Pain management in the pediatric surgical patient.

Surg Clin North Am. 2012 Jun;92(3):471-85

Authors: Sohn VY, Zenger D, Steele SR

Abstract

Surgeons performing painful, invasive procedures in pediatric patients must be cognizant of both the potential short- and long-term detrimental effects of inadequate analgesia. This article reviews the available tools, sedation procedures, the management of intraoperative, postoperative, and postprocedural pain, and the issues surrounding neonatal addiction.

PMID: 22595704 [PubMed - in process]

Pyloric stenosis in pediatric surgery: an evidence-based review.

Surg Clin North Am. 2012 Jun;92(3):527-39

Authors: Pandya S, Heiss K

Abstract

Pyloric stenosis is a common pediatric surgical problem that requires a combination of both medical and surgical attention. This article reviews the classical elements necessary to care for the patient in a safe and effective manner. A well-tested management approach that can be applied to the general surgical environment is described. Perioperative management of the patient is discussed and the currently used techniques are reviewed. Current recommendations include the routine use of ultrasonography for diagnosis, attention to the preoperative correction of electrolytes, and the use of minimally invasive techniques for treatment.

PMID: 22595707 [PubMed - in process]

Pediatric gastroesophageal reflux disease.

Surg Clin North Am. 2012 Jun;92(3):541-58

Authors: Blanco FC, Davenport KP, Kane TD

Abstract

This article reviews the mechanisms responsible for gastroesophageal reflux disease (GERD), available techniques for diagnosis, and current medical management. In addition, it extensively discusses the surgical treatment of GERD, emphasizing the use of minimally invasive techniques.

PMID: 22595708 [PubMed - in process]

Pediatric Chest II: Benign Tumors and Cysts.

Surg Clin North Am. 2012 Jun;92(3):645-58

Authors: Petroze R, McGahren ED

Abstract

Thoracic tumors are rare in children, and metastatic or malignant conditions must be excluded during the diagnostic evaluation. The majority of primary pulmonary neoplasms in children are malignant; this article primarily addresses benign tumors. Surgical resection is the standard treatment for benign thoracic tumors in children. Thoracotomy is a traditional approach, but the thoracoscopic technique for diagnosis and treatment of thoracic tumors is well established. The term benign tumors can be a misnomer in that although their histology is not malignant, these tumors can be locally aggressive with significant associated morbidity and potential for mortality.

PMID: 22595713 [PubMed - in process]

Congenital diaphragmatic hernia and protective ventilation strategies in pediatric surgery.

Surg Clin North Am. 2012 Jun;92(3):659-68

Authors: Garcia A, Stolar CJ

Abstract

Infants affected with congenital diaphragmatic hernias (CDH) suffer from some degree of respiratory insufficiency arising from a combination of pulmonary hypoplasia and pulmonary hypertension. Respiratory care strategies to optimize blood gasses lead to significant barotrauma, increased morbidity, and overuse of extracorporeal membrane oxygenation (ECMO). Newer permissive hypercapnia/spontaneous ventilation protocols geared to accept moderate hypercapnia at lower peak airway pressures have led to improved outcomes. High-frequency oscillatory ventilation can be used in infants who continue to have persistent respiratory distress despite conventional ventilation. ECMO can be used successfully as a resuscitative strategy to minimize further barotrauma in carefully selected patients.

PMID: 22595714 [PubMed - in process]

Chest wall deformities in pediatric surgery.

Surg Clin North Am. 2012 Jun;92(3):669-84

Authors: Obermeyer RJ, Goretsky MJ

Abstract

Chest wall deformities can be divided into 2 main categories, congenital and acquired. Congenital chest wall deformities may present any time between birth and early adolescence. Acquired chest wall deformities typically follow prior chest surgery or a posterolateral diaphragmatic hernia repair (Bochdalek). The most common chest wall deformities are congenital pectus excavatum (88%) and pectus carinatum (5%). This article addresses the etiology, pathophysiology, clinical evaluation, diagnosis, and management of these deformities.

PMID: 22595715 [PubMed - in process]

Neonatal bowel obstruction.

Surg Clin North Am. 2012 Jun;92(3):685-711

Authors: Juang D, Snyder CL

Abstract

Newborn intestinal obstructions are a common reason for admission to neonatal ICUs. The incidence is estimated to be approximately 1 in 2000 live births. There are 4 cardinal signs of intestinal obstruction in newborns: (1) maternal polyhydramnios, (2) bilious emesis, (3) failure to pass meconium in the first day of life, and (4) abdominal distention. The presentation may vary from subtle and easily overlooked findings on physical examination to massive abdominal distention with respiratory distress and cardiovascular collapse. A careful history and physical examination often identify the diagnosis. Concomitant resuscitation (volume, gastric decompression, and ventilatory support) may be necessary.

PMID: 22595716 [PubMed - in process]

Congenital abdominal wall defects and reconstruction in pediatric surgery: gastroschisis and omphalocele.

Surg Clin North Am. 2012 Jun;92(3):713-27

Authors: Ledbetter DJ

Abstract

The embryology, epidemiology, associated anomalies, prenatal course and the neonatal and surgical care of newborns with gastroschisis and omphalocele are reviewed. For gastroschisis temporary intestinal coverage is often done before a more definitive operative closure that may be immediate or delayed. Outcomes in gastroschisis are determined by associated bowel injury. For omphalocele small defects are closed primarily while large defects are treated topically to allow initial skin coverage before a later definitive closure. Outcomes for omphalocele are determined mainly by the presence of associated anomalies.

PMID: 22595717 [PubMed - in process]

Pediatric Malignancies: Neuroblastoma, Wilm’s Tumor, Hepatoblastoma, Rhabdomyosarcoma, and Sacroccygeal Teratoma.

Surg Clin North Am. 2012 Jun;92(3):745-67

Authors: Davenport KP, Blanco FC, Sandler AD

Abstract

Common pediatric malignancies are reviewed: neuroblastoma, Wilms tumor, hepatoblastoma, rhabdomyosarcoma, and sacrococcygeal teratoma. Elements of presentation, diagnosis, staging, treatment, and longterm prognosis are discussed, with particular attention to surgical management.

PMID: 22595719 [PubMed - in process]

Vascular anomalies in pediatrics.

Surg Clin North Am. 2012 Jun;92(3):769-800

Authors: Fevurly RD, Fishman SJ

Abstract

Vascular tumors consist of lesions secondary to endothelial hyperplasia, incorporating both hemangiomas and less common pediatric vascular tumors. Vascular malformations arise by dysmorphogenesis and exhibit normal endothelial cell turnover. Some anomalies may incorporate multiple areas of the vascular tree. Use of this division has provided a clinically useful method of diagnosis and prognosis, as well as a guide to therapy. It is hoped that with continued investigation into the biology and pathogenesis of these lesions, a more comprehensive molecular classification will soon be developed.

PMID: 22595720 [PubMed - in process]

Pediatric surgery.

Surg Clin North Am. 2012 Jun;92(3):xvii-xix

Authors: Azarow KS, Cusick RA

PMID: 22595722 [PubMed - in process]

Hypoperfusion, shock states, and abdominal compartment syndrome (ACS).

Surg Clin North Am. 2012 Apr;92(2):207-20, vii

Authors: Ameloot K, Gillebert C, Desie N, Malbrain ML

Abstract

Cardiovascular dysfunction and failure are commonly encountered in patients with intra-abdominal hypertension or abdominal compartment syndrome. Accurate assessment and optimization of preload, afterload, and contractility are essential to restoring end-organ perfusion and maximizing patient survival. Application of a goal-directed resuscitation strategy, including abdominal decompression, when indicated, improves cardiac function, reverses end-organ failure, and minimizes intra-abdominal hypertension-related patient morbidity and mortality.

PMID: 22414408 [PubMed - indexed for MEDLINE]

Massive transfusion of blood in the surgical patient.

