surgery

Importance: Superficial vein thrombosis (SuVT) is characterized by thrombus in the superficial veins, typically in the lower or upper extremities, and has an estimated annual incidence of 64 to 131 per 100 000 person-years. Approximately 10% of patients with SuVT progress to deep vein thrombosis (DVT) or pulmonary embolism (PE).

Observations: Endothelial injury (caused by infection or intravenous devices), venous stasis (such as from chronic venous insufficiency or prolonged immobility), and hypercoagulability (due to cancer or pregnancy) are pathophysiologic factors associated with SuVT. Clinical risk factors for lower extremity SuVT are similar to those of DVT and PE and include pregnancy, varicose veins, and active cancer. The incidence of SuVT is greater in females than males (78-167 compared with 49-116 per 100 000 person-years). In contrast with lower extremity SuVT, upper extremity SuVT is primarily caused by indwelling intravenous catheters. Patients typically present with a tender, red, palpable cord under the skin in the upper or lower extremity. D-dimer testing has a sensitivity of approximately 48% to 74.3% and, therefore, is not reliable for excluding SuVT. Approximately 25% of patients with lower extremity SuVT present with concomitant DVT, likely because risk factors for SuVT and DVT are similar and because SuVT can extend into deep veins. In people without classic symptoms and signs of SuVT, ultrasonography can establish the presence and extent of the thrombus. Management may include elastic compression stockings and nonsteroidal anti-inflammatory drugs. For patients with SuVTs that are at least 5 cm long or those with persistent or worsening symptoms despite several days of conservative therapy, treatment includes anticoagulation with fondaparinux 2.5 mg. Alternative anticoagulation treatment includes rivaroxaban 10 mg once daily and low-molecular-weight heparins (eg, enoxaparin 40 mg once daily), which may reduce subsequent venous thromboembolic events. SuVT located within 3 cm of a deep vein should be treated with therapeutic doses of anticoagulation such as direct oral anticoagulants.

Conclusions and relevance: SuVT typically presents as a tender, painful, palpable cord under the skin. Management may include elastic compression stockings, nonsteroidal anti-inflammatory drugs, and systemic anticoagulation with fondaparinux 2.5 mg or rivaroxaban 10 mg. SuVTs within 3 cm of a deep vein should be treated with therapeutic dose anticoagulation.

Author/s:

Gregory Piazza, Darsiya Krishnathasan, Nada Hamade

Management of Peripheral Artery Disease

Megan George — Sun, 06 Jul 2025 18:44:56 +0000

Date Added:

July 6, 2025

Journal/Publication:

JAMA Clinical Guidelines Synopsis

Publication Date:

July 2, 2025

URL:

https://jamanetwork.com/journals/jama/fullarticle/2835911?guestAccessKey=4bf0464…

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

doi:10.1001/jama.2025.8408

Keywords

guidelines

surgery

vascular surgery

peripheral arterial disease

Cardiology

PMID (1):

40601325

MeSH

Peripheral Vascular Diseases

atherosclerosis

Ischemia

Guidance regarding management of patients with peripheral artery disease. James W. Mold, MD, MPH

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This JAMA Clinical Guidelines Synopsis summarizes the American College of Cardiology and American Heart Association’s 2024 guidelines on management of lower extremity peripheral artery disease.

Author/s:

Aman Kansal, MD, Andrew M. Davis, MD, MPH, Jennifer A. Rymer, MD, MBA

Management of Peripheral Artery Disease

Megan George — Sun, 06 Jul 2025 18:44:50 +0000

Date Added:

July 6, 2025

Journal/Publication:

JAMA Clinical Guidelines Synopsis

Publication Date:

July 2, 2025

URL:

https://jamanetwork.com/journals/jama/fullarticle/2835911?guestAccessKey=4bf0464…

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

doi:10.1001/jama.2025.8408

Keywords

guidelines

surgery

vascular surgery

peripheral arterial disease

Cardiology

PMID (1):

40601325

MeSH

Peripheral Vascular Diseases

atherosclerosis

Ischemia

Guidance regarding management of patients with peripheral artery disease. James W. Mold, MD, MPH

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This JAMA Clinical Guidelines Synopsis summarizes the American College of Cardiology and American Heart Association’s 2024 guidelines on management of lower extremity peripheral artery disease.

