Articles Posted in Surgery

breconstruct-300x200Cancer and surgery — it’s little wonder that even the most resilient patients can buckle a bit when their doctors talk to them about these two issues together and urgently. That’s why new research may be  valuable to women with breast cancer, providing them with better evidence-based insight about challenges in their reconstructive options.

The information, which experts said surprised them and may change their views on frequently performed procedures, yet again underscores that surgery can carry significant risks and complications.

In fact, 1 in 3 women who undergo cancer-related breast reconstructive surgery develops a postoperative complication over the next two years, 1 in 5 requires more surgery, and in 1 in 20 of cases, reconstruction fails, the New York Times reported of the published findings of medical researchers, most from the University of Michigan.

Doctors and hospitals have a right to blow their own horn a bit when they’re onto something good, don’t they? What’s the harm? Plenty, as reported by Healthnewsreview.org, an independent, nonpartisan health information watchdog site.

As part of a series on patient harm from misleading media, Joy Victory, the site’s managing editor, details the tragic results from superficial news stories, typically on smaller media outlets, that deceive patients and their families about the Nuss procedure, a surgery to correct a congenital condition that results in a concave or “funnel” chest (see photo).

This is a serious operation, as I know from my practice. But as Victory points out, this hard, cold fact somehow gets glossed over in glowing reports about the surgery, written by news services and by reporters at smaller papers in South Carolina, Virginia, and Myrtle Beach, Fla., and even in a larger daily in Kansas City, Mo.

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.

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