Commentary

Recommended reading: top papers in the surgical literature


 

Members of the Surgery News Editorial Advisory Board and their colleagues contributed to the list below, which represents articles from the recent surgical literature that they found particularly interesting. We hope readers across surgical specialties will find this information useful.

Bariatric surgery

"Surgical skill and complication rates after bariatric surgery" (N. Engl. J. Med. 2013;369:1434-2).

The authors conducted a study involving 20 bariatric surgeons in Michigan who participated in a statewide collaborative improvement program. Each surgeon submitted a single representative videotape of himself or herself performing a laparoscopic gastric bypass, which was rated in various domains of technical skill on a scale of 1-5 (with higher scores indicating more advanced skill) by at least 10 peer surgeons who were unaware of the identity of the operating surgeon. The relationships between these skill ratings and risk-adjusted complication rates were assessed with data from a prospective, externally audited, clinical-outcomes registry involving 10,343 patients. The mean summary ratings of technical skill ranged from 2.6 to 4.8 across the 20 surgeons. The bottom quartile of surgical skill, compared with the top quartile, was associated with higher complication rates (14.5% vs. 5.2%; P less than .001) and higher mortality (0.26% vs. 0.05%; P = .01). The lowest quartile of skill also was significantly associated with longer operations and higher rates of reoperation and readmission. The findings suggest that peer rating of operative skill may be an effective strategy for assessing a surgeon’s proficiency, the authors wrote.

Dr. Caprice Greenberg is an ACS Fellow, associate professor of surgery, and director of the Wisconsin Surgical Outcomes Research Program, University of Wisconsin, Madison.

Dr. Henry A. Pitt is an ACS Fellow and chief quality officer, Temple University Health System, Philadelphia.

Bioinformatics

"The Randomized Registry Trial – The Next Disruptive Technology in Clinical Research?" (N. Engl. J. Med. 2013;369:1579-81).

This editorial discusses the emergence of randomized registry trials, scientific studies that leverage clinical information collected in observational registries to expedite the process the conducting of large-scale randomized controlled trials. Randomized registry trials are described as potentially "disruptive technologies," which may transform existing standards, procedures, and cost structures for comparative-effectiveness research.

"Telemedicine as a potential medium for teaching the advanced trauma life support (ATLS) course"(J. Surg. Educ. 2013;70:258-64).

This article describes a controlled trial that compared the performance of first-year family practice residents who were randomized to traditional in-person or telemedicine ATLS courses. There were no statistically significant differences between the groups in terms of post-ATLS multiple-choice question test performance, instructor evaluation of student skill station performance, and overall pass rate, nor were there significant differences in the participant evaluations of course components and overall course quality.

Dr. Grace Purcell Jackson is an ACS Fellow and assistant professor of surgery, pediatrics, and biomedical informatics, Vanderbilt University, Nashville, Tenn.

Endocrine surgery

"A prospective, assessor-blind evaluation of surgeon-performed transcutaneous laryngeal ultrasonography in vocal cord examination before and after thyroidectomy" (Surgery 2013;154:1158-65).

This year there has been increased debate about the role of pre and postoperative laryngoscopy for patients undergoing thyroidectomy. An alternative to laryngoscopy that is garnishing a great deal of attention and interest in the endocrine surgery community is the use of transcutaneous ultrasound to evaluate vocal cord function. In this study of a series of 204 patients, the surgeons were able to visualize the vocal cords in 95% of patients. In their hands, ultrasound had a sensitivity of 93.3% and a negative predictive value of 99.4%. As many surgeons already use ultrasound regularly in their practice, this technique offers great promise for helping to identify patients who may benefit most from a laryngoscopic examination.

"Association Between BRAF V600E Mutation and Mortality in Patients With Papillary Thyroid Cancer" (JAMA 2013;309:1493-1501).

BRAF V600E is an important oncogene in papillary thyroid cancer. While it has been shown to play a useful role in the diagnosis of thyroid cancer, its impact on tumor behavior and patient outcomes is a matter of great debate. While several studies have shown that BRAF V600E is associated with a higher rate of nodal disease and recurrence, it hadn’t been shown to impact survival. This study included 1,849 patients from more than 13 centers and 7 countries. The researchers in this large study that BRAF V600E was associated with an increased incidence of cancer-related death, adjusted HR 2.66 (95% CI, 1.4-4.55). However, when they controlled for other known prognostic factors such as lymph node metastases, extrathyroidal extension, and distant metastases, they found that significance was lost. While BRAF V600E may lead to a worse prognosis, it may not add additional information beyond the already known prognostic factors in papillary thyroid cancer.

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