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Are Fecal Transplants the Cure for Recurrent C. diff?
MIRACLE POOP? Fecal transplants restore missing microbial flora to the gut of a fecal transplant recipient.

Could fecal transplants be a more effective treatment than antibiotics against recurrent Clostridium difficile? Researchers are cautiously optimistic that infusing a healthy donor's stool into a C. diff patient will repopulate the colon with healthy bacteria and prevent a recurrence.

For a study published in the Annals of Internal Medicine, researchers from the University of Pennsylvania's Perelman School of Medicine tracked the nationwide prevalence of C. diff from 2001 to 2012 — with data from nearly 39 million patients — and found that:

  • cases of multiple recurring C. diff increased by 189%;
  • cases of common C. diff increased by 43%; and
  • women over 55 were the most common C. diff victims, especially those who'd been exposed to corticosteroids, proton-pump inhibitors and/or antibiotics.

The researchers also were intrigued by a 2013 study of 43 patients that found that fecal transplant treatments were effective in 81% of recurrent C. diff patients, versus a 31% success rate with patients who were given repeated and extended courses of vancomycin, the conventional treatment.

The researchers say that while infusing donor feces is a potentially safe and effective treatment against recurrent C. diff, they say more data is needed to establish the long-term safety of the procedure. They also note that antibiotic treatment for an initial C. diff infection typically doesn't induce a durable response in about 15 to 26% of patients and that an effective treatment against recurrent C. diff is not available.

In a fecal transplant, fecal matter is collected from a tested donor, mixed with a saline or other solution, strained and then infused in a patient by colonoscopy, endoscopy, sigmoidoscopy or enema. The goal is to replace favorable bacteria — in this case, bacteria that helps prevent C. diff — that's been killed or suppressed, usually by antibiotics.

Jim Burger

Is It Time to Add Same-day Total Disc Arthroplasty?
BACK TO BACK In terms of 2-year patient outcomes, complications and disability index scores, researchers saw no significant difference between the 2 outpatient procedures.

Good news in the world of same-day spine: With anterior cervical discectomy and fusion (ACDF) already established as a popular outpatient offering, a new study suggests cervical disc replacement can be performed in an ambulatory setting just as safely and effectively.

ACDF continues to build steam in outpatient settings, but total disc replacement should be the next logical step, according to the authors of the study, published recently in Spine. Although ACDF has long been considered the gold standard for addressing a number of cervical pathologies, the authors say total disc replacement may more closely reproduce the physiologic kinematics of the cervical spine. It may also limit the amount of stress placed on adjacent discs, thereby reducing the incidence of further disease.

The researchers examined the medical records of 55 consecutive patients undergoing single-level total disc replacement, and and compared them with 55 patients who had single-level ACDF. In the process, they found significant improvements in 2-year post-operative outcomes in both groups, with no statistical significance in disability index scores or serious complications, such as post-operative hematomas or worsening post-op pain. Dysphagia was the most common post-op complaint in both groups.

As with past studies about the safety and efficacy of total disc replacement, the authors note "several factors of concern" associated with performing the procedure in an outpatient setting. Chief among them is the potential for airway compromise secondary to a post-op hematoma or soft-tissue swelling. Concerns aside, the authors conclude that single-level total disc replacement can be performed safely on an outpatient basis, with satisfactory clinical and patient-reported outcomes.

Bill Donahue

Surgeon Moms Face Tough Choices
CHILD CARE Female surgeons need to be supported during their pregnancies and maternity leaves.

There's no ideal time for female surgeons to start a family, so they should decide to have a child when the time is right for them and their significant others, according to a survey of more than 700 physician-mothers who were questioned while they were in medical school.

Of the 738 physician-mothers who were surveyed for the Journal of the American College of Surgeons study, 221 were training to become surgeons. The female surgeons faced greater schedule inflexibility, more physical demands, higher uses of assisted reproduction, shorter maternity leaves and were more likely to have to find coverage for themselves instead of receiving assistance from their department chairs if they needed to take time off from work.

"These issues correlated with lower career satisfaction," says lead researcher Jennifer Davids, MD, FACS, FASCRS, an assistant professor of surgery at UMass Memorial Medical Center in Worcester, Mass.

The research was born out of Dr. Davids' personal experience as a surgeon and mother. She had her first child during residency and her second child in the first year of practice, when she had to juggle a tremendous amount of work responsibility with the demands of home.

Women should follow their passion and have no regrets about doing so, says Dr. Davids. "At the same time, now that there are more surgeon moms in medicine, and more dual medical career couples, finding time to raise a family is becoming more of a global issue," she adds. "Child birth and maternity leave are temporary periods in someone's career. It's important to support women — and men — during these times."

Daniel Cook

InstaPoll: First Case On-Time Starts

When the first case of the day starts late, it can upset the entire day's surgical schedule, delaying subsequent cases, causing bottlenecks, and frustrating patients, surgeons and staff. Tell us in this week's InstaPoll how likely you are to start your first case on time.

More than half (56%) of the 123 respondents to last week's InstaPoll say their surgeons have cut back on the number of painkillers they prescribe to patients after surgery. The results:

Are your surgeons prescribing fewer painkillers in the wake of the opioid epidemic?

  • considerably fewer 23%
  • somewhat fewer 33%
  • about the same 44%

Dan O'Connor

News & Notes
  • Endo pulls the plug on Opana ER Endo Pharmaceuticals will voluntarily remove Opana ER from the market. The announcement came about a month after the U.S. Food and Drug Administration asked Endo to withdraw the opioid pain medication over concerns that it can be too easily abused. It's the first opioid drug that the FDA has sought to remove from the market due to abuse. The agency said it had seen a "significant shift" from people crushing and snorting the pill to get high to injecting it instead. Although Endo says it "remains confident in the clinical research and other data demonstrating the safety and efficacy" of Opana ER, the company will work with FDA to coordinate the orderly removal of the drug "to minimize treatment disruption for patients and allows patients sufficient time to seek guidance from their healthcare professionals."
  • ACL repair more efficient in ASCs Surgeons are able to perform ACL repairs 30 minutes faster and with fewer staff members in ASCs than in hospitals, suggests new research published in the journal Orthopedics. The study compared the efficiency of 28 ACL repairs performed in an ASC and 21 in a hospital's main OR by a single surgeon. The study's authors say orthopedic-specific surgical teams who perform ACL repairs in ASCs are a cost-reducing alternative to hospital ORs and have shown increased surgical efficiency without compromising patient safety.
  • Performance measures added for total joint certification Starting next Jan. 1, facilities looking to be certified for total joints by the Joint Commission will be required to collect monthly data related to 4 new performance measures: regional anesthesia, post-op ambulation on the day of surgery, discharge to home and pre-op functional/health status assessment.