Minimally invasive prostate surgery shortens hospital stays, but it doesn't result in fewer overall complications when compared to open procedures, say researchers at Brigham and Women's Hospital in Boston, Mass.

They report in the Oct. 14 issue of the Journal of the American Medical Association that their review of close to 9,000 male Medicare patients revealed that laparoscopic approaches may have reduced the need for blood transfusions and lessened post-op respiratory complications and anastomotic stricture, but that they also increased the incidence of genitourinary complications, incontinence and erectile dysfunction.

The higher complication rates could be related to the still-developing technical skills of surgeons who are adapting to minimally invasive techniques introduced just 8 years ago, researchers speculate.

Some observers, however, disagree with the study's findings. Mani Menon, MD, FACS, director of the Vattikuti Urology Institute at the Henry Ford Health System in Detroit, Mich., argues that the authors did not distinguish between laparoscopy and robotic prostatectomy.

Dr. Menon says the post-op complication rates following his facility's robotic prostatectomies are a fraction of those reported in the study. This is likely, he says, because the study focused on a national sample of patients 65 years or older who were operated on by surgeons with various levels of training and expertise. "Yes, the robot makes a difference," he says, "but so does the surgeon."

Daniel Cook

While proper hand hygiene is an essential throughout the healthcare hierarchy, non-compliance among such roaming personnel as radiologists or therapists, who see many patients daily, can significantly increase the incidence of healthcare-acquired infections in a facility, according to a French study.

The authors of the study, published in the October 20 issue of the Proceedings of the National Academy of Sciences, created healthcare worker profiles based on how many patients different types of hospital employees would come in contact with, and for how long.

Then they used a mathematical model to predict how many patients would become infected with a pathogen such as methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococci when a single member of each group neglected hand hygiene practices.

Among physicians, who see many patients but for shorter times, the study found a single non-compliant physician threatened a 2% to 7% increase in infections per month. Among nurses, who generally handle a limited number of patients for longer periods of time, a non-compliant nurse could cause a 13% to 17% increase. Among the roaming personnel, whom the study's authors dubbed "superspreaders," a non-compliant worker might increase infections 73% to 238%.

"This points out that the evaluation of compliance to hygiene measures in hospitals should be done individually rather than globally," say the authors. "For instance, evaluating hand-hygiene compliance through a global indicator such as overall hand rub consumption may not prove sufficient to assess the nosocomial risk."

Kent Steinriede

Lasers and electrosurgical devices are the most common igniters of surgical fires, according to survey results presented at the American Academy of Otolaryngology-Head and Neck Surgery Foundation's annual meeting earlier this month.

A poll of 349 otolaryngologists revealed that endotracheal tubes, drapes and towels frequently served as fuel for OR fires. Alcohol-based preps, gauze, sponges, and patients' hair and skin were reported to be less common fuels of surgical blazes.

About one-fourth of the otolaryngologists surveyed said they had witnessed at least 1 blaze during their careers. Ten physicians said they'd experienced 2 fires, and 2 reported seeing 5 fires. Most OR fires take place when supplemental oxygen is used, according to the survey's results.

"Operating room fire may occur in a wide variety of clinical settings," conclude the survey's authors, Lee P. Smith, MD, chief of pediatric otolaryngology at Schneider Children's Hospital in New Hyde Park, N.Y., and Soham Roy, MD, FACS, FAAP, an otolaryngologist at Children's ENT of Houston, Texas. "Endoscopic airway surgery, oropharyngeal surgery, cutaneous surgery and tracheostomy present the highest risk for otolaryngologists,"

They advise surgeons to familiarize themselves with the common scenarios in which fires have been known to occur, avoid using common ignition sources in the presence of high concentrations of oxygen or alcohol vapors and understand that eliminating any element of the fire triad - oxygen, ignition and fuel - decreases the overall risk of OR fire.

Daniel Cook

How do you typically flash-sterilize instruments in non-emergency situations? Tell us in this week's InstaPoll. We'll report the results in this space next week.

Last week we asked you if you thought policymakers had a jaundiced view of ASCs. About two-thirds (67%) of our 52 respondents agreed.

Dan O'Connor