Can a Surgeon's Brash Behavior Foretell Post-op Problems?

RISKING A LOT In addition to increasing the risk for post-operative complications, surgeons' poor behavior made patients feel "embarrassed" and "vulnerable."

Given the choice, most patients would prefer not to be treated by a rude, intimidating or brash surgeon. A new study suggests there's a good reason why: The more complaints a surgeon receives, the greater the risk of that surgeon's patients developing post-operative complications.

A patient whose surgeon has a significant amount of unsolicited patient feedback in the 24 months prior to their operation are at increased risk of surgical and medical complications, as well as even more dire outcomes, according to a study published in JAMA Surgery. This might explain why surgeons with the least favorable reviews often find themselves the most frequent targets of medical malpractice lawsuits.

Among the 32,125 patients (13,230 men, 18,895 women) studied, more than 3,500 mdash; nearly 11% mdash; experienced a surgical complication (5.5%), including surgical site infections and wound disruptions, or a medical complication (7.5%), such as stroke, a cardiovascular condition or a pulmonary condition. Complications were 13.9% more likely for patients whose surgeon was in the highest quartile of unsolicited patient observations compared with patients whose surgeon was in the lowest quartile.

The study cited several examples of patients describing surgeons' behaviors as intimidating, deterring communication or rude to fellow clinicians, including:

  • "I asked Dr. Y how long he thought the operation would take. He said, 'Look, your wife will die without this procedure. If you want to ask questions instead of allowing me to do my job, I can just go home and not do it.'"
  • "Dr. X rushed us through the appointment so quickly; she didn't even explain why she was recommending this procedure over other treatment approaches."
  • "I witnessed a tense exchange between Dr. Z and a nurse. It was difficult to watch someone try to humiliate another person like that. I was embarrassed and it made me feel vulnerable."

The authors suggest focusing on surgeons' ability to communicate respectfully and effectively with patients and other medical professionals. Doing so will not only promote patient safety, they say, but also address the risk of malpractice claims.

Bill Donahue

No Smoking Before Joint Replacement Surgery

PACK A DAY The more cigarettes patients have smoked, the greater their risk of infection.

Smokers are more likely than non-smokers to require reoperations to treat surgical site infections after undergoing total joint replacement procedures, according to a new study in The Journal of Bone & Joint Surgery.

Researchers at the Rothman Institute in Philadelphia, Pa., reviewed the records of more than 15,000 patients who underwent approximately 17,000 hip and knee replacements between 2000 and 2014. According to the study, 9% of the patients were smokers, 34% were former smokers and 57% were nonsmokers.

Although the overall risk of post-op infection was low (0.71%), smokers were at significantly higher risk than non-smokers (1.2% versus 0.56%) to suffer a post-op infection requiring reoperation. The more packs of cigarettes smokers had gone through in their lives, the greater their risk of infection: Smokers and former smokers involved in the study had smoked a median of 233 packs per decade and smoking an extra pack per day over a 10-year span increased risk of infection by 12%, according to the findings.

The researchers say smoking is a risk factor for post-op infection that surgeons can take steps to intervene and manage. They also note that the study offers support for helping patients kick the habit before undergoing joint replacement surgery in order to reduce risk of costly readmissions in the era of value-based care and bundled payments and, just as importantly, to improve their overall health.

Daniel Cook

Zimmer Biomet Recalls More than 3,600 Shoulder Implants Due to a High Fracture Rate

LAST RESORT The Comprehensive Reverse Shoulder is used when shoulder joint replacements have failed.

Zimmer Biomet is recalling more than 3,600 Comprehensive Reverse Shoulder implants that it says have been fracturing at a dangerously high rate, endangering patients.

Classified as Class I by the FDA, because the device in question can cause serious injuries or death, the recall covers implants that were distributed between October 2008 and September 2015.

The implant is designed for patients whose shoulder joint replacements have failed. When it fractures, it requires revision surgeries that could cause permanent loss of shoulder function, infection, or, in rare circumstances, death.

Zimmer Biomet sent recall notices to all affected customers in December, asking them to quarantine any devices they have in stock, return a Certificate of Acknowledgement and wait for a company rep to remove any such devices. No special patient monitoring instructions related to the recall are recommended.

All lots with part number 115340 are subject to the recall. The full list of lot numbers is included in the FDA's notice.

Call the 411 Technical Services at (574) 371-3071 or email with any questions related to the recall.

Jim Burger

InstaPoll: What Was the Last "Never Event" to Occur in Your Facility?

The term "never event" refers to particularly shocking medical errors that should never occur. Tell us in this week's InstaPoll what never event last occurred at your facility: wrong-site surgery, medication error, patient fall, retained object or pressure ulcer.

More than three-fourths (78%) of the 216 respondents to last week's poll view nasal decolonization as a useful tool in the fight against surgical site infections. The results:

Agree or disagree: Nasal decolonization is a promising opportunity for infection control.

  • strongly agree 47%
  • agree 31%
  • disagree 6%
  • strongly disagree 3%
  • unsure 13%

Dan O'Connor

News & Notes

  • Compliance with powdered glove ban Starting now, The Joint Commission surveyors will check for compliance of the FDA ban on powdered gloves that went into effect Jan. 18. The ban says powdered surgeon's gloves, powdered patient examination gloves and absorbable powder for lubricating surgeon gloves "present an unreasonable and substantial risk of illness or injury and that the risk cannot be corrected or eliminated by labeling or a change in labeling."
  • Compounded ophthalmology meds without patient-specific Rx Imprimis Pharmaceuticals customers can now purchase Dropless Therapy injectable and LessDrops topical formulations in 20-unit boxes without patient-specific prescriptions. Imprimis will begin shipping its core ophthalmic formulations from its FDA-registered 503B outsourcing facility in New Jersey, at first to select customers and in the next few weeks to all customers. New and existing customers can register here for an ImprimisRx 503B account.
  • NECC profits fair game at trial The jury hearing the second-degree murder trial of former New England Compounding Center owner Barry J. Cadden will be able to hear a forensic accountant's report showing Mr. Cadden and his wife, Lisa, collected $18.1 million in profits from the now defunct Framingham drug compounding company. Mr. Cadden has been charged with racketeering and 25 counts of second-degree murder as a result of a 2-year probe of the 2012 fungal meningitis outbreak that was caused by fungus-tainted drugs shipped from NECC. The outbreak sickened 778 patients and 76 of them died.