Original Story: theherald-news.com
Years ago Orland Park resident John Jawor was diagnosed with a benign tumor on his pancreas. After the growth was surgically removed, scar tissue developed and the abdominal tissue was weakened, developing a painful tear over time that progressively enlarged. A lump became visible, growing larger than a walnut.
Jawor consulted his primary care doctor, who referred him to see general surgeon Dr. Thomas Vasdekas. Dr. Vasdekas recommended robotic hernia surgery at the Midwest Institute of Robotic Surgery at Silver Cross Hospital. More robotic surgeries are performed at Silver Cross than any other hospital or surgery center in the Chicago metropolitan area.
Jawor is now pain free and the hernia is gone. “I am so grateful to Dr.Vasdekas for repairing my hernia and the great nursing staff at Silver Cross for making my entire experience so pleasant,” said the 63-year old. “Not only was my recovery quick, I was able to return to work much sooner.”
A hernia occurs when an organ or scar tissue pushes through an opening in the muscle or tissue that holds it in place. Hernia surgery is one of the most common general surgical procedures performed in the U.S.
“In John’s case, his prior surgery made his abdomen wall weak causing scar tissue that eventually created a very large hernia, which was actually comprised of five small hernias,” said Dr.Vasdekas, board certified general surgeon on staff at Silver Cross. “By completing the surgery using the da Vinci robot, a less invasive technique was used to insert a large piece of mesh to repair the hernia. In addition, robotic surgery far surpasses any other surgical approach because it greatly enhances the surgeon’s ability to visualize tissue allowing for more flexibility to make repairs in tighter spaces.
“Robotic surgery offers complex cases, like John’s, many potential benefits over traditional open surgery, including minimal blood loss, less scarring, shorter hospital stay, low risk of complications and a faster recovery,” said Dr. Vasdekas.
Showing posts with label Surgery. Show all posts
Showing posts with label Surgery. Show all posts
01 November 2012
Quality of Heath Care Varies by Region According to Study
story first appeared on usatoday.com
Where you live – and where your doctors did their training – has a lot to do with whether you'll be operated on, get an infection or have other potentially risky medical tests, a report out Tuesday said.
And we're not talking about small-town vs. big-city medicine. The report by Dartmouth Medical School's Atlas Project looked closely at 23 medical centers, including many of the top-rated hospitals for clinical excellence by U.S. News and World Report and other leading hospitals affiliated with universities. New Atlas data that include nearly all the teaching hospitals in the U.S. were also released.
The study was done to help medical students decide where to do their residencies, but it also helps consumers better understand how their local hospitals differ from the norm.
Among the findings: If you're in Salt Lake City, you're twice as likely to get knee-replacement surgery than if you're in New York City. Lubbock, Texas, had the highest rate of knee replacements -- 13.2 per 1,000 Medicare beneficiaries.
Arthritis in the knee is "not a dependably progressive disorder" that nearly always requires surgery, says David Goodman, a doctor who is co-principal investigator for the Atlas Project.
The report uses new 2010 Medicare data to update previous reports on regional variations in the treatment of patients at the end of life, trends in surgical procedures and trends in quality of care as it relates to patient experience and safety.
There is an emphasis on more aggressive treatment over preventive care at some hospitals, Goodman says. The report includes a "hospital care intensity index" when it comes to treatment of people at the "end of life."
Goodman says some hospitals may have a lot of capacity in their intensive care units and not enough in primary care.
Patients at NYU Langone Medical Center were 47 times less likely to get an infection from a urinary catheter than patients at the University of Michigan Health System, for example. Mount Sinai Medical Center had the second lowest. Goodman says such infections are "largely preventable."
David Muller, dean for medical education at the Mount Sinai School of Medicine, says the population of patients a hospital treats -- that is, whether they are low income and already in poor health -- can have a lot to do with whether a patient contracts an infection and can recover fully from it. The report's rates were adjusted for age, race and gender using the U.S. Medicare population as the standard.
Muller says the Dartmouth report can be valuable for both medical students and patients, but he notes that the Atlas Project's research is sometimes practically considered a bible, but he says any measures of quality of care in hospitals, varies widely and the subject is controversial.
This list ranks 23 teaching hospitals by the Hospital Care Intensity (HCI) index, which is a measure that combines the number of days patients spent in the hospital and the average number of inpatient physician visits during the last two years of life.
Hospital (ranked by Hospital Care Intensity (HCI) index):
Patients at NYU Langone Medical Center were 47 times less likely to get an infection from a urinary catheter than patients at the University of Michigan Health System, for example. Mount Sinai Medical Center had the second lowest. Goodman says such infections are "largely preventable."