Surg Clin North Am. 2012 Apr;92(2):221-34, vii

Authors: Raymer JM, Flynn LM, Martin RF

Abstract

Hemorrhage remains a leading cause of morbidity and death in both civilian and military trauma. Restoration of effective end-organ perfusion by stopping hemorrhage and restoring intravascular volume in such a way as to minimize acidosis, hypothermia, and coagulopathy, almost always requires the use of blood and/or blood-component therapy. The best method to manage life-threatening hemorrhage is to avoid the circumstance that prompted it or to mitigate blood loss early in the injury cycle; otherwise, blood replacement must suffice. This article reviews current understanding of massive transfusion, along with its attendant unintended consequences, in the management of patients with profound hemorrhage.

PMID: 22414409 [PubMed - indexed for MEDLINE]

Pathogenesis and clinical and economic consequences of postoperative ileus.

Surg Clin North Am. 2012 Apr;92(2):259-72, viii

Authors: Doorly MG, Senagore AJ

Abstract

Postoperative ileus is a preventable disease with surprising economic consequences. Understanding the triad of dysmotility in conjunction with an enhanced recovery program improves patient outcome, decreases length of stay in hospital, and lowers the cost. Alvimopan and other investigational promotility medications can help attain these goals. Surgeons should avoid labeling all postoperative abdominal distention as ileus, which not only prevents timely diagnosis and treatment of early postoperative small bowel obstruction or acute colonic pseudo-obstruction but also increases patient morbidity and mortality.

PMID: 22414412 [PubMed - indexed for MEDLINE]

Postoperative pulmonary complications: pneumonia and acute respiratory failure.

Surg Clin North Am. 2012 Apr;92(2):321-44, ix

Authors: Sachdev G, Napolitano LM

Abstract

Postoperative pulmonary complications (atelectasis, pneumonia, pulmonary edema, acute respiratory failure) are common, particularly after abdominal and thoracic surgery, pneumonia and atelectasis being the most common. Postoperative pneumonia is associated with increased morbidity, length of hospital stay, and costs. Few institutions have pneumonia prevention programs for surgical patients, and these should be strongly considered. Acute respiratory failure is a life-threatening pulmonary complication that requires institution of mechanical ventilation and admission to the intensive care unit, and is associated with increased risk for ventilator-associated pneumonia. This article discusses epidemiology, risk factors, diagnosis, treatment, and prevention of these pulmonary complications in surgical patients.

PMID: 22414416 [PubMed - indexed for MEDLINE]

Multidrug-resistant organisms and antibiotic management.

Surg Clin North Am. 2012 Apr;92(2):345-91, ix-x

Authors: Barie PS

Abstract

The increasing prevalence of multidrug-resistant (MDR) infections in clinical practice stems from clinical and veterinary antibiotic use, and animal husbandry. As resistance to antibiotics becomes more common, a vicious circle develops wherein increasingly broad-spectrum agents must be prescribed empirically to ensure that initial antibiotic therapy is adequate to the task, and new, ever more powerful agents are needed for the treatment of MDR bacteria. Unfortunately, a dearth of new agents and drugs is in development. As clinicians we must learn to make do with what we have for the foreseeable future, according to the principles of antibiotic stewardship.

PMID: 22414417 [PubMed - indexed for MEDLINE]

Postoperative complications: delirium.

Surg Clin North Am. 2012 Apr;92(2):409-31, x

Authors: Allen SR, Frankel HL

Abstract

Delirium is a common feature of the postoperative period, leading to increased morbidity and mortality and significant costs. Multiple factors predispose a patient to delirium in its hypoactive, hyperactive, or mixed forms. Tools have been validated for its quick and accurate identification to ensure timely and effective multidisciplinary intervention and treatment. A significant percentage of patients may require placement in skilled nursing facilities or similar care environments because of the long-lasting effects. The physician must be vigilant in the search for and identification of all forms of delirium and must effectively treat the underlying medical condition and symptoms.

PMID: 22414419 [PubMed - indexed for MEDLINE]

Rescue therapies in the surgical patient.

Surg Clin North Am. 2012 Apr;92(2):433-9, x

Authors: Tisherman SA

Abstract

In the perioperative period, patients may suffer complications leading to serious adverse events. Patient deterioration needs to be rapidly identified, and a rapid response system must be initiated. Additional personnel may also be needed. Rescue therapies, beyond the routine resuscitative efforts, may be needed in some cases. The types of complications that may be faced include a difficult airway, refractory hypoxemia, pulmonary embolism, myocardial infarction, cardiac arrest with restoration of pulse but ongoing coma, and stroke. Although perioperative complications can be catastrophic, rapid intervention, including rescue therapies when necessary, can improve outcomes.

PMID: 22414420 [PubMed - indexed for MEDLINE]

Management of peri-operative complications.

Surg Clin North Am. 2012 Apr;92(2):xiii-xiv

Authors: Martin RF

PMID: 22414422 [PubMed - indexed for MEDLINE]

Fluid and electrolyte management for the surgical patient.

Surg Clin North Am. 2012 Apr;92(2):189-205

Authors: Piper GL, Kaplan LJ

Abstract

For surgical patients, appropriate selection and administration of fluids can mitigate against organ failure, whereas improper dosing can exacerbate already injured systems. Fluid and electrolyte goals and deficiencies must be defined for individual patients to provide the appropriate combination of resuscitation and maintenance fluids. Specific electrolyte abnormalities should be anticipated, identified, and corrected to optimize organ functions. Using the strong-ion approach to acid-base assessment, delivered fluids that contain calculated amounts of electrolytes will interact with the patient’s plasma charge and influence the patient’s pH, allowing the clinician to achieve a more precise end point.

PMID: 22414407 [PubMed - in process]

Postoperative gastrointestinal hemorrhage.

Surg Clin North Am. 2012 Apr;92(2):235-42

Authors: Jones S, May AK

Abstract

Significant gastrointestinal (GI) bleeding in the postoperative period is an uncommon complication of surgery. The management of GI bleeding within the postoperative period is complex because of a larger differential for the source of bleeding and a more complex risk/benefit analysis. There is minimal published literature specific to the management of postoperative GI bleeding, and the infrequency, complexity, and variability of the clinical setting of this complication confound simplistic consideration of its cause and therapy. This article outlines a systematic evaluation of the patient, treatment options, and assessment of risk/benefit ratio for various treatment options.

PMID: 22414410 [PubMed - in process]

Damage control for intra-abdominal sepsis.

Surg Clin North Am. 2012 Apr;92(2):243-57

Authors: Waibel BH, Rotondo MF

Abstract

With the success of damage-control surgery for the treatment of exsanguinating truncal trauma, it has been adapted to other surgical diseases associated with shock states, such as severe secondary peritonitis. The structured approach of damage control is easily adapted to and can incorporate the fundamental elements of the Surviving Sepsis Campaign. It is not meant to replace tried and true surgical principles, such as source control, but is a usable framework in managing the complicated circumstances seen with these patients.

PMID: 22414411 [PubMed - in process]

Perioperative nutritional support: immunonutrition, probiotics, and anabolic steroids.

Surg Clin North Am. 2012 Apr;92(2):273-83

Authors: Maung AA, Davis KA

Abstract

Nutritional support in surgical patients has evolved from simple provision of adequate calories to retard loss of lean body mass to the provision of specific nutrients in an attempt to manipulate metabolic and immune responses. Although still limited, the current understanding of this complex subject indicates that the type, route, amount, and composition of nutritional support provided to patients can affect their outcome. Further studies are, however, needed to better characterize the exact nutritional support that is most beneficial for a specific disease state and a specific patient.

PMID: 22414413 [PubMed - in process]

Surgical prophylaxis and other complication avoidance care bundles.

Surg Clin North Am. 2012 Apr;92(2):285-305

Authors: Schwulst SJ, Mazuski JE

Abstract

Individual health care quality measures that have been shown to improve outcome can be combined together into what are called care bundles, with the expectation that this set of practices produces further improvements in outcome. Prevention of surgical site infection is the focus of several quality measures put forward by the Surgical Care Improvement Project; these can collectively be considered a bundle as well. Whether these process measures, which include several components related to the administration of antibiotic prophylaxis, are effective in decreasing rates of surgical site infection has come under considerable debate recently.

