Surgery News - February 2009 - (Page 2) NEWS FEBRUARY 2009 • SURGERY NEWS different type of patient and should be referred to a tertiary center,” Dr. Martin said. “It is not an individual surgeon issue, but it requires a teamResection • from page 1 coordinated approach. Why should we treat cations. Blood transfusion predicted complica- complex oncologic patients differently than we tions in both groups (odds ratio, 2.98). In addi- treat trauma patients who have better survival if tion, the extent of hepatic disease predicted treated at a level-1 or -2 tertiary center?” “Is it true that hepatobiliary surgeons are recomplications in the simultaneous surgery group, said Dr. Martin, an ACS Fellow with the ally involved up front in the decision?” asked discussant Dr. Bryan M. Clary, an ACS Fellow who Louisville (Ky.) Oncology Center. The investigators graded complications on a 5- is professor of surgery at Duke University, point scale in which 1 equaled a minor compli- Durham, N.C. “When patients are diagnosed with synchrocation and 5 equaled death. There was no significant difference between groups in the severity nous lesions, we are consulted,” Dr. Martin of complications. For example, grade 1 compli- replied. “It allows general surgeons to do the colon cations occurred in 17% of simultaneous patients and us to do the hepatic resection or ablation.” In response to a meeting attendee’s question, and in 15% of staged patients. The other grades were as follows: grade 2, 36% simultaneous ver- Dr. Martin acknowledged surgeon bias in the sus 53% staged; grade 3, 45% versus 30%; grade study but said he considers that a strength because surgeon judgment is important in deter4, 0% versus 2%; and grade 5, 2% versus 2%. Mean operative time was 180 minutes in the mining the extent of disease, comorbidities, the simultaneous group, compared with 235 minutes kind of medical oncology locally available to pain the staged surgery patients. Length of hospi- tients, and the distance they must travel to a tertiary center. tal stay was significantly When Dr. Clary asked shorter: a mean of 10 days Simultaneous Procedure Linked about patients who refor the simultaneous paquire major hepatectomy, tients, compared with 18 To Shorter Hospital Stays Dr. Martin said that he days for the staged pawould probably treat such tients. patients using a staged ap“Simultaneous resec18 days proach. Other researchers tion is safe and acceptable found that simultaneous for patients with synchrocolorectal and minor henous, resectable liver patic resections were safe, metastases,” Dr. Martin 10 days but urged caution with said. “Neither the location major hepatic resections of the primary tumor nor because of increased of the liver disease poses a morbidity (Ann. Surg. contraindication to simulSimultaneous Staged Oncol. 2007;14:3481-91). taneous resection.” procedure procedure Dr. Martin said that The particular hospital median overall survival where surgery is perNote: Based on a review of 230 patients was 32 months for the siformed might make a difwho had synchronous colorectal-liver multaneous patients and ference, however. “I feel cancer. Source: Dr. Martin 35 months in the staged strongly that patients with group. synchronous disease are a Similar Survival Eradication Effort Made MRSA Screening from page 1 and surgical critical care at the hospital and professor and chairman of the department of surgery at East Carolina University. “We felt pressure to do whatever we could to reduce surgical site infections in our community,” he added. In their study, which was presented at the annual meeting of the Southern Surgical Association, Dr. Rotondo, Dr. Pofahl, and their colleagues compared surgical site infection rates before and after adoption of the screening protocol, which involved use of the polymerase chain reaction (PCR) assay. The researchers compared two groups of patients undergoing elective cardiac surgery, orthopedic procedures, and hysterectomies at the 761-bed hospital. For the 8,469 procedures performed in the 3 years prior to universal screening, patients who were at high risk for MRSA (for example, they had a history of infection or lived in a nursing home) were screened with a traditional culture and were isolated pending results. For all 5,094 elective surgical procedures performed in the 20 months after universal screening, patients were submitted to PCR testing, which allows rapid identification of MRSA carriers, Dr. Rotondo said. All positive PCR tests were confirmed by traditional culture. Affected patients were treated with 2% mupirocin nasal ointment and chlorhexidine soap before hospital admission. The universal screening and eradication protocol reduced the overall MRSA-associated surgical site infection rate from 0.23% to 0.09%. This was not a statistically significant difference, Dr. Rotondo said. “It’s significant if you are the one who gets infected,” said study discussant Dr. Martin A. Croce, an ACS Fellow who is professor of general surgery and trauma at the University of Tennessee, Memphis. Patients undergoing orthopedic surgery did experience a statistically significant decrease in MRSA surgical site infections, from 3% to 0%. Screening must be done more than 10 days prior to elective surgery so there is sufficient time to treat carriers, Dr. Pofahl said. “Compliance has been the hardest part, because there are several other portals of entry into the system, such as through private physician groups. We have worked with them to make sure they are compliant.” SURGERY NEWS SURGERY NEWS Editor in Chief, SURGERY NEWS Lazar J. Greenfield, M.D., FACS ACS Director, Division of Integrated Communications Linn Meyer ELSEVIER