David Muller, dean for medical education at the Mount Sinai School of Medicine, says the population of patients a hospital treats -- that is, whether they are low income and already in poor health -- can have a lot to do with whether a patient contracts an infection and can recover fully from it. The report's rates were adjusted for age, race and gender using the U.S. Medicare population as the standard.
Muller says the Dartmouth report can be valuable for both medical students and patients, but he notes that the Atlas Project's research is sometimes practically considered a bible, but he says any measures of quality of care in hospitals, varies widely and the subject is controversial.
This list ranks 23 teaching hospitals by the Hospital Care Intensity (HCI) index, which is a measure that combines the number of days patients spent in the hospital and the average number of inpatient physician visits during the last two years of life.
Hospital (ranked by Hospital Care Intensity (HCI) index):
- Cedars-Sinai Medical Center 2.06
- NYU Langone Medical Center 1.73
- Mount Sinai Medical Center 1.50
- Ronald Reagan UCLA Medical Center 1.48
- New York-Presbyterian Hospital 1.37
- University of Pittsburgh Medical Center 1.28
- Northwestern Memorial Hospital 1.28
- Massachusetts General Hospital 1.19
- Cleveland Clinic 1.12
- Hospital of the Univ. of Pennsylvania 1.08
- University of Michigan Health System 1.07
- Brigham and Women's Hospital 1.06
- Johns Hopkins Hospital 1.01
- United States average 1.00
- Indiana Univ. Health (Clarian Health) 0.96
- Barnes-Jewish Hospital/Washington Univ. 0.95
- UCSF Medical Center 0.92
- Duke University Medical Center 0.87
- Vanderbilt Univ. Medical Center 0.80
- University of Washington Medical Center 0.78
- Stanford Hospital and Clinics 0.78
- St. Mary's Hospital, Mayo Clinic 0.70
- Scott & White Memorial Hospital 0.62
- University of Utah Health Care 0.62
09 April 2012
Bypass Surgery Better than Angioplasty?
Story first appeared in US News.
Study found those with multi-vessel heart disease showed reduced risk of dying four years later.
Patients over the age of 65 who have severe coronary artery disease fare better with bypass surgery than with minimally invasive angioplasty, a large, new study indicates.
Although there was no significant difference in mortality after one year, patients who had undergone bypass surgery had a 21 percent reduced risk of dying after four years compared to those who had received angioplasty, the researchers found.
The trend in cardiology more recently has been to favor angioplasty over surgery.
During angioplasty, cardiologists insert a small "balloon" into the blocked vessel via a catheter. Once in place, the balloon is inflated to widen the vessel. The procedure can be done with or without placing a stent, a wire mesh scaffold that keeps the vessel propped open.
Coronary artery bypass surgery involves grafting part of a healthy vessel onto the blocked vessel to reroute blood flow, bypassing the blocked part of the vessel.
The chair of cardiology at Christiana Care Health System in Newark, Del., said he did not envision an immediate sea change in clinical practice as the result of these findings.
A doctor and his colleagues combined information from two large databases which, all told, included about 200,000 patients, all elderly and all with more than one blood vessel blocked.
About 86,000 underwent surgery and 104,000 had angioplasty. Of those who had angioplasty, 78 percent received drug-eluting stents, 16 percent received bare-metal stents and 6 percent had no stents.
Drug-eluting stents, considered state-of-the-art, ooze a drug out into the artery that prevents scar tissue from building up.
Patients undergoing surgery tended to have more complications such as diabetes, lung disease and heart failure, although the authors did adjust for these factors.
Although the study was not a randomized, controlled trial -- considered the gold standard of medicine because those studies randomly assign people to different treatments and compares them with those who are untreated -- it had several advantages, including the fact that it was looking at a real-world population in real time.
This older population is very broad and represents probably the largest proportion of individuals who need this type of treatment, although the results probably can be extrapolated to other groups.
For more health care related news, visit the Healthcare and Medical News Blog.
Study found those with multi-vessel heart disease showed reduced risk of dying four years later.
Patients over the age of 65 who have severe coronary artery disease fare better with bypass surgery than with minimally invasive angioplasty, a large, new study indicates.
Although there was no significant difference in mortality after one year, patients who had undergone bypass surgery had a 21 percent reduced risk of dying after four years compared to those who had received angioplasty, the researchers found.
The trend in cardiology more recently has been to favor angioplasty over surgery.
During angioplasty, cardiologists insert a small "balloon" into the blocked vessel via a catheter. Once in place, the balloon is inflated to widen the vessel. The procedure can be done with or without placing a stent, a wire mesh scaffold that keeps the vessel propped open.
Coronary artery bypass surgery involves grafting part of a healthy vessel onto the blocked vessel to reroute blood flow, bypassing the blocked part of the vessel.
The chair of cardiology at Christiana Care Health System in Newark, Del., said he did not envision an immediate sea change in clinical practice as the result of these findings.
