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Can a Blood Test Predict Post-op Recovery Times?

A pre-op diagnostic blood test could take the guesswork out of how long it'll take patients to recover from surgery, according to research published in the journal Anesthesiology.

Investigators at Stanford University Medical Center found that signaling responses induced in the immune cell subsets of blood samples from 25 patients before they underwent hip replacement surgery mimicked the immune response seen after surgical trauma. They then compared the immune responses to such factors as post-op pain and hip dysfunction, which are known to extend recovery periods.

They determined that the activity of monocytes — the white blood cells throughout the body that form new connective tissue and blood vessels during wound healing — predicted as much as half of the post-op pain and hip dysfunction variations in patients, as compared to the white blood cell count at the wound site or the patient's mental state, which accounted for only 10% of the variation in recovery time.

The ability to stratify patients based on recovery times predicted by pre-op blood tests would let surgical teams apply individualized perioperative management strategies to ensure recoveries are as safe and efficient as possible, say researchers.

"Patients and physicians want to know how long pain and dysfunction will last after surgery, but the rate at which patients recover is highly variable and differs for every patient," says Martin Angst, MD, study author and professor of anesthesia at Stanford. "Our research indicates that we can capture important aspects of each individual patient's biology that accurately predict how they will handle and recover from surgery. This may ultimately enable us to provide personalized, cost-conscious approaches to aid recovery and have a major impact on perioperative medicine."

Daniel Cook

Are Your Surgeons Too Old to Operate?

Checking a doctor's physical condition and mental ability could help administrators determine whether it's safe for them to continue providing surgical care, say the developers of a new test.

The test, part of The Aging Surgeon Program at Sinai Hospital in Baltimore, features several hand-eye coordination exams to gauge a surgeon's physical performance as well as neurological assessments to check his memory, attention span and emotional status.

Mark Katlic, MD, MMM, FACS, who created the test and founded The Aging Surgeon Program, notes that having a way to monitor a surgeon's performance as he ages is important because unlike other professions, surgeons don't have a mandatory retirement age. In addition to a surgeon's hand-eye coordination, the 2-day test also evaluates the physician's skills and physical conditions such as hearing and vision.

Surgeons who are concerned about their health can take the test at the Sinai Hospital on their own, or facilities can request evaluations of their surgeons. Dr. Katlic says the goal isn't to scare physicians into early retirement, but to help them get the assistance they need for any missed health conditions while also protecting patients.

"We've heard that a number of surgeons have voluntarily retired when threatened with our test, as it were," says Dr. Katlic. "But we're hoping to support the surgeons as much as possible, too."

Kendal Gapinski

An Overlooked Risk Factor for Joint Patients

"Fast-track" total joint patients who are being treated with psychopharmacologic drugs showed significantly higher 90-day surgery-related mortality rates, say Danish researchers, who suggest that the often-overlooked risk is an important patient selection component before same-day joint surgeries.

The researchers' study encompassed 8,757 total joint patients, of whom 1,001 were taking selective serotonin inhibitors, other antidepressants and/or antipsychotics. The morbidity rate for these patients was 0.7%, compared with 0.2% for the control group, and the risk was found to be independent of treatment type and pre-op co-morbidities. The psychopharmacologic patients also had longer lengths of stay and were more likely to have surgery-related readmissions.

It is uncertain, however, whether the increased risk is due to underlying psychiatric disorders, drug-related side effects or both, say the researchers.

Jim Burger

InstaPoll: Which Position Are You Currently Looking to Fill?

Are you hiring? Tell us in this week's InstaPoll which position you're currently looking to fill.

Letting staff launder scrubs at home is a hot-button issue for surgical facility leaders. AORN recommends that surgical attire should be laundered in a healthcare-accredited laundry facility, but not everyone agrees. Of the 471 respondents to last week's poll, 29% let their staff launder their scrubs in their home washing machines. The results:

Do you let your staff launder scrubs at home?

  • Yes 29%
  • No 71%

Dan O'Connor

News & Notes

  • Joint replacement readmissions down Knee replacement patients saw 23% fewer hospital readmissions and hip replacement readmissions were down 20% between 2009 and 2013, according to a recent review of insurance data by the AARP Public Policy Institute.
  • An analgesic advance A newly developed analgesic called isovaline, when given with propofol, could provide general anesthesia and conscious sedation with less risk of respiratory depression than propofol and fentanyl, say researchers in the journal Anesthesia & Analgesia.
  • Taste test for sinus surgery Among patients undergoing surgery for chronic sinusitis, those with the highest level of sensitivity to a certain bitter taste showed the best post-op results, including ease of breathing, fewest infections and soundest sleep, according to research conducted at the University of Pennsylvania and the Monell Chemical Senses Center in Philadelphia.