Surgery News - December 2008 - (Page 1) VOL. 4 • NO. 12 • DECEMBER 2008 New Data Show Bariatric Surgery Benefits in Elderly Two studies contradict earlier findings. ©STEPHEN SPARTANA INSIDE 20/20N Health VISIO The ACS proposes actions the new Administration should take to achieve its goals. • 6 THE Reform BY JANE SALODOF MACNEIL Else vier Global Medical Ne ws “We need to study further the ergonomics of the perioperative environment,” said Dr. Adrian Park (at left). Pain, Stiffness Plague Laparoscopic Surgeons BY ROBERT FINN Else vier Global Medical Ne ws S A N F R A N C I S C O — Nearly 9 out of 10 laparoscopic surgeons said they experienced physical discomfort or symptoms related to performing surgery, according to the results of an online survey. Feedback from the 317 laparoscopic surgeons in North America and Europe who responded to the anonymous survey showed a marked increase in symptoms, compared with those reported in a study conducted in 1999, Dr. Adrian Park said at the annual clinical congress of the American College of Surgeons. According to that study, 8%12% of laparoscopic surgeons reported pain or numbness; and 9%-18% reported stiffness in the neck, shoulder, arm, or wrist (Surg. Endosc. 1999;13:466-8). In contrast, 42% of survey respondents reported neck stiffness. Other common complaints were numbness in the left and right hands (28% and 32%, respectively); stiffness and pain in the back (31% and 36%, respectively); and fatigue in the eyes (27%), neck (23%), left arm (24%), right arm (33%), and back (26%). “If we were subjected to any of the kinds of worksite inspections that manufacturing facilities are the surgical work space would be shut down,” said Dr. Park, an ACS Fellow with the University of Maryland, Baltimore. “We See Laparoscopic Surgeons • page 15 S A N T A F E , N . M . — Contrary to an alarming 2005 report, two new studies have found that bariatric surgery is safe and produces good outcomes in obese Medicare and elderly patients. The first study, a retrospective series of 76 patients at Case Western Reserve University in Cleveland, showed significant weight loss and resolution or improvement of obesity-related comorbidities after gastric bypass surgery in both groups. The second study, a review of discharge data on more than 6,000 Medicare and Medicaid patients, revealed improvements in outcomes after Medicare expanded coverage for bariatric procedures to patients over 65 years of age who are treated at certified, highvolume centers. Investigators of both studies, who presented their findings at the annual meeting of the Western Surgical Association, noted that mortality was low, and their results did not confirm earlier findings that patients aged 65 years and older are significantly more likely than are younger patients to die after bariatric surgery ( JAMA 2005;294:1903-8). In the earlier paper, Dr. David R. Flum, an ACS Fellow with the University of Washington, Seattle, and his associates analyzed Medicare data on 16,155 gastric bypass procedures from 1997 to 2002. They reported that risk of death ranged from 2% at 30 days post surgery to 4.6% at 1 year in elderly patients. The Centers for Medicare and Medicaid Services (CMS) subsequently considered excluding patients aged 65 years and older from coverage for bariatric surgery. Instead, as of See Bariatric Surgery • page 14 News From the College Nominations The College seeks candidates for the Board of Regents and ACS Officers-Elect. • 10 Thoracic Breathing Easier A newly approved implantable bronchial valve controls air leaks after lung surgery. • 12 Postop Management Renal Failure Newly identified predictors for ARF may help manage patients most at risk. • 16 Fee Rule Gives 1.1% Raise, Bonuses B Y M A RY E L L E N SCHNEIDER Else vier Global Medical Ne ws VITAL SIGNS Median Income for General Surgeons $350,000 Actual $300,000 $264,375 $316,909 will have the potential to as Physicians gaintheirmuch as a 5.1% increase in Medicare payments next year, according to a final rule issued by the Centers for Medicare and Medicaid Services. The projected pay raise is a combination of the 1.1% payment increase mandated by Congress this summer, as well as a 2% incentive payment available for physicians who successfully participate in Medicare’s voluntary pay-for-reporting program, and another 2% for those who implement electronic prescribing in their practices next year. The 2009 Medicare Physician Fee Schedule final rule, pub- lished in the Federal Register on Nov. 19, estimates that total Medicare spending for 2009 will reach $61.9 billion, up about 4% over 2008 projections. Without the intervention by Congress over the summer, physicians would be facing a deep payment cut come January. As part of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), which was enacted in July, ConSURGERY NEWS gress eliminated a 10.6% pay cut scheduled to go into effect in July and another 5.4% cut scheduled for January. By law, CMS officials are required to adjust physician payments according to the sustainable growth rate (SGR) formula, which calculates physician payments based in part on the gross domestic product. Over the past See Fee Rule • page 19 Presorted Standard U.S. Postage PAID Permit No. 384 Lebanon Jct. KY $250,000 $247,421 Adjusted* $263,197 ELSEVIER GLOBAL MEDICAL NEWS 60 Columbia Rd., Bldg. B Morristown, NJ 07960 CHANGE SERVICE REQUESTED $200,000 0 2003 2004 2005 2006 2007 *Adjusted for inflation to 2000 dollars. Source: Medical Group Management Association
Table of Contents Feed for the Digital Edition of Surgery News - December 2008 Surgery News - December 2008 Contents The 20/20 Vision: Health Reform News From the College: Nominations Thoracic: Breathing Easier Postop Management: Renal Failure Surgery News - December 2008 Surgery News - December 2008 - Contents (Page 1) Surgery News - December 2008 - Contents (Page 2) Surgery News - December 2008 - Contents (Page 3) Surgery News - December 2008 - Contents (Page 4) Surgery News - December 2008 - Contents (Page 5) Surgery News - December 2008 - The 20/20 Vision: Health Reform (Page 6) Surgery News - December 2008 - The 20/20 Vision: Health Reform (Page 7) Surgery News - December 2008 - The 20/20 Vision: Health Reform (Page 8) Surgery News - December 2008 - The 20/20 Vision: Health Reform (Page 9) Surgery News - December 2008 - News From the College: Nominations (Page 10) Surgery News - December 2008 - News From the College: Nominations (Page 11) Surgery News - December 2008 - Thoracic: Breathing Easier (Page 12) Surgery News - December 2008 - Thoracic: Breathing Easier (Page 13) Surgery News - December 2008 - Thoracic: Breathing Easier (Page 14) Surgery News - December 2008 - Thoracic: Breathing Easier (Page 15) Surgery News - December 2008 - Postop Management: Renal Failure (Page 16) Surgery News - December 2008 - Postop Management: Renal Failure (Page 17) Surgery News - December 2008 - Postop Management: Renal Failure (Page 18) Surgery News - December 2008 - Postop Management: Renal Failure (Page 19) Surgery News - December 2008 - Postop Management: Renal Failure (Page 20)
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