The new Outpatient Surgery website will launch soon, so stay tuned! Watch your email for details!

EMRs Will Prominently Display Patient's Addiction History
JESSIE GRUBB JESSIE GRUBB Jessie's Law will prominently display addiction history in medical records.

A patient's addiction history will be prominently displayed in her electronic medical record with the passage of Jessie's Law, a bill named for Jessie Grubb, a recovering heroin addict who in 2016 was prescribed oxycodone following surgery for an infection in her hip — even though her medical records mentioned her history of drug abuse 8 times.

The discharging doctor, who said he didn't know Ms. Grubb was a recovering addict, sent her home with a prescription for 50 oxycodone pills after surgery. She died the next day of an overdose. She was 30 years old.

Police believe Ms. Grubb crushed up the OxyContin, mixed them with liquid and injected them into the IV port that was in her arm for antibiotics, according to a report in the Ann Arbor News.. Eight of the 50 oxycodone pills were missing when police found Ms. Grubbs, according to the report.

"She should have never have been given a prescription of opioid medication," says U.S. Senator Joe Manchin of West Virginia in an editorial celebrating the enactment of Jessie's Law.

The goal of Jessie's Law is to give addiction history the same prominence in medical records as what is done now for a patient who has an allergy to a prescription medicine, says Sen. Manchin.

If a patient consents, the law will mandate a patient's opioid addiction is clearly presented in medical records. Jessie's Law orders the Department of Health and Human Services over the next year to come up with guidelines and best practices for a "prominent display" of addiction information in a patient's medical records.

Richard Abowitz

Hip Replacement Revisions Increasing in Middle-Aged Patients
Hip Surgery DO OVER Hip replacement surgery is getting safer, but techniques and implant materials must continue to improve.

Patients who opt to get their hips replaced at a younger age are more likely to require a revision surgery to fix joint dislocations or repair faulty implants, according to a study published in The Journal of Bone & Joint Surgery.

The review of 320,500 total hip revisions performed between 2007 and 2013 revealed a 12% increase in the rate of the procedures. A closer look at the data shows that the rate increased by 30% among patients between the ages of 45 and 64, but declined among all other age groups. Revision surgeries caused by hip dislocations decreased by 14%, but rates of mechanical-related complications increased, likely due to the prevalent use of metal-on-metal implants during the study period, according to the researchers.

There was some positive news to take from the findings: Rates of mortality, discharges to skilled nursing facilities and serious post-op complications — including blood clots, heart attack, pneumonia and urinary tract infection — decreased significantly over the study period.

The researchers say their study revealed an overall positive trend in hip replacement outcomes, but add that middle-aged patients who undergo successful hip replacement surgery typically outlive their implants, a reality that demands making the devices with longer-lasting materials.

"Hip arthroplasty revision is a lot safer and more successful than 20 years ago, but still occurs too frequently," says study senior author Guy Paiement, MD, associate director of the Education Orthopaedic Center at Cedars-Sinai Medical Center in Los Angeles, Calif. "We need to continue improving techniques and implants."

Daniel Cook

Opioids Increase Likelihood of Repeat Spinal Fusion Surgery
BAck Pain MORE PAIN Patients using opioids long-term were 80% more likely to be hospitalized for back pain 90 days after surgery.

Patients taking opioids for back pain before their spinal fusion surgery are more likely to need repeat surgery, a study finds.

Almost one-fourth of patients analyzed were prescribed opioids for more than 6 months before their surgery, researchers at the Ohio State University Wexner Medical Center found. More than 90% of them were prescribed hydrocodone/acetaminophen, oxycodone/acetaminophen and oxycodone hydrochloride to manage their back pain.

These patients had a 19% higher risk of surgical wound complications within 90 days of surgery. They were also 31% more likely to visit the ER and 80% more likely be hospitalized for lumbar spine pain in this time frame. Long-term opioid use increased the likelihood a patient would need repeat spinal fusion surgery within a year by 33%.

"All of these findings highlight the vicious cycle of unrelieved pain and fusion and increased healthcare costs in long-term opioid users," the researchers stated in the study published in the journal Spine.

"With increasing emphasis on cost containment and quality improvement, our findings are intended to caution providers about chronic opioid therapy as a risk factor for additional interventions and costs after lumbar fusion," said lead author Safdar Kahn, MD, an orthopedic spine surgeon at the Medical Center's Comprehensive Spine Center and Department Orthopaedic Surgery. "As we head toward a value- and outcomes-based reimbursement system, spine surgeons need to incorporate preoperative opioid use into their surgical decision making."

JoEllen McBride, PhD

InstaPoll: Are Overnight Stays a Good Idea for ASCs?

Should patients be able to stay overnight in ambulatory surgery centers? Tell us in this week's InstaPoll if you prefer loops or ties.

More than half (53%) of the 508 respondents to last week's poll prefer surgical masks with ties while one-fifth (20%) reach for surgical masks with ear loops. Many feel masks with loops aren't suited for the OR because they might not provide a secure facial fit that prevents venting at the sides of the mask.

Surgical masks with loops or ties?

  • loops 20%
  • ties 53%
  • both 27%

Dan O'Connor

News & Notes
  • "Ultra-restrictive" protocol significantly reduces opioid prescriptions, not post-op pain scoresPhysicians reduced the number of opioid tablets they prescribed by 97% in ambulatory or minimally invasive procedures and saw no difference in post-op pain scores, a prospective study conducted at Roswell Park Comprehensive Cancer Center found. The average number of opioid tablets gynecologic surgeons prescribed went from 31.7 to 3.5 at the Center after implementing this restrictive protocol.
  • Lap band surgery reduces knee pain Overweight patients who undergo lap band surgery to shed excess pounds also experience relief from arthritic knee pain, says research published in the journal Seminars in Arthritis and Rheumatism. The study's authors say the knee-preserving benefits of weight-loss surgery are more pronounced in younger patients, a finding that suggests obese individuals should opt to have lap bands placed sooner rather than later.
  • FDA updates statistics linking breast implants to cancer The FDA says 414 women with breast implants have developed anaplastic large-cell lymphoma (ALCL), a rare type of non-Hodgkin T-cell lymphoma associated with breast implants. Nine of those patients have died. The FDA first identified a possible association between breast implants and the development of ALCL in 2011.