Are Overlapping Surgeries Safe?

DOUBLING UP Running two ORs at once improves access to care.

Mayo Clinic researchers have come out in support of having surgeons work 2 cases at once in neighboring ORs, calling the practice safe, efficient and good for patients.

There were no differences in rates of post-op complications or death in the month following surgery among more than 10,500 overlapping surgeries and approximately 16,000 non-overlapping procedures, according to the findings, which were published in the Annals of Surgery.

"Our data show that overlapping surgery as practiced here is safe," says study co-author Robert Cima, MD, a colorectal surgeons and chair of surgical quality at the Mayo Clinic's Rochester campus. "We think it provides value to our patients, because it allows more patients timely access to surgery and care by expert teams."

Overlapping procedures involve staggered start times so surgeons are present for critical stages of surgery in both ORs and immediately available to back up assistants who handle non-critical phases such as wound closure.

The new findings come on the heels of another study that touted the safety and efficiency of overlapping orthopedic surgeries in the ambulatory setting. Both reports were released approximately a year after the practice of surgeons running 2 ORs at the same came under increased scrutiny when the Boston Globe ran an expose on concurrent surgeries performed at Massachusetts General Hospital.

Daniel Cook

FDA: Water Bottle Backflow Can Lead to GI Scope Cross-Contamination

INFECTION RISK The water bottles endoscopists use to supply irrigation for GI procedures can become contaminated by patient fluids.

The water bottle endoscopists use to supply irrigation for GI procedures can become contaminated with blood, stool or other patient fluids that travel back through the endoscope channels and tubing. This so-called "backflow" from irrigation channels into the water bottle and tubing raises the risk of cross-contamination between patients.

In response to reports of heightened cross-contamination risk when the irrigation channel did not have a backflow-prevention mechanism in place, the U.S. Food and Drug Administration has issued a guidance document that outlines strategies designed to reduce the risk of cross-contamination from connectors and irrigation accessories, including device design and labeling.

Regarding device design, FDA recommends having one or more device components within the irrigation system that has a backflow-prevention valve or some other feature designed to prevent backflow so the water bottle and proximal tubes/accessories can be used safely for multiple patients. This valve should be tested with quantitative chemical and/or microbiological analyses, the guidelines suggest, to effectively demonstrate its ability to prevent the backflow under simulated use conditions.

Labeling, meanwhile, should be clear and specific regarding the proper use of the device, the guidelines suggest. Among the recommended instructions for labeling: Provide clear instructions for installing irrigation devices, including valves, connectors and tubing, to the irrigation system of the endoscope; provide clear identification of the device or component that includes a backflow-prevention valve or other backflow-prevention feature; and identify the device as consumable (to be discarded and replaced after every patient use) or reusable (intended for repeated use, either on the same patient or among different patients, with appropriate cleaning and other reprocessing between uses).

Bill Donahue

ACS Releases New SSI-Prevention Guidelines

LIGHTS OUT Smokers should be urged to quit before having surgery.

New guidelines issued by the American College of Surgeons (ACS) and the Surgical Infection Society aim to enlist both clinicians and patients in the battle to prevent, detect and manage surgical site infections.

Studies suggest that up to 60% of SSIs are preventable, says a release from ACS, and the new guidelines are designed to provide step-by-step ways to address them, says principal author Therese M. Duane, MD, MBA FACS, FCCM.

Some of the new guidelines suggest changes in the ways patients are managed. For example, while high blood sugar levels during surgery increase the risk of SSIs, excessively low blood sugar levels don't reduce SSI risk, but do increase risks of other adverse outcomes. So the guidelines set preoperative target blood glucose levels of 110-150 mg/dL for all patients, including diabetics.

Additionally, since smokers have the highest risk of contracting SSIs, the guidelines encourage surgeons to advise patients to stop smoking 4 to 6 weeks before surgery. Obese patients should also be encouraged to lose weight before having surgery, they say.

The guidelines are based on research and clinical practice experience.

Jim Burger

InstaPoll: Do You Throw Your Staff a Holiday Party?

There are many ways to celebrate the holidays at work: a staff luncheon, a gift exchange or a formal after-hours party. Tell us in this week's InstaPoll how you like to party.

More than one-third (34%) of the 309 respondents to last week's poll clean their cubicle curtains twice a year. The results:

How often do you clean your pre-op and PACU cubicle curtains?

  • monthly 15%
  • quarterly 24%
  • twice a year 34%
  • yearly 27%

Dan O'Connor

News & Notes

  • Take Outpatient Surgery's salary survey Don't miss your chance to take part in our annual salary survey, which is now live. If you work in an ASC, go here; if you work in a hospital, go here. We'll report on the results in our January issue.
  • ASCs paid half of hospitalsOn average in 2017, Medicare will pay ambulatory surgical centers 50% of what hospital outpatient departments receive for providing the same surgical services, according to an analysis by the Ambulatory Surgery Center Association.
  • New online-only ortho journal AAOS has launched the Journal of the American Academy of Orthopaedic Surgeons: Global Research & Reviews, which will provide reviews, research articles, clinical trials and commentary about the latest surgical techniques and diagnosis and treatment of musculoskeletal conditions. The open access journal is available only online.