Videos Help Older Patients Predict Likelihood of Complications

Want to know whether elderly patients are more or less likely to have post-op complications following elective surgery? Ask them.

In a recent study, nearly 200 patients 69 years of age or older were asked to watch 10 animated video clips of activities spanning a wide range of functional capacities, then respond to a series of questions about their ability to perform each task. The result: Worse self-reported mobility was associated with more complications, later time to discharge and increased nursing home placement.

The video clips included walking on level ground, a slow jog, walking outdoors on uneven terrain, walking up a ramp with and without using a handrail, stepping over hurdles, ascending and descending stairs with and without the use of a handrail, and climbing stairs while carrying bags.

Although the study was small and more research is needed, the authors say the videos could turn out to be a "quick, reliable, and cost-effective" predictive tool, especially since "traditional risk assessments," such as ASA physical status classification, Revised Cardiac Risk Index, and five-point frailty evaluation, can be "too comprehensive, too focused on single organ systems, or too impractical."

Jim Burger

No More Secondary Cataracts?

British researchers may have identified ways to prevent posterior capsule opacification, a complication of cataract removal that impairs the vision of around 20% of patients within 2 years of surgery.

The complication results from segments of the natural lens that remain after the diseased lens is removed. During the wound-healing process, the remaining tissue grows on the posterior capsule, giving rise to light scatter and subsequent vision deterioration.

According to their research, published in the journal Scientific Reports, newly developed lens implants that enable open-bag cataract surgery would let aqueous humour flow around the implant in order to dilute the growth factor which promotes the regrowth of the natural lens cells and causes posterior capsule opacification.

They also note that drug treatments could target the vascular endothelial growth factor (VEGF) to enhance the effect of lens implants designed to prevent secondary cataracts from developing. In fact, new intraocular lenses containing anti-VEGF treatment, which is currently used to block blood vessel growth in the wet form of age-related macular degeneration, could be created if proven safe in the anterior segment of the eye.

"Secondary visual loss responds well to treatment with laser surgery," says study author Michael Wormstone, PhD, faculty member at the School of Biological Sciences in the United Kingdom. "But as life-expectancy increases, the problems of cataract and posterior capsule opacification will become even greater in terms of both patient well-being and economic burden. It's essential that we find better ways to manage the condition in future."

Daniel Cook

Mentally Ill Patients Fare Worse After Total Hips

Patients with a psychiatric disease who undergo a total hip replacement have significantly higher rates of medical and surgical complications than those without a mental illness, according to a new review published in The Journal of Arthroplasty.

In the study, researchers analyzed arthroplasty data from Medicare between 2005 and 2011. They identified 86,976 patients who had hip replacements and also had a diagnosis of 1 or more of 3 common psychiatric diseases: bipolar disorder, depression or schizophrenia. The researchers then compared these patients' surgeries and post-op results to those of patients who underwent hip arthroplasty, but did not have a mental illness.

The researchers found that within 3 months of surgery, those who had a mental illness were more likely to have 13 of the 14 medical complications studied. The hip implants of patients with mental illness, for example, were more than twice as likely to get infected, break or get dislocated.

The study's authors say that their findings suggest that patients undergoing total hip replacements should be studied and counseled for mental illness before going under the knife to help ensure a safe surgery.

"Patients with these conditions can still have a total hip replacement and achieve excellent relief from their arthritis pain," says Mitchell Klement, MD, lead author and orthopedic surgery resident at Duke University Medical Center. "However, they should know that the rates of problems after surgery might be higher."

Kendal Gapinski

InstaPoll: Do Patients Sign Separate Anesthesia and Procedure Consents?

Informed consent is a process, not a piece of paper that needs to be signed, but this week we want to know how many pieces of paper patients have to sign at your facility. Do you have 2 consents, 1 for anesthesia and 1 for surgery, or just 1 consent for both? Tell us in this week's InstaPoll.

Only 20% of the 379 survey respondents to last week's poll report that their surgeons are present in the OR during anesthesia induction. The results:

Are your surgeons typically present in the room during anesthesia induction?

  • Always 20%
  • Sometimes 40%
  • Rarely 32%
  • Never 8%

Dan O'Connor

News & Notes

  • New drug compounding regulations In a recently published set of proposed guidelines on drug compounding, the FDA clarifies prescription timing requirements, how they'll be applied to hospital and health system pharmacies, and its definition of a healthcare facility under the regulations.
  • Duodenoscope outbreak's expanding impact About 300 to 350 patients were infected by or exposed to duodenoscope cross-contamination at 41 facilities worldwide between January 1, 2010, and October 31, 2015, according to a recent congressional investigation on the outbreak. The number of confirmed incidents is higher than that stated by a previous, narrower investigation.
  • A colonoscopy red flag The discovery of a flat adenoma during a screening colonoscopy is usually a signal that larger, advanced or multiple adenomas will also be found in the colon, say researchers, who suggest that patients in which such findings occur should be screened more frequently and more carefully.