Time Augmented Reality Annotation for Surgical Education During Laparoscopic Surgery: Results from a Single-Center Randomized Controlled Trial and Future Aspects.
We developed an interactive augmented reality tool (HoloPointer) that enables real-time annotation on a laparoscopy monitor for intraoperative guidance. This application operates exclusively via verbal commands and head movements to ensure a sterile workflow. ⋯ The majority of trainees improved their surgical performance using the HoloPointer in elective laparoscopic cholecystectomies, and the rate of classic but potentially misleading corrections was noticeably reduced. The HoloPointer has the potential to improve education in minimally invasive surgery.
-
Randomized Controlled Trial
Breast Cancer Recurrence by Subtype in a Diverse, Contemporary Cohort of Young Women.
Young breast cancer (YBC) patients are a unique subpopulation that are often underrepresented in randomized clinical trials. Furthermore, large national cancer databases lack detailed information on recurrence, a meaningful oncologic outcome for young patients. ⋯ In this large, diverse YBC cohort, recurrences were most frequent among HR + /HER2 - , G3, or HR - /HER2 + invasive tumors; most were distant. There were numerically similar locoregional-only recurrences after breast conservation vs mastectomy. Additional research is needed to identify predictors of recurrence.
-
Randomized Controlled Trial
Effectiveness of Single Chest Tube vs Double Chest Tube Application Post Decortication: Prospective Randomized Controlled Study.
Draining the chest cavity with 2 tubes is a common practice among thoracic surgeons. This research was conducted in Addis Ababa from March 2021 to May 2022. A total of 62 patients were included. ⋯ The placement of a single tube after decortication is effective in reducing drain output, time of drain, and hospital stay. There was no association with pain, and there was no effect on other endpoints.
-
Randomized Controlled Trial Multicenter Study
Predicting Futility in Severely Injured Patients: Using Arrival Lab Values and Physiology to Support Evidence-Based Resource Stewardship.
The recent pandemic exposed a largely unrecognized threat to medical resources, including daily available blood products. Some of the most severely injured patients who arrive in extremis consume tremendous resources yet succumb shortly after arrival. We sought to identify cut points available early in the patient's resuscitation that predicted 100% mortality. ⋯ The use of evidence-based STOP criteria provides cut points of futility to help guide early decisions for discontinuing aggressive treatment of severely injured patients arriving in extremis.