Surgery News - June 2008 - (Page 1)

VOL. 4 • NO. 6 • JUNE 2008 Hyperglycemia Hikes Postop Infection Rates Monitor blood glucose after surgery. BY BRUCE JANCIN INSIDE WASHINGTON 20/20N VISIO THE Work Hours REBECCA KURAMOTO/UNIVERSITY The ACS has urged the IOM to study the impact of further reductions in duty hours. • 4 OF Else vier Global Medical Ne ws Study collaborators Dr. Gregory J. Jurkovich (L) and Dr. Douglas F. Zatzick advocate routine screening of trauma patients. Data Find PTSD Common Among Injured Patients BY BRUCE JANCIN Else vier Global Medical Ne ws N E W Y O R K — Posttraumatic stress disorder and depression are extremely common a full year following hospitalization for injury and are associated with up to a nearly sixfold increased likelihood of failure to return to work, according to the largest-ever U.S. study evaluating the multiple impacts of trauma. With an estimated 2.5 million hospital admissions for injury per year in the United States, the National Study of Costs and Outcomes of Trauma (NSCOT) data suggest 500,000 of these patients will have debilitating posttraumatic stress disorder (PTSD) 1 year later, Dr. Douglas F. Zatzick said at the annual meeting of the American Surgical Association. The economic, social, and health costs of this problem are such that screening for early signs of PTSD and depression should become routine during the acute hospitalization of all trauma patients, regardless of injury severity, according to Dr. Zatzick, a psychiatrist at the University of Washington, Seattle. He reported on 2,707 NSCOT participants hospitalized for injuries requiring surgery at 69 U.S. hospitals, including 18 level 1 trauma centers. The patients, who were followed for 1 year, represented the broad spectrum of trauma with the exception of burn See PTSD • page 2 N E W Y O R K — Postoperative hyperglycemia boosts the 30day risk of infectious complications—regardless of preoperative glucose level or whether a patient has diabetes—according to a study of 995 patients undergoing general or vascular surgery in non-ICU settings. Postoperative blood glucose monitoring should be a routine part of patient management, and maintaining euglycemia postoperatively is a simple intervention that could significantly reduce postoperative infection rates, Dr. Selwyn O. Rogers Jr., said at the annual meeting of the American Surgical Association. More than 2 million postoperative infections occur annually in U.S. patients. Tight postoperative glucose control has previously been shown to reduce the risk of wound infection in diabetic patients and to lower morbidity and mortality in cardiac surgery patients, as well as in critically ill patients in surgical ICUs. But the impact of perioperative hyperglycemia on postoperative infection risk hadn’t previously been studied in noncardiac surgery patients in non-ICU settings—the sort of patients general surgeons see every day, said Dr. Rogers, an ACS Fellow with Brigham and Women’s Hospital, Boston. Dr. Rogers reported on 995 consecutive patients who underwent major general or vascular surgery at Brigham and were enrolled in the observational American College of Surgeons National Surgical Quality Improvement Program. The program’s stated goal is to reduce preventable surgical morbidity and mortality by 25% by 2010. Postoperative infections—including wound infections, pneumonia, sepsis, urinary tract See Infections • page 3 News From the College New Digs The ACS has broken ground for an advocacy and health policy office in Washington, D.C. • 8 General Surgery Banking Blood A new hemodilution technique greatly reduces the need for blood products in hepatic resection. • 1 0 Endocrine System Improved Imaging 4-D CT scanning helps localize the parathyroid gland before reoperation. • 1 1 ACS Presses for a Short-Term Fee Fix B Y M A RY E L L E N SCHNEIDER Else vier Global Medical Ne ws VITAL SIGNS Top 10 Most Expensive Health Conditions (in billions of dollars) Heart conditions Trauma disorders Cancer Mental disorders, including depression Asthma and COPD High blood pressure $42 Type 2 diabetes $34 Joint diseases* $34 Back problems $32 $32 Normal childbirth $76 $72 $70 $56 $54 go before a 10.6% Medicare With less than a month tothe payment cut takes effect, American College of Surgeons and others in the physician community are pushing Congress to take action. At a recent hearing of the House Committee on Small Business, Dr. Charles D. Mabry, chairman of the ACS Health Policy Steering Committee, told members of Congress that short-term legislation is needed to stop the scheduled cut from taking effect on July 1 and to replace the 5.4% cut set for Jan. 2009 with a reasonable increase in Medicare physician payments. By acting to stop payment cuts for the next 18 months, sur- geons will be able to budget their expenses and Congress will have time to look at more permanent solutions, said Dr. Mabry, an ACS Fellow. A short-term fix appears to have support in Congress. The Senate has outlined a plan to delay the cuts for 18 months, and Rep. Nydia M. Velazquez (D.N.Y.), chairwoman of the House Committee on Small Business, said it was one of the top priorSURGERY NEWS ities of Congress to address the scheduled payment cuts. But the clock is ticking. Congress should act by mid-June to ensure that there is not a disruption in payments, according to the Centers for Medicare Medicaid Services. Rep. Velazquez said she is also interested in looking for a permanent fix to how Medicare payments are calculated that See Fee Fix • page 3 Presorted Standard U.S. Postage PAID Permit No. 384 Lebanon Jct. KY 60 Columbia Rd., Bldg. B Morristown, NJ 07960 CHANGE SERVICE REQUESTED *Includes osteoarthritis. Note: Based on 2005 data for visits to doctors’ offices, clinics, and emergency departments, and for hospital stays, home health care, and prescription drugs. Source: Agency for Healthcare Research and Quality ELSEVIER GLOBAL MEDICAL NEWS

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Surgery News - June 2008 Contents Work Hours New Digs Banking Blood Improved Imaging

Surgery News - June 2008

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