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Anesthesia Type Affects Joint Surgery Outcomes

Neuraxial anesthesia produces more favorable outcomes among hip or knee arthroplasty patients than general anesthesia does, according to a study published in the May issue of the journal Anesthesiology.

Researchers from Weill Cornell Medical College in New York City reviewed cases from 400 U.S. hospitals between 2006 and 2010. Eleven percent of total joint surgeries were performed under neuraxial anesthesia, 14.2% under a mix of neuraxial and general, and 74.8% under general alone. Researchers found that neuraxial anesthesia decreased 30-day mortality, costs, length of stay, and postoperative complications. There was no difference between the types in occurrences of acute myocardial infarction and non-myocardial infarction cardiac complications.

The benefits of neuraxial anesthesia also outweighed those of general anesthesia, even though the patients who received neuraxial treatment were on average older than those receiving general. This was important, researchers noted, because age plays a large role in determining any perioperative complications that may arise, and because hip and knee replacement become more common among older populations. According to published reports, more than 1 million Americans undergo the surgery each year, a number that is expected to rise to 3 million annually by 2030.

Researchers speculate that the reason the groups receiving neuraxial or a neuraxial-general combination were smaller than the general anesthesia group may have been attributable to physicians' skill levels or preferences.

Lauren Roberts

Robot-Assisted Prostatectomy Doesn't Improve Outcomes

Robot-assisted radical prostatectomy doesn't improve outcomes over the laparoscopic approach, according to research published in the journal Urology. The study adds to a growing body of evidence suggesting that robots may not be as revolutionary as advertised.

Researchers compared 2 groups of 210 patients who had had either robot-assisted or laparoscopic-approach routine procedures for radical prostatectomy. The 2 groups were assessed with questionnaires at baseline, and at 3-, 12- and 36-month follow-ups. At 36 months, 87.9% of the laparoscopy patients reported having regained baseline urinary function, and 57.3% said they'd regained baseline sexual function. For the robotic group, 82.6% had regained baseline urinary function and 61.3% baseline sexual function.

"Introduction of [robot-assisted prostatectomy] did not result in improvement of functional outcome," write the researchers. While "better urinary function was associated with better general mental health," neither surgical method was found to deliver more effective urinary function or sexual function at 36 months.

Stephanie Wasek

Is Nitrous Oxide Safe?

Complication and mortality rates are not adversely impacted when nitrous oxide is used during general anesthesia, according to a pair of studies published in the May issue of the journal Anesthesia & Analgesia.

In the first study, researchers from Australia's Royal Melbourne Hospital analyzed the case outcomes of more than 5,000 patients, 29% of whom received nitrous oxide. Results were comparable between patients who received nitrous oxide and those who did not: Overall complication rates were close to 7% and risk of death was 3% in both groups.

According to a second study conducted at the Cleveland Clinic in Ohio, risk of death was one-third lower in nearly 17,000 patients who received nitrous oxide during surgeries performed between 2005 and 2009. In addition, the combined rate of major complication and death dropped by 17% in patients who received the anesthetic.

The findings seem to contradict previous research that discovered a small but significant increase in long-term heart attack risks for patients who received nitrous oxide.

However, a pair of accompanying editorials (here and here) address the limitations of the research, including a lack of randomization — the hallmark of strong scientific evidence.

Daniel Cook

InstaPoll: Do You Separate PACU into Phase I and II?

Do all of your patients require admission to a Phase I recovery facility? Tell us in this week's InstaPoll.

Nearly three-fourths (71%) of the 225 respondents to last week's poll round to every department in their facility every day.

How often do you round to every department in your facility?
  • Daily 71%
  • A couple of times a week 13%
  • Weekly 6%
  • Monthly 7%
  • So long I can't recall 3%

Dan O'Connor

News & Notes
  • Surgical errors pose less harm After reviewing 25 years' worth of U.S. malpractice claim payouts, researchers at Johns Hopkins have determined that diagnosis-related errors are more costly and harmful than surgical errors, with $38.8 billion in diagnosis-related claims paid between 1986 and 2010. Diagnosis-based errors also happen more often, as researchers estimate the average diagnostic error rate may be as high as 15%.
  • Are your surgeons social media savvy? Physicians should maintain professional relationships with patients by avoiding contact through social media platforms, and should err on the side of caution when communicating via text message, email, and other forms of electronic communication, according to a policy paper issued by the American College of Physicians and the Federation of State Medical Boards. The paper discusses ways in which social media can impact the patient-physician relationship, and how to avoid incidences that may compromise patient confidentiality.
  • Picturing patients' pain Could functional MRI scans of patients' brains provide a view on their pains? Researchers examined 114 patients while administering sensations of warmth or painful heat. According to their findings, published in the April 11 issue of the New England Journal of Medicine, unique neurological patterns visible on the fMRI scans enabled them to predict with a high degree of accuracy which sensation had been administered. Future research, they say, could deliver a means of identifying and quantifying other types of pain more objectively than through self-reporting.