Author/s:

Aman Kansal, MD, Andrew M. Davis, MD, MPH, Jennifer A. Rymer, MD, MBA

Thyroid Cancer: A Review

Erin Blanchette — Mon, 19 Feb 2024 16:44:44 +0000

Date Added:

February 19, 2024

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

February 6, 2024

Issue:

Volume:

331

Pages:

425-435

URL:

Thyroid Cancer: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2023.26348

Keywords

Targeted and Immune Therapy

PMID (1):

38319329

MeSH

Thyroid Epithelial Cells

An update on thyroid cancer detection, types, and treatment. James W. Mold, MD, MPH

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Importance: Approximately 43 720 new cases of thyroid carcinoma are expected to be diagnosed in 2023 in the US. Five-year relative survival is approximately 98.5%. This review summarizes current evidence regarding pathophysiology, diagnosis, and management of early-stage and advanced thyroid cancer.

Observations: Papillary thyroid cancer accounts for approximately 84% of all thyroid cancers. Papillary, follicular (≈4%), and oncocytic (≈2%) forms arise from thyroid follicular cells and are termed well-differentiated thyroid cancer. Aggressive forms of follicular cell-derived thyroid cancer are poorly differentiated thyroid cancer (≈5%) and anaplastic thyroid cancer (≈1%). Medullary thyroid cancer (≈4%) arises from parafollicular C cells. Most cases of well-differentiated thyroid cancer are asymptomatic and detected during physical examination or incidentally found on diagnostic imaging studies. For microcarcinomas (≤1 cm), observation without surgical resection can be considered. For tumors larger than 1 cm with or without lymph node metastases, surgery with or without radioactive iodine is curative in most cases. Surgical resection is the preferred approach for patients with recurrent locoregional disease. For metastatic disease, surgical resection or stereotactic body irradiation is favored over systemic therapy (eg, lenvatinib, dabrafenib). Antiangiogenic multikinase inhibitors (eg, sorafenib, lenvatinib, cabozantinib) are approved for thyroid cancer that does not respond to radioactive iodine, with response rates 12% to 65%. Targeted therapies such as dabrafenib and selpercatinib are directed to genetic mutations (BRAF, RET, NTRK, MEK) that give rise to thyroid cancer and are used in patients with advanced thyroid carcinoma.

Conclusions: Approximately 44 000 new cases of thyroid cancer are diagnosed each year in the US, with a 5-year relative survival of 98.5%. Surgery is curative in most cases of well-differentiated thyroid cancer. Radioactive iodine treatment after surgery improves overall survival in patients at high risk of recurrence. Antiangiogenic multikinase inhibitors and targeted therapies to genetic mutations that give rise to thyroid cancer are increasingly used in the treatment of metastatic disease.

Author/s:

Laura Boucai, Mark Zafereo, Maria E Cabanillas

Adenotonsillectomy for Snoring and Mild Sleep Apnea in Children

Rowan Hutchins — Sat, 09 Dec 2023 06:00:00 +0000

Date Added:

December 9, 2023

Journal/Publication:

JAMA

Publisher:

AMA

Publication Date:

December 5, 2023

Issue:

Volume:

330

Pages:

2084-2095

URL:

Adenotonsillectomy for Snoring and Mild Sleep Apnea in Children

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jama.2023.22114

Keywords

PMID (1):

38051326

MeSH

Sleep Apnea Syndromes* / complications

Sleep Apnea

Obstructive* / diagnosis

Snoring / complications

Polysomnography

child

Adenotonsillectomy may be helpful for some kids with snoring and mild sleep apnea. James W. Mold, MD, MPH

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Question: Among children who snore without frequent obstructive events, does early adenotonsillectomy compared with watchful waiting with supportive care improve neurodevelopment, behavior, or other symptoms at 12-month follow-up?

