Surgery News - March 2008 - (Page 1) VOL. 4 • NO. 3 • MARCH 2008 REBECCA GARDNER/ELSEVIER GLOBAL MEDICAL NEWS Colorectal Cancer Prognosis Tied to Neurogenesis Stage III exceeded stage II survival. BY ROBERT FINN INSIDE Thoracic Cardiac Arrest New approaches to training are needed to stem the looming shortage of cardiac surgeons. • 1 1 News From the College Else vier Global Medical Ne ws Selected patients with primary sclerosing cholangitis may be able to avoid liver transplantation, according to Dr. Timothy M. Pawlik. Biliary Resection Works In Absence of Cirrhosis B Y J E F F E VA N S Else vier Global Medical Ne ws H O T S P R I N G S , VA . — Primary sclerosing cholangitis patients who do not have liver dysfunction or cirrhosis may obtain the same rate of overall survival with extrahepatic bile duct resection as patients who undergo liver transplantation, Dr. Timothy M. Pawlik reported at the annual meeting of the Southern Surgical Association. The study by Dr. Pawlik and his colleagues, which included 126 patients with primary sclerosing cholangitis (PSC), “reemphasizes the value and role of resection in noncirrhotic patients with PSC. That is not a popular statement. There [are] very little data out there. You won’t find anything any better than this paper to make the case, and it is very well done,” said Dr. C. Wright Pinson, director of the transplant center at Vanderbilt University, Nashville, Tenn., who was a discussant at the meeting. “Liver transplantation has been generally accepted as the optimal treatment modality to treat patients with PSC and end-stage liver disease,” but since the 1980s, some investigators have advocated extrahepatic bile duct resections (EHBRs) for those patients with no underlying hepatic cirrhosis, said Dr. Pawlik of the department of surgery at Johns Hopkins University, Baltimore. See Resection • page 15 HUNTINGTON BEACH, C A L I F. — Colorectal cancer patients with evidence of new nerve growth within their tumors do far worse than those with no evidence of neurogenesis, according to a study presented at the Academic Surgical Congress. In the study of 347 patients with colorectal cancer, KaplanMeier curves showed that those with stage III cancer and no evidence of neurogenesis achieved significantly greater cancer-specific overall survival at 5 years than did those with stage II cancer and a high degree of neurogenesis. Patients with more neurogenesis experienced a 3.8-fold greater risk of cancer-specific death (P = .0005) in a multivariate analysis controlling for standard prognostic factors such as age and tumor location. The only factor that conferred a higher degree of risk was stage IV disease, with a hazard ratio of 14.7. Suggesting that neurogenesis may be “the next angiogenesis,” the lead author, Dr. Jonathan A. Wilks, raised the possibility that neurogenesis could be an attractive target for future therapeutic intervention. Dr. Wilks, a surgery resident in at Baylor College of Medicine, Houston, said that as far as he knew, nothing has been published regarding neurogenesis in solid tumors outside the nervous system. Included in the study was a cohort of patients at Baylor who had resected colon cancer within a 5-year period. All were Veterans Affairs patients; investigators obtained 100% of their clinical and demographic data from their electronic medical records. Dr. Wilks and his colleagues constructed a tissue microarray See Neurogenesis • page 2 Prepared Patients A new book tells patients what to expect when they undergo surgery. • 1 2 Across Specialties Botox to the Rescue Injections of botulinum toxin around an abdominal stoma reduced perspiration that was impeding adherence. • 1 4 Practice Trends Pioneering Work The legacy of Judah Folkman extends far beyond his work on angiogenesis. • 1 7 Demo P4P Project Cuts Costs, Mortality B Y A L I C I A A U LT Else vier Global Medical Ne ws VITAL SIGNS Medicare-sponsored, payHospitals participating in a for-performance demonstration project continue to sustain initial gains in quality improvement and have seen a huge decline in costs and mortality for selected conditions over the first 3 years of the project, according to data released by Premier Inc., a hospital performance improvement alliance. Overall, the median hospital cost per patient dropped by $1,000 in the first 3 years, and the median mortality rate dropped by 1.87%. The project has 250 participating hospitals, and more than 1 million patient records were analyzed. Premier, which is managing the Centers for Medicare and 10 Most Expensive Conditions Treated in Hospitals (total national bill in millions of dollars) Coronary artery disease Mother's pregnancy and delivery Newborn infants Acute myocardial infarction Heart failure Pneumonia Osteoarthritis Sepsis Back pain* $45,985 $43,925 $35,316 $31,946 $30,230 $29,535 ELSEVIER GLOBAL MEDICAL NEWS Medicaid Services–funded Hospital Quality Incentive Demonstration project, estimated that if every hospital in the United States achieved the same benchmarks, there would be 70,000 fewer deaths each year and hospital costs would drop by as much as $4.5 billion a year. At a briefing to release the results, Mark Wynn, Ph.D., director of payment policy demonstrations at CMS, said that the SURGERY NEWS hospital project is considered one of the agency’s primary arguments in favor of value-based purchasing. CMS has been pushing that policy as the most effective way to restructure Medicare reimbursement to reward efficiency and value. Dr. Wynn acknowledged that the financial incentives have been very small, but even so, See P4P Project • page 9 Presorted Standard U.S. Postage PAID Permit No. 384 Lebanon Jct. KY $26,157 Complication of device/implant/graft $25,291 $24,801 $20,327 60 Columbia Rd., Bldg. B Morristown, NJ 07960 CHANGE SERVICE REQUESTED *Includes spondylosis and intervertebral disc disorders. Note: Based on data from the 2005 Nationwide Inpatient Sample. Source: Healthcare Cost and Utilization Project
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