A Las Vegas multispecialty surgery center's endoscopes were not disinfected according to the manufacturer's guidelines for more than a year, the center self-reported to state authorities last month.

Administrators at Specialty Surgicare explained that the machine the center used to clean and disinfect the scopes was set for a one-minute cycle instead of the recommended five minutes. Staff discovered the error during a routine maintenance inspection last month, reports the Las Vegas Sun.

The center reported the lapse to the Nevada State Health Division, the Southern Nevada Health District and the U.S. Centers for Disease Control and Prevention the day after the error was discovered and corrected. State epidemiologist Ihsan Azzam, MD, told the Sun that representatives from the manufacturer and the CDC had assured him that the center's GI patients had faced virtually no risk of contamination or infectious disease due to the error. While state officials aren't recommending that patients seek hepatitis or HIV testing, the surgery center is offering free counseling and screenings for them.

Nevada State Health Division administrator Richard Whitley noted that healthcare facilities failing to meet manufacturers' recommendations is a persistent problem, but he commended Specialty Surgicare for its prompt self-reporting. According to the Sun, the state Bureau of Licensure and Certification is investigating the matter. No penalties have yet been levied against the center.

Irene Tsikitas

The first nationwide look at why hip replacements fail has revealed that surgeons largely may be to blame.

In a review of 50,000 patients who underwent hip replacement revision surgery from October 2005 through December 2006, a research team led by Kevin Bozic, MD, MBA, an assistant professor of orthopedics at the University of California, San Francisco, discovered the three most common causes of implant failure are dislocation of the implant, loosening of the implant and infection acquired either at the time of surgery or later through the bloodstream.

Those findings, which appear in the January 2009 issue of The Journal of Bone and Joint Surgery, contradict the accepted belief that hip replacements often fail because of wear and tear on the bearing surface, notes Dr. Bozic. He adds that factors well within the surgeon's control - the surgical technique used for installing implants, for example - might be more problematic than an implant's design.

"This [study] suggests that in addition to research aimed at developing better implants, we also need to direct new research efforts to improve care in those three areas," he says.

Dr. Bozic hopes to take advantage of new diagnosis and procedure codes specific to hip replacement surgery to create a national joint replacement registry, which would allow researchers to track the outcomes of hip replacement surgery over time.

Daniel Cook

A Beverly Hills, Calif., cosmetic surgeon who fueled his sport-utility vehicle with human fat that he'd liposuctioned out of patients apparently fled the country after authorities opened an investigation into his practice.

Craig Alan Bittner, MD, claimed to be getting about 10 miles to the gallon with the "LipoDiesel" he made from medical waste. "The vast majority of my patients request that I use their fat for fuel," he wrote on his LipoDiesel.org Web site, which ceased operation sometime after Nov. 17. "Not only do they get to lose their love handles or chubby belly, but they get to take part in saving the Earth."

After at least three patients filed negligence lawsuits against him, however - Dr. Bittner allegedly let his girlfriend administer anesthesia and perform liposuction procedures, even though she is not a healthcare provider - the state medical board raided his practice over the illegal use of infectious waste, according to the Beverly Hills Courier.

Dr. Bittner closed Beverly Hills Liposculpture on Dec. 23 and reportedly left the country. "After 10 years of practice, I am going back to South America to volunteer with a small clinic that is very similar to where my medical career began decades ago," he writes on his practice's Web site.

Says attorney Andrew Besser, who represents three lawsuit-filing patients, "When they served the warrant, he left the day after. He got on a plane to South America."

Much of the biodiesel fuel manufactured in the United States is made from animal fat such as beef tallow or pig lard mixed with soybean oil, according to Forbes.com.

Kent Steinriede

Six of the 56 facility managers who answered our last online poll have seen a case of malignant hyperthermia in their facilities. The rare, life-threatening condition is triggered in some susceptible patients by exposure to the volatile anesthetic agents used in general anesthesia and the neuromuscular blocking agent succinylcholine.

According to pharmacy consultant Sheldon Sones, RPh, FASCP, facilities that use triggering agents should stock their emergency carts with an adequate supply (36 vials minimum) of dantrolene, at least 2,500ml of preservative-free sterile water for injection and dosage calculation guidelines. He also recommends that anesthesia staff or a pharmacy consultant give your staff an annual malignant hyperthermia in-service.

This week's poll asks who should be paid more: the administrator of an ambulatory surgical center or the director of a hospital's surgical services department. Go to our front page to participate in the poll and view real-time results.

Dan O'Connor