A doctor and his colleagues combined information from two large databases which, all told, included about 200,000 patients, all elderly and all with more than one blood vessel blocked.
About 86,000 underwent surgery and 104,000 had angioplasty. Of those who had angioplasty, 78 percent received drug-eluting stents, 16 percent received bare-metal stents and 6 percent had no stents.
Drug-eluting stents, considered state-of-the-art, ooze a drug out into the artery that prevents scar tissue from building up.
Patients undergoing surgery tended to have more complications such as diabetes, lung disease and heart failure, although the authors did adjust for these factors.
Although the study was not a randomized, controlled trial -- considered the gold standard of medicine because those studies randomly assign people to different treatments and compares them with those who are untreated -- it had several advantages, including the fact that it was looking at a real-world population in real time.
This older population is very broad and represents probably the largest proportion of individuals who need this type of treatment, although the results probably can be extrapolated to other groups.
For more health care related news, visit the Healthcare and Medical News Blog.
28 March 2012
Virginia Man Gets A New Face In Baltimore
Story first appeared
in The Baltimore Sun.
When the
patient opened his eyes after a marathon 36-hour
surgery to give him a new face, he immediately wanted a mirror.
A natural reaction for a man who had been practically living as a recluse since a 1997 gun accident took off his nose, chin, lips and teeth, said doctors from the University of Maryland who had just performed the world's most extensive face transplant on the 37-year-old from Hillsville, Va.
A natural reaction for a man who had been practically living as a recluse since a 1997 gun accident took off his nose, chin, lips and teeth, said doctors from the University of Maryland who had just performed the world's most extensive face transplant on the 37-year-old from Hillsville, Va.
There were up to 150 doctors, nurses and other professionals from the Maryland
medical system who had a direct hand in caring for the patient. So many hands in the surgery does leave room
for possible error, which could lead to a Baltimore Medical Malpractice Lawyer
stepping in.
Just six days after his
surgery, he was saying some words, shaving and brushing his teeth. He's also
beginning to get some feeling back in his face.
The patient received donor skin from his scalp to his neck, as well as a new jaw, teeth, tongue and the underlying muscle and tissue. In addition to matching his blood type, doctors had to match his skin color and bone structure to a donor.
Unemployed and living with his parents before he came to Maryland in 2005, the patient had undergone a dozen surgeries, but none that could restore him to functioning membership in society.
Maryland had been working for the past decade on face transplant methods, improving the way tissue, muscle, skin and bone are woven onto a recipient and increasing the odds of acceptance by a recipient.
The Department of Defense's Office of Naval Research funded the work with eight grants totaling $13 million. It supports research that could aid returning service members injured by explosives. At some point, injured veterans could undergo transplants at Maryland.
The hospital provided no details about the gun accident, but during Tuesday's news conference at Maryland, doctors and university officials recounted the patient’s transformation through a series of photos.
Doctors showed before and after pictures that included a photo from his high school prom; a post-injury photo where he appeared to have no chin and a mangled nose; and a post-surgery photo that made him appear close to normal, if swollen, after surgery.
The patient’s facial features appear to be a blend of his own and those of his donor, whose family he has not met. The donor was not named by the Living Legacy Foundation of Maryland, which works in the state to supply recipients with needed organs. The same donor provided five life-saving organs to five other recipients, four of whom also had surgeries at Maryland.
Drivers who check "organ donor "on their licenses do not consent to face transplants. A family must give special permission.
Around the world, 22 people have received face transplants since the first was performed in France seven years ago. While Maryland is a large transplant center, this was its first face transplant.
Doctors there have been working to perfect the protocol to prevent rejection of any transplant. Normally, patients are given a daily three-drug cocktail for the rest of their lives to keep them from rejecting their transplants.
Starting five years ago, the center's doctors began using two drugs for many kidney and pancreas transplant patients and they're trying them on the patient, the first time for a face-transplant patient, surgeons said. The drugs suppress the immune system and make a patient more vulnerable to infection, so a smaller amount can reduce that side effect. Eventually, doctors hope to reduce the dosage of the two drugs.
Doctors felt confident using the new drug regimen on the patient after years of lab work at Maryland. The research supported the change as long as they also transplanted high amounts of "vascularized" bone marrow, which came inside the jaw transplanted into his face. The bones and attached vessels give the marrow a ready place to live and steady supply of blood, and that seems to offer some continuous protection from rejection, though researchers aren't entirely sure why.
The patient received donor skin from his scalp to his neck, as well as a new jaw, teeth, tongue and the underlying muscle and tissue. In addition to matching his blood type, doctors had to match his skin color and bone structure to a donor.
Unemployed and living with his parents before he came to Maryland in 2005, the patient had undergone a dozen surgeries, but none that could restore him to functioning membership in society.
