Randomized controlled trial of surgical rib fixation to nonoperative management in severe chest wall injury

Kang M, Kim S, Choi JY, Kim KS, Jung YK, Park B et al. 

Br J Surg 2024; 111: znae102.

This meta-analysis of machine perfusion included 19 RCTs. The risk of delayed graft function was lowest after hypothermic machine perfusion: relative risk 0.77, 95 per cent confidence interval 0.69 to 0.86). Partial hypothermic perfusion was not effective.

Comment: Soon to be the standard of care?

Koskenvuo L, Lunkka P, Varpe P, Hyoty M, Satokari R, Haapamaki C et al.

JAMA Surg 2024; 159: 606-614.  

In this study that included 565 procedures, the addition of oral antibiotics reduced the rate of surgical site infections (odds ratio 0.45, 95 per cent confidence interval 0.27 to 0.77) and anastomotic leaks (0.39, 0.21 to 0.72).

Comment: The authors suggest this should be the standard of care.

Leite RMA, Seo DJ, Gomez-Eslava B, Hossain S, Lesegretain A, de Souza AV et al.

JAMA Surg. ;157: 828-834.

This analysis of eight RCTs showed that the main outcomes were similar: successful treatment at 30 days, major adverse events. The non-operative group had a longer hospital stay and a higher rate of recurrent appendicitis (18 per cent).

Comment: Useful data to help clinicians use an individualised approach.