Surgery News - November 2007 - (Page 1)

VOL. 3 • NO. 11 • NOVEMBER 2007 SURGERY NEWS THE OFFICIAL NEWSPAPER OF THE AMERICAN COLLEGE OF SURGEONS Black Patients Fare Worse Than Whites After Liver Surgery DENVER HEALTH MEDICAL CENTER INSIDE 20/20NWorking VISIO Together THE Twofold increase in mortality risk. B Y M I C H E L E G. S U L L I VA N Physicians and surgeons team up at a new cardiovascular center to improve patient care. • 5 Else vier Global Medical Ne ws Dr. C. Clay Cothren, the survey’s lead investigator, is seeking approval for an Acute Care Surgery fellowship. Survey Suggests Need For Acute Care Surgery B Y J E F F E VA N S Else vier Global Medical Ne ws esults of a recent survey support the views of clinicians who see a widespread need for more formal training in acute care medicine and surgery, according to Dr. C. Clay Cothren, who spoke at the annual meeting of the American Association for the Surgery of Trauma. The survey found that most trauma surgeons have a limited scope of practice in trauma surgery, said Dr. Cothren, lead investigator of the survey and program director of the Acute Care Surgery fellowship at Denver Health Medical Center. The push to develop an acute care surgery specialty derives from R the lack of on-call specialists available to provide emergency care. Also, many trauma cases in the past 2 decades have been managed nonoperatively but still require close care, Dr. Cothren said. “As more Americans seek their health care through an emergency room and wait for disaster to happen, and fewer surgeons are willing to take call, the depth and breadth of [the problem in manpower and continuity of care] become really staggering,” said Dr. Gregory J. Jurkovich, chair of the American Association for the Surgery of Trauma’s (AAST) Acute Care Surgery Committee, in an interview. Denver Health Medical Center’s proposed model of the acute See Acute Care • page 2 N E W O R L E A N S — Compared with white patients, blacks face a significantly increased risk of dying in the hospital after major liver surgery, Dr. Hari Nathan said at the annual clinical congress of the American College of Surgeons. Although hospital and socioeconomic factors may explain some of the disparity, they don’t appear to account entirely for the twofold increase in the risk of mortality, Dr. Nathan said in an interview. “This study speaks to the persistent disparities in our health care system and confirms that, for whatever reason, we are not able to achieve consistent outcomes for all of our patients.” Dr. Nathan, a surgical resident at Johns Hopkins University, Baltimore, extracted data for his study from the 19982005 Nationwide Inpatient Sample. He included 3,562 adult patients who underwent major hepatectomy during a nontrauma admission. Most of the patients (53%) had metastatic liver tumors. Other surgical indications were hepatobiliary cancer (26%), benign neoplasm (9%), other liver disease (4%), and other illnesses (8%). Most of the patients (59%) were white. Black patients comprised 6% of the sample, while Hispanic, Asian, and other races made up the balance. Significant differences between blacks and whites included age (53 vs. 59 years respectively), Medicaid status (13% vs. 3%), and self-pay status (5% vs. 2%). Significantly more blacks were in the lowest income quartile for their ZIP code (39% vs. 18%), and were treated at lowvolume hospitals (13% vs. 8%). Black patients were significantly more likely to have cirrhosis or hepatitis, and significantly less likely to have See Liver Surgery • page 15 Oncology Marginal Evidence? A 10-mm surgical margin for excising colorectal liver metastases may not be necessary. • 8 Trauma Screening Scrutinized Lack of consensus about surveillance methods may make DVT rates a poor way to measure quality of care. • 9 News From the College Healy Takes Helm Gerald B. Healy became the ACS president at last month’s Clinical Congress. • 1 0 New Law Bolsters FDA Funding, Authority B Y A L I C I A A U LT Else vier Global Medical Ne ws VITAL SIGNS Mean Compensation for Surgical Specialties in 2006 $403,130 $392,857 $371,253 $370,927 $355,977 Bush has law legislation that reauthoPresidentFood and signed into rizes the Drug Administration’s collection of product review fees from drug and device makers and gives the agency new safety monitoring and enforcement powers. The new law—which allows for collection of fees through 2012—will impact much of the agency’s mission for years beyond that date. The law “will clarify and strengthen the FDA’s authority and give it new tools to take measured and appropriate steps to protect the health and safety of Americans when the agency’s postmarket surveillance signals potential dangers from a drug or therapy,” said Sen. Mike Enzi $330,215 (R-Wyo.), who helped steer the bill through its unanimous victory in the Senate. The almost-500-page law— known as the Food and Drug Administration Amendments Act of 2007—covers far more than just user fees; it also gives the FDA new authority to ensure that drug and device makers study their products in children, to use a burgeoning collection of electronic data in SURGERY NEWS the private sector to track adverse events, to monitor the content of direct-to-consumer advertising, to track recalls of medical devices, to ensure the safety of seafood and pet food, and to weed out conflict-of-interest among outside advisory committees. The user fees have become central to the agency’s operaSee FDA • page 14 Presorted Standard U.S. Postage PAID Permit No. 384 Lebanon Jct. KY 60 Columbia Rd., Bldg. B Morristown, NJ 07960 CHANGE SERVICE REQUESTED Colon Thoracic and rectal (n = 66) (n = 48) Vascular (n = 208) Bariatric (n = 14) Trauma General (n = 65) (n = 1,113) Source: Medical Group Management Association ELSEVIER GLOBAL MEDICAL NEWS

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Surgery News - November 2007 Contents Black Patients Fare Worse Than Whites After Liver Surgery Survey Suggests Need For Acute Care Surgery New Law Bolsters FDA Funding, Authority Working Together Oncology: Marginal Evidence? Trauma: Screening Scrutinized News From the College: Healy Takes Helm

Surgery News - November 2007

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