Watch Out for the Mice in Your ORs

Which surfaces in your operating rooms should merit special cleaning attention? Researchers from the University of Colorado Hospital have determined that the 5 most frequently touched surfaces are, in order, anesthesia's computer mouse, the OR bed, the circulator's computer mouse, the OR door and the anesthesia cart.

For the study, which appears in the American Journal of Infection Control, the researchers conducted a descriptive analysis to determine which surfaces were contacted most, then cultured those surfaces to judge whether they were more highly contaminated than a control low-touch surface.

The result? Four of the 5 were more highly contaminated, the exception being the OR bed. The authors recommend enhancing cleaning protocols to provide special attention to the identified high-touch surfaces.

Jim Burger

Monitor Patients' Pain While They're Unconscious

Israeli researchers have developed a non-invasive method of accurately gauging the level of pain a patient is experiencing, even while he is under general anesthesia, according to a study appearing in the journal Anesthesiology.

By letting physicians assess the body's response to surgical stimulation, this method could help them better manage anesthesia in the OR, reduce pain during emergence and improve post-op outcomes, say the researchers. The method is based on the nociception (pain) level index, which uses an algorithm to monitor multiple hormonal and neurological reactions in the patient.

Traditionally anesthesia providers monitor a body's reflex responses, such as changes in heart rate or blood pressure, whether the eyes are tearing, and sweating, to determine how it's reacting to painful stimulation during surgery. However, these responses are often inaccurate or result in patient harm or post-op pain if they aren't adequately addressed in time.

The researchers used traditional anesthesia monitoring in addition to a non-invasive, pain-monitoring device to generate the nociception index in 58 anesthetized patients undergoing surgery. The index quantified patients' pain better than traditional monitoring methods during incision and other painful processes, and showed a decrease in pain once medication was administered.

"There's currently no standardized, objective method for physicians to monitor the effectiveness of pain-relieving drugs being administered during surgery," says Ruth Edry, MD, the study's lead author. "Not effectively monitoring bodily responses to painful stimulation can lead to insufficient amounts of pain medication being administered, which can result in the patient having severe pain upon regaining consciousness from anesthesia, while too much medication may cause other side effects such as nausea and vomiting or respiratory complications."

Kendal Gapinski

The High Cost of Surgical Complications

Surgical complications increase the cost of care and cut into profits for hospitals and insurers, according to a study published in JAMA Surgery.

Researchers at the University of Michigan collected complication data collected between January 2008 and April 2015 by the Michigan Surgical Quality Collaborative and the University of Michigan Health System. The data included more than 5,000 episodes of care for general, vascular and gynecologic surgeries. The researchers then compared hospital costs, hospital profit margins and how much insurers reimbursed for cases that did and did not involve complications

Complications occurred during 14.5% of the procedures, according to the findings. The average hospital cost and insurer payment for procedures with complications was $36,000 and $35,870, compared with $16,500 and $17,373, respectively, for procedures without complications. Complications slashed the hospital's profit margin from 5.8% to 0.1%.

The researchers say complications unnecessarily increase the cost of surgical care for both hospitals and insurers, although recent payment policy changes that reward quality care is shifting more of the burden to the hospitals. The study's authors say the findings show that quality improvement efforts aimed at protecting patients also make good financial sense.

Daniel Cook

InstaPoll: Do You Give Antibiotics Before Local Anesthesia?

Do you administer antibiotics before local anesthesia cases? Tell us in this week's InstaPoll.

Most (39%) of the 370 respondents to last week's poll try 2 times to reach post-op patients by telephone. The results:

How many times does your facility try to reach post-op patients by telephone?

  • We don't make post-op calls 5%
  • 1 attempt per patient 26%
  • 2 attempts per patient 39%
  • 3 attempts per patient 28%
  • 4 attempts per patient 2%

Dan O'Connor

News & Notes

  • Win a free stay at ORX If you've ever wanted to do Florida in style, now's your chance. Register for OR Excellence (taking place from Oct. 12 to 14, 2016, in Bonita Springs, Fla.) by this Friday, May 27, and you'll be entered into a drawing for great prizes, including spa gift certificates, room upgrades and the grand prize: a 4-night stay in the Hyatt Regency Coconut Point's gorgeous Presidential Suite. Plus, you'll take advantage of the $100 early-bird price discount and secure your room in the heart of the conference action.
  • Trend in tendon repair? Suture anchors not only provide a less invasive, less anatomically disruptive method of repairing a quadriceps tendon rupture than tunneling through the bone, they also enable knee mobility earlier in recovery, according to University of Missouri researchers. While their study, funded by device maker Arthrex and published in the journal Arthroscopy, suggested that suture anchors are the more expensive option, it notes that the stronger post-procedure outcomes of the knees in which they were implanted is a big benefit.
  • Sleep apnea's surgical complications The existing studies of surgical patients who suffer obstructive sleep apnea are inconsistent on whether the condition creates a heightened risk of post-op mortality, but an analysis appearing in a recent issue of the journal Anesthesia & Analgesia shows that OSA is associated with a greater likelihood of post-op pulmonary complications, among other adverse outcomes.