Small Renal Cancers: For Select Older Patients, Percutaneous Ablation May Be As Effective and Safer

MedicalResearch.com Interview with:

Adam Talenfeld, M.D Assistant Professor of Radiology Weill Cornell Medical College Assistant Attending Radiologist New York-Presbyterian Hospital. 

Dr. Talenfeld

Adam Talenfeld, M.D
Assistant Professor of Radiology
Weill Cornell Medical College
Assistant Attending Radiologist
New York-Presbyterian Hospital.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We know that renal function decreases as we age, and we know that decreased renal function is independently associated with increased mortality. This is why medical society guidelines recommend partial nephrectomy, which preserves kidney tissue and function, over radical nephrectomy for the treatment of the smallest kidney cancers, stage T1a tumors, which are under 4 cm diameter. Paradoxically, though, we know older patients are more likely than younger patients to receive radical nephrectomy for these smallest tumors, probably because it’s a simpler surgery than partial nephrectomy.

Percutaneous ablation, focal tissue destruction using heat or cold emanating from the tip of a needle, is a newer, image-guided, minimally-invasive, tissue-sparing treatment for solid organ tumors. We wanted to test how well percutaneous ablation would compare to partial nephrectomy and radical nephrectomy for these smallest kidney cancers.

We found that percutaneous ablation was associated with similar 5-year overall and cancer-specific survival compared to radical nephrectomy. At the same time, ablation was associated with significantly lower rates of new-onset chronic renal insufficiency and one-fifth as many serious non-urological complications than radical nephrectomy within 30 days of treatment. These were complications, such as deep venous thrombosis or pneumonia, that resulted in emergency department visits or new hospital admissions. The outcomes of percutaneous ablation compared with partial nephrectomy were somewhat less clear, though ablation was again associated with fewer perioperative complications. Continue reading

Surgery For Spondylolisthesis (Spinal Stress Fractures) Reduced Chances of Opioid Dependence

MedicalResearch.com Interview with:

Beatrice Ugiliweneza, PhD, MSPH Assistant Professor Kentucky Spinal Cord Injury Research Center Department of Neurosurgery, School of Medicine Department of Health Management and Systems Science School of Public Health and Information Sciences University of Louisville

Dr. Ugiliweneza

Beatrice Ugiliweneza, PhD, MSPH
Assistant Professor
Kentucky Spinal Cord Injury Research Center
Department of Neurosurgery, School of Medicine
Department of Health Management and Systems Science
School of Public Health and Information Sciences
University of Louisville

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study stems from the observed opioid crisis in the United States in recent years. Opioids are used in the management of pain. In the spine population, back pain is one of the main conditions for which opioids are consumed.

A frequent cause of that pain is degenerative spondylolisthesis. We aimed to evaluate the effect of surgery, which has been shown to improve outcomes, on opioid dependence. We found that surgery is associated with reduced odds of opioid dependence.

MedicalResearch.com: What should readers take away from your report? 

Response: One interesting finding that we observed is that patients are twice less likely to become opioid dependent than they are to become dependent after surgery. However, an important note to keep in mind is that about 10% of patients will be opioid dependent after surgery (about 6% prior non-dependent and 4% prior dependent).  

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Surgery has been proven to improve clinical outcomes and quality of life for patients with degenerative spondylolisthesis. Future research should explore why some patients remain or become opioid dependent after surgery.

It would also be interesting to look at the effect of other treatments for degenerative spondylolisthesis (such as epidural steroid injections for example) on opioid dependence.

MedicalResearch.com: Is there anything else you would like to add?

Response: Spine surgeons should have systems that help them recognize patients who are likely to become opioid dependent after surgery. Our paper discusses factors to watch for such as younger age, prior dependence, etc… This would help provide targeted attention and hopefully combat the ramping opioid crisis.

The authors have no disclosures. 