PMID: 22414414 [PubMed - in process]

Organ failure avoidance and mitigation strategies in surgery.

Surg Clin North Am. 2012 Apr;92(2):307-19

Authors: McConnell KW, Coopersmith CM

Abstract

Postoperative organ failure is a challenging disease process that is better prevented than treated. Providers should use close observation and clinical judgment, and checklists of best practices to minimize the risk of organ failure in their patients. The treatment of multiorgan dysfunction syndrome (MODS) generally remains supportive, outside of rapid initiation of source control (when appropriate) and targeted antibiotic therapy. More specific treatments may be developed as the complex pathophysiology of MODS is better understood and more homogenous patient populations are selected for study.

PMID: 22414415 [PubMed - in process]

Prevention of chronic pain after surgical nerve injury: amputation and thoracotomy.

Surg Clin North Am. 2012 Apr;92(2):393-407

Authors: Buchheit T, Pyati S

Abstract

Although techniques for acute pain management have improved in recent years, a dramatic reduction in the incidence and severity of chronic pain following surgery has not occurred. Amputation and thoracotomy, although technically different, share the commonalities of unavoidable nerve injury and the frequent presence of persistent postsurgical neuropathic pain. The authors review the risk factors for the development of chronic pain following these surgeries and the current evidence that supports analgesic interventions. The inconclusive results from many preemptive analgesic studies may require us to reconceptualize the perioperative treatment period as a time of gradual neurologic remodeling.

PMID: 22414418 [PubMed - in process]

The american college of surgeons trauma quality improvement program.

Surg Clin North Am. 2012 Apr;92(2):441-54

Authors: Nathens AB, Cryer HG, Fildes J

Abstract

The American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) is a recent addition to the many quality improvement collaboratives that have been established in surgery. On the background of a well-established trauma center and its performance improvement activities, ACS TQIP offers the potential to advance trauma care and offers participating centers the opportunity to better understand their strengths and areas for improvement. The rationale for ACS TQIP’s development, implementation challenges, and potential for advancing the quality of trauma care are described.

PMID: 22414421 [PubMed - in process]

Management of Peri-operative Complications.

Surg Clin North Am. 2012 Apr;92(2):xv

Authors: Kaplan LJ, Rosenbaum SH

PMID: 22414423 [PubMed - in process]

Adverse events: root causes and latent factors.

Surg Clin North Am. 2012 Feb;92(1):89-100

Authors: Karl R, Karl MC

Abstract

This article describes the process of root cause analysis (RCA), the theories of error that underlie the concept of systemic or latent factors that allow errors to occur or to be propagated without correction; the difference between the process in health care and those found in high-reliability organizations; and suggests some ways to augment the standard health care RCA into a more robust and helpful process.

PMID: 22269263 [PubMed - indexed for MEDLINE]

Making sense of root cause analysis investigations of surgery-related adverse events.

Surg Clin North Am. 2012 Feb;92(1):101-15

Authors: Cassin BR, Barach PR

Abstract

This article discusses the limitations of root cause analysis (RCA) for surgical adverse events. Making sense of adverse events involves an appreciation of the unique features in a problematic situation, which resist generalization to other contexts. The top priority of adverse event investigations must be to inform the design of systems that help clinicians to adapt and respond effectively in real time to undesirable combinations of design, performance, and circumstance. RCAs can create opportunities in the clinical workplace for clinicians to reflect on local barriers and identify enablers of safe and reliable outcomes.

PMID: 22269264 [PubMed - indexed for MEDLINE]

Residency training oversight(s) in surgery: the history and legacy of the accreditation council for graduate medical education reforms.

Surg Clin North Am. 2012 Feb;92(1):117-23

Authors: Nauta RJ

Abstract

Despite a quarter century of discourse since a sentinel event in New York City raised the question of appropriate oversight for graduate medical education, many questions remain unanswered. Even with the Accreditation Council for Graduate Medical Education rules in place, some opportunity remains to examine handoff methodology, the relationship of duty hours to education, and the impact of fatigue on resident performance. Neurophysiologic adjuncts applied concomitantly to evaluation of didactic performance offer promise for data-driven definition of the optimal shift. Concurrently, the merits of specialty-specific oversight of graduate medical education remain under active consideration.

PMID: 22269265 [PubMed - indexed for MEDLINE]

Teaching the slowing-down moments of operative judgment.

Surg Clin North Am. 2012 Feb;92(1):125-35

Authors: St-Martin L, Patel P, Gallinger J, Moulton CA

Abstract

Surgical judgment has been an elusive construct to define, let alone teach or assess. A recent study has characterized a phenomenon called slowing down when you should, and suggests it is a hallmark for operative judgment. This research highlights areas where surgical judgment can be identified and therefore taught more explicitly in the operating room. Through the identification of these slowing-down moments and an understanding of how control is negotiated between surgeon and trainee during these moments, this article uses several theoretic frameworks to understand how teaching judgment in the operating room can be optimized.

PMID: 22269266 [PubMed - indexed for MEDLINE]

Patient safety.

Surg Clin North Am. 2012 Feb;92(1):xvii-xix

Authors: Sanchez JA

PMID: 22269271 [PubMed - indexed for MEDLINE]

High Reliability Organizations and Surgical Microsystems: Re-engineering Surgical Care.

Surg Clin North Am. 2012 Feb;92(1):1-14

Authors: Sanchez JA, Barach PR

Abstract

Error prevention and mitigation is the primary goal in high-risk health care, particularly in areas such as surgery. There is growing consensus that significant improvement is hard to come by as a result of the vast complexity and inefficient processes of the health care system. Recommendations and innovations that focus on individual processes do not address the larger and often intangible systemic and cultural factors that create vulnerabilities throughout the entire system. This article introduces basic concepts of complexity and systems theory that are useful in redesigning the surgical work environment to create safety, quality, and reliability in surgical care.

PMID: 22269256 [PubMed - in process]

Building high-performance teams in the operating room.

Surg Clin North Am. 2012 Feb;92(1):15-9

Authors: Sax HC

Abstract

Building effective teams requires the delineation of clear goals, an understanding of each member’s role in reaching that goal, and continuous feedback as issues are identified. The solo mentality required to become a health care provider needs to be modified to see a bigger picture. Finally, consistent buy-in and support from senior administration to deal with disruptive personalities is vital for long-term success.

PMID: 22269257 [PubMed - in process]

Human factors and operating room safety.

Surg Clin North Am. 2012 Feb;92(1):21-35

Authors: Elbardissi AW, Sundt TM

Abstract

A human factors model is used to highlight the nature of many systems factors that affect surgical performance, including the OR environment, teamwork and communication, technology and equipment, tasks and workload factors, and organizational variables. If further improvements in the success rate and reliability of cardiac surgery are to be realized, interventions need to be developed to reduce the negative impact that work system failures can have on surgical performance. Some recommendations are proposed here; however, several challenges remain.

PMID: 22269258 [PubMed - in process]

Surgeons’ Non-technical Skills.

Surg Clin North Am. 2012 Feb;92(1):37-50

Authors: Yule S, Paterson-Brown S

Abstract

The importance of non-technical skills to surgical performance is gaining wide acceptance. This article discusses the core cognitive and social skills categories thought to underpin medical knowledge and surgical expertise, and describes the rise of non-technical skill models of assessment in surgery. Behavior rating systems such as NOTSS (Non-Technical Skills for Surgeons) have been developed to support education and assessment in this regard. We now understand more about these critical skills and how they impact surgery. The challenge in the future is to incorporate them into undergraduate teaching, postgraduate training, workplace assessment, and perhaps even selection.

PMID: 22269259 [PubMed - in process]

A Comprehensive Unit-Based Safety Program (CUSP) in Surgery: Improving Quality Through Transparency.

