Publicly reported unplanned hospital readmission rates following spinal surgery may be overestimated by as much as 25%, calling into question the practice of using such data to gauge post-op complication rates, according to research presented last week at the American Association of Neurological Surgeons' annual meeting in Miami.

Researchers at the University of California San Francisco Medical Center reviewed the "all cause" readmissions within 30 days of surgery used by CMS to measure the quality of care patients receive. The problem with the data, say the researchers, is that it doesn't distinguish between planned follow-up surgeries and unplanned surgeries due to unexpected complications.

Including planned readmissions in calculations assessing a facility's readmission rate is not unique to UCSF. The researchers point out the same formula is applied to track readmission rates of hospitals across the country, which could paint an inaccurate picture of the quality of care they deliver. Those inaccuracies could ultimately impact how insurers reimburse hospitals and where patients choose to go for care.

"Reported 'all cause' readmission rates may not be realistic," says neurosurgeon Praveen Mummaneni, MD, the study's lead author. "To be accurate, substantial drill down of readmission rates is needed to find clinically relevant causes."

Daniel Cook

More than 50% of elderly patients who are hospitalized for blood clots had suffered infections in the previous 90 days, say researchers, who note that healthcare-acquired infections presented a particularly elevated risk.

For the study, which appeared in the journal Circulation earlier this month, the researchers reviewed a database of retired American patients.

They found that patients who'd had any type of infection, including skin, respiratory or urinary, were 3 times more likely to be hospitalized for deep vein thrombosis or pulmonary embolism than those who hadn't. Those patients whose infections were healthcare-acquired were 7 times more likely to see hospital admission.

The study "is important because infections are common and many people do not link infections with developing blood clots," says co-author Mary Rogers, PhD, MS, research assistant professor in Internal Medicine at the University of Michigan Medical School. "In fact, many educational websites do not list infections as a risk factor for blood clots - but they are."

David Bernard

As businesses, surgical facilities are not immune to embezzlement and fiscal malfeasance from within. And when an administrator, business office employee, nurse or any employee dips into the till, your facility, physicians, staff, future and confidence take a massive hit.

Given the necessity for many smaller staffs to double-up on duties, cautious financial practices are doubly important. A former surgery center administrator who suffered through the nightmare of embezzlement herself describes the ways it might happen and details the steps your center can take to prevent it from happening at your center.

David Bernard

Your surgeons and staff put themselves at risk whenever they're lax in following personal protective equipment protocol. A common example: letting their masks flop down on their upper chest as they leave the OR. This might look good, but it's a great way to spread bacteria. Tell us in this week's InstaPoll how well your team adheres to the recommended use of facial protective equipment, including surgical masks, respirators and eye and face protection.

Only about 1 in 10 (11%) of the 264 respondents to last week's poll instructs their patients to use dilating drops at home before checking into their facilities for cataract surgery. Some say it beats having to slowly dilate patients in the pre-op area.

Dan O'Connor