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American College of Surgeons, Oct. 23-27

The 106th Annual American College of Surgeons Clinical Congress

The annual meeting of the American College of Surgeons was held virtually this year from Oct. 23 to 27 and attracted participants from around the world, including surgeons, medical experts, allied health professionals, and administrators. The conference included hundreds of general and specialty sessions, postgraduate courses, scientific paper presentations, video-based education presentations, and posters focusing on the latest advances in surgical care.

In a retrospective review, Leonardo Alaniz, a third-year medical student at the University of California, Irvine, and colleagues found that COVID-19 lockdowns likely had a direct effect on decreasing motor vehicle collisions (MVCs) but resulted in a huge spike in bicycle-related trauma.

The authors retrospectively reviewed 27,652 cases from 2019 to 2020 at four Level I trauma centers in Orange County, California; Portland, Oregon; Tulsa, Oklahoma; and Miami. Mechanism of injury (MOI) data were standardized across all locations to include the following main categories: gunshot wounds, MVCs, bicycle accidents, stab wounds, pedestrian accidents, motorcycle-related trauma, falls, and other injuries not covered by any of the main categories. For the statistical analysis, the authors compared MOI relative incidence rates between 2019 and 2020 and ran a descriptive analysis to obtain the overall picture of the different MOIs. The researchers found that trauma cases involving bicycle-related injuries increased 100 percent overall during the COVID-19 lockdown.

“It is impossible to know for certain what led to these changes. What we do know is that we need more granular research to determine if we need to address wellness and wellness support in the future,” Alaniz said. “It is clear that more resources should be applied to addressing issues of wellness, particularly stress reduction and mental health.”

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In the Comparison of Outcomes of antibiotic Drugs and Appendectomy (CODA) trial, David R. Flum, M.D., of the University of Washington in Seattle, and colleagues found that patients with appendicitis may receive medical treatment with antibiotics before opting for surgery with appendectomy, despite likely needing surgery in the future.

The authors randomly assigned 1,552 patients with appendicitis across 25 U.S. medical centers to receive either antibiotics or appendectomy. The researchers found that seven of 10 who started on antibiotics avoided appendectomy by 90 days. By three years, approximately one-half of patients with appendicitis did not need surgery following an initial course of antibiotics.

“The American College of Surgeons guidelines now (since the COVID-19 pandemic) call antibiotics for appendicitis as an accepted first-line treatment,” Flum said. “Based on a patient’s priorities, circumstances, and characteristics, antibiotics are probably a good treatment for many, but not all with appendicitis.”

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In a prospective trial, Kristine Kenning, M.D., of the Virginia Commonwealth University School of Medicine in Richmond, and colleagues found that the COVID-19 pandemic has created barriers to screening for colorectal cancer owing to concerns about infection and out-of-pocket costs.

The authors performed a cross-sectional survey to assess attitudes toward and intentions for colorectal cancer screening among adults aged 50 to 75 years during the pandemic (October to December 2020). The results of this survey provided the investigators with data to help them characterize the concerns that decreased adherence to colorectal cancer screening during the pandemic and suggest ways to overcome these concerns. Respondents reported more concern about COVID-19 infection than copays. The researchers found that stool tests as an initial screen were viewed more favorably than a colonoscopy even after offering patients protective equipment, weekend appointments, or visits to smaller offices.

“Clinicians in the United States rely on colonoscopy for colon screening, which is the ‘gold standard,’ and is also the recommended intervention if any of the other screening tests are positive. However, colonoscopy has many disadvantages, especially during a pandemic, as it requires an in-person interaction with the health care environment, may have out-of-pocket costs, and requires time to prepare for and undergo the procedure,” Kenning said. “This study indicates that using stool-based tests as an initial screen is acceptable to many patients and may help increase access to screening.”

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Jessica Magarinos, M.D., of Temple University Hospital in Philadelphia, and colleagues found that virtual lung cancer screening was just as effective as in-person screening and helped maintain patient access to lung cancer screening during the COVID-19 pandemic. This was especially true for African Americans, who have been known to have worse outcomes associated with lung cancer.

The authors evaluated the efficacy of a single-visit telemedicine-based screening program during the COVID-19 pandemic. A total of 1,113 patients were screened for lung cancer (before [673 patients] and after the pandemic [440 patients via telemedicine-based screening]). The authors retrospectively analyzed prospectively collected data according to race, smoking history, educational status, Lung-RADS categories, cancer diagnosis, and staging. The researchers found that following the COVID-19 pandemic, the telemedicine-based screening modality screened fewer patients; however, of the patients screened, African Americans were the majority (37 percent in telemedicine cohort, the largest patient demographic percentage). In addition, the researchers found no evidence of stage migration and no significant difference in the number of diagnostic procedures implemented.

“Our study shows telemedicine-based screening visit is a viable option for lung cancer screening and preserves access to African American patients who have historically been underscreened,” Magarinos said. “Although we did not find evidence of stage migration, our screening numbers were significantly decreased likely due to impact of COVID-19.”

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ACS: Patients Can Be Evaluated for Stroke and Trauma With STRAUMA Alert

WEDNESDAY, Nov. 3, 2021 (HealthDay News) — The novel STRAUMA alert activation allows for expedited evaluation of both stroke and trauma, according to a study presented at the annual meeting of the American College of Surgeons, held virtually from Oct. 23 to 27.

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ACS: Length of Stay for Surgical Patients Dropped From 2014 to 2019

TUESDAY, Oct. 26, 2021 (HealthDay News) — For patients undergoing surgery, the median length of stay decreased from 2014 to 2019, while postdischarge complications increased, according to a study presented at the annual meeting of the American College of Surgeons, held virtually from Oct. 23 to 27.

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ACS: Surgery May Benefit Men With Stage IV Breast Cancer

MONDAY, Oct. 25, 2021 (HealthDay News) — Men with stage IV breast cancer and known estrogen receptor and progesterone receptor status may benefit from surgical intervention rather than systemic therapy alone, according to a study presented at the annual meeting of the American College of Surgeons, held virtually from Oct. 23 to 27.

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