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Digital Issues

Researchers Pinpoint 2 Most Common Causes of Endophthalmitis

Researchers have identified staphylococci and streptococci bacterial strains as the most common cause of endophthalmitis, the debilitating eye surgery complication that can cause blindness, according to their account in the journal Ophthalmology.

The investigators assessed a total of 988 microbes noted in records of endophthalmitis events occurring between 1987 and 2011 at the New York Eye and Ear Infirmary of Mount Sinai in Manhattan in order to identify the pathogens that caused the condition. Their findings report that most infections were caused by gram-positive bacteria, with nearly all successfully treated with the common antibiotics vancomycin and ceftazidime.

However, they also found that the bacteria were increasingly resistant to several first-generation antibiotics, including cephalosporins and methicillin. Resistance to the latter increased incidences of endophthalmitis by 28% since the late 1980s, they say.

"This is consistent with what other physicians have found throughout the United States with methicillin-resistant staphylococcus aureus causing severe skin and soft-tissue infections," says study lead author Ronald C. Gentile, MD, professor of ophthalmology at the Icahn School of Medicine at Mount Sinai and chief of ocular trauma service at NYEE.

The researchers say their findings are important in the context of the CDC identifying antimicrobial resistance as one of the country's most serious health threats. They call for the judicious use of antibiotics, and suggest using therapy that is most effective against endophthalmitis.

Daniel Cook

Knee Surgery May Not Be Helping Older Patients

Middle-aged and older patients with mild or no accompanying osteoarthritis are gaining little or no benefit from arthroscopic surgeries to repair meniscus tears, says a recent study published in the Canadian Medical Association Journal.

Other treatments should be used first, say the authors, who reviewed 7 randomized, controlled trials that took place between 1946 and 2014 and involved 805 patients. The mean age of the patients was 56. In 4 of the trials, no pain relief was recorded in the first 6 months after surgery. No improvement in function occurred up to 2 years after surgery in 5 of the trials.

Physicians should carefully weigh costs and benefits related to the surgery, says the study's principal investigator, Moin Khan, MD, an orthopedic surgery resident at McMaster University in Ontario, "as there is limited evidence supporting partial meniscectomy surgery for meniscus tears."

Jim Burger

The Rise of Robots Brings Change to Prostatectomy

As robot-assisted prostatectomy has become more common, fewer physicians may be performing the surgery and its overall costs may be increasing, says a new study.

For the study, published in the journal BJU International, researchers reviewed the cases of nearly 490,000 men who had their prostates removed between 2003 and 2010. During that time, researchers say, the number of U.S. surgeons who did at least half of their prostate removals with robotic help dramatically increased from 0.7% in 2003 to 42% by 2010.

However, they add, the actual number of surgeons performing prostate removals during that time decreased from 10,000 to 8,200. The authors suggest that as more high-volume surgeons adopted the technology, those who performed only a few cases a year stopped altogether.

The use of robotic technology was also tied to an increase in overall spending on prostate removals. Although robot-assisted surgeries still cost more than traditional open or laparoscopic ones, surgery using the technology was found to become less expensive over time.

Kendal Gapinski

InstaPoll: Who's Got the Best Job in Surgery?

Of all the talented professionals who make surgery successful, who's got the best job? Tell us in this week's InstaPoll, then check back next week for the results.

You're most likely to find anesthesia providers hanging out in the staff lounge, according to more than one-third of the 631 respondents to last week's poll. Nurses spend the least amount of time in the break room, they say. The results:

Who spends the most time in the staff lounge?

  • Surgeons 21%
  • Anesthesia providers 38%
  • Nurses 16%
  • Techs 25%

Dan O'Connor

News & Notes

  • Worldview affects knee replacement recoveries Patients who feel that life isn't fair may suffer more post-op pain after knee replacements, according to Canadian researchers. For a study in the July 2014 issue of the journal Pain, they surveyed 116 total knee arthroplasty patients on their pre-op "pain severity, physical disability, perceptions of injustice, pain catastrophizing and fear of movement," as well as their pain and disability at 1 year post-op. "Perceived injustice contributed modest but significant unique variance to the prediction of postsurgical pain severity," the researchers write, suggesting that pre-op psychological intervention may improve recoveries for patients given to pessimism.
  • Alcon buying WaveTec Vision Ophthalmic giant Alcon has announced plans to acquire WaveTec Vision, the manufacturer of the ORA intra-operative guidance system, whose measurements can verify lens selection and placement during cataract surgery. Financial details of the deal were not disclosed.
  • Procedure packs recalled Medical manufacturer Customed has recalled certain lots of its procedure packs due to an adhesion defect that may impair the products' sterility. The packs were manufactured between January 2009 and May 2014, and distributed domestically during that time to facilities in Florida, New York state, Puerto Rico and the U.S. Virgin Islands.