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| Study: PONV Persists as a Significant Problem
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It's not uncommon for surgical personnel seeking to reduce the incidence of post-surgical site infections to recommend pre-operative antibacterial showers for their patients and to remove hair at the surgical site before incision. Two new studies, however, suggest that these practices are not as effective as is commonly believed.
In the showering study, researchers reviewed six randomized controlled trials that compared the outcomes of more than 10,000 patients who either washed with 4% chlorhexidine gluconate, a placebo or bar soap, or did not wash at all. The difference in outcomes was not statistically significant. "This review provides evidence of no benefit for pre-operative showering or bathing with chlorhexidine over other wash products, to reduce surgical site infection," the researchers write.
In the hair removal study, researchers reviewed eleven trials involving more than 5,000 patients that compared outcomes after several hair removal scenarios using razors, clippers and depilatory creams, or not removing hair at all.
"The evidence finds no difference in SSIs among patients who have had hair removed prior to surgery and those who have not," the researchers write. "If it is necessary to remove hair, then clipping results in fewer SSIs than shaving using a razor.
"There is insufficient evidence regarding depilatory cream compared with shaving using a razor," they continue. "There is no difference in SSIs when patients are shaved or clipped one day before surgery or on the day of surgery."
While the two practices have become standard surgical hygiene, the studies' authors suggest that reconsidering them may result in time and cost benefits.
The studies appear in a recent issue of The Cochrane Library, a publication of the international, non-profit healthcare researcher The Cochrane Collaboration.
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| Studies Question Value, Frequency of Colonoscopy
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Two studies appearing in the latest issue of the Journal of the American Medical Association question the conventional wisdom when it comes to colonoscopy.
The first suggests that, even though the prevalence of colon tumors increases with age, screening colonoscopies in patients 80 and older result in smaller gains in life expectancy as compared to younger patients.
Researchers looked at 1,244 asymptomatic individuals in three age groups (50 to 54 years, 75 to 79 years, 80 years and older, n = 63) who underwent screening colonoscopies. The oldest group's life expectancy was extended an average of only 0.13 years as compared with the 0.85 years of the 50-to-54-year-old group.
"The results reported here show that even though the prevalence of colonic neoplasia increases with age, screening colonoscopy in very elderly patients results in only 15 percent of the expected gain in life expectancy achieved in younger patients," the authors write. "These data suggest that the benefit of screening colonoscopy in very elderly patients may be smaller than what is commonly believed. This should help individual patients and clinicians decide whether screening colonoscopy should be performed and help avoid its use in patients who are unlikely to benefit substantively."
Current guidelines recommend colorectal cancer screening for all patients 50 years or older, but do not specify an age limit above which screening is not recommended.
The second study finds that patients with a negative colonoscopy examination have a reduced risk of developing colorectal cancer for more than 10 years as compared to the general population, and may not need screening colonoscopy at less than 10-year intervals.
Researchers analyzed data from nearly 36,000 colonoscopic evaluations that did not result in the diagnosis of colorectal neoplasia to determine the magnitude and duration of patients' lowered risk of developing colorectal cancer. The patients were followed from the time of the colonoscopy until diagnosis of colorectal cancer, death, relocation or the end of the study period on Dec. 31, 2003. The researchers found that a negative colonoscopy was associated with 31 percent lower incidence of colorectal cancer at six months; 34 percent lower incidence at one year; 41 percent lower incidence at two years; 45 percent lower incidence at five years; and 72 percent lower incidence at 10 years.
"This study demonstrates that following a negative result from a colonoscopy performed in the usual clinical practice, the risk of developing CRC is at most 60 percent to 70 percent of the risk of developing CRC in the general population and the duration of the interval of decreased CRC risk persists for more than 10 years," say the study's authors. "Furthermore, if an individual undergoes a single negative colonoscopy, excepting any follow-up endoscopies at which CRC is diagnosed, the risk of developing CRC is even lower and the duration of the interval of decreased risk again exceeds the 10-year interval currently recommended between screening colonoscopies."
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| IOL Gets New Technology Designation
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The Centers for Medicare and Medicaid Services have designated Alcon's AcrySof IQ IOL as a New Technology Intraocular Lens under the classification of reduced spherical aberration (astigmatism). The NTIOL designation went into effect on May 19 and will increase the Medicare payment to ASCs for cataract surgery using the lens by $50 through Feb. 27, 2011.
In order to gain inclusion in the NTIOL category, AcrySof IQ demonstrated the same or greater clinical benefit — reduced spherical aberration and improved night driving performance compared with conventional spherical IOLs — as the lens that established the NTIOL subset.
"We are pleased that CMS has recognized the clinical advantages that patients gain from this advanced lens technology versus conventional IOL implants," says Kevin Buehler, Alcon's senior U.S. vice president and chief marketing officer. "Studies have shown that by reducing spherical aberration, the AcrySof IQ IOL enhances image quality and improves contrast sensitivity."
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| News and Notes
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The Centers for Medicare and Medicaid Services have designated Alcon's AcrySof IQ IOL as a New Technology Intraocular Lens under the classification of reduced spherical aberration (astigmatism). The NTIOL designation went into effect on May 19 and will increase the Medicare payment to ASCs for cataract surgery using the lens by $50 through Feb. 27, 2011.
In order to gain inclusion in the NTIOL category, AcrySof IQ demonstrated the same or greater clinical benefit — reduced spherical aberration and improved night driving performance compared with conventional spherical IOLs — as the lens that established the NTIOL subset.
"We are pleased that CMS has recognized the clinical advantages that patients gain from this advanced lens technology versus conventional IOL implants," says Kevin Buehler, Alcon's senior U.S. vice president and chief marketing officer. "Studies have shown that by reducing spherical aberration, the AcrySof IQ IOL enhances image quality and improves contrast sensitivity."
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