A study comparing outcomes and reimbursements for colonoscopy and CT colonography (also known as "virtual colonoscopy") suggests that the latter screening method is not as cost-effective as the former if reimbursed at the same rate.

For their study, published online last week by the Journal of the National Cancer Institute, researchers at Massachusetts General Hospital in Boston used computer simulation models and the cases of unscreened Medicare beneficiaries aged 65 years and older to determine how virtual colonoscopy compared to other colorectal cancer screening timelines.

The researchers' simulations calculated the lifetime screening costs and patient life expectancies projected from such screening options as a virtual colonoscopy every 5 years, a colonoscopy every 10 years, an annual fecal occult blood test, flexible sigmoidoscopy every 5 years (by itself and in conjunction with the blood test) and no screenings at all.

What they found was that the lifetime costs of the virtual screening option would be higher than those of the colonoscopy option, with a slightly shorter life expectancy, if both were reimbursed at $488. Since in addition the Centers for Medicare and Medicaid Services don't presently reimburse for virtual colonoscopies, and it is unclear whether the computer-assisted option would convince more patients to undergo screenings, the researchers conclude that CT colonography is not as cost-effective as other options.

An accompanying editorial questions the pros and cons of both virtual and actual colonoscopy and speculates on the possibilities of an improved blood test for screening.

David Bernard

Small hospitals in rural settings match their larger, urban counterparts when it comes to implementing surgical safety initiatives quickly and efficiently, according to researchers at the University of Louisville in Kentucky.

A series of studies published in the July issue of the American Journal of Surgery examined 2,300 surgeries, including hip and knee replacement, hysterectomy, colon resection and hernia repair, performed at 5 small hospitals in Kentucky and Indiana. Researchers gauged how willing and committed the hospitals' staffs were to performing a surgical time out and implementing additional safety-related practices, says senior investigator Susan Galandiuk, MD, professor of surgery at the university.

In addition to confirming that surgical teams identified the correct patient, site and procedure, the researchers noted the correct timing of pre-op antibiotic delivery and the measuring of patients' core temperatures and blood glucose levels during procedures that lasted longer than 2 hours.

They observed that surgical teams performed pre-op time outs prior to 97% of all cases, and maintained normothermia and delivered antibiotics properly in a majority of the cases.

Hiram C. Polk, MD, former chair of the university's department of surgery and one of the study's authors, says the consistency of such measures industrywide is critical since close to 40% of Americans undergo surgery in hospitals far from the bright lights of big cities. "Our research showed that clinicians in these rural hospitals showed an extremely high standard of care to their patients," he says, "equal to that given at urban and tertiary counterparts."

Daniel Cook

Twenty percent of knee or hip replacement patients lose a clinically significant amount of weight following their surgeries, most likely due to a new ability to move with less pain, say researchers at the Mount Sinai School of Medicine in New York City.

They were quick to point out that the procedure is not intended as a treatment for obesity. "Total joint arthroplasties are performed with the intent of relieving a patient's pain and disability," says Michael Bronson, MD, the hospital's chief of joint replacement surgery. But the repair does seem to result in "a healthier overall lifestyle."

The researchers followed 196 knee and hip replacement patients for 3 months to more than 3 years post-surgery. They found that knee replacement patients were more likely to lose weight than hip replacement patients, and that the heaviest patients, those with body mass indexes of more than 30, were more likely to slim down. Results of the study were published in the June issue of the journal Orthopedics.

Patients who had successful surgery were able to surmount a barrier to living an active lifestyle, write Dr. Bronson and his colleagues. "Overweight patients often report that their osteoarthritis limits their mobility and ability to exercise."

Kent Steinriede

How often do you verify the efficacy of the chemical germicide you use for scope reprocessing? Are you testing it before each scope is washed (a method that, while thorough, could be expensive and time-consuming)? Twice a day? Just daily? Tell us in this week's online poll, and check back next week for the results.

You just can't put those Blackberries and iPhones down, can you? Last week's InstaPoll asked whether you're able to resist the temptation to check your work e-mail while you're on vacation. Of the 221 responses we received, 61% said they can't help themselves: They check their e-mail every day that they're away. Perhaps we should have asked the 39% who said they leave it all behind for their secret to signing off.

Dan O'Connor