Maryland had been working for the past decade on face transplant methods, improving the way tissue, muscle, skin and bone are woven onto a recipient and increasing the odds of acceptance by a recipient.
The Department of Defense's Office of Naval Research funded the work with eight grants totaling $13 million. It supports research that could aid returning service members injured by explosives. At some point, injured veterans could undergo transplants at Maryland.
The hospital provided no details about the gun accident, but during Tuesday's news conference at Maryland, doctors and university officials recounted the patient’s transformation through a series of photos.
Doctors showed before and after pictures that included a photo from his high school prom; a post-injury photo where he appeared to have no chin and a mangled nose; and a post-surgery photo that made him appear close to normal, if swollen, after surgery.
The patient’s facial features appear to be a blend of his own and those of his donor, whose family he has not met. The donor was not named by the Living Legacy Foundation of Maryland, which works in the state to supply recipients with needed organs. The same donor provided five life-saving organs to five other recipients, four of whom also had surgeries at Maryland.
Drivers who check "organ donor "on their licenses do not consent to face transplants. A family must give special permission.
Around the world, 22 people have received face transplants since the first was performed in France seven years ago. While Maryland is a large transplant center, this was its first face transplant.
Doctors there have been working to perfect the protocol to prevent rejection of any transplant. Normally, patients are given a daily three-drug cocktail for the rest of their lives to keep them from rejecting their transplants.
Starting five years ago, the center's doctors began using two drugs for many kidney and pancreas transplant patients and they're trying them on the patient, the first time for a face-transplant patient, surgeons said. The drugs suppress the immune system and make a patient more vulnerable to infection, so a smaller amount can reduce that side effect. Eventually, doctors hope to reduce the dosage of the two drugs.
Doctors felt confident using the new drug regimen on the patient after years of lab work at Maryland. The research supported the change as long as they also transplanted high amounts of "vascularized" bone marrow, which came inside the jaw transplanted into his face. The bones and attached vessels give the marrow a ready place to live and steady supply of blood, and that seems to offer some continuous protection from rejection, though researchers aren't entirely sure why.
07 February 2012
State Legislatures Looking to Decide What Doctors Can Do
First appeared in USA Today
State legislatures are considering a host of measures that
would make it tougher — or easier — for doctors to perform surgery outside of
their specialties, including in their offices.
Only 20 states require doctors doing surgery in their
offices to have facilities that are licensed or accredited, according to the
American Association for Accreditation of Ambulatory Surgical Facilities. Los
Angeles plastic surgeon and AAAASF President-elect Geoffrey Keyes says
licensing or accreditation helps ensure there is adequate emergency equipment
and procedures and that doctors are properly trained in what they are doing.
But some doctors say it's too costly and restricts available
care for needy patients.
Legislators are also increasingly grappling with "scope
of practice" issues, which involve ways medical professionals want to
expand what they are allowed to do.
It includes anything from OB/GYNs doing cosmetic surgery to
optometrists who want to do cataract surgery to pharmacists seeking to expand
the vaccines they can give.
Iowa state Sen. Jeff Danielson, a Democrat who chairs the
State Government committee, says about a third of his time is spent weighing
issues involving medical professionals wanting to expand what they can do. At
least 10 bills in Florida involve scope of practice issues.
"As insurance reimbursements go down and physicians'
overhead goes up, they're trying to find new ways to meet their economic
needs," says Florida state Sen. Eleanor Sobel, a Democrat who is vice
chair of the Senate Health Regulations panel. "But they're not necessarily
qualified to do what they're doing."
New Jersey state legislators are deciding whether offices
where doctors perform surgery should be licensed or accredited. Democratic
state Rep. Herb Conaway says he sponsored the House version of the bill in part
because of data showing many office-based facilities didn't have proper
emergency equipment.
Other bills:
·
Chiropractors in Florida are fighting to be able
to provide medical clearance for young athletes to return to sports fields
after concussions. Their opposition to a bill that would allow only doctors to
grant clearance scuttled the bill last year.
·
Iowa legislators are considering whether
outpatient surgery facilities should have to be licensed and accredited as
hospitals are.
·
Dentists trained as oral surgeons could perform
cosmetic surgery in New York under a measure reintroduced in that state
legislature.
Conaway, an internal medicine doctor and lawyer, says
accreditation or licensing of office surgery facilities is a matter of safety:
"Who would have thought two years ago that someone would attempt to do
breast augmentation in their office? Now we're hearing about those procedures
being done."
25 January 2012
Less Invasive Surgery Procedures
First appeared on Chron.com
Dr. Sandra Hurtado moved her right hand, ever so slightly, and a kidney appeared on the screen.
"Keep coming," surgical robotics instructor Armando Garcia urged. "Keep coming ... Now, go right above it with your left hand."