Citation:

Journal of Neurosurgery: Spine
Posted online on June 19, 2018.
Factors predicting opioid dependence in patients undergoing surgery for degenerative spondylolisthesis: analysis from the MarketScan databases
Mayur Sharma, MD, MCh, Beatrice Ugiliweneza, PhD, MSPH1, Zaid Aljuboori, MD1, Miriam A.Nuño, PhD2, Doniel Drazin, MD3, and  Maxwell Boakye, MD, MPH, MBA1

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Are Abortions Safer in Ambulatory Surgery Centers Than Medical Offices?

MedicalResearch.com Interview with:

Sarah CM Roberts, DrPH Associate Professor ObGyn&RS Zuckerberg San Francisco General UCSF

Dr. Roberts

Sarah CM Roberts, DrPH
Associate Professor
ObGyn&RS
Zuckerberg San Francisco General
UCSF

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Thirteen states have laws that require abortions to be provided in Ambulatory Surgery Centers (ASCs); many of these laws apply only in the second trimester.  We examined outcomes from more than 50,000 abortions provided in two facility types:  Ambulatory Surgery Centers and office-based settings.

We found that there was no significant difference in abortion-related complications across facility type; in both settings, about 3.3% had any complication and about 0.3% had a major complication.  There also was no significant difference in complications across facility types for second trimester and later abortions.

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2/3 Canadians Do Not Receive Timely Surgery for Hip Fractures

MedicalResearch.com Interview with:

Daniel Pincus MD Department of Surgery Institute for Clinical Evaluative Sciences University of Toronto

Dr. Pincus

Daniel Pincus MD
Department of Surgery
Institute for Clinical Evaluative Sciences
University of Toronto

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We chose to look at hip fractures because is the most common reason for urgent surgery complications have be tied to wait times (and in particular wait times greater than 24 hours).

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For Your Surgeon, Do You Want Younger Hands or More Experience?

MedicalResearch.com Interview with:
“Untitled” by Marcin Wichary is licensed under CC BY 2.0
Yusuke Tsugawa, MD, MPH, PhD
Assistant professor
Division of General Internal Medicine and Health Services Research
David Geffen School of Medicine at UCL
Los Angeles, CA 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We studied whether patients’ mortality rate differ based on age and sex of surgeons who performed surgical procedures. Using a nationally representative data of Medicare beneficiaries aged 65-99 years who underwent one of 20 major non-elective surgeries, we found that patients treated by older surgeons have lower mortality than those cared for by younger surgeons, whereas there was no difference in patient mortality between male and female surgeons. When we studied age and sex together, we found that female surgeons at their 50s had the lowest patient mortality across all groups.

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Racial Disparities in Post-Procedure ED Visits and Hospitalizations

MedicalResearch.com Interview with:

Dr-Hillary-J-Mull

Hillary J. Mull, PhD, MPP
Center for Healthcare Organization and Implementation Research
Veterans Affairs (VA) Boston Healthcare System
Department of Surgery, Boston University School of Medicine
Boston, Massachusetts

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Little is known about outpatient procedures that can be considered invasive but are not conducted in a surgical operating room. These procedures are largely neglected by quality or patient safety surveillance programs, yet they are increasingly performed as technology improves and the U.S. population gets older.

We assessed the rate of invasive procedures across five specialties, urology, podiatry, cardiology, interventional radiology and gastroenterology in the Veterans Health Administration between fiscal years 2012 and 2015. Our analysis included examining the rates of post procedure emergency department visits and hospitalizations within 14 days and the key patient, procedure or facility characteristics associated with these outcomes. We found varying rates of post procedure ED visits and hospitalizations across the specialties with podiatry accounting for a high volume of invasive outpatient care but the lowest rate of postoperative utilization (1.8%); in contrast, few of the procedures were in interventional radiology, but the postoperative utilization rate was the highest at 4.7%. In a series of logistic regression models predicting post procedure healthcare utilization for each specialty, we observed significantly higher odds of post procedural outcomes for African American patients compared to white patients.

