Latest Updates

Obesity

    • Emergence of virtual technologies in monitoring and scheduling weight loss management
    • Updated with 2020 CMA Practice Guidelines
    • In the United States, prevalence of overweight and obese adults has been increasing over the past several decades. Most recently published US data (2013-2014), the overall age-adjusted prevalence of obesity was 37.7%; among men, it was 35.0% and among women, it was 40.4%.
    • Analyses of changes over the decade from 2005 through 2014, adjusted for age, race/Hispanic origin, smoking status, and education, showed significant increasing linear trends among women for overall obesity and for class 3 obesity (BMI>40) but not among men.

Obesity

    • Emergence of virtual technologies in monitoring and scheduling weight loss management
    • Updated with 2020 CMA Practice Guidelines
    • In the United States, prevalence of overweight and obese adults has been increasing over the past several decades. Most recently published US data (2013-2014), the overall age-adjusted prevalence of obesity was 37.7%; among men, it was 35.0% and among women, it was 40.4%.
    • Analyses of changes over the decade from 2005 through 2014, adjusted for age, race/Hispanic origin, smoking status, and education, showed significant increasing linear trends among women for overall obesity and for class 3 obesity (BMI>40) but not among men.

Surgical Treatment of Obesity and the Metabolic Syndrome

    • Emergence of virtual technologies in monitoring and scheduling weight loss management
    • Updated with 2020 CMA Practice Guidelines
    • Metabolic surgery
    • Robotic surgery
    • Endoscopic therapies

Soft Tissue Sarcoma

    • The updated AJCC TNGM Staging classification for soft tissue sarcomas.
    • The most recent edition of the WHO Classification of Tumours of the Soft Tissue and Bone lists over 120 different histologic subtypes of soft tissue lesions… Based on data from a randomized trial coordinated by the European Organisation for Research and Treatment of Cancer (EORTC) and on retrospective studies demonstrating an association between treatment with neoadjuvant chemotherapy and improved disease-specific survival in patients with large, high-grade, extremity lesions, neoadjuvant chemotherapy is considered for patients with high-grade tumors that are larger than 10 cm.
    • In most instances, neither computed tomography nor magnetic resonance imaging can define the histologic subtype, although they can be highly suggestive; for example, myxofibrosarcoma often has tail-like projections spreading along fascial planes and enhancing after administration of contrast.

Perioperative Antithrombotic Therapy Management and Venous Thromboembolism Prophylaxis

    • A recent meta-analysis comparing the safety and efficacy of new oral anticoagulants with those of warfarin revealed comparable safety with a reduction in stroke and systemic embolic events in patients on the new agents… The risk of deep vein thrombosis (DVT) or pulmonary embolism (PE) complications in thyroidectomy and parathyroidectomy patients is very low at 0.16%, with a risk of bleeding requiring a return to the operating room that is 10-fold higher. Venous thromboembolism (VTE) prophylaxis should be reserved for only the highest risk patients undergoing these procedures
    • Recent results from the EINSTEIN-DVT and -PE studies that compared the efficacy and safety of single-drug oral rivaroxaban versus standard therapy of low-molecular-weight heparin and a vitamin K antagonist for the treatment of DVT/PE revealed similar efficacy of rivaroxaban with lower rates of major bleeding.

Perioperative Antithrombotic Therapy Management and Venous Thromboembolism Prophylaxisperiop

    • A recent meta-analysis comparing the safety and efficacy of new oral anticoagulants with those of warfarin revealed comparable safety with a reduction in stroke and systemic embolic events in patients on the new agents… The risk of deep vein thrombosis (DVT) or pulmonary embolism (PE) complications in thyroidectomy and parathyroidectomy patients is very low at 0.16%, with a risk of bleeding requiring a return to the operating room that is 10-fold higher. Venous thromboembolism (VTE) prophylaxis should be reserved for only the highest risk patients undergoing these procedures
    • Recent results from the EINSTEIN-DVT and -PE studies that compared the efficacy and safety of single-drug oral rivaroxaban versus standard therapy of low-molecular-weight heparin and a vitamin K antagonist for the treatment of DVT/PE revealed similar efficacy of rivaroxaban with lower rates of major bleeding.

Injuries to the Spleen and Diaphragm

    • Although controversial, multiple institutions have increasingly used angiography routinely in higher-grade spleen injuries undergoing nonoperative management (NOM).
    • A meta-analysis published in 2011 and a subsequent prospective study in 2014 highlighted the higher splenic salvage rate during NOM when angioembolization is employed in all grade IV and V injuries. This is echoed in a Level 2 recommendation in the Eastern Association for the Surgery of Trauma practice management guidelines from 2016
    • Subcapsular hematomas also may be at higher risk for delayed rupture, and special consideration should be given to patients with this injury pattern. Also currently controversial is the superiority of proximal embolization versus distal embolization.

Strategies of Hemodialysis Access

    • Update National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) clinical practice guidelines
    • Conversion of Fistula First Breakthrough Initiative (FFBI) to Fistula First Catheter Last (FFCL) Workgroup Coalition
    • Use of cryovein for AV access
    • Use of subclavian and superior vena recannilizations for venous hypertension
    • Treatment of megafistula
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