Hurtado, an ob-gyn, has performed laparoscopic surgeries since leaving medical school more than 20 years ago. But last week, she was at Memorial Hermann Hospital's surgical training lab to gain skills in a movement that has sharply reduced the demand for traditional surgical procedures.
Despite resistance from some peers, Hurtado and other midcareer surgeons are scrambling to keep pace with the growth in less-invasive surgical techniques, allowing them to satisfy patients' demands for smaller scars and quicker recoveries.
Young surgeons learn the procedures during training, but Dr. Daniel Albo, chief of surgical oncology at Baylor College of Medicine, said some older surgeons still resist.
"There's an ego that gets in the way of a surgeon saying, 'I need to get back and retrain,' " Albo said. "Laparoscopic surgery requires a completely different skill set.
"Think of it as grandpa versus the grandson playing video games," he said. "For the grandson, it is very intuitive. For the grandpa, it's an aggravation."
Cost factor unclear
There aren't definitive statistics for how many of the 27 million surgical procedures performed in the United States every year are done with minimally invasive techniques or how much money that saves.
Some people question the conventional wisdom that the new techniques save money, since the up-front costs can be high. But that hasn't slowed the rush toward the new procedures.
The revolution started in France in 1987, when a gynecologist used a video monitor and specialized instruments to remove a patient's gallbladder through small incisions, rather than the traditional hip-to-hip cut across the abdomen.
Similar procedures had been done before, but that procedure in Lyons, France, is considered the true beginning of minimally invasive surgery. Now, it's the standard way to remove a gallbladder.
Colorectal surgeries, at the other extreme, are still done almost exclusively via a large incision, Albo said.
Minimally invasive surgery includes a variety of techniques: Cardiologists use stents as an alternative to chest-cracking coronary bypasses. Surgeons use endoscopes, inserted through the mouth or another body opening, for some procedures. Laparoscopic procedures use special tools inserted through one or more small incisions.
A tiny camera is slipped inside the body to display the view on a video screen, since the surgeon can't see the internal organs directly.
Challenge for veterans
The techniques require a shift in mindset, said Dr. Shawn Tsuda, chief of the division of minimally invasive and bariatric surgery at the University of Nevada Medical School.
"You're looking at a two-dimensional screen instead of the patient's body and tissues," he said. "For the young generation, maybe they play video games or punch in texts on their tiny phones. They're good at it.
"For more experienced surgeons, it can be a real challenge."
From bariatric surgery to breast augmentation surgery, robot-assisted surgeries are the next frontier.
The video display is three-dimensional, and Hurtado said the tools offer more dexterity than those used in traditional laparoscopic surgery.
She and her Obstetrical & Gynecological Associates colleagues at the Woman's Hospital of Texas already perform mostly minimally invasive procedures, but some patients still require more extensive open surgery, she said.
Last week she was learning to use robot-assisted tools, which she said will reduce the need for that.
Patients like the smaller incisions and faster recovery. Erik Wilson, a surgeon and faculty member at the University of Texas Medical School at Houston, said patients always ask for minimally invasive procedures.
"That's where everything is going because that's what everyone wants," said Wilson, a founding member of the Clinical Robotic Surgery Association. "I don't open people up for anything unless they're critically ill and you just don't have any time."
Financial edge?
There is less agreement on the financial advantages. Initial costs increase to pay for the new surgical tools, Tsuda said.
Robot-assisted surgery has especially high startup costs; Peter Herrera, director of surgical innovation at Memorial Hermann, said each station and its accompanying tools cost $1.5 million or more.
But most patients leave the hospital sooner than those who undergo traditional surgery.
They also have fewer complications and return to work more quickly, all of which can reduce costs over time.
"If you look at global health care costs, the cost of not only the procedure itself, but of complications, the cost of managing complications, recovery times, return to work times, then laparoscopic surgery reduces the cost of care," Albo said.
Dr. Sandra Hurtado moved her right hand, ever so slightly, and a kidney appeared on the screen.
"Keep coming," surgical robotics instructor Armando Garcia urged. "Keep coming ... Now, go right above it with your left hand."
Hurtado, an ob-gyn, has performed laparoscopic surgeries since leaving medical school more than 20 years ago. But last week, she was at Memorial Hermann Hospital's surgical training lab to gain skills in a movement that has sharply reduced the demand for traditional surgical procedures.
Despite resistance from some peers, Hurtado and other midcareer surgeons are scrambling to keep pace with the growth in less-invasive surgical techniques, allowing them to satisfy patients' demands for smaller scars and quicker recoveries.
Young surgeons learn the procedures during training, but Dr. Daniel Albo, chief of surgical oncology at Baylor College of Medicine, said some older surgeons still resist.
