Gastrointestinal complications and surgical site infections are the 2 leading causes of hospital readmission following general surgery, according to a study published in the Journal of the American College of Surgeons.

Researchers at the Emory University School of Medicine in Atlanta say the need to understand the cause of hospital readmissions is heightened in light of CMS's plan to limit reimbursements to hospitals with higher-than-expected rates for surgical patients.

They note 11% of the nearly 1,500 general surgery patients operated on between 2009 and 2011 were readmitted within 30 days of discharge. Complication rates were highest following complex GI procedures such as pancreatectomy, colectomy and liver resection, notes the study.

Post-op wound sepsis and urinary tract infections cause a five-fold increase in readmission rates, research showed. Urinary tract infections, while rare, were associated with the highest risk of readmission, says John F. Sweeney, MD, FACS, the study's lead author and the chief of general and gastrointestinal surgery at Emory

Dr. Sweeney suggests post-op caregivers start transition-of-care planning early, especially for high-risk patients, to encourage early discharges. A reduction in post-op complications would carry huge financial implications for hospitals, patients and payors, he says.

Daniel Cook

Since triclosan is beginning to lose ground to new generations of bacteria, there's a growing need for a suture coating that's both effective and able to overcome bacterial resistance. Researchers may have found just that in PAMBM, an amphiphilic polymer that is bactericidal against Staphylococcus aureus.

Because it is derived from naturally occurring antimicrobial peptides, PAMBM can kill a wide range of bacteria while posing a very low risk of spurring bacterial resistance and the eventual emergence of superbugs. The research showed PAMBM to have "excellent antimicrobial activity at a low concentration," and found that PAMBM kills bacteria more effectively than triclosan does.

A press release on the study points out that this is because triclosan "slows the growth of bacteria but does not actually kill those already present." It also notes that triclosan coatings can be absorbed by the body, the lasting effects of which are unknown, whereas PAMBM doesn't pose this risk.

"As bacterial resistance to current agents continues to increase and with resistance to triclosan now documented, the discovery of new antimicrobial agents that remain active in biomedical device coatings is essential," say the researchers.

Stephanie Wasek

What would you do to reduce your surgical site infection rate by a third? Would talking over practices and potential improvements with your surgical colleagues be too much to ask?

For a study appearing in the August issue of the Journal of the American College of Surgeons, researchers at the Johns Hopkins University School of Medicine looked at the effect that a comprehensive unit-based safety program (CUSP) had on post-operative SSI rates among colorectal surgery patients.

The program involved the meeting of administrators, surgeons, nurses, techs and anesthesia providers in small groups to discuss clinical practices, dissect inconsistencies and develop solutions for handling this high-infection-risk patient population. The goal: create a culture of patient safety in which frontline staff could speak openly when they witnessed potential hazards. The groups' suggestions included standardized prep procedures, active patient warming and safety checklists, among other efforts.

The results were promising. In the year before implementing the CUSP (July 2009 to July 2010), the mean SSI rate among colorectal surgery patients was 27.3% (76 of 278 patients). In the year after the program's introduction, the rate was 18.2% (59 of 324 patients), a 33.3% drop.

"The benefits of a bottom-up versus a top-down approach to patient safety were immediately obvious," says Elizabeth Wick, MD, an assistant professor of surgery at Hopkins.

"By bringing together front-line providers with hospital administrators, the program bridges a growing divide in healthcare," adds associate professor of surgery Martin Makary, MD, MPH.

David Bernard

When done correctly, flash sterilization is a safe and effective process for sterilizing instruments intended for use during surgery, such as when you inadvertently drop an instrument you need for the case to continue. But flashing routinely for reasons of convenience or as an alternative to purchasing additional instrument sets is not considered good practice. In this week's InstaPoll, we want to know: when's the last time you flashed?

Is mandatory quality reporting for ASCs a good idea?Nearly three-fourths (73%) of the 370 respondents to last week's poll think that mandatory quality reporting for ambulatory surgical centers is a good idea. See the September issue of Outpatient Surgery Magazine for all the details about the start of next month's ASC quality reporting program.

Yes (I work in an ASC): 58%

No (I work in an ASC): 26%

Yes (I work in a hospital): 15%

No (I work in a hospital): 1%

Dan O'Connor