Surgeons who are made aware of the costs associated with implanting and removing ill-fitting hardware during spinal surgery can save surgical facilities more than $20,000 a year, according to a study published in the journal Spine.

Researchers at the Albert Einstein College of Medicine in New York City instituted an educational program in 2010 designed to inform surgeons performing single-level discectomy and fusion about the definition and cost of "explantation," the placement and removal of hardware during the same operation. The researchers say hardware is explanted when, for example, implanted plates don't fit or screws are too loose or too short.

From January to April, surgeons were unaware of the researchers' concerns over explantation costs. At the end of April, the researchers educated surgeons about the cost and frequency of explantation and informed them that their explantation rates and costs would be tracked for the remainder of the year.

Explantation rates dropped from 45% to 16% for screws, plates and spacers after the educational sessions, according to the study. In addition, the overall cost of explanted devices fell from 20% to around 6% after surgeons were educated.

Explanted devices are significant contributors to the overall cost of surgery, say the study's authors, who point out that the plates used in their research cost about $1,450 each and the screws about $1,200 per set.

The researchers say their findings are the tip of the iceberg when it comes to controlling implant costs, and push for further research to address ways of reducing implant waste during more complex spine procedures.

Daniel Cook

Administering a local anesthetic into the joint may provide more effective pain management to knee replacement patients than opioids and a more convenient option than regional anesthesia or pain pumps, according to a recent study.

Researchers at the Rothman Institute at Thomas Jefferson University Hospital in Philadelphia examined the cases of 150 unilateral knee replacement patients, intraoperatively and for 2 post-op days delivering either bupivacaine or saline through a catheter into their joints. Patients were asked to self-report their pain levels and narcotic usage for 4 weeks after discharge. The researchers found that patients in the bupivacaine group showed the least pain and lowest opioid consumption, with no difference in complications between the 2 groups.

"This study opens up a potential new option for better pain management post-surgery for our knee replacement patients," says study co-author Nitin Goyal, MD. "Though further study is needed, these initial results are promising."

Mark McGraw

If you want to reap Medicare's reimbursements, you've got to keep a close eye on your facility's SSI reduction efforts. Since May 2009, CMS's Conditions For Coverage require ASCs to assign a staff member or contract a consultant to handle the duties of infection preventionist.

"The requirements for this role are vague at best," says Phenelle Segal, RN, CIC, "but there are attributes to seek in a designee to lead your infection control program."

In her article "Who Should Be Your Infection Preventionist?", published in Outpatient Surgery Magazine, Ms. Segal describes the key characteristics necessary in such a position to ensure that the quality of patient care remains high and that your facility remains compliant with regulators' guidelines.

David Bernard

Whether you've been in your current position for 10 years or for 10 weeks, we want to hear from you. Tell us in this week's InstaPoll how long you've been on the job.

Nearly half (47%) of the 175 respondents to last week's poll have been been slammed on doctor review sites by a disgruntled patient. Keep an eye out for a "Protect Your Online Reputation," a feature article appearing in the March issue of Outpatient Surgery Magazine.

Dan O'Connor