"There's an ego that gets in the way of a surgeon saying, 'I need to get back and retrain,' " Albo said. "Laparoscopic surgery requires a completely different skill set.
"Think of it as grandpa versus the grandson playing video games," he said. "For the grandson, it is very intuitive. For the grandpa, it's an aggravation."
Cost factor unclear
There aren't definitive statistics for how many of the 27 million surgical procedures performed in the United States every year are done with minimally invasive techniques or how much money that saves.
Some people question the conventional wisdom that the new techniques save money, since the up-front costs can be high. But that hasn't slowed the rush toward the new procedures.
The revolution started in France in 1987, when a gynecologist used a video monitor and specialized instruments to remove a patient's gallbladder through small incisions, rather than the traditional hip-to-hip cut across the abdomen.
Similar procedures had been done before, but that procedure in Lyons, France, is considered the true beginning of minimally invasive surgery. Now, it's the standard way to remove a gallbladder.
Colorectal surgeries, at the other extreme, are still done almost exclusively via a large incision, Albo said.
Minimally invasive surgery includes a variety of techniques: Cardiologists use stents as an alternative to chest-cracking coronary bypasses. Surgeons use endoscopes, inserted through the mouth or another body opening, for some procedures. Laparoscopic procedures use special tools inserted through one or more small incisions.
A tiny camera is slipped inside the body to display the view on a video screen, since the surgeon can't see the internal organs directly.
Challenge for veterans
The techniques require a shift in mindset, said Dr. Shawn Tsuda, chief of the division of minimally invasive and bariatric surgery at the University of Nevada Medical School.
"You're looking at a two-dimensional screen instead of the patient's body and tissues," he said. "For the young generation, maybe they play video games or punch in texts on their tiny phones. They're good at it.
"For more experienced surgeons, it can be a real challenge."
From bariatric surgery to breast augmentation surgery, robot-assisted surgeries are the next frontier.
The video display is three-dimensional, and Hurtado said the tools offer more dexterity than those used in traditional laparoscopic surgery.
She and her Obstetrical & Gynecological Associates colleagues at the Woman's Hospital of Texas already perform mostly minimally invasive procedures, but some patients still require more extensive open surgery, she said.
Last week she was learning to use robot-assisted tools, which she said will reduce the need for that.
Patients like the smaller incisions and faster recovery. Erik Wilson, a surgeon and faculty member at the University of Texas Medical School at Houston, said patients always ask for minimally invasive procedures.
"That's where everything is going because that's what everyone wants," said Wilson, a founding member of the Clinical Robotic Surgery Association. "I don't open people up for anything unless they're critically ill and you just don't have any time."
Financial edge?
There is less agreement on the financial advantages. Initial costs increase to pay for the new surgical tools, Tsuda said.
Robot-assisted surgery has especially high startup costs; Peter Herrera, director of surgical innovation at Memorial Hermann, said each station and its accompanying tools cost $1.5 million or more.
But most patients leave the hospital sooner than those who undergo traditional surgery.
They also have fewer complications and return to work more quickly, all of which can reduce costs over time.
"If you look at global health care costs, the cost of not only the procedure itself, but of complications, the cost of managing complications, recovery times, return to work times, then laparoscopic surgery reduces the cost of care," Albo said.
26 July 2011
VA HOSPITALS HAVE TOO MANY “CLOSE CALL” SURGERIES
Story first appeared in the Associated Press
Medical procedures and surgeries on the wrong patient and wrong body part have declined substantially at Veterans Affairs hospitals nationwide, while reports of close calls have increased, according to a study that credits ongoing quality improvement efforts. A Michigan Spinal Cord Injury Lawyer has seen a decrease in calls.
These efforts include a VA requirement for doctors, nurses and other hospital workers to report medical errors and near-misses to their bosses. The study is based on reports from mid-2006 to 2009; they were compared with data from the previous five years.
The per-month rate of reported errors declined to about two from about three at the VA's 153 centers that do surgery or other major medical procedures. Reported monthly close calls increased to about three from almost two.
Skeptics might wonder if a decline in reported errors means hospital workers are clamming up, but co-author Julia Neily, a nurse and associate director with the VA's National Center for Patient Safety, said, care is becoming safer. She said the increase in close-call reports suggests doctors, nurses and their co-workers are becoming more willing to speak up when something goes wrong or looks like it's about to.
The VA's quality improvement efforts encourage that kind of openness. Veterans facilities also are among hospitals that have adopted pilot-style checklists, where a member of the operating team reads off things like the patient's name, the type of procedure, anesthesia and tools needed. Body parts to be operated on are marked, and team members are supposed to speak up if something doesn't sound right. Patients, too, are sometimes involved before being wheeled into the operating room.
The study was published online Monday in the Archives of Surgery.