Surg Clin North Am. 2012 Feb;92(1):51-63

Authors: Cooper M, Makary MA

Abstract

Many medical errors can be attributed to large and complex health care systems in which care is increasingly fragmented. Hospitals with good safety cultures have lower complication rates, and improved patient and staff satisfaction. Transparency in health care is an increasingly recognized means to improve outcomes by allowing the free market to reward hospitals with a strong safety culture, good outcomes, and compliance with evidence-based medicine. As more data become available regarding strategies that work to improve patient safety and such strategies are more widely implemented, significant improvements in the quality of care that is delivered nationwide should become apparent.

PMID: 22269260 [PubMed - in process]

Hospital-acquired infections.

Surg Clin North Am. 2012 Feb;92(1):65-77

Authors: Lobdell KW, Stamou S, Sanchez JA

Abstract

Health-acquired infection (HAI) is defined as a localized or systemic condition resulting from an adverse reaction to the presence of infectious agents or its toxins. This article focuses on HAIs that are well studied, common, and costly (direct, indirect, and intangible). The HAIs reviewed are catheter-related bloodstream infection, ventilator-associated pneumonia, surgical site infection, and catheter-associated urinary tract infection. This article excludes discussion of Clostridium difficile infections and vancomycin-resistant Enterococcus.

PMID: 22269261 [PubMed - in process]

Information technologies and patient safety.

Surg Clin North Am. 2012 Feb;92(1):79-87

Authors: Ellner SJ, Joyner PW

Abstract

Advances in health information technology provide significant opportunities for improvements in surgical patient safety. The adoption and use of electronic health records can enhance communication along the surgical spectrum of care. Bar coding and radiofrequency identification technology are strategies to prevent retained surgical sponges and for tracking the operating room supply chain. Computerized intraoperative monitoring systems can improve the performance of the operating room team. Automated data registries collect patient information to be analyzed and used for surgical quality improvement.

PMID: 22269262 [PubMed - in process]

The role of unconscious bias in surgical safety and outcomes.

Surg Clin North Am. 2012 Feb;92(1):137-51

Authors: Santry HP, Wren SM

Abstract

Racial, ethnic, and gender disparities in health outcomes are a major challenge for the US health care system. Although the causes of these disparities are multifactorial, unconscious bias on the part of health care providers plays a role. Unconscious bias occurs when subconscious prejudicial beliefs about stereotypical individual attributes result in an automatic and unconscious reaction and/or behavior based on those beliefs. This article reviews the evidence in support of unconscious bias and resultant disparate health outcomes. Although unconscious bias cannot be entirely eliminated, acknowledging it, encouraging empathy, and understanding patients’ sociocultural context promotes just, equitable, and compassionate care to all patients.

PMID: 22269267 [PubMed - in process]

When bad things happen to good surgeons: reactions to adverse events.

Surg Clin North Am. 2012 Feb;92(1):153-61

Authors: Luu S, Leung SO, Moulton CA

Abstract

Adverse events are, unfortunately, common components of surgical practice. Much has been done to develop safer systems to prevent these adverse events; however, there has been less focus on the surgeon experiencing these events. This article presents a framework to understand surgeons’ reactions to adverse events that was derived from a more recent study as well as a review of relevant psychology literatures. This framework is then situated within the broader picture of mindful practice to explore how the psychological and social dimensions of the surgeon can affect judgment and cognition.

PMID: 22269268 [PubMed - in process]

Open disclosure of adverse events: transparency and safety in health care.

Surg Clin North Am. 2012 Feb;92(1):163-77

Authors: Eaves-Leanos A, Dunn EJ

Abstract

Many patients suffering adverse events in health care turn to the legal system to learn what happened to them and to seek compensation. Health care providers have ethical, professional, and legal duties to disclose the harmful effects of care to the patient, regardless of how small the risk. The purpose of open disclosure is to explain what happened to the patient and to seek a just outcome for patient and provider. This article explores our experience of managing and implementing an open disclosure program in an acute and chronic tertiary care facility with university affiliation in the Veterans Health Administration.

PMID: 22269269 [PubMed - in process]

Patient safety.

Surg Clin North Am. 2012 Feb;92(1):xiii-xv

Authors: Martin RF

PMID: 22269270 [PubMed - in process]

Tipping the balance: the pathophysiology of obesity and type 2 diabetes mellitus.

Surg Clin North Am. 2011 Dec;91(6):1139-48, vii

Authors: McKenney RL, Short DK

Abstract

Obesity plays a major role in the development of type 2 diabetes mellitus, and it has long been accepted that weight loss plays a significant role in diabetes therapy. This weight loss has traditionally been accomplished through lifestyle changes including diet and exercise. What has only more recently gained acceptance is that bariatric surgery may have a role to play in diabetes therapy as well. This article discusses the pathophysiology of type 2 diabetes mellitus and obesity and provides a basic understanding of these diseases, which forms the basis for understanding the importance of weight loss in their treatment.

PMID: 22054144 [PubMed - indexed for MEDLINE]

Physiology of weight loss surgery.

Surg Clin North Am. 2011 Dec;91(6):1149-61, vii

Authors: Park CW, Torquati A

Abstract

The clinical outcomes achieved by bariatric surgery have been impressive. However, the physiologic mechanisms and complex metabolic effects of bariatric surgery are only now beginning to be understood. Ongoing research has contributed a large amount of data and shed new light on the science behind obesity and its treatment, and this article reviews the current understanding of metabolic and bariatric surgery physiology.

PMID: 22054145 [PubMed - indexed for MEDLINE]

Surgical treatment for morbid obesity: the laparoscopic Roux-en-Y gastric bypass.

Surg Clin North Am. 2011 Dec;91(6):1203-24, viii

Authors: Powell MS, Fernandez AZ

Abstract

Over the past 20 years bariatric surgery proved to be a valid treatment for reduction and elimination of obesity-related diseases and long-term sustainable weight loss. Minimally invasive or laparoscopic techniques such as laparoscopic Roux-en-Y (LRNY) have replaced open procedures. Many factors play important roles in the small intricacies and variations of the procedure, chief of which is the creation and size of the gastrojejunostomy. Regardless of the variations in technique, the LRNY remains the gold standard for the surgical treatment of clinically severe or morbid obesity, with relatively low morbidity and mortality.

PMID: 22054149 [PubMed - indexed for MEDLINE]

Complications of laparoscopic Roux-en-Y gastric bypass.

Surg Clin North Am. 2011 Dec;91(6):1225-37, viii

Authors: Al Harakeh AB

Abstract

Despite the well-documented safety of laparoscopic RYGB, several short-term and long-term complications, with varying degrees of morbidity and mortality risk, are known to occur. Bariatric surgeons, all too familiar with these complications, should be knowledgeable in risk-reduction strategies to minimize the incidence of complication occurrence and recurrence. Bariatric and nonbariatric surgeons who evaluate and treat abdominal pain should be familiar with these complications to facilitate early recognition and intervention, thereby minimizing the associated morbidity and mortality.

PMID: 22054150 [PubMed - indexed for MEDLINE]

Complications of adjustable gastric banding.

Surg Clin North Am. 2011 Dec;91(6):1249-64, ix

Authors: Snow JM, Severson PA

Abstract

Adjustable gastric banding (AGB) has become increasingly used by bariatric surgeons and their patients as the surgical weight loss procedure of choice. The popularity of this procedure is in large part a result of the remarkable safety profile and low initial complication rate. Complications of AGB were initially believed to be minor and infrequent, but longer-term studies have increasingly described complications that lead to revisional surgery. In addition, a larger fraction of patients fail to lose weight than with other surgical weight loss procedures, frequently necessitating conversion to these other options.

PMID: 22054152 [PubMed - indexed for MEDLINE]

Sleeve gastrectomy.

