Robotic colorectal surgery in the emergent diverticulitis setting: is it safe? A review of large national database.

BACKGROUND: As robotic colorectal surgery continues to advance in conjunction with improved recovery protocols, we began implementing robotic surgery (RS) as an option for emergent diverticulitis surgery. Our hospital system utilizes the Da Vinci Xi system, and staff are required to undergo training, making emergent colorectal surgery a feasible option. However, it is essential to determine the safety with reproducibility of our experiences. METHODS: A de-identified retrospective review was performed of Intuitive's national database which obtained data from 262 facilities from January 2018 through December 2021. This identified over 22,000 emergent colorectal surgeries. Of those, over 2500 were performed for diverticulitis in which 126 were RS, 446 laparoscopic surgery (LS), and 1952 open surgery (OS). Clinical outcome metrics including conversion rates, anastomotic leaks, intensive care unit (ICU) admissions, length of stay, mortality, and readmissions were obtained. The cohort was defined by patients who were seen in the emergency department (ED) with diverticulitis and proceeded to have a sigmoid colectomy within 24 h of ED arrival. RESULTS: RS was associated with increased operating time (RS 262, LS 207, OS 182 min), but data has shown many benefits of emergent RS compared to OS. We identified significant decreases in ICU admission rates (OS 19.0%, RS 9.5%, p = 0.01) and anastomotic leak rates (OS 4.4%, RS 0.8%, p = 0.04), with borderline improvement in overall length of stay (OS 9.9, RS 8.9 days, p = 0.05). When compared with LS, RS showed many comparable results. However, RS witnessed a statistically significant improvement in anastomotic leak rates (LS 4.5%, RS 0.8%, p = 0.04). Importantly, there was a striking difference in conversion rates to OS. LS converted over 28.7% of cases to OS, whereas RS only converted 7.9%, p = 0.000005. CONCLUSION: Given these findings, RS is another MIS tool that could be a safe and feasible option for the acute management of emergent diverticulitis.

Safety code blue! Assessing the use of blue surgical sterilization wrap for homemade respirator masks during the COVID-19 crisis.

The use of surgical sterilization wrap for respirator masks during the COVID-19 crisis has become a popularized personal protective equipment alternative option due to claims supporting its ability to meet N95 standards. This study sought to assess these claims using standardized filter testing. The tested material failed to meet N95 standards and suggests its use may place medical personnel at increased risk of harm when managing COVID-19 patients.

Quality Assurance During a Global Pandemic: An Evaluation of Improvised Filter Materials for Healthcare Workers.

OBJECTIVE: The proliferation of improvised masks during the COVID-19 pandemic has raised questions regarding filter effectiveness and safety. We sought to compare the effectiveness of commonly used improvised filter materials against N95 industry standards. METHODS: Six different filter materials commonly used in the community were tested using both single- and multi-layer configurations with the TSI 8130 automated filter tester in accordance with National Institute for Occupational Safety and Health (NIOSH) standards for N95 respirators. RESULTS: Only three of the tested filter material configurations met N95 parameters with regard to filtration efficiency and pressure drop across the filter material-the: True-high-efficiency particulate air (HEPA) filter, four-layer MERV 13 and 14 HVAC filters. CONCLUSIONS: Many proposed filter materials for improvised masks do not meet current industry standards and may pose safety and efficacy concerns. Care should be taken when selecting materials for this critical respirator component, particularly for health care workers or others at high risk for pathogen exposure.

Influence of preoperative psychotropic medications on opioid requirements and outcomes following bariatric surgery.

INTRODUCTION: Opioid use continues to impose a substantial burden on the healthcare system. Multiple studies suggest that depression and psychosis increase the risk of chronic opioid use. We hypothesized that patients' pharmacologic profiles would affect postoperative opioid requirements following bariatric surgery. MATERIALS AND METHODS: Retrospective analysis identified patients who underwent laparoscopic bariatric surgery at a high-volume center from 2014 to 2016. Prescriptions from one year prior through 3 months after surgery were collected. Patients with complicated operative courses were excluded. RESULTS: A total of 201 patients met inclusion criteria. Forty-six patients(23%) required an opioid refill within 3 months of surgery. Opioid exposure was strongly associated with need for repeat opioid prescription(OR 3.1, p = 0.001). When controlled for preoperative opioid exposure, antidepressant and antipsychotic use showed no such association. Patients using antipsychotics were significantly more likely to have complicated postoperative courses(OR 2.25, p = 0.043). CONCLUSIONS: Opioid exposure increased the risk of chronic opioid requirements after surgery, but other psychotropic medications showed no such effect. Patients using anti-psychotics may be prone to surgical complications making them vulnerable to chronic opioid use.