Outpatient Surgery's Biggest Risk Factors

There are 7 statistically significant conditions that independently increase the risk of morbidity and mortality after outpatient surgery, according to research recently reported in Anesthesiology News.

For a presentation at the American Society of Anesthesiologists' annual meeting last year, researchers at the University of Michigan selected the 150 most common outpatient procedures and reviewed more than 240,000 cases in a clinical database. They identified these 7 "red flags":

  • history of cancer;
  • paraplegia/quadriplegia;
  • age 70 or older;
  • history of renal failure/dialysis;
  • current steroid use;
  • chronic obstructive pulmonary disease; and
  • history of cerebral vascular attack/transient ischemic attack.

Complications resulting in "major morbidity or mortality" were incredibly low, occurring in 0.3% of cases. But the top 5 perioperative complications included unplanned re-intubation, post-op pneumonia, surgical site infection, intraoperative blood transfusion and inability to intubate, according to the research.

Stephanie Wasek

Indiana Nurses Fired After Refusing Flu Shots

Does patient safety trump employee rights? As healthcare providers face what appears to be an early and severe flu season, one Indiana hospital has mandated that the answer is "yes."

Indiana University Health Goshen Hospital fired 8 of its employees, including 3 longtime nurses, last December for refusing to be vaccinated against influenza, reports ABC News.

Following the urgings of the Centers for Disease Control and Prevention, American Medical Association and American Nurses Association in September, the hospital required all of its employees to get a flu shot by Dec. 15.

Critical care nurse Ethel Hoover, 61, sought a religious exemption from the mandatory vaccination, but was denied. Despite nearly 22 years of service at the hospital and respect among her co-workers, she was one of the employees fired on Dec. 21, when the deadline passed and she hadn't been immunized.

The hospital notes that participation in its flu prevention program is a condition of employment, pointing to its chief goal of patient care and the fact that patients may already be in a weakened state, immunologically.

David Bernard

The Safety of Outpatient Laryngopharyngeal Surgery

Ambulatory laryngopharyngeal surgery is a safe but underused option, according to a study published in Archives of Otolaryngology - Head and Neck Surgery.

A review by researchers at the University of California in Irvine of outpatient pharyngeal and laryngeal surgeries performed in 1996 and 2006 shows no significant difference in case volume (176,305 vs. 189,930, respectively), complications or patient demographics.

The researchers note the typical patient was male, 45 to 64 years old, who underwent the procedure under general anesthesia in a hospital setting. The admission rate following the procedure was less than 4%, minor complications such as high blood pressure, PONV and hemorrhaging occurred in 9% of cases and no serious adverse events — cardiac arrest, airway obstruction, malignant hyperthermia or hypoxia, for example — were reported.

This study quantifies the risks of ambulatory laryngopharyngeal surgery as the specialty continues to evolve, and as previous studies have questioned the safety of the procedures and encouraged the post-op admission of patients, say the researchers.

While population levels have increased, the number of ambulatory laryngopharyngeal surgeries has remained constant despite "relatively low" complication rates, which the researchers say demonstrates the safety of the procedures.

Daniel Cook

InstaPoll: Time Bandits

We live in an era of distractions, time wasters lurking all around us. For you, it might be Facebook. For others, office drop-ins or phone calls. Tell us in this week's InstaPoll what steals the most minutes away from your days.

More than half (56%) of the 160 facility managers who took last week's poll say their facility is leaving money on the table because "we don't maximize our reimbursement" — 30% strongly agreed with that statement and 26% agreed somewhat. The results:

  • Strongly agree: 30%
  • Agree somewhat: 26%
  • Neither agree nor disagree: 8%
  • Disagree somewhat: 10%
  • Strongly disagree: 26%

Dan O'Connor

News & Notes
  • AAAASF deeming authority CMS has unconditionally renewed the American Association for the Accreditation of Ambulatory Surgery Facilities' deeming authority to accredit ASCs for the Medicare or Medicaid programs. The move reflects AAAASF's standards for quality patient care and extends its deeming authority for 6 years, through Nov. 27, 2018. CMS announced the renewal in the Federal Register.
  • Glaucoma kit recalled Mobius Therapeutics is voluntarily recalling 2 lots of Mitosol (mitomycin for solution) 0.2mg/vial kits for ophthalmic use. The affected lots may be non-sterile, the company has ascertained. Distributed between Oct. 22 and Dec. 14, they may contain a strain of yeast on 1 or more parts in the kit and should be considered unsafe for use. Their use could result in serious eye complications, infections or possible blindness. The recalled lot numbers and a list of the 20 states to which the product was distributed are listed in a company press release.
  • Meniscus repair failure rate Regardless of technique, the long-term failure rate after meniscal repair is similar, with a pooled rate of 23.1%, according to a review in The Journal of Bone & Joint Surgery. Researchers conducted a systematic literature review and meta-analysis of 13 studies to investigate meniscal repair outcomes at 5 years post-op. Failure rates were similar for the medial (24.2%) and lateral (20.2%) meniscus and for patients with a intact or reconstructed ACLs.
  • Can shellfish improve wound healing? The powerful adhesive protein found in mussels could help control bleeding and promote tissue healing after surgery, according to researchers at Penn State University and the University of Texas at Arlington. The researchers incorporated the adhesive protein's chemical structure into the design of an injectable synthetic polymer that adheres well in wet environments, has more controlled degradability, improved biocompatibility and lower manufacturing costs without side effects as compared to current wound closure adhesives and glue options. The researchers say they are still optimizing the protein's formulation to make it stronger and to potentially add anti-microbial properties.