Surg Clin North Am. 2011 Dec;91(6):1265-79, ix

Authors: Brethauer SA

Abstract

Sleeve gastrectomy (SG) was originally performed as the restrictive component of the duodenal switch procedure. This partial vertical gastrectomy served to reduce gastric capacity and initiate short-term weight loss while the malabsorptive component of the operation (biliopancreatic diversion) provided the long-term weight loss. Some patients, however, could not undergo the intestinal bypass, and early investigations found that substantial weight loss occurred with the SG alone. The sleeve then developed into a risk management strategy for very large or high-risk patients who would not tolerate a longer or higher-risk procedure.

PMID: 22054153 [PubMed - indexed for MEDLINE]

Biliopancreatic diversion with duodenal switch.

Surg Clin North Am. 2011 Dec;91(6):1281-93, ix

Authors: Sudan R, Jacobs DO

Abstract

The biliopancreatic diversion with a duodenal switch (BPD-DS) is a less commonly performed but very effective bariatric procedure that has been in existence for more than 20 years. It is particularly effective for the resolution of diabetes and is associated with the highest weight loss among other bariatric operations. Typically, the BPD-DS is not associated with postgastrectomy symptoms, such as dumping and marginal ulceration. Because of its complexity, it has usually been performed by laparotomy in the past; but, more recently, minimally invasive techniques are being used with acceptable risk.

PMID: 22054154 [PubMed - indexed for MEDLINE]

Bariatric surgery outcomes.

Surg Clin North Am. 2011 Dec;91(6):1313-38, x

Authors: Dumon KR, Murayama KM

Abstract

Obesity is associated with an increased risk of death, and morbid obesity carries a significant risk of life-threatening complications such as heart disease, diabetes, and high blood pressure. Bariatric surgery is recognized as the only effective treatment of morbid obesity. The estimated number of bariatric operations performed in the United States in 2008 was more than 13 times the number performed in 1992. Despite this increase, only 1% of the eligible morbidly obese population are currently treated with bariatric surgery.

PMID: 22054156 [PubMed - indexed for MEDLINE]

Adolescent bariatric surgery.

Surg Clin North Am. 2011 Dec;91(6):1339-51, x

Authors: Ibele AR, Mattar SG

Abstract

Obesity has become an increasingly serious problem in pediatric and adolescent populations in the United States. Although bariatric surgery has been offered to morbidly obese adolescents for the past several decades, it remains controversial. However, the benefits of weight loss surgery in this population have been realized, particularly its long-term physical and emotional effects on adolescents. This article reviews the demographics and health implications of adolescent obesity, describes the most common adolescent bariatric surgical procedures and their outcomes, discusses the ethical issues involved in elective surgery in this population, and outlines the key components of an adolescent bariatric surgical program.

PMID: 22054157 [PubMed - indexed for MEDLINE]

Revisional bariatric surgery.

Surg Clin North Am. 2011 Dec;91(6):1353-71, x

Authors: Kellogg TA

Abstract

With the increase in bariatric surgical procedures, an increase in revision operations is expected. A thorough preoperative work-up is essential to formulate an appropriate revision strategy. Outcomes vary according to the primary operation and chosen approach to revision. Recent studies have shown acceptably low complication rates and good weight loss with the associated health benefits. Although there is no direct evidence in the form of randomized studies indicating which patients with inadequate weight loss or weight regain will benefit most from revision, or to support one particular revision approach rather than another, it is possible to develop general, effective strategies.

PMID: 22054158 [PubMed - indexed for MEDLINE]

Future directions in bariatric surgery.

Surg Clin North Am. 2011 Dec;91(6):1373-95, x

Authors: Lee SM, Pryor AD

Abstract

Bariatric surgery is a field in rapid evolution, and the speed of this evolution has been accelerating over the last several decades. A thorough understanding of past developments is crucial to anticipating the future intelligently. The trends that have driven evolution historically often persist, and continue to be influential in the future. With this in mind, this article briefly outlines the historical and current trends in bariatric surgery, and follows the trajectory of these trends into the future to anticipate the technologies and techniques that will be most important to the field in the coming years.

PMID: 22054159 [PubMed - indexed for MEDLINE]

Bariatric and metabolic surgery.

Surg Clin North Am. 2011 Dec;91(6):xvii

Authors: Kothari SN

PMID: 22054161 [PubMed - indexed for MEDLINE]

Gastric surgery. Foreword.

Surg Clin North Am. 2011 Oct;91(5):ix-xi

Authors: Martin RF

PMID: 21889022 [PubMed - indexed for MEDLINE]

Gastric surgery. Preface.

Surg Clin North Am. 2011 Oct;91(5):xiii

Authors: Fuhrman GM

PMID: 21889023 [PubMed - indexed for MEDLINE]

Gastric acid and digestive physiology.

Surg Clin North Am. 2011 Oct;91(5):977-82

Authors: Ramsay PT, Carr A

Abstract

The primary function of the stomach is to prepare food for digestion and absorption by the intestine. Acid production is the unique and central component of the stomach’s contribution to the digestive process. Acid bathes the food bolus while stored in the stomach, facilitating digestion. An intact defense against mucosal damage by the stomach’s acid is essential to avoid ulceration. This article focuses on the physiology of gastric acid production, the stomach’s defense mechanisms against acid injury, and the most common challenges to the gastric defenses. A brief description of the stomach’s nonacid digestive capabilities is included.

PMID: 21889024 [PubMed - indexed for MEDLINE]

Gastric motility physiology and surgical intervention.

Surg Clin North Am. 2011 Oct;91(5):983-99

Authors: Rostas JW, Mai TT, Richards WO

Abstract

Disordered gastric motility represents a spectrum of dysfunction ranging from delayed gastric emptying to abnormally rapid gastric transit, commonly referred to as the “dumping syndrome.” Both extremes of gastric motility disorders can arise from similar pathologic processes, and produce remarkably identical symptoms. This fact underscores the need to attain a precise diagnosis to ensure the institution of optimal therapy. Disordered gastric motility is primarily managed with dietary modification followed by pharmacotherapy, as traditional surgical interventions tend to be fraught with complications. However, continued improvements in minimally invasive diagnostic and therapeutic modalities promise novel options for earlier and more effective treatment.

PMID: 21889025 [PubMed - indexed for MEDLINE]

Emergency ulcer surgery.

Surg Clin North Am. 2011 Oct;91(5):1001-13

Authors: Lee CW, Sarosi GA

Abstract

The rate of elective surgery for peptic ulcer disease has been declining steadily over the past 3 decades. During this same period, the rate of emergency ulcer surgery rose by 44%. This means that the gastrointestinal surgeon is likely to be called on to manage the emergent complications of peptic ulcer disease without substantial experience in elective peptic ulcer disease surgery. The goal of this review is to familiarize surgeons with our evolving understanding of the pathogenesis, epidemiology, presentation, and management of peptic ulcer disease in the emergency setting, with a focus on peptic ulcer disease-associated bleeding and perforation.

PMID: 21889026 [PubMed - indexed for MEDLINE]

Gastroesophageal reflux disease.

Surg Clin North Am. 2011 Oct;91(5):1015-29

Authors: Rosemurgy AS, Donn N, Paul H, Luberice K, Ross SB

Abstract

Millions of Americans are affected by gastroesophageal reflux disease (GERD) in many different ways. The magnitude of the problem of GERD was brought to light by the ambulatory pH test, the introduction of minimally invasive surgery, and the advent of the many medications that are effective in acid suppression. Patients with GERD suffer from various consequences associated with the disease. However, interventions beyond medical therapy, such as laparoscopic fundoplication, provide satisfactory outcomes and definitive relief of acid reflux.

PMID: 21889027 [PubMed - indexed for MEDLINE]

Achalasia.

Surg Clin North Am. 2011 Oct;91(5):1031-7

Authors: Beck WC, Sharp KW

Abstract

This article reviews the diagnosis and treatment of achalasia, a rare esophageal motility disorder characterized by absent peristalsis and failure of the lower esophageal sphincter (LES) to relax. Various treatment options including management with sublingual nitrates or calcium channel blockers, injection of the LES with botulism toxin, pneumatic dilation of the LES, and pneumatic dilation are discussed. Laparoscopic Heller myotomy is minimally invasive with incumbent low morbidity and mortality rates, and combined with a partial fundoplication is a durable, safe, and effective treatment option for patients with achalasia.

