CONVENTION ISSUE:
American Society of Colon and Rectal Surgeons
GENERALSURGERYNEWS.COM
May 2015 • Volume 42 • Number 5
The Independent Monthly Newspaper for the General Surgeon
Opinion
New Studies Reveal Shift in Understanding of Sepsis
You Are as Smart As Your Patients
Return to Hospital After Sepsis ‘Cure’ Likely; New Approach Needed
B Y I BRAHIM E ID , MD
A
s surgeons, we have always lived in the selfcontained medical community bubble where our image depends predominantly on our personal and social relationships with our peers and referring physicians, and where our hospital status emanates from the volume of procedures we command, assuming a reasonable safety profile. Patients have always been handed down our recommendations as the only path to better health. This physician-centric world belongs to the past, and the future one being charted in front of our eyes is governed by new rules that use words like “patient experience,” “engagement,” “patient-centered” and “value-based.” This new world, outlined by the language of health care reform, was born out of the exorbitant cost of the status quo, a cost that was not matched with the quality that other less expensive systems provided. The 2009 white paper by Thomson Reuters’s Robert Kelley, outlining where
see page 16
B Y M ONICA J. S MITH
A
year ago, a study published in the Journal of the American Medical Association ((JAMA A) reported that more patients than ever are surviving after treatment for severe sepsis (2014;311:1295-1297). But now, research shows that the finding only tells one part of the story. A spate of recent studies shows the immense burden of sepsis survivorship in the United States. Four studies and two editorials revealed that people who are treated for and survive severe sepsis and septic shock are frequently rehospitalized within a few months, often for potentially preventable conditions,
and credited it with helping prepare him for a broad surgical practice. “I saw TTP as a great opportunity for a number of reasons. The first, and perhaps most important for me in my residency, was to plan for a gradual increase in autonomy from resident to completely independent practice,” Dr. Kellogg said.
CHATTANOOGA, TENN.—Routine torso computed tomography (CT) imaging is a significant g source of patient radiation, cost and delays to treatment. New research suggests that a thorough history and physical exam in the trauma bay can allow the physician to order CT imaging selectively in patients with lowimpact blunt trauma. “Our aim was to demonstrate if it was safe and feasible to limit torso imaging of these patients, especially those who fall from standing, toileting or sleeping,” said Kedar Lavingia, MD, a postgraduate year 3 resident at Eastern Virginia Medical School in Norfolk. To do so, Dr. Lavingia and his colleagues conducted a retrospective chart review of 156 patients admitted to the trauma bay between January 2013 and April 2014, eliminating nine who met the exclusion criteria of undergoing intubation or having a Glasgow Coma Score (GCS) less than 13. Dr. Lavingia reported the group’s findings at the Southeastern Surgical Congress. The investigators defined significant thoracic injury as hemothorax (HTX), pneumothorax (PTX) or more than three rib fractures. Significant abdominal injuries were defined as solid organ
see SURGICAL TRAINING page 23
see CT SCANNING page 27
see SEPSIS page 26
Lacking Confidence in Training? Program Provides Bridge to Practice B Y M ONICA J. S MITH CHATTANOOGA, TENN.—As one of the first participants in the American College of Surgeons (ACS) Transition to Practice (TTP) Program, Benjamin E. Kellogg, MD, said the program eased his transition from resident to a practicing general surgeon,
INSIDE In the News
In the News
Opinion
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Doing the Math: Can Robotic Surgery Be Cost-Effective for General Surgery? Part 1 of 2
Unnecessary CTs Avoided With Thorough History, Exam
B Y C HRISTINA F RANGOU
see PATIENT-CENTERED page 28
Perioperative Goal-Directed Therapy: Optimizing Fluid Management and Reducing Postoperative Complications
Selective Scanning Warranted for LowImpact Trauma
Nearly 500,000 Americans Suffered From C. Difficile e Infections In a Single Year
Oncologist argues that breast ultrasound-guided biopsies should be done the same day as imaging whenever possible