Findings: In this randomized clinical trial of 458 children with mild sleep-disordered breathing (SDB), adenotonsillectomy compared with watchful waiting resulted in no significant differences in executive function or attention at 12 months. The adenotonsillectomy group had improved quality of life, symptoms, behavior, and blood pressure, which were among the secondary outcomes measured.

Meaning: In children with mild SDB, adenotonsillectomy resulted in no statistically significant differences in changes in executive function or attention but led to improved secondary outcomes including symptoms, behavior, and blood pressure.

Author/s:

Susan Redline, Kaitlyn Cook, Ronald D. Chervin

Perioperative Management of Anticoagulant and Antiplatelet Therapy

Rowan Hutchins — Wed, 27 Sep 2023 05:00:00 +0000

Date Added:

September 27, 2023

Publication Date:

May 23, 2023

Issue:

Volume:

URL:

Perioperative Management of Anticoagulant and Antiplatelet Therapy

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1056/EVIDra2200322

Keywords

MeSH

Platelet Aggregation Inhibitors

Fibrinolytic Agents

An algorithmic approach to management of long-term anticoagulants and antiplatelet agents before and after surgical procedures. James W. Mold, MD, MPH

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The management of patients who are receiving an anticoagulant or antiplatelet drug and require surgery or an invasive procedure is a common clinical problem encountered by a broad spectrum of health care professionals. This review provides an evidence-based but practical approach to common clinical scenarios involving patients who require an elective surgery/procedure and are receiving either a vitamin K antagonist, a direct oral anticoagulant, or single or dual antiplatelet therapy. This review also addresses the role of perioperative heparin bridging and the management of patients who are receiving an anticoagulant drug and need urgent surgery.

Demystifying breast cancer

Aubrey Delammermore — Sat, 15 Jul 2023 05:00:00 +0000

Date Added:

July 15, 2023

Journal/Publication:

Canadian Family Physician

Publisher:

College of Family Physicians of Canada

Publication Date:

July 1, 2023

Issue:

Volume:

Pages:

473-476

URL:

Demystifying breast cancer

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.46747/cfp.6907473

Keywords

PMID (1):

37451990

MeSH

patients

breast neoplasms

Combined Modality Therapy

Humans

female

A concise summary of the types of breast cancer and their treatment. James W. Mold, MD, MPH

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The first question a patient often asks their FP after receiving a diagnosis of breast cancer (BC) is “What will my treatment be?” This article will help FPs answer this complex question by reviewing multimodal therapy for BC, which is contingent on molecular subtype and stage.

Author/s:

Wilkinson, A. N.

Patient-Reported Outcomes 12 Years after Localized Prostate Cancer Treatment

Aubrey Delammermore — Wed, 05 Apr 2023 05:00:00 +0000

Date Added:

April 5, 2023

Journal/Publication:

New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

March 11, 2023

Issue:

Volume:

URL:

Patient-Reported Outcomes 12 Years after Localized Prostate Cancer Treatment

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/EVIDoa2300018

Keywords

Androgens

Prostatectomy

Patient Reported Outcome Measures

MeSH

Evidence of long-term quality of life-relevant outcome after various treatments for localized prostate cancer from an RCT. James W. Mold, MD, MPH

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Long-term patient-reported outcomes are needed to inform treatment decisions for localized prostate cancer.

METHODS
Patient-reported outcomes of 1643 randomly assigned participants in the ProtecT (Prostate Testing for Cancer and Treatment) trial were evaluated to assess the functional and quality-of-life impacts of prostatectomy, radiotherapy with neoadjuvant androgen deprivation, and active monitoring. This article focuses on the outcomes of the randomly assigned participants from 7 to 12 years using mixed effects linear and logistic models.