PMID: 21889028 [PubMed - indexed for MEDLINE]

Gastric adenocarcinoma surgery and adjuvant therapy.

Surg Clin North Am. 2011 Oct;91(5):1039-77

Authors: Patel SH, Kooby DA

Abstract

Gastric adenocarcinoma is one of the most common causes of death worldwide. Surgical resection remains the mainstay of therapy, offering the only chance for complete cure. Resection is based on the principles of obtaining adequate margins, with the extent of lymphadenectomy remaining controversial. Neoadjuvant and adjuvant therapies are used to reduce local recurrence and improve long-term survival. This article reviews the literature and provides a summary of surgical management options and neoadjuvant/adjuvant therapies for gastric adenocarcinoma.

PMID: 21889029 [PubMed - indexed for MEDLINE]

Gastrointestinal stromal tumor surgery and adjuvant therapy.

Surg Clin North Am. 2011 Oct;91(5):1079-87

Authors: Grignol VP, Termuhlen PM

Abstract

Gastrointestinal stromal tumors (GIST) are a unique class of mesenchymal tumors identified within the past decade. Intense molecular and genetic study has been used to characterize these tumors and develop treatment strategies. Although the mainstay of treatment remains surgical resection, therapy targeted at inhibiting tyrosine kinases has had dramatic results. Because of the rapid accumulation of information about the diagnosis and treatment of these tumors, the National Comprehensive Cancer Network convened a GIST task force to provide updated recommendations in 2010. As understanding of these tumors advances, rapid changes in recommendations will continue and should warrant regular updates in tumor management.

PMID: 21889030 [PubMed - indexed for MEDLINE]

Minimally invasive gastric surgery.

Surg Clin North Am. 2011 Oct;91(5):1089-103

Authors: Carbonell AM

Abstract

The most common indications for gastric resection remain benign ulcer disease and neoplasm. Surgery for these diseases can be performed safely with laparoscopy. As surgeons adhere to the original tenets of open gastric resections while performing laparoscopic resections, disease outcomes will remain the same with the improved surgical outcomes of less pain, a shorter hospital stay, and a lower incidence of wound complications. Laparoscopic gastric resections can be divided into the more straightforward wedge/tumor resections performed for submucosal tumors or the more formal anatomic gastric resections. This article reviews the tools and techniques for laparoscopic gastric resection.

PMID: 21889031 [PubMed - indexed for MEDLINE]

Postgastrectomy syndromes.

Surg Clin North Am. 2011 Oct;91(5):1105-22

Authors: Bolton JS, Conway WC

Abstract

The first postgastrectomy syndrome was noted not long after the first gastrectomy was performed. The indications for gastric resection have changed dramatically over the past 4 decades, and the overall incidence of gastric resection has decreased. This article focuses on the small proportion of patients with severe, debilitating symptoms; these symptoms can challenge the acumen of the surgeon who is providing the patient’s long-term follow-up and care. The article does not deal with the sequelae of bariatric surgery.

PMID: 21889032 [PubMed - indexed for MEDLINE]

Miscellaneous disorders and their management in gastric surgery: volvulus, carcinoid, lymphoma, gastric varices, and gastric outlet obstruction.

Surg Clin North Am. 2011 Oct;91(5):1123-30

Authors: Dada SA, Fuhrman GM

Abstract

This article focuses on less common diseases that surgeons are called on for management options. Five topics-volvulus, carcinoid, lymphoma, gastric varices, and gastric outlet obstruction from peptic ulcer disease-are frequently used to evaluate surgical knowledge. Knowledge of these topics is useful for residents preparing for an in-training examination or board certification. Patients with these diseases require multidisciplinary management with oncologists and/or gastroenterologists, and mastery of these topics allows surgeons to effectively participate in the multidisciplinary care of these patients and advocate for surgical management when appropriate.

PMID: 21889033 [PubMed - indexed for MEDLINE]

Epidemiology and economic impact of obesity and type 2 diabetes.

Surg Clin North Am. 2011 Dec;91(6):1163-72

Authors: Shamseddeen H, Getty JZ, Hamdallah IN, Ali MR

Abstract

Obesity has become a major public health concern in the United States and the rest of the world. This disease carries significant health risks that encompass several organ systems. Type 2 diabetes mellitus is a major comorbidity of obesity that predisposes patients to significant end-organ damage. The prevalence of obesity and diabetes is increasing worldwide, and the economic impact of these diseases currently assumes a significant portion of health care expenditure. These factors mandate implementation of therapeutic medical and surgical strategies that target prevention and treatment of obesity and its related medical conditions.

PMID: 22054146 [PubMed - in process]

The economic costs of obesity and the impact of bariatric surgery.

Surg Clin North Am. 2011 Dec;91(6):1173-80

Authors: Richards NG, Beekley AC, Tichansky DS

Abstract

The obesity epidemic has far-reaching implications for the economic and health care future in the United States. Treatments that show reduction in health care costs over time should be approved and made available to as many patients as possible. It is our opinion that bariatric surgery meets this criterion. However, bariatric surgery cannot provide the impact necessary for reduction in health care and economic costs on a national scale. The obesity epidemic must be addressed by policy efforts at the local, state, and national levels. As experts on obesity, bariatric surgeons must be prepared to guide and inform these efforts.

PMID: 22054147 [PubMed - in process]

The history and evolution of bariatric surgical procedures.

Surg Clin North Am. 2011 Dec;91(6):1181-201

Authors: Baker MT

Abstract

The search for the ideal weight loss operation began more than 50 years ago. Surgical pioneers developed innovative procedures that initially created malabsorption, then restricted volume intake, and eventually combined both techniques. Variations, alterations, and modifications of these original procedures, combined with intense efforts to follow and document outcomes, have led to the evolution of modern bariatric surgery. More recent research has focused on the hormonal and metabolic effects of these procedures. These discoveries at the cellular level will help develop possible mechanisms of weight loss and comorbidity reduction beyond the traditional explanation of reduced food consumption and malabsorption.

PMID: 22054148 [PubMed - in process]

Evolution of laparoscopic adjustable gastric banding.

Surg Clin North Am. 2011 Dec;91(6):1239-47

Authors: McBride CL, Kothari V

Abstract

This article reviews the use of laparoscopic adjustable gastric banding in the United States today. It comments on the history of the procedure as well as technical aspects of the operation. Short-term and long-term outcomes of the procedure are examined, and the advantages and disadvantages of this procedure in comparison with the laparoscopic gastric bypass are discussed.

PMID: 22054151 [PubMed - in process]

Impact of bariatric surgery on comorbidities.

Surg Clin North Am. 2011 Dec;91(6):1295-312

Authors: Kaul A, Sharma J

Abstract

Published data show that bariatric surgery not only leads to significant and sustained weight loss but also resolves or improves multiple comorbidities associated with morbid obesity. Evidence suggests that the earlier the intervention the better the resolution of comorbidities. Patients with metabolic syndrome and comorbidities associated with morbid obesity should be promptly referred for consideration for bariatric surgery earlier in the disease process.

PMID: 22054155 [PubMed - in process]

Bariatric and metabolic surgery.

Surg Clin North Am. 2011 Dec;91(6):xiii-xv

Authors: Martin RF

PMID: 22054160 [PubMed - in process]

Nutrition and metabolism of the surgical patient, Part II.

Surg Clin North Am. 2011 Aug;91(4):xiii-xiv

Authors: Martin RF

PMID: 21787962 [PubMed - indexed for MEDLINE]

The relationships of nutrients, routes of delivery, and immunocompetence.

