Ultrasonic surgical instruments are just as safe as, and sometimes more effective than, traditional instruments in several surgical specialties, according to a study published in the June issue of the journal Archives of Surgery.

In comparison to other forms of cautery, patients lost less blood, had shorter procedure times and suffered less tissue damage when ultrasonic instruments were used, write researchers from Washington University in St. Louis, Columbia University in New York and the Health Analytics Group in Medford, Mass. They found, however, that the use of ultrasonic instruments in colorectal procedures and Nissen fundoplication was associated with greater blood loss.

In their meta-analysis of 51 studies covering 4,902 patients between 1990 and 2005, which was funded by medical device manufacturer Ethicon Endo-Surgery, the researchers found that ultrasonic instruments were associated with less tissue damage from heat.

"Vibration of the scalpel blade does not generate as much heat as monopolar cautery or laser cautery, and the vibration in potential spaces results in cavitation, which may facilitate tissue dissection," they write. They also found that complications such as blood clots, bowel leaks and nerve injuries occurred less frequently in ultrasonic procedures.

Kent Steinriede

Proposed legislation that would add new restrictions on physician ownership of specialty hospitals could reduce Medicare spending by an estimated $2.4 billion between 2009 and 2018, says the Congressional Budget Office in a recent letter to Rep. Joe Barton (R-Texas).

The bill adds to existing laws governing physician referrals to healthcare providers in which they have a financial interest. Specifically, the law would bar new physician-owned hospitals from participating in Medicare. It would also place new requirements on existing physician-owned hospitals, effectively limiting the number and size of such facilities, according to the letter from CBO Director Peter R. Orszag.

CBO expects those changes to cut Medicare spending "by reducing the number of hospital services provided to Medicare beneficiaries and by shifting the provision of some services to settings where payment rates are lower than for services furnished in hospitals," writes Mr. Orszag.

The physician-ownership provision is included in the Paul Wellstone Mental Health and Addiction Equity Act, which the House passed on March 5. Lawmakers are now working on a compromise between that bill and a competing version passed in the Senate last September.

Irene Tsikitas

The dangers of MRSA, E. coli, enterococcus and other such "bugs" are well-documented, but you may never have heard of surgeries cancelled on account of actual bugs, like the ones that infiltrated a surgical suite at the North Hills Hospital in North Richland Hills, Texas, last Tuesday.

The hospital's surgical staff was forced to call off the day's first procedure after noticing a few mosquitoes circling high above the OR table. "We kept the OR closed all day as a precaution," says North Hills spokeswoman Bethe Spurlock. "The OR was reopened the following morning and no other rooms or cases were affected. It was an isolated incident."

"I haven't heard of a mosquito in the OR, but I have killed many a fly in there," says traveling nurse Paula Watkins, RN, CNOR, author of Outpatient Surgery Magazine's's Behind Closed Doors humor column. "In fact, we have several ways to send the little buggers to their death."

When a fly is seen over an open field, Ms. Watkins says staff she has worked with postpone or relocate the scheduled procedure, tear down the field, "kill the little beast" and clean the room. "If the case is in progress and a fly is discovered," she says, "we cover the wound, destroy the intruder and open up another field."

Daniel Cook