What articles related to current topics in general surgery, such as enhanced recovery after surgery (ERAS) protocols, surgical site infection prevention, and management of common surgical conditions, are relevant for presentation in a journal club?

Recommended Articles for General Surgery Journal Club

For a general surgery resident in a private hospital setting, I strongly recommend presenting Enhanced Recovery After Surgery (ERAS) implementation studies, particularly the 2023 ERAS Society consensus guidelines for emergency laparotomy, as these represent the most impactful and clinically relevant topics that directly improve patient outcomes while being highly feasible for your practice setting. 1, 2

Top Priority Articles for Presentation

1. Emergency Laparotomy ERAS Guidelines (2023)

This is your highest-yield choice - the three-part ERAS Society consensus guidelines for emergency laparotomy published in World Journal of Emergency Surgery represent the most current, comprehensive, and clinically applicable evidence for high-risk surgical patients. 1

• Part 1 covers preoperative diagnosis, rapid assessment, and optimization - critical for emergency general surgery patients with sepsis and physiological derangement 3
• Part 2 addresses intra- and postoperative care with 23 specific components using GRADE methodology 1
• Part 3 focuses on organizational aspects and end-of-life considerations, acknowledging the high mortality in this population 1

These guidelines are particularly relevant because they address the reality that emergency laparotomy patients have 30-64% morbidity rates and represent ideal candidates for structured care pathways. 1

2. Colorectal Surgery ERAS Guidelines (2019)

The updated ERAS Society recommendations for elective colorectal surgery provide the gold standard for perioperative care, demonstrating 50% reduction in complications and 2.5-day reduction in hospital stay. 1

• All recommendations are GRADE-assessed with evidence from meta-analyses, RCTs, and large cohort studies 1
• Covers preadmission, preoperative, intraoperative, and postoperative care elements systematically 1
• Directly applicable to your daily practice with measurable outcomes 2

3. Surgical Site Infection Prevention

Present the cardiac surgery ERAS guidelines (2019) section on SSI reduction bundles - this provides a comprehensive, evidence-based approach applicable across surgical specialties. 1

The care bundle includes:

• Topical intranasal mupirocin to eradicate Staphylococcus aureus colonization (18-30% of surgical patients are carriers with 3x infection risk) 1
• Weight-based cephalosporin administration <60 minutes before incision, continued 48 hours postoperatively 1
• Redosing antibiotics for cases >4 hours 1
• Electric clipping (not shaving) close to surgery time 1
• Sterile dressing removal within 48 hours with daily chlorhexidine washing 1

High-Impact Research Articles

4. ERAS and Healthcare-Associated Infections Meta-Analysis (2017)

This systematic review demonstrates ERAS protocols significantly reduce:

• Lung infections (RR = 0.38,95% CI 0.23-0.61, p<0.0001) 4
• Urinary tract infections (RR = 0.42,95% CI 0.23-0.76, p=0.004) 4
• Surgical site infections (RR = 0.75,95% CI 0.58-0.98, p=0.04) 4
• Hospital length of stay (standard mean difference = -0.83) 4

This is powerful evidence that ERAS is a transdisciplinary infection prevention strategy, not just a recovery protocol. 4

5. SSI Prevention Bundle in Gynecologic Oncology (2024)

This recent implementation study shows real-world results:

• Infectious complications decreased from 42.1% to 24.4% (p<0.001) 5
• Wound infections reduced from 17.0% to 10.8% (p=0.02) 5
• UTIs decreased from 12.7% to 4.5% (p<0.001) 5
• Median length of stay reduced from 3 to 2 days (p=0.001) 5

Feasible Research Projects You Can Propose

With a 30-patient daily census, you have sufficient volume to conduct meaningful ERAS research: 2

Prospective ERAS Implementation Study

• Document baseline compliance with ERAS elements (preoperative carbohydrate loading, minimally invasive techniques, early mobilization, early feeding) 2
• Primary outcomes: length of stay, 30-day complications, readmission rates 2
• Use the ERAS Interactive Audit System for tracking 2
• Follow the RECOvER checklist when publishing results 2

Emergency Laparotomy Protocol Development

• Conduct retrospective analysis followed by prospective protocol implementation 2
• Measure 30-day mortality, major complications, ICU length of stay, hospital length of stay 2
• This addresses a high-risk population with significant improvement potential 1

Day Surgery Expansion Study

• Expand 23-hour stay procedures for laparoscopic cholecystectomy, appendectomy, hernia repairs 2
• Track successful discharge rates, unplanned admissions, 30-day complications 2

Why These Topics Matter

ERAS protocols represent value-based care applied to surgery - they simultaneously improve clinical outcomes while reducing costs, making them ideal for presentation and implementation in your setting. 6

• ERAS reduces length of stay by 30-50% 6
• Complications decrease by similar magnitudes 6
• Readmissions and costs are reduced 6
• The multimodal approach reduces surgical stress to retain anabolic homeostasis 6

Common Pitfalls to Avoid

• Don't present ERAS as just "early feeding and mobilization" - emphasize the comprehensive, evidence-based multimodal approach with 20+ protocol elements 1
• Avoid focusing solely on elective surgery - emergency laparotomy ERAS guidelines represent cutting-edge application to high-risk patients 1
• Don't ignore compliance tracking - successful ERAS implementation requires systematic audit of process compliance and patient outcomes 2, 6
• Recognize that strong recommendations can come from low-quality data when the balance of benefits clearly outweighs risks 1