Hip and knee replacement patients are taxing the critical care services of hospitals before being discharged, according to a study published online in the journal Anesthesiology.

About 3% of more than 500,000 patients who underwent hip and knee replacements between 2006 and 2010 required critical care post-op, say researchers at the Hospital for Special Surgery in New York City. Patients who were more likely to need critical care included those who were older and obese, or who presented with advanced diabetes or chronic obstructive pulmonary disease. The use of general anesthesia, instead of regional techniques, also increased the use of critical care services, according to the study.

With joint replacement surgeries on the rise, hospital leaders need to familiarize themselves with the unique post-op needs of these patients and allocate the necessary resources to properly care for them, says the study's lead researcher, Stavros Memtsoudis, MD, PhD, director of critical care services at HSS.

In another study presented last week at the annual meeting of the Association for Professionals in Infection Control and Epidemiology, researchers say properly caring for patients who develop infections following hip and knee replacements could save the healthcare system up to $65 million a year.

A review of nearly 175,000 hip and knee replacement patients showed a little more than 2,000 were hospitalized for surgical site infections within 1 year of surgery. Of those patients, 12.5% were readmitted due to SSI-related complications, say the researchers. The secondary hospitalizations resulted in average stays of 8.6 days at an average cost of nearly $27,000.

The findings highlight the importance of maintaining effective infection prevention programs in order to prevent readmissions associated with SSIs, says APIC President Michelle Farber, RN, CIC.

Daniel Cook

Anesthesia information management systems (AIMS) may not record more than 50% of anesthesia-related critical events, according to new research.

University of Pennsylvania School of Medicine researchers studied data from a clinical trial they had previously conducted, in which research assistants evaluated fasting gastric volumes and incidences of nausea and vomiting in 995 same-day surgery patients.

In that study, the assistants were instructed to enter data into a system and submit quality improvement reports. Researchers found that 8 occurrences of induction-related vomiting were documented in clinical trial records, but only 3 were recorded in the AIMS. Only 1 QI report was submitted. Statistical analysis found that AIMS was 38% sensitive and 100% specific, with a positive predictive value of 100%.

The number of cases of emesis is insufficient to determine the negative predictive value of AIMS, according to study leader Mohamed Rehman, MD, clinical associate professor in the Philadelphia-based university's department of anesthesiology and critical care medicine. Because the study used research assistants, determining whether the findings accurately reflect anesthesiologists' AIMS and quality improvement reporting practices requires further research, he added.

Still, "our results indicate that there is under-reporting of significant events and suggest that user-dependent reports extracted from AIMS records may not be a reliable source for either realizing the occurrence of clinical events or conducting outcomes research," says Dr. Rehman. "One approach to improving the reporting rate might be to reduce the amount of text the user has to enter and to increase the amount of discrete data to include more binary questions, for example."

Mark McGraw

When it comes to surgical supplies, physicians have some strong feelings about their choice of gloves. "In the surgical workplace, we all have things that are close to our hearts, and for surgeons, nothing is closer to their hearts than their fingers," says one administrator.

Still, standardizing this staple can offer economic, organizational and safety benefits. Here's how she convinced the 17 surgeons who operate at her facility to use the same brand of non-latex glove, through persuasion as well as budgetary force.

David Bernard

Two proposed arrangements between an ASC and an anesthesia provider could run afoul of federal anti-kickback law, according to a new advisory opinion from the Office of Inspector General. In the first arrangement, the anesthesia provider would pay the surgical center a "management fee" for rent and supplies. In the second, the anesthesia provider would be an employee of a shell anesthesia services company that the ASC forms. How do you feel about surgeons profiting from the professional services of anesthesia service providers? Tell us in this week's InstaPoll.

Two-thirds of the 510 faciliy managers who took last week's InstaPoll have a 2-stick policy, meaning they'll call in an anesthesia provider to start the IV if the pre-op nurse can't get it done in 2 tries. The results: