Sending 50% of the urological procedures currently done in hospitals to ASCs and physician offices would save Medicare nearly $66 million a year, according to a study published in the Journal of Urology.

Researchers analyzed cost data for 22 procedures across the 3 settings, including costs for post-operative complications and unexpected hospitalizations within 30 days of the procedures, and found ASCs and physician offices less costly for all but 2 procedures. Eighty-eight percent of the procedures analyzed were performed in the non-hospital settings, and patients in ASCs and physician offices tended to be lower-risk than those in hospital settings.

Average total payments ranged from $200 for urethral dilation in a physician's office to $5,688 for shock-wave lithotripsy in the hospital. Urodynamic procedures were more than 33% less expensive in ASCs, and prostate biopsies were nearly 75% less so. Physician offices weren't significantly more cost-efficient sites of service compared with ASCs. "Facility payments tended to be the driver of payment differences," write the researchers.

"The Medicare program accounts for 19% of total national spending on personal health services, making it the single largest payer in the United States," says lead study author John M. Hollingsworth, MD, of the department of urology, Dow Division of Health Services Research and Center for Healthcare Outcomes and Policy, at the University of Michigan in Ann Arbor. "Therefore, with regard to healthcare financing, as Medicare goes, so goes the nation."

Stephanie Wasek

Sevoflurane has a distinctly different effect on the metabolism of pediatric patients' brains than propofol does, according to a recent study, and this effect may explain why the inhaled agent presents more of a risk of emergence delirium than the intravenous one.

Previous studies have associated the use of sevoflurane with emergence delirium among young surgical patients. But researchers at Stony Brook University in Stony Brook, N.Y., have determined — through the imaging of rodents' and children's brains during anesthetic experiences — that inhaled sevoflurane generates more lactate there than IV propofol does.

And, their data demonstrates, the "children who emerged from anesthesia with more agitation and dissociative behavior had the highest levels of brain lactate."

"As an increasingly young patient population continues to have a growing need for general anesthesia," the researchers write, "it is important to determine the impact inhalant and intravenous anesthetics have on children."

The study appears in the November issue of the journal Anesthesiology.

David Bernard

Most patients with spinal stenosis realize improved outcomes following surgery, as compared to individuals who opt for non-surgical treatments of the condition, according to a study in the Oct. 1 issue of the journal Spine.

Researchers from the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H., reviewed the cases of 419 patients who underwent surgery (standard open decompressive laminectomy) to correct the narrowing of their spines and 235 individuals who tried physical therapy or non-steroidal anti-inflammatory drugs.

The study's authors, who point out their findings apply only to patients with persistent symptoms and narrowing of the spine confirmed by imaging studies, say patients who underwent surgery showed greater improvement on a disability index scale — measuring bothersome back and leg pain — than patients who did not.

Notably, patients who smoke did not achieve similar positive results following surgery. Why smokers showed the same improvement with or without surgery is unclear, note the researchers, but the finding suggests these individuals should kick the habit before being considered for spinal stenosis surgery.

Another study published online in Spine says spinal stenosis outcomes differ across 13 spine surgery facilities nationwide.

Specifically, the researchers noted variations in surgical times, patient blood loss, incidence of durotomy (repair of dural tears resulting from accidental punctures), length of post-op hospital stays and wound infections. They say the choice of surgical facility influences outcomes, but concede further research is needed to determine which facility characteristics are most important.

Daniel Cook

Your sharps exposure control plan must include an annual review of sharps safety devices to reflect changes in technology. Tell us in Outpatient Surgery Magazine's InstaPoll if you've conducted a sharps safety trial within the past year.

One thing that's not lacking in the facilities that took last week's InstaPoll: dispensers and bottles of hand sanitizer. Last week we asked Do you have enough dispensers and bottles of hand sanitizer in your facility? The results, based on 283 responses: 93% said yes, they had enough, while only 7% said they didn't have enough.

Dan O'Connor

• A surgical complication costs $17K The average total cost for a surgical patient who suffers complications post-operatively is $35,465, according to an analysis published in the journal Health Affairs. The cost of treating patient without complications was $18,403, a difference of over $17,000. "Reducing surgical complications is, foremost, critically important for patients," write the authors. "Moreover, in a competitive environment increasingly characterized by transparency of outcomes, the surgical complication rate is an important measure of hospital performance that could strongly influence choices of care and care sites made by patients and payers."
• Obese suffer after knee replacements Obese patients are at greater risk of complications following knee replacement and twice as likely to need revision procedures compared to non-obese patients, according to a study published in the Journal of Bone and Joint Surgery. The study notes obese patients have double the rate of post-op infections and higher rates of superficial and deep wound infections. The study's authors say obese patients can still undergo knee replacement surgery, but should first be educated about the increased risk of post-complications.
• What's wearing down anesthesiologists? A national survey of anesthesiologists over age 50 shows that, on average, they spend 81% of their time on clinical care, and that their work-weeks (on average, 49.4 hours), while similar in length to other physicians, are longer than many other professional occupations'. The survey's findings, compiled by researchers from the Yale University School of Medicine and published in the November issue of the journal Anesthesiology, have been presented as the factors that might influence a potential upcoming shortage of anesthesia MDs.