GLOBAL MEDICAL NEWS EDITORIAL ADVISORY BOARD Anesthesiology: Robert Morell, M.D., Clinical Associate Professor of Anesthesia, Fort Walton Beach Medical Center Bariatric: Myriam J. Curet, M.D., FACS, Professor of Surgery, Stanford University Cardiothoracic: Mark S. Allen, M.D., FACS, Professor of Surgery, Mayo Clinic Cardiothoracic: Fred A. Crawford, Jr., M.D., FACS, Chief, Division of Cardiothoracic Surgery, Medical University of South Carolina Colorectal: Robert Madoff, M.D., FACS, Professor of Surgery, University of Minnesota Endocrine Surgery: Robert Udelsman M.D., FACS, Chairman, Department of Surgery, Yale University Ethics: James W. Jones, M.D., Ph.D., FACS, Visiting Professor of Medicine and Medical Ethics, Baylor University Information Technology: Gretchen Purcell Jackson, Assistant Professor of Surgery and Biomedical Informatics, Vanderbilt University Minimally Invasive and Gastrointestinal: Gerald M. Fried, M.D., FACS, Professor of Surgery, McGill University Neurological: Hunt Batjer, M.D., FACS, Michael J. Marchese Professor, Northwestern University Obstetrics and Gynecology: William J. Hoskins, M.D., FACS, Executive Director of Surgical Activities, Memorial Sloan-Kettering Cancer Center Ophthalmology: Natalie C. Kerr, M.D., FACS, Chief, Pediatric Ophthalmology Service, University of Tennessee Orthopedic: Mark R. Belsky, M.D., FACS, Chief of Orthopedic Surgery, Newton-Wellesley Hospital Otolaryngology: Mark Weissler, M.D., FACS, J.P. Riddle Distinguished Professor, University of North Carolina Pediatric Surgery: Jay L. Grosfeld, Lafayette Page Professor of Pediatric Surgery and Chairman Emeritus, Indiana University Plastic Surgery: Linda Phillips, M.D., FACS, Truman G. Blocker Jr., M.D. Distinguished Professor, University of Texas Resident/Associate Society: Jacob Moalem, M.D., Assistant Professor of Surgery, University of Rochester Surgical Oncology: Patrick McGrath, M.D., FACS, Professor and Chief, Division of General & Vascular Surgery, University of Kentucky Transplantation: Jeffrey Punch, M.D., FACS, Associate Professor of Surgery, University of Michigan Trauma (Burns and Mass Casualties): Steven E. Wolf, M.D., FACS, Professor of Surgery, University of Texas Trauma and Critical Care: Grace S. Rozycki, M.D., FACS, Professor of Surgery, Emory University Urology: Badrinath R. Konety, M.D., FACS, Vice Chair, Dept. of Urology, University of California at San Francisco Vascular: Linda Harris, M.D., FACS, Associate Professor of Surgery, Millard Fillmore Hospital SURGERY NEWS is the official newspaper of the American College of Surgeons and provides the practicing surgeon with timely and relevant news and commentary about clinical developments and about the impact of health care policy on the profession and on surgical practice today. Content for SURGERY NEWS is provided by International Medical News Group and Elsevier Global Medical News. Content for the NEWS FROM THE COLLEGE is provided by the American College of Surgeons. The ideas and opinions expressed in SURGERY NEWS do not necessarily reflect those of the College or the Publisher. The American College of Surgeons and Elsevier Inc., will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services mentioned herein. POSTMASTER: Send changes of address (with old mailing label) to Circulation, SURGERY NEWS, 60 B Columbia Rd., 2nd flr., Morristown, NJ 07960. The American College of Surgeons’ headquarters is located at 633 N. Saint Clair St., Chicago, IL 60611-3211. SURGERY NEWS (ISSN 1553-6785) is published monthly for the American College of Surgeons by Elsevier Inc., 60 B Columbia Rd., 2nd flr., Morristown, NJ 07960; 973-290-8200; fax 973290-8250. ELSEVIER SOCIETY NEWS GROUP, A DIVISION OF INTERNATIONAL MEDICAL NEWS GROUP President, IMNG Alan J. Imhoff Director, ESNG Mark Branca Editor in Chief Mary Jo M. Dales Executive Editor, IMNG Denise Fulton Executive Editor, EGMN Kathy Scarbeck Publication Editor Elizabeth Wood Publication Associate Editor Jay C. Cherniak VP, Medical Education Sylvia H. Reitman Senior Director, Marketing and Research Janice Theobald Circulation Analyst Barbara Cavallaro, 973-2908253, b.cavallaro@elsevier.com Executive Di
Table of Contents Feed for the Digital Edition of Surgery News - February 2009 Surgery News - February 2009 Contents The 20/20 Vision ICD-10 Looms News From the College: MedPAC Flak Oncology: Best for Breast General Surgery: Weighty Problem Surgery News - February 2009 Surgery News - February 2009 - Contents (Page 1) Surgery News - February 2009 - Contents (Page 2) Surgery News - February 2009 - Contents (Page 3) Surgery News - February 2009 - Contents (Page 4) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 5) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 6) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 7) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 8) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 9) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 10) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 11) Surgery News - February 2009 - Oncology: Best for Breast (Page 12) Surgery News - February 2009 - Oncology: Best for Breast (Page 13) Surgery News - February 2009 - Oncology: Best for Breast (Page 14) Surgery News - February 2009 - Oncology: Best for Breast (Page 15) Surgery News - February 2009 - Oncology: Best for Breast (Page 16) Surgery News - February 2009 - Oncology: Best for Breast (Page 17) Surgery News - February 2009 - Oncology: Best for Breast (Page 18) Surgery News - February 2009 - General Surgery: Weighty Problem (Page 19) Surgery News - February 2009 - General Surgery: Weighty Problem (Page 20)
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.