Surgery News - March 2009 - (Page 5) MARCH 2009 • SURGERY NEWS NEWS Body Fat Best Defines Obesity SSI • from page 1 Health Research Also Supported Stimulus • from page 1 Ms. Waisbren said at the meeting on perioperative medicine at the University of Miami. A total of 130 patients (67%) were obese according to the body fat criterion, compared with 74 (38%) using the BMI definition. Participants were assessed before, during, and 30 days after elective surgery (primarily general, orthopedic, and obstetric procedures) on the basis of medical records, questionnaires, and follow-up telephone interviews. A total of 31% of the patients were taking antihypertensive medication, and 18% were current smokers. Most patients had an American Society of Anesthesiologists (ASA) Score of II, “so they were relatively healthy,” Ms. Waisbren said. Surgical site infections (SSIs) developed in 27 patients (14%). According to the percent body fat cutoffs, infections occurred in 4.7% of nonobese patients and in 18.5% of obese patients. In contrast, when the BMI cutoff was used, 14.2% of the nonobese and 13.5% of obese patients developed SSIs. As percent body fat increased, there was a statistically significant increase in SSIs. For example, patients with percent body fat greater than 37% were two times more likely to develop an SSI, Ms. Waisbren said. “An association with increased SSI risk was seen with BMI also, but it was not statistically significant.” Although there were no deaths related to these infections, Ms. Waisbren said that patients with an SSI experienced more adverse outcomes, includ- ing wound dehiscence, seroma, and hematoma, than did those without infections. A meeting attendee asked if patients were possibly overlabeled as obese because two-thirds met the percent body fat definition. “There have been very little data to define the cutoff point,” Ms. Waisbren said. “But you raise the point of how appropriate the American Council on Exercise definition is.” When a meeting attendee asked why the hip-to-waist ratio was not assessed, Ms. Waisbren said the investigators believed BMI was more accurate than hip-to-waist ratio. However, she said, “BMI misses an important difference in body composition.” For example, a male body builder and an overweight woman with the same height and weight would have the same BMI, but very different body fat percentages. Percent body fat was an independent predictor of SSI, according to a univariate analysis. Pedal edema, recent surgery, higher National Nosocomial Infection Surveillance score, and class 2 (clean-contaminated) or higher wound ratings were other predictors. A multivariate assessment is planned as part of the ongoing study, Ms. Waisbren said. This study was awarded the best research abstract at the meeting. Data collected for a total of 436 patients in this ongoing study concur with the initial cohort findings, Ms. Waisbren said. She added the plan is to enroll 600 elective surgery patients in the final assessment. adoption and use. Eligible Medicaid providers could receive incentives of up to $75,000 over 5 years. Under the law, Medicaid providers could receive up to $25,000 for the purchase and initial implementation of a certified EHR system and up to $10,000 a year for the maintenance and use of the system. The funding in the law is likely to fuel significant activity in the health information technology area, said Dr. Don Detmer, president and CEO of the American Medical Informatics Association (AMIA), although the federal government will need to clarify some of the provisions in the law through regulation, particularly how the new privacy protections will be implemented. Recent surveys show that most physicians would be motivated to adopt EHRs if given this level of incentives, said Douglas Peddicord, Ph.D., president of Washington Health Strategies Group, which represents AMIA in the District of Columbia. Also under the new law, the Health and Human Services department will provide competitive grants to states to help them develop loan programs. The loans will enable health care providers to purchase, upgrade, or improve the security of EHR systems or to train staff on the technology. The law also includes $87 billion to help states pay for their Medicaid programs. With a higher percentage of funds for their Medicaid programs coming from federal dollars, “a state with a budget shortfall won’t feel as much pressure to cut Medicaid back,” said Kathleen Stoll, deputy executive director of Families USA, noting that at least 40 states have proposed cuts to their Medicaid programs. About $10 billion in funding under the new law has been slated for the National Institutes of Health to use toward research grants, construction, and the purchase of research equipment. A little over $1 billion has been aimed at comparative effectiveness research, with $300 million going to the Agency for Healthcare Research and Quality, $400 million to the NIH, and $400 million to be used at the HHS secretary’s discretion. The research will be overseen by a new national council that will advise Congress and federal agencies on priorities. Many in the pharmaceutical and medical device industry supported the notion of comparative effectiveness studies, but did not want to see the money used to support coverage decisions. The House and Senate conference report specifically stated that the research could not be used to “mandate coverage, reimbursement, or other policies for any public or private payer.” That brought applause from AdvaMed, the medical device industry trade group. “The purpose of the research is to assist patients and health professionals in making better treatment decisions, not to mandate onesize-fits-all coverage decisions that would deny patients access to safe and effective treatments,” Stephen J. Ubl, president and CEO of AdvaMed, said in a statement. Alicia Ault and Joyce Frieden contributed to this story. SURGERY NEWS SURGERY NEWS Editor in Chief, SURGERY NEWS Lazar J. Greenfield, M.D., FACS ACS Director, Division of Integrated Communications Linn Meyer 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 E
Table of Contents Feed for the Digital Edition of Surgery News - March 2009 Surgery News - March 2009 Contents Trauma Training More for Less? Stress Test Mentoring Surgery News - March 2009 Surgery News - March 2009 - Contents (Page 1) Surgery News - March 2009 - Contents (Page 2) Surgery News - March 2009 - Contents (Page 3) Surgery News - March 2009 - Contents (Page 4) Surgery News - March 2009 - Contents (Page 5) Surgery News - March 2009 - Trauma Training (Page 6) Surgery News - March 2009 - Trauma Training (Page 7) Surgery News - March 2009 - Trauma Training (Page 8) Surgery News - March 2009 - More for Less? (Page 9) Surgery News - March 2009 - Stress Test (Page 10) Surgery News - March 2009 - Stress Test (Page 11) Surgery News - March 2009 - Stress Test (Page 12) Surgery News - March 2009 - Mentoring (Page 13) Surgery News - March 2009 - Mentoring (Page 14) Surgery News - March 2009 - Mentoring (Page 15) Surgery News - March 2009 - Mentoring (Page 16)
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