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Medicaid Expansion Improved Access to Cardiac Care Without Diminishing Outcomes

MedicalResearch.com Interview with:

Donald Likosky, Ph.D., M.S. Associate Professor Head of the Section of Health Services Research and Quality Department of Cardiac Surgery. University of Michigan

Dr. Likosky

Donald Likosky, Ph.D., M.S.
Associate Professor
Head of the Section of Health Services Research and Quality
Department of Cardiac Surgery.
University of Michigan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Michigan was one of several states to expand Medicaid. Current evaluations of the Michigan Medicaid expansion program have noted increases in primary care services and health risk assessments, but less work has evaluated its role within a specialty service line. There has been concern among some that Medicaid patients, who have traditionally lacked access to preventive services, may be at high risk for poor clinical outcomes if provided increased access to cardiovascular interventions.

Using data from two physician-led quality collaboratives, we evaluated the volume and outcomes of percutaneous coronary interventions and coronary artery bypass grafting 24mos before and 24mos after expansion. We noted large-scale increased access to both percutaneous coronary interventions (44.5% increase) and coronary artery bypass grafting (103.8% increase) among patients with Medicaid insurance. There was a decrease in access for patients with private insurance in both cohorts. Nonetheless, outcomes (clinical and resource utilization) were not adversely impacted by expansion.  Continue reading

OviTex Reinforced BioScaffolds Combine Synthetic and Biologic Materials For Soft Tissue Repair

MedicalResearch.com Interview with:

Michael Sawyer, MD, FACS General Surgeon Comanche County Memorial Hospital Lawton, Oklahoma

Dr. Michael Sawyer

Michael Sawyer, MD, FACS
General Surgeon
Comanche County Memorial Hospital
Lawton, Oklahoma 

MedicalResearch.com: What is the background for this study?

 

Response: Repair of complex incisional hernias is a challenging surgical task. Abdominal wall surgeons are utilizing advanced abdominal wall reconstruction (AWR) techniques including myofascial advancement flap creation with reinforcement by biologic or synthetic prostheses with greater frequency.

Numerous synthetic or biologic surgical mesh products are currently available to reinforce these soft tissue repairs. Each type of biologic or synthetic material has its own advantages and limitations.

OviTex Reinforced BioScaffolds (RBSs) are unique in that they interweave polymer in a custom “lock-stitch” pattern through layers of biologic tissue in an embroidered construction, aiming to incorporate the salutary properties of both biologic and synthetic repair materials. The biologic material, derived from ovine rumen, has been optimized to minimize foreign body response and enables functional tissue remodeling. The polymer provides additional strength, along with improved handling and load‑sharing capability.

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Multifactorial Aspects of Sex Bias in Surgical Research

MedicalResearch.com Interview with:
Neel Mansukhani, MD
Department of Surgery
Northwestern University and

Melina R. Kibbe, MD, FACS, FAHA
Colin G. Thomas Jr. Distinguished Professor and Chair
Department of Surgery
Professor, Department of Biomedical Engineering
The University of North Carolina at Chapel Hill
Chapel Hill, NC 27599-7050
Editor in Chief, JAMA Surgery 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: This study is a follow-up to our previous work that examined sex bias in surgical research. Previously, we examined sex bias in basic and translational science surgical research, as well as in clinical surgical research. We discovered previously that sex bias exists in basic and translational surgical research in the unequal inclusion of male and female research subjects.
In clinical research, we found sex bias in the degree of sex matching of included subjects, and in the frequency of sex-based reporting, analysis, and discussion of the data.

In this current work, we sought to understand the effect of author gender on sex bias in surgical research. In this work, we found that most authors are male, most authors work with other authors of the same gender, and sex bias is prevalent regardless of author gender. Most importantly, we found that sex inclusive research receives more citations after publication compared to sex-biased research.  Continue reading

Ankle Fracture: Close Casting Can Be Alternative To Surgery For Older Patients

MedicalResearch.com Interview with:
David Keene DPhil
NIHR Postdoctoral Research Fellow
NDORMS Research Fellow in Trauma Rehabilitation
Critical Care, Trauma and Rehabilitation Trials Group
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences
University of Oxford 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Our clinical trial comparing close contact casting to the usual internal fixation surgery for unstable ankle fractures in older adults found that ankle function at six months was equivalent. There was more abnormal healing of the fracture seen on radiographs (malunion) in the casting group (15 percent, compared to 3 percent for surgery) so we aimed to investigate the ankle function outcomes in the longer term. We found that equivalence in ankle function between initial close contact casting and surgery was maintained at three years. 

