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GENERAL SURGERY NEWS The Independent Monthly Newspaper for the General Surgeon
GeneralSurgeryNews.com
April 2021 • Volume 48 • Number 4
Court Ruling Alters Informed Consent Process
Overnight Telemedicine Services Reduce Mortality In ICU Patients
Physicians and Researchers React to Pennsylvania Ruling, Hoping to Avoid Litigation
By CHRISTINA FRANGOU
P
atients in the ICU who received telemedicine services overnight were less likely to die, and were more likely to be discharged quicker than patients receiving traditional ICU care with no on-site intensivist overnight, according to a study presented at the 2021 Critical Care Congress Virtual Event. The retrospective study ended just before the COVID19 pandemic began, but the results underscore the value of ICU telemedicine at a time when critical care specialists are in short supply, according to the investigators. “In an ideal world, patients would have an intensivist at the bedside 24/7, but the reality is that even if we had all of the money in the world, we don’t have enough trained professionals to do the job,” said Chiedozie I. Udeh, MD, a critical care anesthesiologist at the Cleveland Clinic
By CHRISTINA FRANGOU
A
four-year-old ruling by the Pennsylvania Supreme Court is making doctors and researchers across the country change the way they obtain patients’ informed consent, according to a panel of experts who spoke at the 2020 virtual Clinical Congress of the American College of Surgeons. Many physicians, researchers and administrators are concerned that the landmark decision, Shinal v. Toms, leaves them vulnerable to legal Continued on page 22
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The Post-Bariatric Patient With Complications
Short or Long Course Of Antibiotics for Intraabdominal Infections?
Tips on Diagnosis and Management For the Nonbariatric Surgeon
Evidence Leans Toward Shorter Duration, But Uncertainty Remains
By MONICA J. SMITH
By VICTORIA STERN
M
H
any general surgeons have only six weeks or so of training in bariatric surgery during residency, but they are likely to encounter post-bariatric surgery patients who will need their help. At the American College of Surgeons 2020 virtual Clinical Congress, surgeons discussed their approaches for treating these patients, who should see them, and when surgical intervention is urgent.
ow long should patients with intraabdominal infections receive antibiotics? Guidelines issued by the Surgical Infection Society and the Infectious Diseases Society of America in 2010 recommend limiting antimicrobial therapy from four to seven days in patients with adequate source control. However, in clinical practice, treatment for these patients typically lasts much longer—10 to 14 days, according to several reports (Surg Infect
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IN THE NEWS
3 Dexmedetomidine, Propofol Have Similar Outcomes in Ventilated Septic Patients J OURNAL WATCH
4 Anal Fistula; Cerebrovascular Injury; Opioids T H E GREAT DEBATES
14 Mandating Intraopertive Cholangiography
Arthrex Launches SynergyID™ Multispecialty Surgical Video System PAGE 16
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OPINION
Traumatic Brain Injury By HENRY BUCHWALD, MD, PhD
A
pproximately half of all Americans have sustained at least one traumaticc brain injury (TBI) due to major accidents, assault, military trauma and sports injuries. It is estimated that each year there are 2.8 million TBIs in the United States and 69 million worldwide, at a financial cost of $4 billion in the United States and $400 billion globally. Recent national focus on TBIs has been the result of the press coverage given to the longterm significance of frequently sustained concussions in the game of football. Continued on page 24