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Digital Issues

The Latest on the Deadly Duodenoscope Superbug Outbreak

The recent CRE outbreak at UCLA's Ronald Reagan Medical Center has at least one high-ranking health official pointing fingers at the FDA, accusing the agency of failing to act properly in light of infections in several other states that were eventually traced to duodenoscopes.

"FDA didn't do its job," Diana Zuckerman, president of the National Center for Health Research, tells the Los Angeles Times. But an FDA spokeswoman fires back, "If we pulled the devices from the market, we would prevent hundreds of thousands of patients from accessing a beneficial and life-saving procedure."

The FDA did issue guidance late last week, acknowledging that "the complex design" of duodenoscopes "may impede effective reprocessing," and recommending that providers talk to patients about benefits, risks and potentially problematic post-treatment symptoms; consider taking the scopes out of service if links to multidrug-resistant organisms are suspected; and report suspected problems with the scopes to the FDA.

UCLA announced last week that 2 patients had died after contracting CRE (carbapenem-resistant Enterobacteriaceae) from infected scopes, and that nearly 200 others might have been exposed to the often-fatal superbug. In the past 2 years there have been similar outbreaks in Seattle, suburban Chicago and Pittsburgh.

Jim Burger

Are Your Patients at Risk for Post-op Chronic Pain?

A new pre-op planning tool may help doctors predict if patients will experience chronic pain after surgery, according to a study published in the journal Anesthesiology.

Researchers followed the cases of 3,000 patients who underwent hernia repair, hysterectomy or thoracotomy to evaluate their post-op pain at 4, 12 and 24 months. Finding that about 18% of the patients reported chronic pain after 4 months, and 5.2% after 24 months, they determined 6 patient predictors that may help to identify patients who are at a higher risk for post-op chronic pain.

The predictors, which include surgery type, age, physical and mental health status, pre-op pain at the surgical site and in other areas, led to the development of a planning tool that the researchers hope physicians will be able to use to prevent pain among high-risk patients.

"We sought a tool that would reliably predict a patient's risk preoperatively, at the time surgery is being planned," says Antonio Montes Perez, MD, PhD, the study's lead author. "We developed a risk scoring system that can be used before surgery, when care planning and preventive measures are critically important."

Kendal Gapinski

Are Morcellation Fears Overblown?

The spread of unrecognized cancer during minimally invasive gynecological surgery has occurred in very few women, according to a pair of new studies, which may allay at least some fears about power morcellation's potential risks to patient health.

In November 2014, the FDA issued a warning about the use of power morcellators during fibroid surgery, stating that the devices may spread unsuspected cancer and decrease patients' long-term survival rates.

But a study published in Obstetrics and Gynecology showed a very low incidence of uterine sarcoma among hysterectomy patients. University of Michigan researchers had reviewed 7,499 cases — mostly undertaken for benign reasons — to find that the 2.7% of unexpected gynecologic cancers included only 0.22% were uterine sarcoma. Women with sarcoma were more likely to have a history of venous thromboembolism and pre-op blood transfusions, notes the study.

"We found that there is a risk of unexpected cancer discovery at the time of a hysterectomy for what was presumed to be for a benign or non-cancerous indication, however, the risk is fairly small," says senior author Sawsan As-Sanie, MD, MPH, an assistant professor of obstetrics and gynecology at Michigan.

Dr. As-Sanie says caution is still warranted when planning hysterectomies, but a minimally invasive approach can't be automatically avoided for many women. "Physicians need to balance optimizing technologies that have well-known patient-centered benefits while still being cognizant of the rare but true risk of undiagnosed cancer," she adds.

Another study, published in JAMA Oncology, showed uterine cancer appeared in 0.19% of nearly 40,0000 women who underwent myomectomy without power morecellation and in 0.09% of the approximately 3,000 women who had the procedure performed with power morecellation. Notably, incidence of pathologic abnormalities increased with age.

"Given that older women are at the greatest risk for pathologic abnormalities, electric power morcellation should be approached with caution in patients older than 50 years undergoing myomectomy," the authors write.

Daniel Cook

InstaPoll: Satisfied With Your EHR System?

Tell us in this week's InstaPoll if you're satisfied with the functionality of your EHR system.

Despite AORN's recommending that OR staff wear long-sleeve jackets in restricted areas to prevent shedding of skin cells, less than half (44%) of the 290 respondents to last week's poll require their staff to cover their arms. The results:

Do you require staff to wear long-sleeve jackets in restricted areas?

  • Yes 44%
  • No 56%

Dan O'Connor

News & Notes

  • Anesthesiologist jailed for billing fraud Doron Feldman, MD, the Buffalo, N.Y., anesthesiologist who pleaded guilty last year to billing the University of Rochester Medical Center for nearly $1.5 million in undelivered anesthesia services, has been sentenced to 2 years' imprisonment and ordered to pay restitution to the center as well as to the Internal Revenue Service, with which he filed a false tax return. Debra Bulter, the former administrator of the center's anesthesia department, also pleaded guilty last summer and is scheduled for sentencing in March.
  • When bariatric isn't a benefit Bariatric surgery has been shown to extend the life expectancies of the patients who undergo it, but only up to a point, say researchers. According to a study conducted at the University of Cincinnati, "super obese" patients whose body mass indexes are 62 or higher may actually see a decreased life expectancy following weight-loss surgeries, which researchers attribute to the likelihood that their comorbidities will result in increasingly severe complications.
  • Game your surgeons for scheduling efficiency Stanford University researchers found that a slate of surgeries they'd observed ran 58.5% longer, on average, than the physicians who'd scheduled them had anticipated. In order to boost scheduling and staffing efficiency, the researchers challenged the surgeons to more accurately estimate their OR times, offering more block time to those whose estimates improved. The game and reward worked: later surgeries only went an average of 20% overtime. The researchers presented their findings at the American Society of Anesthesiologists' recent practice management conference.