Intravenous acetaminophen does in fact reduce incidents of PONV, despite recent research findings that showed otherwise, according to a study presented at the annual gathering of the American Society of Anesthesiologists.

The IV anti-inflammatory drug reduces the need for post-op opioids — the main trigger for PONV, says a team of researchers led by Christian C. Apfel, MD, PhD, associate professor at the University of California in San Francisco. They say the impact of IV acetaminophen in reducing PONV compares with the efficacy of anti-emetics used to prevent nausea and vomiting.

Their surface review of 31 studies comparing patients who received IV acetaminophen with those who did not showed similar nausea and vomiting rates between the 2 groups, which coincided with previous conclusions. However, a difference in PONV risks became apparent when the researchers analyzed the timing of acetaminophen's first dose.

When given prophylactically before, during or immediately after surgery — before patients enter PACU — IV acetaminophen reduces PONV by approximately 30%, according to the researchers, who note the impact was similar for single and multiple doses of the drug. The findings also showed that acetaminophen doesn't reduce PONV rates when given after the onset of pain.

Daniel Cook

Are you a patient satisfaction guru? Would you like to help create a nationwide survey that aims to evaluate the outpatient surgery experience from the patient's point of view? If so, federal healthcare quality researchers would like to hear from you.

As part of a continuing effort to improve care and inform consumers, the Centers for Medicare and Medicaid Services is planning a standardized survey of patients' satisfaction with and self-reported outcomes from surgeries or other procedures at ASCs and hospital outpatient departments.

For the survey, to be drafted in partnership with the Agency for Healthcare Research and Quality and with the Consumer Assessment of Healthcare Providers and Systems Consortium, Medicare is seeking input from a wide range of surgical stakeholders, from administrators, surgeons and staff to patients, vendors and insurers.

The input that CMS is seeking (by March 26, 2013) includes suggestions for relevant topic areas to cover in a patient satisfaction survey as well as publicly available surveys, questions and measures that have previously gauged the subject.

For more information on how to submit suggestions, see the request for information as published in the Federal Register.

David Bernard

A 10-year study on the use of systematic arthroscopy in treating moderate to severe osteoarthritis has shown the practice may be able to delay a patient's need for total knee replacement for up to 10 years.

Called "The Package" by physicians at the Steadman Philippon Research Institute in Vail, Colo., the treatment combines knee arthroscopy with comprehensive rehabilitation. Their study observed 81 knees in 73 patients, male and female, with Kellgren-Lawrence (KL) grades 3 and 4 osteoarthritis.

Patients were aware their treatments were considered a method for potentially reducing symptoms and delaying knee replacement, not curing arthritis. All participants had initially tried conservative treatment measures to no avail. They then underwent the comprehensive "Package" procedure, which included a defined rehabilitation program focusing on maintaining patellar mobility and overall knee motion.

The mean survival time after arthroscopic treatment of osteoarthritis with the defined protocol was 6.8 years. Forty percent of patients delayed arthroplasty for a minimum of 10 years. However, patients with KL grade 4 changes in their knees had a higher likelihood that arthroplasty would be necessary and a significantly lower mean survival time.

Stephanie Wasek

Laws requiring transparency in health care — public reporting of infection rates, never events and other outcome data — are generally good for health care. Tell us in this week's InstaPoll if you agree or disagree.

The pre-op phone call is the preferred method of conducting initial pre-anesthesia patient screenings, according to 51% of the 548 respondents to last week's poll.

• Phone call: 51%
• Patient visits facility: 22%
• Patient completes online screening: 3%
• Some combination of all 3: 24%

Dan O'Connor

• Hospira recalls Lactated Ringers Pharmaceutical manufacturer Hospira has recalled lot number 05-019-JT of its Lactated Ringers and 5% Dextrose Injection (1,000mL in a flexible container with an expiration date of May 1, 2013). According to the company, a customer reported seeing a spore-like contaminant in a container of the solution. The affected lot was distributed nationwide between June 2011 and January 2012.
• Prostatectomy and quality of life Patients who opt for surgery instead of radiation therapy to treat prostate cancer experienced more urinary and sexual function issues 2 to 5 years post-op, but those quality-of-life differences became far less pronounced 15 years after surgery, according to a study appearing in the Jan. 31 issue of the New England Journal of Medicine. "Regardless of the form of initial treatment, patients had significant declines in sexual and urinary function over the duration of the study," says David Penson, MD, MPH, professor of urologic surgery and medicine at Vanderbilt University and the study's senior author. "The causes of these declines probably include advancing age and additional cancer therapies, in addition to the original therapy."
• Botox for bladders The FDA has approved the use of Botox to treat overactive bladders. Botox injections cause a bladder to relax, increasing its storage capacity and reducing episodes of urinary incontinence. The procedure can be performed during a cystoscopy.