Study: More ASCs = More Unneeded Procedures

Another study is portraying physicians who own surgery centers as being more concerned with their profits than their patients. Researchers found that the number of optional gastroenterology procedures performed in a healthcare market increased when surgery centers were built, due in part, they contend, to the financial interests of physician-owners.

The study, published in the February issue of Archives of Surgery, reviewed the procedure rates of patients aged 65 and older undergoing colonoscopy and upper GI endoscopy in Florida markets before and after the arrival of ASCs.

Researchers led by John M. Hollingsworth, MD, urologist and Robert Wood Johnson Foundation Clinical Scholar at the University of Michigan in Ann Arbor, note that rates for colonoscopy and upper endoscopy increased by 1,610 and 775 procedures, respectively, per 100,000 residents after ASCs opened. That resulted in 25,000 more colonoscopies and 9,800 additional upper GI procedures being performed between 2002 and 2006, according to the study.

While the researchers say those increases could be linked to procedure volume backlogs, they suggest physicians with ownership interests in ASCs factored in the rising rates. Noting that 83% of physicians who staff ASCs have ownership interests in the facilities, the researchers say the financial success of their centers "may motivate some owners to lower treatment thresholds."

This isn't the first time Dr. Hollingsworth has targeted physician-owners. In a study published in the April 2010 issue of the journal Health Affairs, he claimed physician-owners perform twice as many surgeries as their non-owner colleagues do.

David Shapiro, MD, chair of the Ambulatory Surgery Center Association, says Dr. Hollingsworth's latest study unfairly implies that physician financial incentives, rather than medical necessity, explain the link between an increase in the number of outpatient surgery centers and an uptick in surgeries performed annually. "This implication does not properly characterize the findings of the study - or reality," he adds.

According to the U.S. Preventive Services Task Force, says Dr. Shapiro, colorectal cancer is the third most common type of cancer and the second leading cause of cancer death in the United States. "The data used in this analysis were collected at a time when Medicare made changes to its coverage to encourage certain procedures, including colonoscopies," he says.

The increase in colonoscopy procedures should be "expected, and even encouraged," says Dr. Shapiro, pointing to the improved quality of life and cost-savings to insurers afforded by the screenings.

Daniel Cook

Envisioning the Environmentally Friendly OR

Surgical facilities that adopt environmentally mindful practices could cut costs and reduce their carbon footprint without risking patient care and safety, say Johns Hopkins researchers.

Their study, published in the February issue of the journal Archives of Surgery, recommends 5 strategies: separating biohazardous, conventional and recyclable wastes; reprocessing single-use devices; purchasing with sustainability in mind; consuming energy wisely and reducing pharmaceutical waste.

"If we're going to get serious as a country about being environmentally conscious, we need to look at our biggest institutions," says Martin A. Makary, MD, MPH, associate professor of surgery at the university's medical school and the study's lead author. "When an individual decides to recycle or dispose of waste differently, it has an impact. But when a hospital decides as an organization to go green, the impact is massive."

Dr. Makary's team reviewed 43 studies covering hospitals' efforts toward sustainability and consulted with experts to develop practical environmental solutions. The healthcare industry generates more than 6,600 tons of waste per day, the team's report notes, with ORs and labor and delivery suites making up 70% of that total.

In calling for change, the report points to several practices that are not only environmentally wasteful but also avoidably expensive, such as discarding non-hazardous refuse with red-bag trash, opening sterilized supplies for a case that go unused, and installing energy-inefficient lighting. The researchers admit that reprocessing single-use devices often presents a perceived conflict between sustainability and patient safety, but can satisfy both concerns and save money at the same time.

David Bernard

Researchers Examine Knee Scope Clot Risks

A pair of studies presented at the American Academy of Orthopaedic Surgeons' annual meeting last month is helping to identify which patients would most benefit from anticoagulant therapy in knee arthroscopy.

Guidelines currently discourage the routine use of anticoagulants to prevent venous thromboembolism during the procedure as they increase the risk of bleeding. But researchers at the Hospital for Special Surgery in New York City and the Mayo Clinic in Rochester, MInn., say in their studies that patients with a history of cancer or VTE, as well as older patients, should receive preventive treatment.

"While pulmonary embolism after knee arthroscopy is extremely rare, it can happen," says Iftach Hetsroni, MD, of Meir General Hospital in Kfar Saba, Israel, who led the research team that looked at the New York data. Indeed, previous VTE incidents increased a patient's risk ninefold, say the Mayo researchers.

The Hospital for Special Surgery researchers looked at 418,323 knee arthroscopy cases between 1997 and 2006 and found an incidence rate of 0.028% for pulmonary embolism, while the Mayo researchers looked at 12,595 cases between 1988 and 2008 and found an overall VTE incidence of 0.34% with a rate of 0.06% for pulmonary embolism.

As a result of the findings, the Mayo Clinic has changed its protocols for knee arthroscopy to include preventative measures for patients with a history of VTE, cancer or at least 2 of the "classic" risk factors such as smoking, age above 65, use of hormone replacement therapy or oral contraceptives and chronic circulation problems.

Kent Steinriede

InstaPoll: Who Calls the Time Out at Your Facility?

Who calls the time out in your ORs: the circulator, the surgeon or the ansthesia provider? Tell us in this week's InstaPoll. You can also comment on the subject and read your colleagues' views on our Second Opinions discussion board.

Many people assume that just because you work in health care, you have the best healthcare coverage. Last week's InstaPoll revealed that isn't necessarily the case for surgical facility leaders. Here's how 161 respondents rated their satisfaction with their benefits. On a scale of 1 (low opinion) to 5 (high satisfaction), they reported:

  • 1: I pray I don't get sick. 14%

  • 2: Co-pays and deductibles keep rising. 47%

  • 3: I've had better, had worse. 14%

  • 4: I'm pretty proud of the plan I have. 19%

  • 5: Top of the line. 6%

    Dan O'Connor

  • News & Notes
  • Tip of the week In an effort to improve its on-time starts, a Colorado surgery center tapped into its physicians' competitive natures by posting an on-time start board near their locker room. The board lists each physician's on-time start percentage, the facilitywide average and the times they were tardy. "Some docs are surprised to see how late they really were for a case," says Sandy Beers, BSN.

  • Gastric bypass's benefits Diabetic patients lost more excess weight after undergoing gastric bypass surgery than they did following gastric banding, according to a new study published in the February issue of Archives of Surgery. The research shows that gastric bypass provides better weight loss, better resolution of diabetes and more improvement in quality of life than Allergan's Lap-Band device, say the study's authors. The results come weeks after the FDA lowered the BMI requirement for patients to undergo Lap-Band surgery.

  • Algae-based anesthesia An experimental local anesthetic derived from algae provided better pain management than bupivacaine in a clinical trial of 137 laparoscopic cholecystectomy patients in Chile. The drug, neosaxitoxin, provides local pain relief for up to 24 hours, say researchers from Children's Hospital Boston.
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