Articles Posted in Surgery

obamacare-cartoon-2-a-300x240As the already known complications to its demise have increased by the minute, there may be some detectable pauses in the partisan zeal to give the Affordable Care Act, aka Obamacare, the bum’s rush. That’s because the legislation’s repeal-and-replace proponents — despite seven years and several dozen U.S. House votes  to roll back the ACA — have yet to detail how 20 million Americans who have gotten health insurance under Obamacare will be covered in the days ahead.

Opponents also haven’t explained how they may change the far reach of the ACA, including how the law and the Obama administration have reshaped, and often, improved American health care, for example, by changing entrenched payment practices and forcing greater accountability.

The New York Times, in reviewing the presidential legacy, has reported on what it terms the transformational aspects of Obamacare that also may sustain, no matter the partisan attacks on the attempt to provide broader health insurance coverage. In brief, the paper says Obamacare forced health care in this country to become more data-driven and evidence-based, as well as refocused on patients and their needs. Although some of the major drivers of these reforms, including hefty spending for electronic health records, haven’t hit the high marks advocates hoped for, progress has occurred.

breastIt’s described as an “aggressive, costly, morbid, and burdensome” surgery that often lacks “compelling evidence” that it contributes to patients’ “survival advantage.” So why are increasing numbers of women  deciding to have both their breasts removed when doctors detect early stage cancer in one breast?

New research, based on a questionnaire and follow-up with more than 2,400 women, recommends that surgeons be clearer and more direct about treatment options and outcomes with breast cancer patients. That’s because 17% of respondents said, incorrectly, that they think that removing the other healthy breast in a woman with cancer in one breast helps prevent the disease’s recurrence, while almost 40 percent said they didn’t know this procedure’s effects.

Researchers found that many women—including more than 40 percent of their respondents—with breast cancer contemplate the surgery known as contralateral prophylactic mastectomy (CPM), and that sufficient numbers of surgeons may not explain why it may be inappropriate for them. Their study has been published in the peer-reviewed Journal of the American Medical Association Surgery. As the Los Angeles Times reported:

knee-replacement-300x240Uncle Sam is struggling to figure how best to ensure the safety, quality, and accessibility of a major surgery for a sharply rising number of seniors who need it and want the government, through Medicare, to pay for it. Baby boomers, after decades of running, dancing, aerobics, football, basketball, zoomba, and all manner of joint-stressing activity, are lining up for knee replacements. Where should these procedures occur and how should they be paid for and evaluated?

The New York Times has reported that surgeons, some in hospitals and some in free-standing surgical centers, are riven by proposed rule changes that would allow patients 65 and older with Medicare to undergo complex, extensive knee replacement operations on an outpatient basis.

The surgeons who now do these operations in hospitals say this is a risky move for patients, who now typically spend several days hospitalized in recovery. The “hospital” docs say knee replacement is a complex procedure, with high risk of infection and post-operative complications, because, for example, patients receive powerful clot-busting drugs and potent painkillers as part of the surgical regimen.

ratingsPatients need much more information in more user-friendly fashion to determine how hospitals might work best for them, a big new study finds, while also debunking a notion that’s a little hard to fathom on its face. Ordinary consumers seem clearly to understand that hospitals differ greatly in their quality, right? But this research doesn’t make the consumers’ job any easier.

The experts involved in the latest hospital research scrutinized 22 million admissions, with data from both the federal Medicare program and private insurers. They analyzed the information based on two dozen measures of medical outcomes. They took into account how sick the patients were and other factors, like age and income.

The New York Times reported on the researchers’ findings:

fda hipThe pain and suffering that a flawed medical device can cause can last a long time. A Dallas jury provided a timely reminder of that, deciding six California plaintiffs should be paid more than $1 billion for the harm they suffered because of metal-on-metal hip replacement hardware made by Johnson & Johnson’s DePuy Orthopedics unit.

The Californians proved to jurors that they suffered tissue death, bone erosion, and other at times excruciating injury due to the faulty Pinnacle hip replacement product, which they said had been promoted as longer lasting and less risky than other alternatives. Jurors also heard that DePuy knew the products were defective and failed to warn patients.

Johnson & Johnson said it had acted appropriately and believed the verdict, which came in one of more than 8,000 Pinnacle-related lawsuits in Texas alone, would be overturned on appeal due to what the company said were errors by the presiding judge.

