In Brief

Optimal timing of perioperative chemical thromboprophylaxis in elective major abdominal surgery

This meta-analysis identified 14 studies (24,922 patients) investigating the timing of chemoprophylaxis in patients
undergoing major abdominal surgery. Chemoprophylaxis was initiated before skin closure in 10,403 patients and postoperatively in 14,519 patients. Symptomatic and overall VTE rates were comparable. Intraoperative usage increased the risk of bleeding, blood transfusion and reintervention. Authors recommended initiating chemoprophylaxis postoperatively in elective abdominal surgery.

Klonis C, Ashraf H, Cabalag C et al. Ann Surg 2023; 277(6): 904–911

Oncological surgery follow-up and quality of life: meta-analysis

This meta-analysis evaluated 35 studies of different follow-up strategies after oncological surgery. The results of this review suggest that a lower-intensity follow-up approach is non-inferior and, in some instances, even results in slightly better health-related quality of life (HRQoL) and lower anxiety rates.

Overall, these findings enable a reduction in follow-up intensity for patients with cancer without impact on the main purposes of follow-up: cancer-specific survival and HRQoL. Authors concluded that a patient-tailored follow-up approach is feasible.

Wullaert L, Voigt KR, Verhoef C, Husson O, Grunhagen DJ. Br J Surg 2023; 110(6): 655–665

Early outcomes following implementation of a multispecialty geriatric surgery pathway

This observational study evaluated geriatric-specific outcomes following implementation of a multispecialty geriatric surgical pathway (GSP). A total of 533 (300 pre-GSP, 233 GSP) patients similar by demographics (age and ethnicity) and clinical profile (frailty) were included. GSP showed decreased risk for loss of independence, major complications and was independently associated with a reduction in duration of stay. Authors concluded that implementation of a GSP-led to improved geriatric-specific surgical outcomes.

Ehrlich A, Owodunni O, Mostales J et al. Ann Surg 2023; 277(6): 859–865

Standardised perioperative management in acute abdominal surgery: Swedish SMASH controlled study

This prospective study of 1,344 patients undergoing emergency laparotomy evaluated the introduction of a new standardised clinical protocol. Time from the decision to operate to surgery was reduced with use of the new protocol. The 30-day mortality rate was 14.5% in the historical control group and 10.7% in the intervention group (P = 0.045). The mean duration of hospital stay decreased and the rate of serious surgical complications (grade IIIb–V) was lower. Authors concluded that standardised management protocols improved outcomes after emergency laparotomy.

Timan TJ, Karlsson O, Sernert N, Prytz M. Br J Surg 2023; 110(6): 710–716

Preoperative treatment of locally advanced rectal cancer

This multicentre, randomised trial of 1,194 patients with rectal cancer compared neoadjuvant FOLFOX (with chemoradiotherapy given only if the primary tumour decreased in size by <20% or if FOLFOX was discontinued) with chemoradiotherapy. At a median follow-up of 58 months, FOLFOX was non-inferior to chemoradiotherapy for disease-free survival. The groups were similar with respect to overall survival and local recurrence. Authors concluded in patients with locally advanced rectal cancer who were eligible for sphincter-sparing surgery, preoperative FOLFOX was noninferior to preoperative chemoradiotherapy.

Schrag D, Shi Q, Weiser MR et al. N Engl J Med 2023; June 4: doi: 10.1056/NEJMoa2303269