RESULTS
Response rates exceeded 80% for most measures. Among the randomized groups over 7 to 12 years, generic quality-of-life scores were similar. Among those in the prostatectomy group, urinary leakage requiring pads occurred in 18 to 24% of patients over 7 to 12 years, compared with 9 to 11% in the active monitoring group and 3 to 8% in the radiotherapy group. In the prostatectomy group, 18% reported erections sufficient for intercourse at 7 years, compared with 30% in the active monitoring and 27% in the radiotherapy groups; all converged to low levels of potency by year 12. Nocturia (voiding at least twice per night) occurred in 34% in the prostatectomy group compared with 48% in the radiotherapy group and 47% in the active monitoring group at 12 years. Fecal leakage affected 12% in the radiotherapy group compared with 6% in the other groups by year 12. The active monitoring group experienced gradual age-related declines in sexual and urinary function, avoiding radical treatment effects unless they changed management.

CONCLUSIONS
ProtecT provides robust evidence about continued impacts of treatments in the long term. These data allow patients newly diagnosed with localized prostate cancer and their clinicians to assess the trade-offs between treatment harms and benefits and enable better informed and prudent treatment decisions. (Funded by the UK National Institute for Health and Care Research Health Technology Assessment Programme projects 96/20/06 and 96/20/99; ISRCTN number, ISRCTN20141297; ClinicalTrials.gov number, NCT02044172.)

Author/s:

Donovan, J. L., Hamdy, F. C., Lane, J. A., Young, G. J., Metcalfe, C., Walsh, E. I., Davis, M., Steuart-Feilding, T., Blazeby, J. M., Avery, K. N., Martin, R. M., Bollina, P., Doble, A., Doherty, A., Gillatt, D., Gnanapragasam, V., Hughes, O., Kockelbergh, R., Kynaston, H., Paul, A., Paez, E., Powell, P., Rosariom D. J., Rowe, E., Manson, M., Catto, J. W., Peters, T. J., Wade, J., Turner, E. L., Williams, N. J., Oxley, J., Staffurth, J., Bryant, R. J., Neal, D. E.

Conservative versus surgical management for patients with rotator cuff tears: a systematic review and META-analysis

Devin Evans — Wed, 03 Feb 2021 06:00:00 +0000

Date Added:

February 3, 2021

Journal/Publication:

BMC Musculoskeletal Disorders

Publication Date:

January 8, 2021

Issue:

Volume:

Pages:

URL:

Conservative versus surgical management for patients with rotator cuff tears: a systematic review and META-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1186/s12891-020-03872-4

Keywords

Conservative treatment

PMID (1):

33419401

MeSH

conservative treatment

Shoulder

MEDLINE

pain

This meta-analysis found very little benefit from rotator cuff surgery in patients with full thickness tears compared to conservative management. James W. Mold, MD, MPH

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Background: This study aims to compare conservative versus surgical management for patients with full-thickness RC tear in terms of clinical and structural outcomes at 1 and 2 years of follow-up.

Methods: A comprehensive search of CENTRAL, MEDLINE, EMBASE, CINAHL, Google Scholar and reference lists of retrieved articles was performed since the inception of each database until August 2020. According to the Cochrane Handbook for Systematic Reviews of Interventions, two independent authors screened all suitable studies for the inclusion, extracted data and assessed risk of bias. Only randomised controlled trials comparing conservative and surgical management of full-thickness RC tear in adults were included. The primary outcome measure was the effectiveness of each treatment in terms of Constant-Murley score (CMS) and VAS pain score at different time points. The secondary outcome was the integrity of the repaired tendon evaluated on postoperative MRI at different time points. The GRADE guidelines were used to assess the critical appraisal status and quality of evidence.

Results: A total of six articles met the inclusion criteria. The average value of CMS score at 12 months of follow-up was 77.6 ± 14.4 in the surgery group and 72.8 ± 16.5 in the conservative group, without statistically significant differences between the groups. Similar results were demonstrated at 24 months of follow-up. The mean of VAS pain score at 12 months of follow-up was 1.4 ± 1.6 in the surgery group and 2.4 ± 1.9 in the conservative group. Quantitative synthesis showed better results in favour of the surgical group in terms of VAS pain score one year after surgery (- 1.08, 95% CI - 1.58 to - 0.58; P < 0.001).