MedicalResearch.com: What should readers take away from your report?

Response: Our findings indicate that close contact casting is an appropriate alternative treatment to surgery for older people with an unstable ankle fracture. These longer-term outcomes will help surgeons and patients to make informed decisions about the right course of action for them. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future research will explore if there are certain types of older patients that do well after close contact casting or surgery. 

MedicalResearch.com: Is there anything else you would like to add?

Response: It is worth highlighting that the initial close contact casting was applied in the operating room under anesthesia.

There were no conflicts of interest. 

Citations:

Keene DJ, Lamb SE, Mistry D, et al. Three-Year Follow-up of a Trial of Close Contact Casting vs Surgery for Initial Treatment of Unstable Ankle Fractures in Older Adults. JAMA. 2018;319(12):1274–1276. doi:10.1001/jama.2018.0811

 

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

TXA Increasingly Use in Shoulder Surgery To Reduce Transfusion Risk and Complications

MedicalResearch.com Interview with:

Shawn Anthony, MD, MBA Assistant Professor of Orthopaedics Icahn School of Medicine at Mount Sinai

Dr. Anthony

Shawn Anthony, MD, MBA
Assistant Professor of Orthopaedics
Icahn School of Medicine at Mount Sinai

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Rates of total shoulder arthroplasty are increasing, especially with an aging population.  Blood loss requiring transfusion is less common than in total hip or knee replacements but still required in some patients.  Tranexamic acid (TXA) is increasingly used to reduce blood loss in lower extremity arthroplasty but limited data exists for its effectiveness and safety in patients undergoing shoulder arthroplasty. We aimed to utilize national data to assess frequency of use and effectiveness of TXA in shoulder arthroplasty patients.

While utilization of TXA has become very common in total hip and knee arthroplasty, TXA is still used in less than 50% of patients undergoing shoulder arthroplasty as of 2016.  TXA use was associated with a 36% decrease in transfusion risk and a 35% decreased risk for combined complications. Moreover, TXA use was associated with 6.2% shorter hospital stay.

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Urgent/Emergent TAVR Feasible But Mortality Higher Than When Performed Electively

MedicalResearch.com Interview with:

Dawn Abbott, MD, FACC, FSCAI Associate Chief, Faculty Development and Academic Advancement Director, Interventional Cardiology and Structural Fellowship Programs Associate Professor of Medicine Warren Alpert Medical School, Brown Providence, RI 02903

Dr. Abbott

Dawn Abbott, MD, FACC, FSCAI
Associate Chief, Faculty Development and Academic Advancement
Director, Interventional Cardiology and Structural Fellowship Programs
Associate Professor of Medicine
Warren Alpert Medical School, Brown
Providence, RI 02903 

MedicalResearch.com: What is the background for this study?

Response: Approximately 35,000 transcatheter aortic valve replacement (TAVR) procedures are now performed annually in the United States (US). TAVR is usually performed as an elective procedure in hemodynamically stable patients. Approximately 1 in 5 hospitalizations for severe aortic stenosis (AS) are emergent with acute decompensation. Balloon aortic valvuloplasty (BAV) is a therapeutic option in patients with acute decompensated AS; however, long-term survival after BAV remains poor with a high incidence of valvular re-stenosis. Data on the outcomes of urgent/emergent TAVR as a rescue therapy in patients with acute decompensated severe AS are extremely limited.

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Labor Costs Account For Largest Percentage of Operating Room Expenses

MedicalResearch.com Interview with:

Dr. Chris Childers, M.D.  Division of General Surgery David Geffen School of Medicine at UCLA Los Angeles, CA 90095

Dr. Childers

Dr. Chris Childers, M.D.
Division of General Surgery
David Geffen School of Medicine at UCLA
Los Angeles, CA 90095

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Over 20 million Americans undergo a surgical procedure each year with a price tag over $1 trillion.  The operating room (OR) is a particularly resource dense environment, yet little is known about the actual costs of running an OR.  Most previous efforts focusing on OR costs have come from single-site studies with little detail about the drivers of OR costs.

