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

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

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

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