"Sutton's Law in Surgery: 'That's Where the Money is'".

Many students, residents, and learners have heard of the infamous bank robber, who when arrested was asked "Why do you rob banks?" He supposedly replied "Because that's where the money is." Except it did not happen that way. He did rob close to a hundred banks and jewelry stores and stole an estimated $2,000,000.1 A well-known maxim in medicine and surgery, few know the details of the unrelated men behind "Sutton's Law."

Creating historical controls using data from a previous line of treatment - Two non-standard approaches.

Where medical interventions are licensed based on only uncontrolled study data (for example a single-arm trial), a common approach for estimating the incremental benefit is to compare the treatment to a 'historical control'; data collected from patients who did not receive the intervention. We illustrate with motivating examples two methods for the creation of historical controls where disease progression and overall survival are typically the key clinically meaningful endpoints. The first method utilises information routinely collected in a clinical trial programme: patients' time to disease progression on their previous line of treatment against which outcomes can be compared. The second uses published clinical outcomes for the prior line of treatment which can be extrapolated to estimate outcomes at the next line. As examples we use two pharmaceuticals licensed on the basis of uncontrolled clinical studies - idelalisib for double-refractory follicular lymphoma and ofatumumab for double-refractory chronic lymphocytic leukemia. Although subject to limitations that should be considered on a case-by-case basis, the methods may be appropriate when trying to quantify the clinical benefit of treatment based on limited and uncontrolled trial data. As a result, the methods can be used to inform health technology adoption decisions.

Contemporary experience with cholecystectomy: establishing 'benchmarks' two decades after the introduction of laparoscopic cholecystectomy.

With quality and public reporting of increasing importance, benchmarks are anticipated to grow in relevance. We studied cholecystectomy in a practice in an urban tertiary care hospital. A total of 1083 cholecystectomies were performed in 2008 and 2009. Laparoscopic cholecystectomy was performed in 97.8 per cent of patients with a 2.2 per cent conversion rate. A planned open procedure was performed in only 2.2 per cent of patients. Approximately half of procedures were urgent and performed during an acute hospitalization. Most patients (74%) were female and most patients were overweight or obese (64.8%). Ages into the tenth decade of life were represented. Comorbidities included hypertension, 28.7 per cent; coronary disease, 15.6 per cent; diabetes mellitus, 13.4 per cent; gastroesophageal reflux disease, 10.7 per cent; and asthma, 5.5 per cent. Of female patients, 98 (12.2%) were postpartum and five (0.6%) were pregnant. Of 137 patients without gallstones, 59.1 per cent had biliary dyskinesia and 27 per cent had acalculous cholecystitis. Preoperative magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) were performed in most patients with suspected choledocholithiasis. Intraoperative cholangiograms were performed in 6.9 per cent of patients, 3.3 per cent for abnormal liver function studies. Postoperative ERCP was used in most patients with positive intraoperative cholangiograms. All-cause mortality was 0.8 per cent and attributable mortality was 0.2 per cent. Complications occurred in 7.5 per cent of patients, including retained common bile duct stones in 1.1 per cent, bile duct leak in 0.3 per cent, and common bile duct injury in 0.1 per cent.