Using financial statements from all California hospitals we estimated that the average cost to the hospital for one minute of OR time was between $36 and $37. Perhaps more notable was the composition of these costs.  Almost two-thirds ($20-21) was attributable to “direct costs” – those generated by the OR itself – including $14 for the wages and benefits of staff, $2.50-3.50 for surgical supplies, and $3 for “other” costs such as equipment repair and depreciation. Interestingly, the remainder ($14-16) was dedicated to “indirect costs” such as the costs associated with hospital security and parking.  While these indirect costs are necessary for a hospital to run, they are not under the purview of the operating room.

Finally, we also learned that OR costs have increased quickly over the past 10 years – faster than other sectors of healthcare as well as the rest of the economy. Continue reading

Hemophilia B: Rebinyn® Now Available To Treat Acute Bleeds and Surgical Bleeding

MedicalResearch.com Interview with:

Stephanie Seremetis, M.D. Corporate Vice President and Chief Medical Officer Biopharmaceuticals at Novo Nordisk

Dr. Stephanie Seremetis

Stephanie Seremetis, M.D.
Corporate Vice President and Chief Medical Officer
Biopharmaceuticals at Novo Nordisk


MedicalResearch.com:
What is the background for this announcement?

Response: We’re proud and excited to make Rebinyn® (Coagulation Factor IX (Recombinant), GlycoPEGylated) available as a new extended half-life treatment for hemophilia B management.

Rebinyn® is an injectable medicine used to treat and control bleeding in adults and children with hemophilia B. It can be used to treat bleeds when they occur and to manage bleeding during surgery. Rebinyn® is not used for routine prophylaxis or for immune tolerance induction in patients with hemophilia B.

Hemophilia B is a serious, chronic, inherited bleeding disease that affects about 5,000 people in the U.S. People living with hemophilia B have low levels of clotting Factor IX protein in the blood, often resulting in prolonged or spontaneous bleeding, especially into the muscles, joints or internal organs.  Continue reading

HoloLens Uses Mixed Reality To Facilitate Reconstruction in Trauma Patients

MedicalResearch.com Interview with:
Dr. Dimitri Amiras, FRCR
Consultant radiologist
Imperial College Healthcare NHS Trust
Dr. Philip Pratt PhD
Research Fellow
Department of Surgery & Cancer
Imperial College London at St Mary’s Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We have used the Microsoft HoloLens to assist with complex reconstructive surgery on several patients at a major trauma centre at St Marys Hospital. We believe this is the first report of such a use in reconstructive surgery.

From dedicated CT scans we have been able to construct patient specific 3D models of the vascular channels supplying the skin to help the surgeon plan their surgical approach for the harvest of these skin flaps. These 3D models are then projected onto the patient as holograms using the Microsoft HoloLens making the information available and directly relevant at the time of the procedure.

The technique helps the surgeon in planning his approach for the patient as well saving time locating the correct vessels at the time of surgery. 

The surgeon's view. Credit: Philip Pratt, et al. Eur Radiol Exp, 2018

Surgical View Using Mixed Reality Image Created By HoloLens
Credit: Philip Pratt, et al.

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Teaching Deep Breathing Before Abdominal Surgery Reduced Post-Op Pneumonia

MedicalResearch.com Interview with:
Ianthe Boden

Titled Cardiorespiratory APAM, PhD Candidate, MSc, BAppSc
Manager Abdominal Surgery Research Group
Clinical Lead – Cardiorespiratory Physiotherapy, Physiotherapy Department
Allied Health Services
Tasmanian Health Services – North |
Launceston General Hospital
Launceston TA 

MedicalResearch.com: What is the background for this study?

Response: Major upper abdominal surgery involves opening up the abdomen – mainly to remove cancer or damaged bowel, liver, stomach, pancreas, or kidney.  It is, by far, the most common major surgical procedure performed in developed countries with millions of procedures performed per annum. Unfortunately a respiratory complication following these operations occurs relatively frequently with between 1 in 10 to almost a half of all patients getting some type of respiratory complication after surgery. Respiratory complications included problems such as pneumonia, lung collapse, respiratory failure, and an acute asthma attack. These complications, especially pneumonia and respiratory failure, are strongly associated with significant morbidity, mortality, increased antibiotic usage and longer hospital stay.

