Articles Posted in Surgery

jetsons-300x231Although big, rich hospitals and their sprawling campuses jammed with shiny new buildings may be reaching a point where they’re unsustainable for competitive cost, safety, and efficiency reasons, a rising health care alternative already may be hitting its own major woes that can’t be ignored.

The Wall Street Journal and New York Times have put up pieces with intriguing projections about the future of hospitals, including how economics may force them, as is occurring now, to spin off major functions, including many kinds of surgery, which will be handled, instead, in smaller, free-standing surgical centers.

At the same time, USA Today and the independent and nonpartisan Kaiser Health News Service have presented their investigation into dangers and deaths that patients encounter at the such centers, which already are burgeoning nationwide.

massgen-300x140Canadian researchers have come up with at least 2,500  reasons why elite surgeons should reconsider their own wishes and practices to protect patients undergoing hip surgeries from significant post-operative complications. They could do so by curbing even more their dual surgeries, in which they dash between two operating rooms.

A new study has found a 90 percent increase in the risk for surgical complications at one year when doctors repair hip fractures or replace hips in so-called overlapping surgeries.

The Boston Globe, starting in 2015, has raised major issues regarding the safety and effectiveness of simultaneous operations, conducted most often at major academic medical centers (such as Massachusetts General, shown above) and by leading practitioners.

soccerknee-300x97Here’s another painful reminder to grownups about youngsters and sports: Moderation matters, and youthful games are supposed to fun, diverting, and character building—and most definitely should not leave today’s aspiring athletes as tomorrow’s hobbled adults.

The New York Times has reported on what a pediatric sports medicine expert has described as a “dirty little secret” of orthopedics, which is “the chance of getting arthritis within a decade of tearing a tendon or a ligament in the knee is greater than 50 percent.” And more and more youths, as they participate aggressively and frequently in sports programs, are undergoing surgeries on damaged or torn anterior cruciate ligaments, a procedure well-known as the ACL repair.

The sports medicine doc says he is gathering data for a study that will show that patients at 26 children’s hospitals he has focused on underwent 500 ACL repairs in 2005, but by 2014, more than 2,500 youths had these surgeries.

choosing-wisely@2x-300x197Up to a third of medical spending goes for over-treatment and over-testing, with an estimated $200 billion in the U.S. expended on medical services with little benefit to patients. But getting doctors and hospitals to stop this waste isn’t easy, nor is it a snap to get patients to understand what this problem’s all about so they’ll push their health care providers to do something about it.

Which is why kudos  go to Julie Rovner, of the nonprofit, independent Kaiser Health News Service, and National Public Radio for the recent story on how older women with breast cancer suffer needlessly and run up wasteful medical costs due to over-testing and over-treatment.

Rovner and Kaiser Health News worked with a medical benefit management company to analyze records of almost 4,500, age 50-plus women who received care for early-stage breast cancer in 2017. She found that just under half of them got a medically appropriate, condensed, three-week regimen of radiation therapy. Research has shown this care is just as effective as a version that’s twice as long, costs much more, and subjects patients to greater inconvenience, especially with more side-effects.

heart-300x190Hospitals and heart doctors may need to rethink their common test to determine if their patients have suffered a heart attack, and whether a newer alternative open-heart procedure carries with it more risks than benefits.

Health News Review, a health information watchdog site, has raised interesting questions as to why mainstream media outlets haven’t paid much attention to the recommendation by the High Value Practice Academic Alliance (HVPAA), a blue-chip group of medical scientists and institutions (including Johns Hopkins), for the phase out of the creatine kinase-myocardial band. CK-MB is the “go-to blood test doctors used to determine if a patient’s heart muscle had been damaged by a heart attack (or myocardial infarction).”

To the tune of $400 million or so annually, doctors turn to CK-MB tests millions of times each year to distinguish, along with patient symptoms and EKGs, if the person before them has suffered a heart attack, HVPAA members write in the medical journal JAMA Internal Medicine.

knees-300x81Although grandma and grandpa and even older ancestors before them didn’t live as long nor usually as well as many of us do, they still can provide valuable insights into how modern Americans can avoid painful debilitation that now leads to some of the most commonly performed surgeries on seniors.

Want to avoid an inconvenient, costly knee or hip replacement?

Keep your weight down and keep moving—two steps that researchers say may have helped reduce the prevalence of the joint rheumatoid arthritis (RA) that pushes tens of thousands of baby boomers each year to seek medical treatment, up to and including knee and hip procedures that cost taxpayers billions of dollars through the Medicare and Medicaid health programs.

kidguns-300x168We love our kids dearly, and most of us would do most anything for them. So why can’t folks with sway get it together to make some straight-forward, common sense changes that would significantly benefit young people? Here are three suggestions, based on recent reports:

  1. Congress should make clear that it not only supports but it will fund public health research into gun violence, which is killing kids at unacceptable rates.
  2. Hospitals and surgeons should make public and transparent their surgical volume and outcome data on procedures performed on youngsters.

Knee-300x166Hip and knee replacements, especially among seniors, have become so prevalent that almost 7 million Americans by 2010 had undergone the surgeries. With the cost to Medicare of knee replacements running between $16,500 and $33,000, and with roughly half of the procedures’ expense occurring post-operatively, there’s some good news for patients on saving money—and staying safer too.

Patients may want to get themselves out of the hospital and stay out of in-patient rehab centers in favor of well-planned, careful recuperation at home, studies show. The research focused on single adults living alone, and whether they fared better over the short- and long-term by rehabbing from total knee and hip replacements at skilled nursing facilities or at home, particularly if their home care was well considered and followed through.

They did at least as well and were happier recuperating at home, researchers found, adding that they also may have been safer: That’s because a third of patients in rehab facilities suffered adverse events in their care, a rate comparable to unacceptably high hospital harms and those in skilled nursing facilities.

Prostate-e1492269148971-483x1024A burst of bad headlines and not so great news reports may have confused some men. But to put it in lay terms:  The use of the common test for routine prostate cancer screening got a dim grade of C for many men, up from a dismal D, in a re-evaluation by independent experts who assess the nation’s preventive medical services.

That blunt review of regular prostate-specific antigen (PSA) tests, despite some reports to the contrary, keeps with how the influential U.S. Preventive Services Task Force (USPTF) looked at annual  screening for this most common form of cancer for men when it issued its first guidelines in 2012, notes

The health information site says the USPTF earlier had surprised many, downgrading routine prostate cancer screening to a D, and noting, “There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.” It now says it rates a C for many men younger than 70, meaning physicians should “Offer or provide this service for selected patients depending on individual circumstances,” and that “There is at least moderate certainty that the net benefit is small.”

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