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| Major Insurers Wary of Pain Pumps
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Citing a lack of statistically significant clinical trials, three of America's four largest health care insurers — Aetna, United Healthcare and Cigna — are declining to reimburse the cost of infusion pumps for post-op pain management, the Wall Street Journal reports in its Jan. 11 issue.
Numerous studies have supported manufacturers' claims that the pumps ease patients' post-op pain, reduce their narcotic use and speed their recovery. The article counts 50 studies since pain pumps were developed five years ago. But it also notes that many of the studies' test samples only included 25 patients to 90 patients, leading insurers to view the results -- and the products -- with skepticism. Insurers have also expressed reservations about the possibility of increased infection risks and catheter leakage, the article states.
Manufacturers and study authors reply that advances in pump technology reduce the risk of infections and that Blue Cross Blue Shield companies, among other payers, still cover pumps, the article says.
The article estimates that more than 1 million pumps have been implanted in American patients, adding that only 34 incidents of related complications, such as infection or necrosis, have been reported to the FDA through 2004.
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| Study: Anesthesia Doesn't Complicate Long Facial Plastic Surgeries
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A new study challenges the notion that patients undergoing plastic surgery procedures lasting longer than four hours are more likely to suffer anesthesia-related complications than those undergoing shorter procedures.
For the study, published in January's Archives of Facial Plastic Surgery, researchers undertook a ten-year outcomes analysis of more than 1,000 patients who spent more than four hours under anesthesia for facial procedures as well as more than 150 who didn't.
There were no deaths, myocardial infarctions or pulmonary embolisms among the patients studied, and the occurrences of major complications in the two groups were similar. A comparison of the two groups showed no indications of a higher incidence of intractable nausea, vomiting or pain in the longer operations.
Highly publicized patient deaths in office-based plastic surgery facilities have led Pennsylvania, Tennessee and other states to enact regulations requiring operations lasting longer than four hours to be performed at inpatient facilities. But, the researchers write, "When regulatory bodies consider creating surgical guidelines, a detailed understanding of specific risks associated with different types of surgery is needed to avoid generalization and inappropriate, non-data-driven regulation."
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| Prevent Post-op Infections With Carbs?
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The pre-operative intake of a carbohydrate-rich drink can prevent depression of the immune system due to surgery, potentially reducing the risk of surgical site infections, according to a study published in the January/February issue of the Journal of Parenteral and Enteral Nutrition.
Researchers in Amsterdam, The Netherlands, investigated the effect of surgery on the post-op immune response in 10 patients who had fasted pre-operatively and in 20 patients who randomly received one of two clear, carbohydrate-rich beverages pre-operatively. Human leukocyte antigen-DR expression on monocytes, an indication of immune system activity, was measured pre- and post-operatively. HLA-DR expression decreased significantly post-op in the control group, say researchers, while patients in both beverage groups did not exhibit this decrease.
No aspiration incidents occurred after induction of anesthesia; all patients in the beverage group received and took their drink in time before surgery. "Fasting before surgery is still common care in a lot of western hospitals," researchers write, "[but] overnight fasting can induce post-operative insulin resistance. Insulin resistance has been shown to be related to infectious morbidity. It was shown that post-operative insulin resistance could be attenuated by pre-operative intake of a clear carbohydrate-rich beverage."
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| News and Notes
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WILL CALIFORNIA BE THE NEXT STATE to attempt a tax on cosmetic surgery procedures? That question may be answered later this month when the state's Board of Equalization resolves sales tax rules on the use of the wrinkle-reducing drug Botox. The question arose as state auditors scrutinized doctors' failure to levy sales tax on Botox treatments. While the state exempts prescription medications from sales tax, auditors note that the cosmetic use of Botox is not a disease-fighting medicine. Plastic surgeons, dermatologists and consumers seek continued exemption, arguing that taxing Botox may lead to the taxing of other drugs or surgical procedures, allowing auditors to legislate the line between medical necessity and cosmetic procedures.
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