These breathing problems occur quite quickly after surgery, becoming evident usually within the first two to three days after surgery. In an effort to ameliorate these complications in developed countries it is common for physiotherapists/respiratory therapists to see a patient for the first time on the day after surgery and start patients doing breathing exercises. However as respiratory dysfunction starts occurring immediately following surgery it is debated that these breathing exercises are being provided too late. Initiating prophylactic treatment more than 24 hours after the end of surgery may not be as effective as starting prophylaxis immediately. Unfortunately, immediately after surgery patients are either very sleepy, in pain, feeling sick, or delirious. It may not be possible to effectively teach patients at this point on the importance of breathing exercises and get good performance.

One method to overcome this would be to meet patients before the operation to educate them about their risk of a postoperative chest infection and to motivate and train them to perform breathing exercises to do immediately on waking from surgery. Previous trials have indicated that this may help prevent postoperative respiratory complications, although evidence is inconclusive and weak.

We set out to robustly and conclusively see if respiratory complications could be prevented after major upper abdominal surgery if patients were taught breathing exercises to do as soon as they woke up after the operation. We ran this trial in two countries (Australia and New Zealand) and three different types of hospitals.  All patients were met by a physiotherapist at our hospitals’ scheduled pre-admission clinic appointment and either provided with an information booklet (control) or provided with an additional 30 minute education and training session with the physiotherapist. At this preoperative session the patient was educated about respiratory complications, their risk, and how to prevent them with breathing exercises. These exercises were then taught and practiced for just three repetitions. Patients were instructed to do these breathing exercises for 20 repetitions as soon as they woke from surgery and then 20 times every hour after surgery until they were up and out of bed frequently.

Following surgery each patient had a standardised rehabilitation program and no respiratory therapy of any type was provided to the patients after surgery.

For the first two weeks after surgery patients were assessed daily for a respiratory complication by research assistants unaware of what treatment the patient had received before surgery.

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Medicaid Expansion Led To Better, More Timely Surgical Care

MedicalResearch.com Interview with:

Andrew Phillip Loehrer MD MPH Fellow in Surgical Oncology Department The University of Texas MD Anderson Cancer Center

Dr. Loehrer

Andrew Phillip Loehrer MD MPH
Fellow in Surgical Oncology Department
The University of Texas MD Anderson Cancer Center

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: A growing number of studies have examined the effects of the Affordable Care Act’s Medicaid expansion.  But none to date have looked at effects on surgical conditions, which are both expensive and potentially life-threatening.  We examined data for nearly 300,000 patients who presented to hospitals with common and serious surgical conditions such as appendicitis and aortic aneurysms.

We found that expansion of Medicaid coverage was linked to increased insurance coverage for these patients, but even more importantly, Medicaid expansion led patients to come to the hospital earlier before complications set in, and they also received better surgical care once they got there.

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Unnecessary Routine Preoperative Cataract Testing Costs Medicare Millions

MedicalResearch.com Interview with:
Catherine L. Chen, MD, MPH

Assistant Professor
UCSF Department of Anesthesia & Perioperative Care

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Routine preoperative medical testing (such as common laboratory tests looking at a patient’s blood cell counts and kidney function, or cardiac tests like an EKG) are not recommended in patients undergoing cataract surgery, but these tests still occur quite frequently among Medicare cataract surgery patients because these patients tend to be older and sicker than the general population. In the past, researchers have used a 30-day window counting backwards from the date of surgery to determine whether a given test should be categorized as a routine preoperative test. However, we know that testing often takes place outside this window and therefore, the frequency and cost of routine preoperative medical testing has generally been underreported.

