Rectal resections for cancer are independently associated with an increased likelihood of superficial, deep, and organ space infections. The policy on surgical site infections as a quality measure currently in place requires modification to adjust for the location of pathology and, hence, the anatomical segment resected when assessing the risk for type of surgical site infection.

ObjectiveThe purpose of this meta‐analysis is to compare the safety and efficacy of transcatheter aortic‐valve replacement (TAVR) to surgical aortic valve replacement (SAVR) in low‐surgical‐risk patients.BackgroundTAVR is proven to be safe and effective in patients with high‐ and intermediate‐risk aortic stenosis. However, there is limited data on the safety and efficacy of TAVR in patients with low surgical risk.MethodsWe conducted an electronic database search of all published data for studies that compared TAVR to SAVR in low‐surgical‐risk patients (mean society for thoracic surgery [STS] score <4% and/or logistic EuroScore <10%) and reported on subsequent all‐cause mortality, cardiac mortality, stroke rates, and other outcomes of interest. Event rates were compared with a forest plot of odds ratio using a random‐effects model assuming interstudy heterogeneity.ResultsA total of seven studies (n = 6,293 patients; TAVR = 2,912; and SAVR = 3,381) were included in the final analysis. There was no significant difference between TAVR and SAVR in terms of all‐cause mortality (OR 0.82; 95% CI 0.50–1.36, I2 = 51%), cardiac mortality (OR 0.57; 95% CI 0.32–1.02, I2 = 0%), new pacemaker implantation (OR = 3.11; 95% CI 0.58–16.60, I2 = 89%), moderate/severe paravalvular leak (PVL; OR 3.50; 95% CI 0.64–19.10, I2 = 54%) and rate of stroke (OR 0.63; 95% CI 0.34–1.15, I2 = 39%) at 1‐year follow‐up. TAVR was found to have a significantly lower incidence of atrial fibrillation (AF; OR 0.15, 95% CI 0.10–0.24, I2 = 38%) as compared to SAVR.ConclusionThe results of our meta‐analysis demonstrate similar rates of all‐cause mortality, cardiac mortality, and stroke at 1‐year follow‐up in patients undergoing TAVR and SAVR. TAVR is associated with a lower incidence of AF relative to SAVR. However, there was a significantly higher incidence of PVL with TAVR compared to SAVR.

No abstract

Objective: This meta-analysis sought to evaluate the outcomes of absorb bioresorbable vascular scaffolds (BVS) compared with second-generation drug-eluting stents (DES) after 3 years, the approximate time of complete polymer bioresorption.Background: BVS were found to be inferior to second-generation DES in early and mid-term outcomes with a higher rate of target vessel myocardial infarction (TV-MI) and device thrombosis (DT). Improper implantation techniques and incomplete bioresorption of the poly-L-lactide (PLLA) polymer were sighted as possible reasons. Methods:We conducted an electronic database search for all randomized control trials that compared absorb BVS to second-generation DES and reported outcomes of interest after 3 years of absorb BVS implantation. Assuming interstudy heterogeneity, a random-effects analysis was conducted with odds ratio as the effect size of choice to compare the event rates between the two groups. Results: A total of four studies (n = 3,245, BVS = 2075, DES = 1,170) were included in the final analysis. Pooled analysis revealed that there was no difference between absorb BVS and second-generation DES with respect to target lesion failure (TLF) (OR = 1.23, 95% CI = 0.73-2.07, p = 0.44), TV-MI (OR = 1.03, 95% CI = 0.42-2.53, p = 0.95), target lesion revascularization (TLR) (OR = 1.61, 95% CI = 0.77-3.33, p = 0.20) and definite/probable DT (OR = 0.71, 95% CI = 0.10-5.07, p = 0.74). Also, there was no difference in cardiac mortality (OR = 0.66, 95% CI = 0.22-1.94, p = 0.45). Conclusions: Between 3 and 4 years of follow-up, patients receiving absorb BVS did not have significantly different outcomes, in terms of TLF, TV-MI, TLR, DT, and cardiac mortality, compared to DES. K E Y W O R D S absorb, bioresorbable vascular scaffolds, clinical outcomes, drug-eluting stents

Background Debate still occurs of the benefits of transradial access (TRA) versus transfemoral access (TFA), especially for complex percutaneous coronary interventions. Recent data has shown equivalent efficacy and improved safety outcomes with TRA. Objectives To systematically review and perform a meta‐analysis comparing procedural characteristics and clinical outcomes of TRA versus TFA in patients who underwent percutaneous coronary intervention (PCI) for left main (LM) disease. Methods We conducted an electronic database search of all published data for studies that compared TRA with TFA in patients undergoing PCI of LM disease. Event rates were compared using the odds ratio (OR) as a measure of effect size. Random‐effects models were used to account for interstudy heterogeneity. Results A total of 12 observational studies including 17,258 patients (TRA n = 7,971; TFA n = 9,287) were included. Compared to TFA, TRA was associated with a significant reduction in access site bleeding (OR = 0.11; 95% confidence interval [CI] = 0.04–0.26; I2 = 0%; p < .0001), major bleeding (OR = 0.44; 95% CI = 0.27–0.69; I2 = 0%; p = .0005) or any bleeding episode (OR = 0.43; 95% CI = 0.27–0.69; I2 = 12%; p = .0004). Rates of access site or vascular complications (OR = 0.26; 95% CI = 0.17–0.40; I2 = 0%; p < .00001) and in‐hospital mortality (OR = 0.49; 95% CI = 0.31–0.79: I2 = 11%; p = .004) were also lower in the TRA group. There were no significant differences in procedural outcomes between TRA and TFA except for a significant reduction in the rate of long‐term target vessel revascularization (TVR) in the TRA group (OR = 0.62; 95% CI = 0.41–0.94: I2 = 0%: p = .02). We further performed a subgroup analysis for unprotected left main PCI only, which showed a significant reduction in rates of any bleeding episode, lower access site or vascular complications, and in‐hospital mortality with TRA as compared to TFA. Conclusion Patients undergoing PCI for LM disease via TRA have with less bleeding, reduced access site or vascular complications, reduced in‐hospital mortality, comparable procedural success, and possibly better long‐term clinical efficacy when compared to those undergoing the procedure via TFA.

In colorectal surgery, an already high-risk outlier for SSI, obesity and proctectomy are associated with the highest risk of SSI. Despite the particular technical challenges of laparoscopy in these circumstances, the minimally invasive approach attenuates the risk of SSI in these high-risk patients and thus should be strongly considered during treatment planning.

No abstract

No abstract