Wednesday, May 27, is your last chance to participate in Outpatient Surgery Magazine's OR Excellence Early-bird Contest. There is no time like the present to secure your spot and lock in great savings for the surgical conference of the year, while also entering the running for great prizes. Early-bird registrants receive a $100 discount off the conference's full registration fee, guarantee their spots at the meeting and secure discounted rooms at the San Francisco Hilton, the center of the conference action. In addition, all attendees who are paid in full on May 27 will be entered into a drawing for prizes that include $50 Union Square gift certificates, special dinners and the grand prize: a free luxury suite at the Hilton during their OR Excellence stay. Please visit the OR Excellence Web site for more information.

Men who take the drug tamsulosin for the treatment of enlarged prostate-related urinary disorders in the 2 weeks prior to cataract surgery are at significantly higher risk of experiencing such post-operative complications as retinal detachment or lost lens, according to a new study.

For the study, published in the May 20 issue of the Journal of the American Medical Association, Chaim M. Bell, MD, PhD, and a team of researchers at St. Michael's Hospital in Toronto reviewed the cases of 96,128 Canadian men, 66 years of age or older, who were prescribed tamsulosin or other medications for the treatment of benign prostatic hyperplasia at the time they underwent cataract surgeries between 2002 and 2007.

An analysis of post-procedure adverse events showed that patients who'd taken tamsulosin within 14 days of the surgery had a 7.5% rate of complications, as compared to the control group's 2.7%. Patients who'd taken other medications showed no increased rate of complications.

The researchers note that tamsulosin, marketed under the brand name Flomax, treats the symptoms of benign prostatic hyperplasia by relaxing smooth muscle in the prostate and bladder, which it also may do to the smooth muscle of the iris, causing intraoperative floppy iris syndrome.

"It is unclear whether drug discontinuation prior to surgery reduces this risk," the researchers write. But since it's not uncommon for older men to have both cataracts and enlarged prostates, they say, patients should be warned of and healthcare providers should identify the risk in order to anticipate possible complications.

In an accompanying editorial, Alan H. Friedman of the Mount Sinai School of Medicine in New York argues that, while intraoperative floppy iris syndrome is already noted as a precaution on tamsulosiin's prescribing information, this large study's data may warrant a federal black-box warning.

David Bernard

Only a portion of the patients who are assigned a billing code for Barrett's esophagus actually have the condition, according to research published in the May issue of the journal Gastrointestinal Endoscopy.

The study involved a manual review of 2,470 California patients coded with Barrett's esophagus between 1994 and 2005. Researchers at the Oakland Medical Center and division of research at Kaiser Permanente in Oakland, Calif., discovered that final pathology reports confirmed the condition in only 61.9% of the records. They cite two reasons for the discrepancy: Physicians might note the diagnosis code of Barrett's in endoscopy reports based on visual evidence before a path lab confirms the findings, and facility coders sometimes overcode the condition when physicians report the possibility of Barrett's in procedural paperwork.

In an accompanying editorial, Joel H. Rubenstein, MD, MSc, of the Veterans Affairs Center for Clinical Management Research and the division of gastroenterology at the University of Michigan Medical School in Ann Arbor, says the misuse of billing codes for Barrett's is in part due to the confusion among providers regarding the criteria required to make a correct diagnosis: the endoscopic identification of columnar-appearing mucosa residing in the distal esophagus and the histologic identification of intestinal metaplasia in biopsy specimens obtained from that area.

To improve the accuracy of coding for Barrett's, Dr. Rubenstein advises endoscopists to send biopsy specimens to path labs with a precise record of where they were obtained, to take a few extra minutes to identify sliding and subtle hiatal hernias and minimize overdiagnosis of columnar-lined esophagus, to use precise language in endoscopy reports suggesting the finding of Barrett's instead of confirming it (that conclusion must be based on the pathology report) and to communicate with patients verbally and in writing that newly suspected Barrett's needs to be confirmed by pathologic examination.

Daniel Cook

Breaking away for a vacation is no easy feat for our readers. Last week's online poll found that only 36% of the 56 surgical facility managers who responded take all the vacation time they earn in a year. For those that don't take all the time they've accrued, 30% said that their facilities would crumble without them there. Another 34% said that they take some of it and carry over the allowable to the following year.

Dan O'Connor