In our study, we used a new method to figure out how to determine the start of the routine preoperative testing period. In cataract patients, ocular biometry is a diagnostic test that is performed in anticipation of cataract surgery, and this test is only performed in cataract patients who will be having cataract surgery in the near future. For each patient, we calculated the elapsed time between the ocular biometry and cataract surgery dates to get a better idea of when to start looking for unnecessary routine preoperative testing. Our goal was to identify all the routine preoperative medical testing that occurs once the decision has been made to operate and better estimate the cost to Medicare of this unnecessary testing.

In a previous study that we published in the New England Journal of Medicine, we reported a significant spike in the rate of routine preoperative medical testing that occurs in the 30 days before surgery compared to the baseline rate of testing. In our current study, we discovered that there is a second spike in testing that occurs in the 30 days after ocular biometry. In fact, even if you exclude the testing that takes place during the 30 days before surgery, there is still a 41% increase in testing rates during the interval between ocular biometry and cataract surgery over the baseline rate of testing. In addition, we found that the cost of routine preoperative testing was 47% higher when looking at the entire biometry to surgery timeframe compared to testing that occurs just in the 30 days before surgery.

We estimate that the cost to Medicare of all of this unnecessary testing approaches $45.4 million annually. Continue reading

Children with Heart Failure from Dilated Cardiomyopathy are Surviving Longer in the Most Recent Era

This file was derived from Blausen 0165 Cardiomyopathy Dilated.png

Structural categories of cardiomyopathy Wikipedia image

MedicalResearch.com Interview with:
Rakesh K. Singh MD, MS

Department of Pediatrics, University of California–San Diego and
Rady Children’s Hospital
San Diego, California

Steven E. Lipshultz MD
Department of Pediatrics
Wayne State University School of Medicine and
Children’s Hospital of Michigan
Detroit, Michigan 

MedicalResearch.com: What is the background for this study?

Response: Dilated cardiomyopathy (DCM) is a disease characterized by dilation and dysfunction of the left ventricle of the heart. While DCM is a relatively rare disease in children, nearly 40% of children with DCM require a heart transplant or die within 2 years of diagnosis. Heart transplantation has improved the outcomes of children with DCM over the last 3 decades, but is limited by donor heart availability. Newer therapies, including advanced ICU care and artificial heart machines, are now being used to treat children with DCM.

This study published in the November 28, 2017 issue of the Journal of American College of Cardiology (JACC) sought to determine whether more children with DCM were surviving longer in the more recent era. Specifically, it investigated whether children with DCM were surviving longer without the need for heart transplantation. Rakesh Singh, MD is the first author and an Associate Professor of Pediatrics at UC San Diego/Rady Children’s Hospital, while the senior author is Steven Lipshultz, MD, Professor at Wayne State University School of Medicine/Detroit Medical Center’s Children’s Hospital of Michigan and Director of Children’s Research Center of Michigan.

The Pediatric Cardiomyopathy Registry (PCMR) is a National Heart, Lung, and Blood Institute (NHLBI) sponsored registry from 98 pediatric centers in United States and Canada created to study the outcomes of children with various heart muscle disorders known as cardiomyopathies. For this study, outcomes of 1,199 children diagnosed with DCM from 1990-1999 were compared with 754 children diagnosed with DCM from 2000-2009.

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Antibiotic Resistance Common In Infections After Ocular Surgery

MedicalResearch.com Interview with:

Dr-Penny Asbell

Dr. Asbell

Penny Asbell, MD
Icahn School of Medicine
Mt. Sinai, New York City.

MedicalResearch.com: What is the background for this study?

─     Bacterial endophthalmitis is a serious, although infrequent, complication of ocular surgery, typically caused by perioperative introduction of bacterial flora from the patient’s own conjunctiva and skin.

─     Prophylactic measures such as perioperative antibiotic treatment may minimize the risk for endophthalmitis, but can be complicated by antibiotic resistant bacteria.

─     The ongoing Antibiotic Resistance Monitoring in Ocular micRoorganisms (ARMOR) study is the only nationwide antibiotic resistance surveillance program specific to ocular pathogens.

─     The purpose of this presentation is to report on the antibiotic susceptibility profiles of bacterial isolates from the vitreous and aqueous humor collected in the ARMOR study expanding upon earlier findings.

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