Surg Clin North Am. 2011 Aug;91(4):737-53, vii

Authors: Jayarajan S, Daly JM

Abstract

Malnutrition has marked consequences on surgical outcomes. Adequate nutrition is important for the proper functioning of all organ systems, particularly the immune system. Determination of the type and amount of nutrient supplementation and the appropriate route of nutrient delivery is essential to bolster the immune system and enhance the host’s response to stress. Correct administration of immunonutrients could lead to reductions in patient morbidity following major surgery, trauma, and critical illness.

PMID: 21787965 [PubMed - indexed for MEDLINE]

Contributions of intestinal bacteria to nutrition and metabolism in the critically ill.

Surg Clin North Am. 2011 Aug;91(4):771-85, viii

Authors: Morowitz MJ, Carlisle EM, Alverdy JC

Abstract

Important advances in the study of bacteria associated with the human gastrointestinal tract have significant implications for clinicians striving to meet the metabolic and nutritional needs of critically ill patients. This article offers a broad overview of the importance of the host-microbe relationship, discusses what is currently known about the role of gut microbes in nutrition and metabolism in the healthy human host, reviews how gut microbes are affected by critical illness, and discusses interventions that have already been used to manipulate the gut microbiome in patients in the intensive care unit.

PMID: 21787967 [PubMed - indexed for MEDLINE]

Nutritional support of surgical patients with inflammatory bowel disease.

Surg Clin North Am. 2011 Aug;91(4):787-803, viii

Authors: Wagner IJ, Rombeau JL

Abstract

Patients with inflammatory bowel disease (IBD) in need of surgery are often malnourished, which in turn increases the risk for postoperative complications. Malnutrition in IBD patients who must undergo surgery is due to the disordered activity of the diseased intestine, decreased dietary intake, and adverse effects of potent medications. IBD operations predispose patients to both macronutrient and micronutrient deficiencies. If the gut can be used safely it is the preferential route for feeding, though preoperative and postoperative parenteral nutrition remains a viable alternative for severely malnourished patients. New nutrient therapies include immunonutrition, fish oils, and probiotics.

PMID: 21787968 [PubMed - indexed for MEDLINE]

Nutritional support in acute and chronic pancreatitis.

Surg Clin North Am. 2011 Aug;91(4):805-20, viii

Authors: Grant JP

Abstract

Nutritional support can have a significant beneficial impact on the course of moderate to severe acute pancreatitis. Enteral nutrition is preferred, with emphasis on establishment of jejunal access; however, parenteral nutrition can also be of value if intestinal failure is present. Early initiation of nutritional support is critical, with benefits decreasing rapidly if begun after 48 hours from admission. Severe malnutrition in chronic pancreatitis can be avoided or treated with dietary modifications or enteral nutrition.

PMID: 21787969 [PubMed - indexed for MEDLINE]

Nutritional support of the obese and critically ill obese patient.

Surg Clin North Am. 2011 Aug;91(4):837-55, viii-ix

Authors: Kaafarani HM, Shikora SA

Abstract

With the dramatic increase in the prevalence of obesity worldwide and in the United States, it is virtually certain that clinicians will be caring for bariatric and obese nonbariatric patients in increasing numbers. This patient population presents several difficulties from the medical and surgical management perspectives. In particular, nutrition of the bariatric patient and critically ill obese patient is challenging. A clear understanding of the nutritional assessment and unique management strategies available for the bariatric and the critically ill obese patient is essential to provide them with the safest and most effective care.

PMID: 21787971 [PubMed - indexed for MEDLINE]

Nutritional considerations in adult cardiothoracic surgical patients.

Surg Clin North Am. 2011 Aug;91(4):857-75, ix

Authors: Sanchez JA, Sanchez LL, Dudrick SJ

Abstract

The importance of the preoperative nutritional status of cardiothoracic surgical patients in determining outcomes is demonstrated and discussed. Demographic, anthropometric, and biochemical changes in patients undergoing cardiothoracic surgery increase the importance of identifying those at risk for postoperative complications resulting from malnutrition. The interrelationships of chronic heart failure, cardiac cachexia, nutritional status, and nutritional support are identified and emphasized. The complexities of myocardial energetics and metabolism are outlined together with the nutrient needs for patients undergoing cardiac, pulmonary, or other intrathoracic operative procedures.

PMID: 21787972 [PubMed - indexed for MEDLINE]

Historical highlights of the development of enteral nutrition.

Surg Clin North Am. 2011 Aug;91(4):945-64, x

Authors: Dudrick SJ, Palesty JA

Abstract

The most significant events and discoveries regarding the development of enteral nutrition (EN) dating back to 1500 BC are chronicled. A more detailed description and discussion of subsequent more recent progress during the past two decades is focused primarily on 3 of the most dynamic areas of endeavor: tight glycemic control; timing and combining of EN and total parenteral nutrition to meet early target nutrition goals in intensive care unit patients; and the role, advances, and future of immunonutrition. An abridged classification of solutions for enteral feeding, and a brief outline of key prudent oral dietary guidelines are also presented.

PMID: 21787977 [PubMed - indexed for MEDLINE]

The prevention and treatment of intestinal failure-associated liver disease in neonates and children.

Surg Clin North Am. 2011 Jun;91(3):543-63

Authors: Nehra D, Fallon EM, Puder M

Abstract

Intestinal Failure Associated Liver Disease (IFALD) is a common and potentially life-threatening problem for pediatric patients receiving long-term parenteral nutrition (PN). Risk factors for IFALD include premature birth, low birth weight, long-term PN, intestinal stasis and sepsis. Preventative strategies are the cornerstone of improving outcomes in IFALD and include enteral feeding, weaning of PN, reduced dose lipid emulsions and the early recognition and treatment of sepsis. Recent work also demonstrates the efficacy of fish-oil based lipid emulsions in the prevention and treatment of IFALD. Transplantation is an option for end-stage liver disease but is associated with significant morbidity and mortality.

PMID: 21621695 [PubMed - indexed for MEDLINE]

Nutrition in critical care.

Surg Clin North Am. 2011 Jun;91(3):595-607

Authors: Bartlett RH, Dechert RE

Abstract

Critical care has evolved from a prolonged recovery room stay for cardiac surgery patients to a full medical and nursing specialty in the last 5 decades. The ability to feed patients who cannot eat has evolved from impossible to routine clinical practice in the last 4 decades. Nutrition in critically ill patients based on measurement of metabolism has evolved from a research activity to clinical practice in the last 3 decades. The authors have been involved in this evolution and this article discusses past, present, and likely future practices in nutrition in critically ill patients.

PMID: 21621698 [PubMed - indexed for MEDLINE]

Nutrition management of patients with malignancies of the head and neck.

Surg Clin North Am. 2011 Jun;91(3):631-9

Authors: O’Neill JP, Shaha AR

Abstract

The importance of nutrition and the prognostic impact of malnutrition in patients with head and neck cancer are not fully appreciated in the surgical world where a pervasive attitude exists that weight loss during treatment is inevitable and nutritional expertise or intervention may be dismissed out of ignorance. In this article, the authors explore the nutritional requirements of these patients and the impact of a multidisciplinary therapeutic approach to head, neck, and skull base cancer care.

PMID: 21621700 [PubMed - indexed for MEDLINE]

Nutrition and Metabolism of the Surgical Patient, Part II.

Surg Clin North Am. 2011 Aug;91(4):xv-xvii

Authors: Dudrick SJ, Sanchez JA

PMID: 21787963 [PubMed - in process]

Total parenteral nutrition and cancer: from the beginning.

Surg Clin North Am. 2011 Aug;91(4):727-36

Authors: Copeland EM, Pimiento JM, Dudrick SJ

The early development of total parenteral nutrition and its evolution as an adjunct to the nutritional, metabolic, and antineoplastic therapy of cancer patients is described. Examples related to the sine wave of responses to new data and discovery are placed in context to understand better past, present, and how and where to proceed in the future to achieve optimal results from multimodal comprehensive management of patients with malignancies. Practical and philosophic thoughts are proffered to justify continued, intensified, logical, controlled clinical studies directed toward establishing the most rational, safe, and effective use of total parenteral nutrition in treating patients with cancer.

