The extent of the fungal meningitis outbreak linked to an injectable steroid product has widened as more states report sickened patients and more facilities identify cases that used the contaminated drugs.

According to the latest reports, 8 patients have died and 105 others were infected after being injected with preservative-free methylprednisolone acetate during outpatient lumbar epidural procedures.

Certain lots of the drug, produced by Framingham, Mass.-based New England Compounding Center, are determined to have been contaminated with the fungus Aspergillus, which sparked the outbreak. The affected lots were shipped to 76 facilities in 23 states from July to September, but as yet only 9 states have reported resulting patient illnesses or death. A nationwide recall of the drug — as well as all of the company's products — is underway, and the company has voluntarily ceased production.

The outbreak was first detected in Tennessee, which has seen 3 deaths and 32 illnesses. Michigan has reported 2 deaths and 20 illnesses, Maryland and Virginia 1 death each. Florida, Indiana, Minnesota, North Carolina and Ohio have also reported sickened patients. Other states whose facilities have used the drugs are in the process of contacting patients.

Unlike viral or bacterial strains of the disease, fungal meningitis is not contagious. The U.S. Food and Drug Administration and the Centers for Disease Control and Prevention are recommending healthcare facilities to avoid using — but to retain and secure — any products obtained through the New England Compounding Company until further notice.

David Bernard

The U.S. Department of Health & Human Services' Office of Inspector General is zeroing in on hospital-ASC mergers and the discrepancy between Medicare reimbursement rates in the 2 settings, according to the OIG's 2013 Work Plan.

Here are the specifics of what the OIG will watch closely next year:

• Hospital acquisitions of ASCs, to determine the impact such transactions have on Medicare payments and beneficiary cost savings. The OIG says it's concerned that hospitals may be acquiring ASCs to secure the higher Medicare rates paid for outpatient services performed in hospital-owned surgical centers.
• The appropriateness of Medicare's methodology for setting ASC payment rates under the revised payment system established in January 2008, to determine "whether a payment disparity exists between the ASC and hospital outpatient department payment rates for similar surgical procedures provided in both settings."
• The safety and quality of care provided Medicare patients undergoing surgery in both settings, including before and during procedures, in light of CMS and its stakeholders seeking a comparison of the quality of care provided in ASCs and HOPDs.
• Physicians' coding of Medicare Part B claims for services performed in ASCs or HOPDs, to ensure the setting is properly coded. Physicians receive different levels of payments based on where they perform procedures.

Representatives from the ASC Association did not respond to requests for comment, and the American Hospital Association could not comment in time for publication.

Click here to receive e-mail alerts from the OIG when reports on these issues are completed and posted.

Daniel Cook

About 15% of surgical procedures result in complications within 30 days post-op, according to an analysis presented at the American College of Surgeons' annual meeting last week.

Researchers at the University of Alabama Birmingham reviewed 60,000 orthopedic, GI, vascular and gynecology cases performed at 112 Veterans Administration hospitals from 2005 to 2009. Assessing pre- and post-discharge complication rates (including those for surgical site, urinary tract, respiratory, and cardiac infections and vascular problems), they found that GI and vascular surgery had the highest at 27.5% and 20% respectively, followed by orthopedic (7%) and gynecological (6.7%).

However, 80% of the gynecological complications presented after discharge, compared with about 40% for vascular and orthopedic procedures. Lead author Melanie Morris, MD, an assistant professor of surgery at UAB, says the variation is due to the typically shorter hospital stays (and frequent same-day discharges) of gynecological procedures. Most of those post-discharge complications were SSIs, says the study.

These figures highlight the importance of tracking patients after they've left your facility and capturing "the data points that we're going to be held accountable for," says Dr. Morris. "Public reporting of SSI rates is here, [and] we need to ensure a level playing field, so patients and payors have accurate data. Further, it's important for our gynecology colleagues and our orthopedic colleagues to be sure that they're adequately educating patients about SSIs and how to diagnose them to ensure timely and appropriate treatment."

According to the CDC, about 197,000 emergency department visits each year are attributed to medical or surgical complications within 7 days of hospital discharge.

Stephanie Wasek

The nationwide outbreak of fungal meningitis tied to custom-made steroid injections used to treat back pain has made national headlines. It's also put compounding pharmacies in the spotlight. Share your views on compounding pharmacies in Outpatient Surgery Magazine's InstaPoll.

Last week we asked when you last received a salary increase. More than half (55%) of our 868 respondents say they've gotten a raise within the past year. For 20% of respondents, however, it's been 3 years or longer since their last increase. The results: My last salary increase was:

• within the past year 55%
• 2 years ago 17%
• 3 years ago 8%
• more than 3 years ago 14%
• so long ago I can't remember 6%

Dan O'Connor

• Anesthesia survival rates increase More patients who receive general anesthesia survive today than 50 years ago, according to a worldwide study published in the Sept. 22 issue of The Lancet journal. Canadian researchers reviewed 87 studies published up to February 2011 that reported anesthetic-related mortality rates with sample sizes of at least 3,000 surgical patients. The researchers note that perioperative mortality has declined significantly, despite an increase in surgeries involving patients categorized by the American Society of Anesthesiologists' physical status scores as riskier.
• Post-traumatic spine disorder Nearly 20% of lower-back fusion surgery patients developed post-traumatic stress disorder symptoms following the procedure, according to a recent Oregon Health & Science University study published in the journal Spine. Researchers say this is the first study to monitor for, and find, PTSD symptoms in elective-surgery patients. The strongest determining factor for post-op PTSD symptoms is whether the patient suffered depression or anxiety disorders before surgery, but some patients who did not present with such diagnoses also suffered PTSD after their surgeries.
• Studying older shoulders Older and younger patients suffer shoulder dislocation injuries at about the same rate, but since older patients are more likely to injure the rotator cuff — which doesn't play much of a role in stabilizing the shoulder — they're less likely to suffer recurring injuries than younger patients who injure the ligaments that do, say researchers. However, older patients' shoulder injuries are more often overlooked, misdiagnosed or treated non-surgically, leaving them more often with chronic pain or impairment.