SouthDakota-StateSeal.svgSouth Dakotans will need their state lawmakers’ help now to pry open physicians’ iron grip on secret decisions about which doctors get to practice in hospitals and why. That’s because the state’s Supreme Court ruled this vital information must be kept confidential, even if releasing it would serve a wider good of disclosing possible criminal or fraudulent conduct.

The high court ducked its potential role in helping more than 30 patients who claim they were mangled in excruciating, needless surgeries performed by Allen Sossan, an osteopath with an easily discovered criminal past and a checkered medical practice record in the area around Yankton, S.D. I’ve written about this case before.

Several South Dakota hospitals gave Sossan practice privileges after his credentials were reviewed by physician committees, which, since have fought mightily to keep secret what they knew and when they knew it about him. Sossan since has been indicted for providing false information to medical licensing authorities. The convicted burglar and check kiter apparently has fled the country and may be back in his native Iran.

heatercoolerPost-op heart surgery patients who experience night sweats, muscle aches, weight loss, fatigue, or unexplained fever should contact their doctors, stat, federal officials say. They’re warning that a medical device, designed to keep organs and blood at a constant temperature, was contaminated with nontuberculous mycobacterium (NTM). Officials already have confirmed more than two dozen NTM infections in open heart patients, and thousands more may be at risk.

The federal Centers for Disease Control and Prevention flagged the potential patient risks linked to the Stöckert 3T, temperature-regulating surgical devices made by LivaNova PLC (formerly Sorin Group Deutschland GmbH).

Temperature-regulating devices are common in the 250,000 open heart surgeries performed annually in hospitals, officials say, and 60 percent of the procedures involve the German-made model. NTM infections may not develop immediately, and some cases were confirmed as many as four years after surgery. They typically are not fatal but can be problematic for immune-compromised patients, such as many open heart patients are. They respond well to antibiotics if detected.

38_Special_mushrooming_side_viewA lethal epidemic is sweeping Baltimore neighborhoods, costing taxpayers millions of dollars, as well as demoralizing caregivers who struggle with its casualties daily. Researchers, tragically, are barred from developing detailed data about this scourge to try to curb its increasingly deadly harm.

Kudos to the Baltimore Sun and reporter Justin George for investigating for a year the gun violence that torments the city, sending at least 200 patients to area hospitals already just in 2016. The Sun says hospitals in the poor city have spent in five years more than $80 million caring for patients involved in gun crimes. Hospitals have seen their gunshot caseload double, and the costs of this care increase by 30 percent. Taxpayers end up footing most of the bill under Medicaid, the federal-state insurance for the poor.

The Sun’s multi-part series looks at gun violence from many aspects but the violence’s effects on the city’s health care is tragic and distressing.

aanningA conscience-stricken surgeon in South Dakota has publicly confirmed one of the great frustrations for patients pursuing medical malpractice claims after they have been harmed: He says doctors are too willing to lie in court to protect themselves and colleagues, as he did two decades ago in a case involving a partner in his practice.

Dr. Lars Aanning says he no longer could live with his lie. Because he is 77, retired, and cannot be subject to colleagues’ retribution, he decided to ‘fess up, and to help attorneys who represent injured patients. Aanning says he does not know whether his false testimony was decisive in his partner’s lawsuit. But he confesses that he knew his colleague’s patient had suffered because of the treatment this stroke victim received. He also had had doubts before about his partner’s work.

He tells a reporter for Pro Publica, the Pulitzer Prize-winning online investigative site, that he knew at the moment he uttered his untruths that his lying flew in the face of everything he thought he stood for. But he says, “I did it as a matter of course. And I did it because there was a cultural attitude I was immersed in: You viewed all attorneys as a threat and anything that you did was OK to thwart their efforts to sue your colleagues. I just accepted that as normal. It wasn’t like, ‘I’m going to lie. It was, ‘I’m going to support my colleague.’ ”

prostateA  study involving more than 80,000 men followed for 10 years gives some important clues, but no final answers, on what patients with a diagnosis of prostate cancer should do. It’s long been a puzzle because prostate cancer is one of the most common and deadliest cancers for men, yet in many cases it’s so slow to grow that men die with, not from, prostate cancer.

Here’s the bottom line, which the researchers emphasized needs to be continued for an even longer time for its findings to be more authoritative:

At a median of 10 years, prostate-cancer–specific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. Surgery and radiotherapy were associated with lower incidences of disease progression and metastases than was active monitoring.

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