PMID: 21787964 [PubMed - in process]

Nutrition and gut immunity.

Surg Clin North Am. 2011 Aug;91(4):755-70

Authors: Fukatsu K, Kudsk KA

The human intestine contains huge amounts of nonpathologic bacteria surviving in an environment that is beneficial to both the host and the bacterial populations. When short pauses in oral intake occur with minimal alterations in the mucosa-microbial interface, critical illness, with its attendant acidosis, prolonged gastrointestinal tract starvation, exogenous antibiotics, and breakdown in mucosal defenses, renders the host vulnerable to bacterial challenge and also threatens the survival of the bacteria. This review examines the altered innate and adaptive immunologic host defenses that occur as a result of altered oral or enteral intake and/or injury.

PMID: 21787966 [PubMed - in process]

The surgical treatment of type two diabetes mellitus.

Surg Clin North Am. 2011 Aug;91(4):821-36

Authors: Pories WJ, Mehaffey JH, Staton KM

Since the discovery that gastric bypass surgery leads to the rapid reversal of type 2 diabetes mellitus in morbidly obese patients, researchers have been searching for possible mechanisms to explain the result. The significance of bariatric surgery is twofold. It offers hope and successful therapy to the severely obese; those with T2DM, sleep apnea, or polycystic ovary disease; and others plagued by the comorbidities of the metabolic syndrome. This article examines four surgical procedures and their outcomes.

PMID: 21787970 [PubMed - in process]

Nutrition management of geriatric surgical patients.

Surg Clin North Am. 2011 Aug;91(4):877-96

Authors: Dudrick SJ

Surgery in geriatric patients is accompanied by increases in morbidity and mortality, increases in functional abnormalities and poor outcomes, and increases in severe malnutrition, compared with surgery of similar magnitude in nongeriatric patients. Hospitalized elderly patients are at significant risk of presenting with, or developing, protein-energy and other nutrient deficiencies. However, nutritional assessment of older geriatric patients, 65 to 100 years of age, is a challenging task because of lack of adequate age-specific reference data in this diverse and heterogeneous population. Dietary counseling and conscientious, aggressive nutritional support are required for optimal metabolic and surgical care of this age group.

PMID: 21787973 [PubMed - in process]

Overview of enteral and parenteral feeding access techniques: principles and practice.

Surg Clin North Am. 2011 Aug;91(4):897-911

Authors: Phillips MS, Ponsky JL

The importance of adequate nutrition has long been established in the surgical patient population. Enteral nutrition provides the safest, most cost-effective approach with endoscopic and surgical options for permanent access. Parenteral nutrition should be reserved for patients in whom enteral nutrition is contradicted. This article summarizes the routes of access for both enteral and parenteral nutrition as well as the indications, procedural pearls, and complications associated with each approach.

PMID: 21787974 [PubMed - in process]

Home parenteral nutrition support for intestinal failure.

Surg Clin North Am. 2011 Aug;91(4):913-32

Authors: Rhoda KM, Suryadevara S, Steiger E

Home parenteral nutrition is a life-saving treatment for many patients with intestinal failure. Expert placement and care of the vascular access device reduces the incidence of access-related complications. Careful monitoring of fluid, electrolyte, and macronutrient and micronutrient status can minimize major organ dysfunction and metabolic complications. A multidisciplined, integrated nutrition support team can allow patients with intestinal failure who need home parenteral nutrition maintain a near-normal life.

PMID: 21787975 [PubMed - in process]

Nutritional supplements in the surgical patient.

Surg Clin North Am. 2011 Aug;91(4):933-44

Authors: Stohs SJ, Dudrick SJ

This article presents an overview of the current knowledge, status, and use of supplements by patients before surgical operations, together with the benefits expected of the supplements by the patients. The indications, potential advantages and disadvantages, and the relationships with various aspects of the preoperative preparation and postoperative management of surgical patients are discussed, with emphasis on the significant percentage of this population that is deficient in fundamental nutrients. Recent revisions and recommendations for some of the macronutrients are presented, together with a summary of federal regulations and an oversight of supplements.

PMID: 21787976 [PubMed - in process]

Nutrition and metabolism of the surgical patient, part I.

Surg Clin North Am. 2011 Jun;91(3):xv-xvii

Authors: Dudrick SJ, Sanchez JA

PMID: 21621690 [PubMed - in process]

Nutrition and metabolism of the surgical patient, part I.

Surg Clin North Am. 2011 Jun;91(3):xiii-xiv

Authors: Martin RF

PMID: 21621689 [PubMed - in process]

Metabolic considerations in management of surgical patients.

Surg Clin North Am. 2011 Jun;91(3):467-80

Authors: Blackburn GL

Metabolic changes after surgery, trauma, or serious illness have a complex pathophysiology. The early posttraumatic stress response is physiologic and associated with a state of hyperinflammation, increased oxygen consumption, and increased energy expenditure. These are part of a systemic reaction that encompasses a wide range of endocrinological, immunologic, and hematological effects. Surgery initiates changes in metabolism that can affect virtually all organs and tissues; the metabolic response results in hormone-mediated mobilization of endogenous substrates that leads to stress catabolism. Hypercatabolism has been associated with severe complications related to hyperglycemia, hypoproteinemia, and immunosuppression. Proper metabolic support is essential to restore homeostasis and ensure survival.

PMID: 21621691 [PubMed - in process]

Management of enterocutaneous fistulas.

Surg Clin North Am. 2011 Jun;91(3):481-91

Authors: Schecter WP

Management of enterocutaneous fistulas (ECFs) involves (1) recognition and stabilization, (2) anatomic definition and decision, and (3) definitive operation. Phase 1 encompasses correction of fluid and electrolyte imbalance, skin protection, and nutritional support. Abdominal imaging defines the anatomy of the fistula in phase 2. ECFs that do not heal spontaneously require segmental resection of the bowel segment communicating with the fistula and restoration of intestinal continuity in phase 3. The enteroatmospheric fistula (EAF) is a malevolent condition requiring prolonged wound care and nutritional support. Complex abdominal wall reconstruction immediately following fistula resection is necessary for all EAFs.

PMID: 21621692 [PubMed - in process]

Nutrition support in the pediatric surgical patient.

Surg Clin North Am. 2011 Jun;91(3):511-41

Authors: Herman R, Btaiche I, Teitelbaum DH

This article deals with the nutritional needs of pediatric patients. It begins by discussing the caloric requirements of different pediatric patients and moves on to a breakdown of the specific nutrients required. It then progresses to a detailed description of the enteral and parenteral modalities for delivery of nutrition to pediatric patients. The article concludes with a discussion of specific problems and disorders encountered in pediatric surgical patients.

PMID: 21621694 [PubMed - in process]

Current management of the short bowel syndrome.

Surg Clin North Am. 2011 Jun;91(3):493-510

Authors: Thompson JS, Weseman R, Rochling FA, Mercer DF

Short bowel syndrome is a challenging clinical problem that benefits from a multidisciplinary approach. Much progress has recently been made in all aspects of management. Medical intestinal rehabilitation should be the initial treatment focus, and several new potential pharmacologic agents are being investigated. Surgical rehabilitation using nontransplant procedures in selected patients may further improve intestinal function. Intestinal lengthening procedures are particularly promising. Intestinal transplantation has increasingly been used with improving success in patients with life-threatening complications of intestinal failure.

PMID: 21621693 [PubMed - in process]

Adjuvant nutrition management of patients with liver failure, including transplant.

Surg Clin North Am. 2011 Jun;91(3):565-78

Authors: Kerwin AJ, Nussbaum MS

This article reviews nutrition support in patients with liver disease, including those who are undergoing surgery or liver transplant. The topics covered include the multifactorial etiology of malnutrition, nutritional assessment, and nutritional therapy. Recommendations for use of both enteral and parenteral nutrition are given in patients with alcoholic hepatitis, cirrhosis, and acute liver failure and in patients undergoing surgery or liver transplant.

PMID: 21621696 [PubMed - in process]