Laparoscopic ventral hernia repair bests open repair in obese patients by limiting complications, shortening hospital stays and reducing healthcare costs, according to researchers at Tufts University School of Medicine in Boston.

An analysis of 48,000 obese patients who underwent ventral hernia repair between 2008 and 2009 revealed that surgeons opted for laparoscopic approaches 21.5% more often than open repairs, resulting in an average of 7.4% fewer complications, 1 fewer day in the hospital and $8,000 less in total hospital charges. Patients with private insurance were more likely to undergo lap hernia repair, say the researchers.

The findings, published in JAMA Surgery, suggest more ventral hernia repairs are being performed on obese patients, and are a safe, low-cost option in an era when a growing number of overweight individuals are presenting for surgery.

The ultimate benefits of open and laparoscopic hernia repair are still being debated. Research previously published in JAMA noted defect recurrence rates are comparable between the 2 techniques. Lap patients lost less blood, according to the study, but open procedures resulted in fewer complications. Additionally, lap procedures were found to be longer by an average of 24 minutes.

Whatever the literature shows, a growing number of patients seeking less visible scars and faster post-op recoveries are requesting laparoscopic hernia repair. Find out if your facility is equipped for the trend.

Daniel Cook

Orthopedic surgeons working with mental health professionals have reported a "significant and substantial" correlation between patients who suffer from depression and patients suffering severe post-op pain.

For a study published in the May 2013 issue of the Clinical Journal of Pain, researchers from the University of Wuerzburg in Germany evaluated 200 orthopedic surgery patients before and after their procedures. The patients' levels of pain and depressive symptoms were self-reported by way of pain scales and questionnaires.

"Our results suggest that early postoperative depressive symptoms predicts pain at discharge and preoperative pain predicts postoperative depressive symptoms," wrote the researchers. "In conclusion, perioperative pain therapy should include the treatment of both pain and depressive symptoms, to achieve sufficient pain relief."

While the correlation was convincing, they warned, however, that any causal evidence would require future research.

David Bernard

Although bariatric surgery has been shown to be an effective path to weight loss and diabetes control for obese patients who have BMIs of 35 or greater, along with obesity-related comorbidities, more data is needed to conclude that the surgery is also appropriate for diabetic patients with BMIs in the 30 to 35 range.

Researchers at UCLA who reviewed more than 50 studies from which direct and indirect comparisons could be drawn have concluded that data support the notion that the surgery benefits the 30 to 35 group, too, at least in the short run.

But, they caution, there is "no robust surgical data beyond 5 years of follow-up on outcomes of diabetes, glucose control, or macrovascular and microvascular outcomes" and that "long-term adverse events are unknown."

In contrast, the available data support benefits at 10 years or more for nonsurgical therapies, say the researchers, who reported their findings in the June 5 issue of the Journal of the American Medical Association.

Jim Burger

Does your staffing policy require employees to undergo annual physicals? Tell us about your typical employee health practices in this week's InstaPoll.

Last week we asked who starts IVs at your facility. Not surprisingly, the overwhelming majority of our 644 InstaPoll respondents report that it's an RN.

Who starts IVs at your facility?

• RNs: 90%
• Anesthesia providers: 10%

Dan O'Connor

• SGNA opposes SUD reuse Citing patient safety, the Society of Gastroenterology Nurses and Associates is opposing the reprocessing and reuse of critical medical devices manufactured for single use. The reduction of costs and wastes must take a backseat to further study on the practice's risks versus benefits, according to the organization's recently issued position statement on the matter.
• ACL tunnels vary When repairing anterior cruciate ligaments, orthopedic surgeons place femoral and tibial tunnels within published guidelines, but differ slightly when setting tunnel height and depth, notes a study in the American Journal of Sports Medicine. The study's authors noted a 19% range in femoral tunnel height, a 16% range in tibial tunnel location when measured anterior to posterior and a 4% range in tibial tunnel location from medial to lateral. Surgeons are relatively consistent in their ACL techniques, suggest the findings, but the difference in average tunnel depth is likely because of differences between surgeons' preferred tunnel locations.
• Anesthesia linked to dementia in elderly Older patients who are given general anesthesia have a 35% greater likelihood of developing dementia, according to French researchers. Their study focused on more than 9,000 seniors who were interviewed and tested at various intervals over a 10-year period. More than 1,300 were given general anesthesia during that time. Among the 632 participants who developed dementia, 22% had been given general anesthesia, compared with 19% of those without dementia.