Conclusions: At a 2-year follow-up, shoulder function evaluated in terms of CMS was not significantly improved. Further high-quality level-I randomised controlled trials at longer term follow-up are needed to evaluate whether surgical and conservative treatment provide comparable long-term results.

Author/s:

Longo, Umile G., Ambrogioni, Laura R., Candela, Vincenzo, Berton, Alessandra, Carnevale, Arianna, Schena, Emiliano, Denaro, Vincenzo

Preoperative Evaluation Before Noncardiac Surgery

John Bayhi — Wed, 20 Nov 2019 21:00:21 +0000

Date Added:

November 20, 2019

Journal/Publication:

Mayo Clinic Proceedings

Publisher:

Mayo Foundation for Medical Education and Research / Elsevier, Inc.

Publication Date:

November 18, 2019

URL:

Preoperative Evaluation Before Noncardiac Surgery

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.mayocp.2019.04.029

Keywords

surgery

preoperative evaluation

MeSH

This is a fairly comprehensive review of the preoperative considerations and evaluation components for a patient undergoing non-cardiac surgeries. James W. Mold, MD, MPH

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The medical complexity of surgical patients is increasing and medical specialties are frequently asked to assist with perioperative management surgical patients. Effective pre-anesthetic medical evaluations are a valuable tool in providing high-value, patient-centered surgical care and should systematically address risk assessment and identify areas for risk modification. This review outlines a structured approach to the pre-anesthetic medical evaluation, focusing on the asymptomatic patient. It discusses the evidence supporting the use of perioperative risk calculation tools and focused preoperative testing. We also introduce important key topics that will be explored in greater detail in upcoming reviews in this series.

Author/s:

Bierle, DM, Raslau, D, Regan, DW, Sundsted, KK, Mauck, K.F.

How Will Treating My Early-Stage Prostate Cancer Affect My Quality of Life?

John Bayhi — Tue, 16 Jul 2019 20:56:31 +0000

Date Added:

July 16, 2019

Publisher:

Patient-Centered Outcomes Research Institute

Publication Date:

September 21, 2019

URL:

Evidence Update for Patients: Prostate Cancer

Type:

Patient Education Materials

Keywords

This is a concise comparison of the quality of life results of prostatectomy vs. radiation therapy for early-stage prostate cancer for patients. James W. Mold, MD, MPH

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Early-stage prostate cancer can be treated in different ways. The three main ways are active surveillance, surgery, and radiotherapy. Active surveillance means having your prostate checked every few months to make sure the cancer is not spreading. Surgery would take out the prostate, and radiotherapy uses high-energy rays to kill cancer cells in the prostate.

Two recent PCORI-funded studies compare the effects of these choices on the quality of life for men with early-stage prostate cancer. These studies looked at three effects treatment might have on a man’s quality of life. These are problems having sex, urinary problems, and bowel problems.

Author/s:

Patient-Centered Outcomes Research Institute

Current Treatments for Localized Prostate Cancer and Symptom-Related Quality of Life

John Bayhi — Tue, 16 Jul 2019 20:46:11 +0000

Date Added:

July 16, 2019

Publisher:

Patient-Centered Outcomes Research Institute

Publication Date:

September 21, 2017

URL:

Current Treatments for Localized Prostate Cancer and Symptom-Related Quality of Life

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Web Page

Keywords

This is a concise comparison of the quality of life results of prostatectomy vs. radiation therapy for early-stage prostate cancer for clinicians. James W. Mold, MD, MPH

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Given the evidence of high 5- and 10-year survivorship rates for localized prostate cancer, the effect of treatment on symptom-related quality of life is an important consideration for men choosing among available treatment options. Two PCORI-funded studies published in the March 21, 2017 issue of JAMA compare the impact of current treatments on symptom-related quality of life for men with localized prostate cancer. Quality of life scores refer to symptoms, how much men were bothered by symptoms, or a combination of the two. The studies looked at observed outcomes from a combined total of 3,600 men for periods of two and three years following treatment. This evidence offers information that can help patients make treatment decisions.

Author/s:

Patient-Centered Outcomes Research Institute