Laparoscopic Technique Lowers Clot Risk in Colorectal Surgery

Performing colorectal surgery laparoscopically instead of via open techniques may reduce the risk of post-operative clotting, according to a study published in the Archives of Surgery.

In an analysis of nearly 150,000 patients who underwent colorectal surgery over a 5-year period, those who had open procedures "were almost twice as likely to develop [venous thromboembolism] compared with patients" who had minimally invasive surgery, say researchers from the University of California-Irvine Medical Center. Specifically, 1.44% of open surgery patients developed VTE, compared with 0.83% of laparoscopic surgery patients.

The decreased risk of blood clotting may be attributed to the shorter recovery times, reduced post-op pain and reduced bowel obstruction associated with laparoscopic vs. open surgery, suggest the researchers.

Basing their analysis on National Inpatient Sample data from about 20% of U.S. hospitals between 2002 and 2006, the authors also identify several other statistically significant risk factors for VTE among colorectal surgery patients, including inflammatory bowel disease, patients undergoing rectal resections, cancer, obesity and congestive heart failure.

"These findings may help colorectal surgeons use appropriate VTE prophylaxis for patients" undergoing such procedures, write the authors.

"VTE is one factor for mortality associated with colorectal surgery. Anything you can do to reduce the incidence should be utilized," says co-author Ninh Nguyen, MD. He noted that just because the risk is lower for patients having minimally invasive procedures doesn't mean you can eliminate prophylaxis for those patients.

Share your facility's strategy for reducing the risk of blood clots on Outpatient Surgery Magazine's online discussion board.

Irene Tsikitas

FDA Revisits Silicone Breast Implant Safety

Following up on the decision that returned silicone-gel-filled breast implants to the surgical market, the U.S. Food and Drug Administration stands by the devices' safety but urges patients to understand their potential complications.

In a report issued last week (and summarized in this executive summary), the FDA details preliminary safety data collected by the implants' manufacturers since the agency's November 2006 re-approval.

Among its conclusions, the FDA's report warns breast augmentation and reconstruction patients that:

  • 20% of augmentation patients and perhaps 50% of reconstruction patients will see complications and require implant removal within 10 years of surgery.

  • Common complications requiring removal or revision surgery include capsular contracture, "implant rupture, wrinkling, asymmetry, scarring, pain, and infection."

  • While currently available studies have shown no links between the implants and cancer or chronic illnesses, larger and longer-term studies are required to rule them out entirely.

    "The FDA will continue to monitor and collect safety and performance information on silicone gel-filled breast implants, but it is important that women with breast implants see their health care providers if they experience any symptoms," says Jeffrey Shuren, MD, JD, who directs the agency's Center for Devices and Radiological Health. "Women who have enrolled in studies should continue to participate so that we may better understand the long-term performance of these implants and identify any potential problems."

    David Bernard

  • Study: Hypnosis Improves Patient Comfort

    Hypnosis, combined with local blocks, outperforms general anesthesia among patients undergoing breast and thyroid surgeries, according to Belgian researchers.

    Fabienne Roelants, MD, and Christine Watremez, MD, from the department of anesthesiology at Catholic University of Louvain in Brussels, say hypnosis and local anesthesia lead to less perioperative drug use and faster recovery times.

    The researchers studied 78 women who underwent breast quadrantectomy and sentinel node biopsy or axillary dissection and video-assisted thyroidectomy under either hypnosis and local anesthesia or under general anesthesia.

    Patients were hypnotized and received lidocaine 0.5% plus levobupivacaine 0.25% in the OR prior to surgery, the researchers reported at this month's annual meeting of the European Anesthesiology Congress. Patients who received general anesthesia were induced with propofol, ketamine, clonidine, lidocaine and sufentanil.

    According to the study's findings, breast surgery operative times were comparable between the 2 groups. Patients under hypnosis and local anesthesia, however, received no ephedrine, spent less time in recovery and went home faster.

    Using hypnosis and local anesthesia prior to video-assisted thyroidectomy yielded similar results, say the researchers. Hypnotized patients received less drugs, spent on average 45 fewer minutes in recovery and went home in a day. Patients receiving general anesthesia spent less time in the OR, but received more drugs, stayed in recovery longer and remained hospitalized beyond 24 hours.

    Dr. Roelants claims local anesthesia alone is not enough to ensure patient comfort. The hypnotic techniques used prior to surgery to reduce anxiety and pain require special training, she says, which half of her hospital's staff will receive by the end of the year.

    Daniel Cook

    InstaPoll: Why Are More ASCs Partnering With Hospitals?

    Why are more ASCs turning to their local hospitals for partnerships? To get bailed out? To get better reimbursement? To access the hospitals' operational efficiencies? Tell us in this week's InstaPoll. Check back here next week for the results.

    Great response to last week's poll. We asked if it's OK to prank colleagues undergoing surgery, by painting their toenails, applying temporary tattoos or other tomfoolery. Of the 245 responses we received, 21% said "Sure, it's all in good fun," while 79% said "Absolutely not." See page 6 of our July print edition for a closer look at this topic.

    Dan O'Connor

    News & Notes
  • Tip of the week A parent's presence at a child's anesthetic induction can help in reducing anxiety, as long as you set guidelines and educate patients and their parents about what to expect, writes Leigh Johnson. Pre-operative explanations and tours of the surgical suite can help to smooth the path.

  • Drug dispensers determine diversion Physicians in the anesthesia department at Thomas Jefferson University Hospital in Philadelphia say that an automated drug dispensing system helped them to identify incidents of diversion and abuse among their staff. According to a report published in the July issue of the journal Anesthesia & Analgesia, data showing "atypical transactions" pointed to 2 providers who'd been previously unsuspected of stealing and abusing drugs. This data also highlighted shoddy recordkeeping by another staffer, and was used to investigate whether 2 other staffers cited for drug use had stolen from the facility.

  • EMR product meets meaningful use AmkaiSolutions' AmkaiCharts 3.0 electronic medical record system has been certified as an ambulatory meaningful use product and placed on the federal Office of the National Coordinator's Certified HIT Product List. The certification means physicians and clinics that use AmkaiCharts can qualify for federal stimulus funding set aside for providers who achieve "meaningful use" of EMRs. These financial incentives are not yet available to ASCs, but the company believes they "may ultimately be required to adhere to certification criteria, and we want our solutions to be ready so that our clients can take full advantage when they do," says AmkaiSolutions President and CEO Joe Macies.