During the 42 months studied, there were 101 medical errors and 136 close calls, out of more than half a million procedures.
The researchers and patient safety experts not involved in the study said the results show a promising trend, including a decline in the severity of medical errors at VA hospitals.
Still, there were troubling signs - 30 procedures or surgeries on the wrong patient and 48 on the wrong body part or wrong side of the body.
Most "wrong patient" events involved CT scans, MRIs and other radiology procedures. "Wrong" surgeries included implanting the wrong size eye lens and the wrong type of knee joint.
Why these major errors continued to happen despite a big focus on improving safety is the question, Neily acknowledged.
Sometimes patients have the same or similar names, she said.
Sometimes patients speak different languages or otherwise have difficulty communicating with their doctors, said Dr. Allan Frankel of the Institute for Healthcare Improvement, who stressed that non-VA hospitals are also struggling to get those numbers down to zero after adopting similar systems.
Dr. David Mayer, co-director of the Institute for Patient Safety Excellence at the University of Illinois at Chicago, said sometimes surgeons and other OR team members are distracted during "time-outs" and checklist-reading before surgeries, thinking ahead to the operation.
At UIC's medical center, surgeons are encouraged to have these sessions outside the operating room, in a quiet setting around patients' beds, to make it easier to focus, Mayer said. Some VA hospitals also use that approach, Neily said.
The study lacked data on deaths related to surgery mistakes during the study, although the authors said there were no deaths in 2009, the most recent year examined.
A 2006-08 study published last year reported an 18 percent decline in deaths at 74 Veterans hospitals that had adopted the surgery checklist approach.
Medical procedures and surgeries on the wrong patient and wrong body part have declined substantially at Veterans Affairs hospitals nationwide, while reports of close calls have increased, according to a study that credits ongoing quality improvement efforts. A Michigan Spinal Cord Injury Lawyer has seen a decrease in calls.
These efforts include a VA requirement for doctors, nurses and other hospital workers to report medical errors and near-misses to their bosses. The study is based on reports from mid-2006 to 2009; they were compared with data from the previous five years.
The per-month rate of reported errors declined to about two from about three at the VA's 153 centers that do surgery or other major medical procedures. Reported monthly close calls increased to about three from almost two.
Skeptics might wonder if a decline in reported errors means hospital workers are clamming up, but co-author Julia Neily, a nurse and associate director with the VA's National Center for Patient Safety, said, care is becoming safer. She said the increase in close-call reports suggests doctors, nurses and their co-workers are becoming more willing to speak up when something goes wrong or looks like it's about to.
The VA's quality improvement efforts encourage that kind of openness. Veterans facilities also are among hospitals that have adopted pilot-style checklists, where a member of the operating team reads off things like the patient's name, the type of procedure, anesthesia and tools needed. Body parts to be operated on are marked, and team members are supposed to speak up if something doesn't sound right. Patients, too, are sometimes involved before being wheeled into the operating room.
The study was published online Monday in the Archives of Surgery.
During the 42 months studied, there were 101 medical errors and 136 close calls, out of more than half a million procedures.
The researchers and patient safety experts not involved in the study said the results show a promising trend, including a decline in the severity of medical errors at VA hospitals.
Still, there were troubling signs - 30 procedures or surgeries on the wrong patient and 48 on the wrong body part or wrong side of the body.
Most "wrong patient" events involved CT scans, MRIs and other radiology procedures. "Wrong" surgeries included implanting the wrong size eye lens and the wrong type of knee joint.
Why these major errors continued to happen despite a big focus on improving safety is the question, Neily acknowledged.
Sometimes patients have the same or similar names, she said.
Sometimes patients speak different languages or otherwise have difficulty communicating with their doctors, said Dr. Allan Frankel of the Institute for Healthcare Improvement, who stressed that non-VA hospitals are also struggling to get those numbers down to zero after adopting similar systems.
Dr. David Mayer, co-director of the Institute for Patient Safety Excellence at the University of Illinois at Chicago, said sometimes surgeons and other OR team members are distracted during "time-outs" and checklist-reading before surgeries, thinking ahead to the operation.
At UIC's medical center, surgeons are encouraged to have these sessions outside the operating room, in a quiet setting around patients' beds, to make it easier to focus, Mayer said. Some VA hospitals also use that approach, Neily said.
The study lacked data on deaths related to surgery mistakes during the study, although the authors said there were no deaths in 2009, the most recent year examined.
A 2006-08 study published last year reported an 18 percent decline in deaths at 74 Veterans hospitals that had adopted the surgery checklist approach.
10 January 2010
New, More Expensive Antiseptic Proves Its Value In The Surgical Theatre
Houston Chronicle
A study led by a Houston researcher has found that a less-popular, but more-expensive surgery-site antiseptic is more effective at reducing infections than the most commonly used product.
