General Surgery

Non-technical errors contributed to most emergency general surgery deaths.

In a national retrospective cohort of 1,164 emergency general surgery deaths, non-technical errors (NTEs) occurred in 67.9% of cases. Reviewers identified 1,053 unique NTEs; situational awareness (49.3%) and decision-making errors (40.9%) were most common. Nearly 90% of NTEs occurred outside the operating theatre and involved both surgical and non-surgical teams. Improvement efforts should extend beyond technical training to behaviorally informed, system-level NTS interventions. 1

Pilot RCT: prophylactic GIK improved perioperative glycemia in non-diabetics.

In 103 non-diabetic adults undergoing major abdominopelvic surgery, prophylactic glucose-insulin-potassium (GIK) achieved euglycemia (<125 mg/dL) in 42% versus 27% with placebo. GIK reduced hyperglycemia and need for treatment insulin, with treatment completed in 97% and no severe hypoglycemia reported. Fewer complications were observed with GIK (12% vs 21%), but confidence intervals were wide and underpowered for clinical endpoints. A full-scale RCT focused on morbidity and mortality is feasible before routine adoption. 2

5x-multiplier discharge algorithm lowers prescribed opioids with similar short-term use.

In 150 patients after open intra-abdominal cancer surgery, the 5x-multiplier reduced median discharge OME to 25 mg versus 75 mg with a 3-tier model (P<0.001). The 5x approach produced 44% opioid-free discharges versus 1% with the 3-tier model. Median 14-day opioid consumption was similar (0 mg vs 10 mg) and patient satisfaction and refill rates did not differ. Implementing the 5x rule may safely reduce prescribed opioids; monitor refill requests and symptom control after rollout. 3