Surgery News - May 2008 - (Page 1)

VOL. 4 • NO. 5 • MAY 2008 PITTSBURGH MEDICAL CENTER/PRESBYTERIAN HOSPITAL Innovative GI Procedures May Improve Diabetes Experimental approach holds promise. B Y J E F F E VA N S INSIDE 20/20N Crystal VISIO Ball Dr. Paul Taheri is the first of many experts invited to envision surgery’s future. • 4 THE Else vier Global Medical Ne ws The anteroaxillary approach is now standard for lung transplants at the University of Pittsburgh, said Dr. Yoshiya Toyoda (left). New Lung Approach Speeds Extubation BY MITCHEL L. ZOLER Else vier Global Medical Ne ws B O S T O N — A novel, minimally invasive approach for lung transplant surgery produces small, cosmetically superior incisions and causes less pain than the conventional surgical method, according to results from a series of 116 patients. In 68 patients treated with an anteroaxillary approach and 48 patients treated with a conventional approach, survival rates to 180 days after surgery were very similar—more than 90% in both groups. Patients in the anteroaxillary group were more likely to be extubated within 48 hours of surgery and less likely to need mechanical ventilation for more than 5 days, Dr. Yoshiya Toyoda reported at the annual meeting of the International Society for Heart and Lung Transplantation. The anteroaxillary approach also preserved bilateral internal mammary arteries and the sternum, permitted rapid use of cardiopulmonary bypass, resulted in quick chest closure because of a small incision, and required less manipulation of the heart and phrenic nerve. Because of these and other advantages, the anteroaxillary approach has become the standard surgical method used for lung transplants at the University of Pittsburgh Medical Center, where Dr. Toyoda is a thoracic See Lung • page 10 P H I L A D E L P H I A — Surgical procedures designed to correct the pathophysiologic mechanisms of type 2 diabetes appear to improve the hormonal profile, glycemic control, and comorbidities of patients who are not morbidly obese, according to the results of two studies. The researchers evaluated the effects of interposing a segment of ileum into the proximal jejunum with a sleeve gastrectomy, or of interposing a segment of ileum into the proximal duodenum with a diverted sleeve gastrectomy, said Dr. Aureo L. DePaula, who presented the studies at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons. Dr. Philip R. Schauer, who discussed one of the studies at the meeting, cautioned that “these are truly experimental procedures and they should be done only within the context of an IRB [institutional review board] protocol until we have further data to suggest that they are safe and efficacious.” Dr. Schauer is director of the Cleveland Clinic Bariatric and Metabolic Institute. The effect of incretins—hormones that increase insulin secretion—is markedly reduced in type 2 diabetes, especially in regard to the decline of glucagon-like peptide 1 (GLP-1) and resistance to glucose-dependent insulinotropic peptide (GIP), said Dr. DePaula of the department of surgery at Hospital de Especialidades, Goiânia, Brazil. Based on the pathophysiologic mechanisms of type 2 diabetes, Dr. DePaula and his coinvestigators designed the procedures to address the following objectives: Early exposure of ingested nutrients to the transposed See Diabetes • page 8 News From the College UNIVERSITY Medical Modeling A new database consolidates information on medical modeling and simulation. • 1 3 OF Thoracic Surgery Ventricular Valve Transcatheter insertion of a stented aortic valve through the left ventricular apex has saved some high-risk patients. • 1 6 Finance Taking Stock Understanding market trends can help keep investors calm in a volatile economy. • 1 9 Quality Programs Differ on Risk Data B Y J E F F E VA N S Else vier Global Medical Ne ws VITAL SIGNS Number of Candidates on Organ Transplant Waiting List Kidney Liver Heart Kidney and pancreas Lung 2,627 2,322 ELSEVIER GLOBAL MEDICAL NEWS 73,487 16,669 2,321 Pancreas 1,649 Intestine 219 Heart and lung 112 Note: Based on U.S. data as of Oct. 8, 2007. Source: Kalorama Information C I N C I N N A T I — Quality improvement programs at hospitals might report significantly different rates of risk-adjusted comorbidities and outcomes after surgery, according to a retrospective analysis of two programs within one health system. The risk-adjusted mortalities calculated by the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) and the University HealthSystem Consortium (UHC) for the general and vascular surgery services in the Ohio State University health system were different for “pretty much the same patient population over the same time period,” said Dr. Steven M. Steinberg at the annual meeting of the Central Surgical Association. In an effort to understand the reasons for such variance, Dr. Steinberg, chief of the division of critical care, trauma, and burn in the department of surgery at Ohio State, and his coinvestigators compared the NSQIP records of 120 consecutive general and vascular surgery inpatients with their matching records, which were SURGERY NEWS submitted to UHC from January to June 2006. NSQIP provides a prospective database of 30-day, risk-adjusted surgical outcome data on inpatients and outpatients from participating hospitals. NSQIP’s methodology includes the following: Standardized definitions for comorbidities and outcomes. See Risk Data • page 20 Presorted Standard U.S. Postage PAID Permit No. 384 Lebanon Jct. KY 60 Columbia Rd., Bldg. B Morristown, NJ 07960 CHANGE SERVICE REQUESTED

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Surgery News - May 2008 Contents New Lung Approach Speeds Extubation Innovative GI Procedures May Improve Diabetes Quality Programs Differ on Risk Data Crystal Ball Medical Modeling Ventricular Valve Taking Stock

Surgery News - May 2008

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