The research, led by Dr. Rabih Darouiche and published in today's edition of theNew England Journal of Medicine, is prompting a local hospital — one of six across the country to participate in the seven-year study — to change its pre-surgery skin cleanser.
The first-of-its-kind study compared two surgery-site antiseptics — including the one most widely used in the United States to cleanse patients' skin before surgery — and found that the more expensive, less popular product reduces infections about 40 percent more than the other product does.
Research sites included Ben Taub General Hospital and the Michael E. DeBakey VA Medical Center.
Every year in the United States, 300,000 to 500,000 patients have surgical-site infections. Twenty to 30 percent of those infections are caused by staph and more than half of those infections come from bacteria already on the patient's skin.
The more-effective antiseptic — chlorhexidine-alcohol — is used for about 10 percent of U.S. surgeries, but the slightly higher price pales in comparison to the savings for avoiding costly infections, Darouiche said.
Since 2002, the Centers for Disease Control and Prevention has recommended chlorhexidine-alcohol to reduce vascular catheter-association bloodstream infections. Studies have shown the antiseptic is more effective than povidone-iodine for cleaning the entry site for those tiny needles used to move fluids through patients.
“This is a very powerful, quick and practical approach to prevent surgical-site infections,” said Darouiche, who practices at the DeBakey VA Medical Center and teaches at Baylor College of Medicine.
The study included 849 patients.
Most VA hospitals continue to use povidone-iodine to cleanse surgical sites, but because of the study, the DeBakey VA Medical Center is in the process of switching to chlorhexidine-alcohol, Darouiche said.
“The reason they use it is not just because it has been used for decades, but they use it because it's essentially cheap,” he said. An average surgery would require a $12 chlorhexidine-alcohol product. A similar povidone-iodine skin preparation costs about $3.
“You can save anywhere from $10 to $400 (in infection treatment costs) for each extra dollar you spend,” said Darouiche, an internist whose specialties include infectious disease and spinal cord injury medicine.
Neither officials at the hospitals nor CareFusion — the company that makes both antiseptic products — knew about the study results until they were released Wednesday afternoon, Darouiche said.
The company supplied researchers with ChloraPrep, a chlorhexidine-alcohol preoperative skin preparation, along with another product that contained povidone-iodine. The study was almost entirely funded through grants and consulting fees to researchers from Cardinal Health, which recently spun off CareFusion.
The research, led by Dr. Rabih Darouiche and published in today's edition of theNew England Journal of Medicine, is prompting a local hospital — one of six across the country to participate in the seven-year study — to change its pre-surgery skin cleanser.
The first-of-its-kind study compared two surgery-site antiseptics — including the one most widely used in the United States to cleanse patients' skin before surgery — and found that the more expensive, less popular product reduces infections about 40 percent more than the other product does.
Research sites included Ben Taub General Hospital and the Michael E. DeBakey VA Medical Center.
Every year in the United States, 300,000 to 500,000 patients have surgical-site infections. Twenty to 30 percent of those infections are caused by staph and more than half of those infections come from bacteria already on the patient's skin.
The more-effective antiseptic — chlorhexidine-alcohol — is used for about 10 percent of U.S. surgeries, but the slightly higher price pales in comparison to the savings for avoiding costly infections, Darouiche said.
Since 2002, the Centers for Disease Control and Prevention has recommended chlorhexidine-alcohol to reduce vascular catheter-association bloodstream infections. Studies have shown the antiseptic is more effective than povidone-iodine for cleaning the entry site for those tiny needles used to move fluids through patients.
“This is a very powerful, quick and practical approach to prevent surgical-site infections,” said Darouiche, who practices at the DeBakey VA Medical Center and teaches at Baylor College of Medicine.
The study included 849 patients.
Most VA hospitals continue to use povidone-iodine to cleanse surgical sites, but because of the study, the DeBakey VA Medical Center is in the process of switching to chlorhexidine-alcohol, Darouiche said.
“The reason they use it is not just because it has been used for decades, but they use it because it's essentially cheap,” he said. An average surgery would require a $12 chlorhexidine-alcohol product. A similar povidone-iodine skin preparation costs about $3.
“You can save anywhere from $10 to $400 (in infection treatment costs) for each extra dollar you spend,” said Darouiche, an internist whose specialties include infectious disease and spinal cord injury medicine.
Neither officials at the hospitals nor CareFusion — the company that makes both antiseptic products — knew about the study results until they were released Wednesday afternoon, Darouiche said.
The company supplied researchers with ChloraPrep, a chlorhexidine-alcohol preoperative skin preparation, along with another product that contained povidone-iodine. The study was almost entirely funded through grants and consulting fees to researchers from Cardinal Health, which recently spun off CareFusion.
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