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Healthcare-Associated Infections Cost Nearly $10B Annually

Despite facilities' ongoing efforts to improve care through infection control, the tab for treating healthcare-associated infections is about $9.8 billion a year, according to a study recently published online by JAMA Internal Medicine.

Surgical site infections account for slightly more than one-third (33.7%) of that total, followed closely by ventilator-associated pneumonia (31.6%) and central line-associated bloodstream infections (18.9%). Rounding out the top 5 are C. diff. (15.4%) and catheter-associated urinary tract infections (<1%).

On a per-case basis, the central-line infections are the most costly, adding an average of almost $46,000 to patient bills. Ventilator-associated pneumonia costs about $40,000 per case, followed by SSIs ($20,785), C. diff. ($11,285) and catheter UTIs ($900). The study is based on data from 1986 to 2013, and the totals are converted to 2012 dollars.

In an accompanying editorial, Mitchell H. Katz, MD, director of the Los Angeles County Department of Health Services, suggests that the study could help motivate providers to further invest in prevention strategies, especially if insurers follow Medicare's lead and refuse to pay for treating healthcare infections. That refusal would be "an important part of the movement toward paying for quality, not quantity, of care," he says.

Jim Burger

The Benefits and Drawbacks of Lap Hernia Repair

The laparoscopic repair of primary ventral hernias results in fewer surgical site infections than open repair does, say Texas researchers, but it can present more of other types of complications.

For a study published online by JAMA Surgery last week, researchers retrospectively reviewed the cases of 532 patients who'd consecutively undergone elective ventral hernia repairs at the Michael E. DeBakey VA Medical Center in Houston between 2000 and 2010. From that group, they chose 79 demographically similar patients each who'd had laparoscopic or open procedures.

The laparoscopic patients saw a significantly lower rate of post-op surgical site infections than open patients did, they reported (7.6% to 34.1%). And there was no difference in recurrences at the site (both showed a rate of 11.4%).

But, they noted, the laparoscopic cases saw more incidents of post-op bulging (21.5% to 1.3%) among their outcomes, and slightly more port-site herniations (2.5% to 0%), leading them to conclude that further study is needed to identify causes and mitigation strategies.

David Bernard

Are Robotic Surgery Complications Under-Reported?

Out of approximately 1 million robotic surgeries performed since 2000, only 245 complications and 71 deaths have been reported to the FDA, according to skeptical researchers at Johns Hopkins University School of Medicine in Baltimore, Md.

"The number reported is very low for any complex technology used over a million times," says Martin Makary, MD, MPH, an associate professor of surgery at the Johns Hopkins and one of the study's authors.

The research team cross-referenced a review of the FDA adverse events database with scans of news and court record search engines, discovering that 8 cases were not appropriately reported to the FDA. Five of those were never filed and 2 were filed only after media reports surfaced.

Their findings, which appear online in the Journal for Healthcare Quality, also reveal that, of the 71 patient deaths, 22 occurred during gynecologic procedures, 15 during urologic surgery and 12 during cardiothoracic procedures. Excessive bleeding was the cause of death in a majority of the cases. In non-fatal cases, 43% of reported complications occurred during hysterectomies.

Dr. Makary is calling for a standardized method of reporting adverse events related to robotic devices due to the technology's wildly increasing use. The number of procedures performed robotically jumped more than 400 percent between 2007 and 2011.

"Doctors and patients can't properly evaluate safety when we have a haphazard system of collecting data that is not independent and not transparent," he says. "There may be some complications specific to the use of this device, but we can only learn about them if we accurately track outcomes."

Daniel Cook

InstaPoll: Surgical Patient Readiness: How Do You Rate?

In an ideal world, a patient should be ready for surgery when the OR calls or when he arrives in pre-op. But all too often there are avoidable delays — for instance, consents aren't signed or H&Ps aren't updated. How ready are your patients for surgery when they arrive from home? Tell us in this week's InstaPoll, then check back next week for the results.

Not very many surgical facility leaders like to pick up the phone nowadays. Only 14% of the 404 respondents to last week's InstaPoll prefer to use the phone at work. Most (41%) prefer to e-mail instead. The results:

Do you see phone calls as an intrusion, or do you prefer e-mail or text?

  • I still prefer to pick up the phone. 14%
  • I prefer e-mail. 41%
  • I'd rather text. 9%
  • I use all 3 modes of communication pretty equally here at work. 36%

Dan O'Connor

News & Notes
  • Cataract patients live longer Patients who undergo surgery to treat cataract-related vision impairment are 60% more likely to live longer than those who don't, according to a studyin the journal Ophthalmology. Researchers concede the association between cataract surgery and reduced mortality risk is not clearly understood, but point to physical and emotional well-being, optimism, greater confidence associated with independent living after vision improvement, and a greater ability to comply with prescription medications as possible factors.
  • Steroids not a quick fix for carpal tunnel While injections of methylprednisolone are commonly used for short-term pain relief and function among carpal tunnel syndrome patients, Swedish researchers writing in the Annals of Internal Medicine have found that longer-term repair still usually requires surgery.
  • Gastric bypass alternative A newly developed plastic gastric sleeve that can be inserted endoscopically may provide an alternative to invasive bariatric surgery. The "MetaboShield," which was developed by students at the Hebrew University of Jerusalem, is designed to mimic the shape of the duodenum, blocking food absorption without damaging the intestine. It requires no general anesthesia or incisions, and does not damage tissue, say its inventors.