Anesthesia providers may soon be able to wear head-mounted displays that project patient data into their line of vision, letting them observe patients without looking away at vital signs monitors, according to research appearing in the journal Anesthesia & Analgesia.

The wireless headset #151; connected to a battery pack and handheld computer contained in a backpack #151; receives data transmissions from patient monitors, displaying the information as a monochrome red image via a single transparent monocle in front of the right eye, according to the study. It's a technology inspired by the heads-up displays used by pilots to notice unexpected changes to flight instrumentation faster than they would with traditional cockpit dials, say the researchers.

Anesthesia heads-up displays could solve ergonomic issues associated with the location of patient monitors and would let providers perform such clinical tasks as drawing medications while continuously monitoring the patient, according to the study.

Safety checklists and now head-mounted displays: Once again, researchers are looking to the aviation industry to improve surgical safety. Mark Green, a practicing CRNA at Springfield (Vt.) Hospital, recognizes the benefits of heads-up displays in airplanes but isn't so sure about the technology's application in ORs. Plus, he says, moving his head around to check on patients keeps him alert and his blood flowing.

"There are times when I have to do a procedure, such as placing an arterial catheter or an epidural, when I have to reposition my anesthesia monitors so I can keep tabs on my patient," he adds. "I'll bet my technique is way less expensive than a heads-up display, and I can't think of anything so pressing that I would need a monitor constantly in my face."

Daniel Cook

Surgeons are increasingly recommending that Medicare patients go for more expensive and riskier spinal fusion surgery over other treatments for spinal stenosis, according to a study published in the Journal of the American Medical Association.

While the overall rate of surgery for stenosis declined slightly from 137.4 per 100,000 Medicare beneficiaries in 2002 to 135.5 per 100,000 in 2007, the rate of fusion procedures increased 15-fold, to 20 per 100,000. The more complex fusion procedures had more than twice as many life-threatening complications (5.6%) than less invasive disk decompression surgery (2.3%).

"Risks of spine surgery are particularly important in older adults, for whom stenosis is the most common surgical indication," write the authors from the Oregon Health and Science University in Portland, the University of Washington in Seattle, and Dartmouth University in Lebanon, N.H. They also report that the average hospital charge for complex fusion procedures is $80,888, compared to $23,724 for decompression procedures.

The researchers conclude that marketing forces must be contributing to the increase in fusion procedures. "It seems implausible that the number of patients with the most complex spinal pathology increased 15-fold in just 6 years," they write. "The introduction and marketing of new surgical devices and the influence of key opinion leaders may stimulate more invasive surgery."

"Economic incentives are clearly at work," agrees Eugene J. Carragee, MD, a spine surgeon and professor at the Stanford University School of Medicine in California, in an editorial also published in JAMA's April 7 issue. "Simple decompression operations rarely have well-funded advertising campaigns or well-orchestrated promotions at professional meetings."

Kent Steinreide

The use of a sequential compression device after joint replacement surgery prevents deep vein thrombosis as effectively as blood-thinning medication does, without the risk of bleeding, according to a recent study.

For the study, published in the March issue of the Journal of Bone & Joint Surgery, researchers followed the cases of 410 hip replacement surgery patients at multiple facilities nationwide. Half of the patients were treated with a compression device and half with heparin until they were ambulatory 10 days after surgery. The patients were examined for blood clots with ultrasound imagery.

Three percent of the patients in both groups saw the formation of venous blood clots below the knee. Only 1% of compression patients suffered the more risky above-the-knee clots, as compared to 2% of heparin patients. And no compression patients suffered major bleeding following surgery, compared to 6% of heparin patients.

Chest physicians tend to favor medication for the prevention of post-surgical DVT among at-risk joint surgery patients, notes co-author Douglas E. Padgett, MD, chief of adult reconstruction and joint replacement at the Hospital for Special Surgery in New York City. "Orthopedic surgeons on the other hand have to balance the desire to reduce the risk of blood clots with the reality that many of these chemical modalities that thin the blood are in fact associated with bleeding and hemorrhagic complications."

The development of small, battery-operated, wearable compression devices, as opposed to traditional stationery units, may also boost compression's use in preventive care, says Dr. Padgett.

David Bernard

Does your facility use CNAs (certified nursing assistants), either to assist with patient care in pre- and post-op or in the OR? Tell us in this week's poll question. We'll report the results in this space next week.

More than three-fourths (78%) of the 138 facility managers who answered last week's poll say that their ORs are equipped with Internet access so surgeons and staff can listen to music on such sites as Pandora or call up outside X-rays.

Dan O'Connor