Surgery News - December 2007 - (Page 1)

VOL. 3 • NO. 12 • DECEMBER 2007 SURGERY NEWS THE OFFICIAL NEWSPAPER OF THE AMERICAN COLLEGE OF SURGEONS Mortality Soars in Some Patients With Respiratory Distress Nontrauma patients with ARDS affected. BY BRUCE JANCIN INSIDE 20/20N VISIO THE New Ideas A new position statement is giving shape to the art of surgical innovation. • 4 News From the College Else vier Global Medical Ne ws ©JOHN BEALE Having a high grade of invasive tumor is an important prognostic factor, said Dr. Heather A. Jones, who did a subgroup analysis. Breast Radiation Boost Cuts Cancer Recurrence BY JANE SALODOF MACNEIL Else vier Global Medical Ne ws L O S A N G E L E S — A “boost” dose of radiation to the tumor bed after breast-conserving surgery and whole breast radiation cut the 10-year rate of local breast cancer recurrence by nearly half in a large European trial designed to test this common practice. The boost so reduced the effect of close and positive margins after treatment that the only significant risk factors for local relapse were younger age and a high grade of invasive tumor or ductal carcinoma in situ (DCIS), researchers reported at the annual meeting of the American Society for Therapeutic Radia- tion and Oncology (ASTRO). “You don’t need the re-excision. You don’t need the mastectomy,” principal investigator Dr. Harry Bartelink of the Netherlands Cancer Institute in Amsterdam told reporters. If margins are found to be close or even positive after treatment, radiating the tumor bed should eliminate stray tumor cells without further surgery. The European Organisation for Research and Treatment of Cancer sponsored the Boost–No Boost trial, which randomized 5,318 women with stage I or II breast cancer. All participants underwent lumpectomies and 50 Gy of whole breast radiation. Half received the additional 16See Radiation • page 7 COLORADO SPRINGS — Nontrauma surgical ICU patients who develop acute respiratory distress syndrome have a 10-fold greater 30-day mortality than those without this complication, Dr. Shirin Towfigh said at the annual meeting of the Western Surgical Association. This observation, derived from analysis of a large prospective single-center acute respiratory distress syndrome (ARDS) registry, stands in marked contrast to the situation prevailing among trauma surgical intensive care unit patients. Multiple centers have reported that in contemporary practice, ARDS in trauma surgery patients in the ICU isn’t an independent predictor of increased mortality, said Dr. Towfigh, an ACS Fellow with the University of Southern California, Los Angeles. Although ARDS has historically been a major cause of mortality among the critically ill, the incidence of ARDS among surgical ICU patients has declined sharply during the past decade. However, nearly all prior studies of ARDS in surgical patients have come from trauma centers and been restricted to trauma patients. To round out the picture, Dr. Towfigh reported on 2,046 consecutive nontrauma surgical patients admitted to the ICU at USC during 2000-2005. All were evaluated daily for ARDS, as has been routine practice there since 2000. The overall incidence of ARDS in the study population was 6.1%. But as has previously been reported in trauma surgery patients at USC and other trauma centers, the rate among these nontrauma surgical ICU patients decreased from 12.2% in 2000 to 2.1% in 2005. That’s an 83% drop in 5 years. “The cause of this is unknown, but we do know that over the past decade or so in See Mortality • page 14 Quality Standards The ACS is involved in efforts to establish evidence-based performance measures for surgery. • 8 General Surgery Helping Hand Hand-assisted laparoscopic colectomy can reduce the rate of conversion to an open procedure. • 1 3 Trauma Spleen Protocol An early repeat CT scan may increase nonoperative management of blunt splenic injuries. • 1 4 New Codes Promote Alcohol Screening BY DIANE SCHNEIDMAN American College of Surgeons VITAL SIGNS new CPT evaluation and management codes for Twoscreening and brief structured intervention related to alcohol and other substance abuse take effect on Jan. 1, 2008. Code 99408 is for SBI services of 15-30 minutes in duration, and code 99409 is for those lasting more than 30 minutes. Services of less than 15 minutes’ duration are not separately reportable. “These new codes are relevant to many medical specialties, including primary care, adolescent medicine, and so on, but most of all to trauma surgery,” said Dr. Lawrence M. Gentilello, of the department of surgery at the University of Texas Southwestern Medical Center, Dallas. “For example, Percentage Change in Medicare Payments From 1989 to 2007 for Procedures Colectomy Hernia Transurethral Coronary Coronary resection of artery artery bypass prostate endarterectomy graft the American College of Surgeons requires level I trauma centers to screen for alcohol and to provide an intervention, but until now, it was sort of an unfunded mandate,” noted Dr. Gentilello, who is also an ACS Fellow, a member of the ACS Committee on Trauma, and a leading advocate for the new codes. Approximately 50% of patients admitted to trauma centers SURGERY NEWS and 25% of injured emergency department (ED) patients are alcohol intoxicated, Dr. Gentilello said. Often, they screen positive for drug use. But fewer than 10% of adults with alcohol or drug disorders are identified and treated, according to Eric Goplerud, Ph.D., of the department of health policy at George Washington University, Washington. See Codes • page 2 Presorted Standard U.S. Postage PAID Permit No. 384 Lebanon Jct. KY ELSEVIER GLOBAL MEDICAL NEWS −26% −37% −47% −50% 60 Columbia Rd., Bldg. B Morristown, NJ 07960 CHANGE SERVICE REQUESTED −54% Note: Assumes an annual Medicare Economic Index of 1.5%. Source: American College of Surgeons

Table of Contents Feed for the Digital Edition of Surgery News - December 2007

Surgery News - December 2007 Contents Breast Radiation Boost Cuts Cancer Recurrence Mortality Soars in Some Patients With Respiratory Distress New Codes Promote Alcohol Screening New Ideas News From the College: Quality Standards General Surgery: Helping Hand Trauma: Spleen Protocol

Surgery News - December 2007

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