Articles Posted in Surgery

surgtools-150x150Seniors and their loved ones should take note of new and increasing data that researchers are developing about the risks undertaken by elderly patients who choose to undergo significant surgeries — procedures that make up a little less than half of costly operations performed in this country.

The numbers about invasive medical work can be mind-changing, especially for those with age-associated conditions, the independent, nonpartisan Kaiser Health News Service reported. As KHN’s “navigating aging” columnist Judith Graham wrote:

“Nearly 1 in 7 older adults die within a year of undergoing major surgery, according to an important new study that sheds much-needed light on the risks seniors face when having invasive procedures. Especially vulnerable are older patients with probable dementia (33% die within a year) and frailty (28%), as well as those having emergency surgeries (22%). Advanced age also amplifies risk: Patients who were 90 or older were six times as likely to die than those ages 65 to 69. The study in JAMA Surgery, published by researchers at Yale School of Medicine, addresses a notable gap in research: Though patients 65 and older undergo nearly 40% of all surgeries in the U.S., detailed national data about the outcomes of these procedures has been largely missing.”

ascension-st-vincent-riverside-hospital-300x200The nurses complained, and so did a handful of doctors. The patients howled. Yet, for years, administrators at a Florida hospital ignored the repeated alarms, critics say.

Now, 350 lawsuits have been filed and 100 more are expected, all asserting that Dr. Richard David Heekin, a seasoned orthopedist, suffered from a progressively debilitating, rare, neurologic condition that significantly impaired his capacity to perform what should have been common, uncomplicated knee and hip replacements, putting patients in harm’s way, NBC News reported.

Instead, during his flawed procedures, bones fractured, tendons ruptured, and nerves were severed. Patients required costly, painful, and unnecessary revision surgeries.

instruments-300x166While the coronavirus pandemic has forced patients, doctors, and hospitals to curtail crucial tests, procedures and treatments in worrisome fashion, a trend with one kind of medical practice apparently continues apace: The so-called “Zoom boom” in plastic and cosmetic surgeries is still going strong.

Patients, though, soon will get a tough reality TV warning about the damages that can occur in the costly pursuit of beauty.

For the many who have struggled with illness, as well as professional, personal, and economic hardship during the pandemic, it may be distressing to be reminded of the upswing in elective procedures, ostensibly to improve the aesthetics of patients’ faces and other body parts. But the Los Angeles Times interviewed Drs. Jason Litner and Peyman Solieman to learn why they say their Beverly Hills surgical practices with cosmetic procedures have been busier than ever — or as much as the pandemic allows, as Litner reported:

stretch-195x300Even as patients in a giant and rapidly graying generation throng orthopedic surgeons’ offices seeking relief from aging’s pain and discomfort, the evidence for these pricey and invasive medical interventions is slim at best and too often is simply unpersuasive.

Those are the findings of an expansive, rigorous “meta examination” of major medical databases and reports on hundreds of reports they contained of clinical trials and other evidence on 10 of the most commonly performed orthopedic procedures. Researchers published their results in the BMJ, a respected medical journal of the British Medical Association.

As the New York Times reported of the experts’ conclusions:

bugatti-300x118If big hospitals really want to keep surgeons happy and provide them with greater comfort during procedures, why not build giant, sanitary glass garages next to operating rooms and let docs park their Bentleys, Lamborghinis, and Bugattis there for ogling and maybe even to take a break under the vehicles’ hoods?

Okay, maybe we’re being a bit too snarky.  Yet that hyperbolic scenario just might be cheaper and more medically justifiable than the sustained embrace by specialists and profit-seeking institutions of fancy robotic surgical devices costing more than $1 million annually — and for which patients, ultimately, pay. Here’s what the New York Times reported of yet another published meta-analysis of dozens of studies on the devices and their outcomes found:

“Surgical procedures performed with the aid of a robot is sometimes marketed as the ‘best’ form of surgery. But a recent review of 50 randomized controlled trials, testing robot-assisted surgeries against conventional methods for abdominal or pelvic procedures, suggests that while there may be some benefits to robotic surgery, any advantages over other approaches are modest … Some surgeons believe that these robots allow more precision during the operation, shorter recovery time, and generally better clinical outcomes for patients. But the review found that in many ways, compared outcomes from the robotic and conventional procedures showed little difference.

davincirobot-300x176Hospitals finally are saying bull feathers to the leading maker of surgical robots that cost institutions millions of dollars annually to buy and maintain. New lawsuits against Intuitive Surgical dispute the company’s business practices, including the exclusivity it demands for its costly services and products.

But will the civil claims also crack open the door to bigger questions about daVinci robots and other such medical devices and whether they benefit patients or just add backbreaking costs to their hospital bills?

Intuitive has declined to comment on the suits filed against it in federal courts in California by the Franciscan and Kaleida health systems. The company has denied one aspect of the media reports about the suits — that it shut down its robots remotely in the middle of a patient’s operation, forcing a surgeon and his team to improvise and finish the procedure (without problems) using standard techniques.

Patients, politicians, and regulators may find it tough to believe, so they need sharp periodic reminders: While there are many terrific, dedicated doctors working today, there also are some truly terrible ones. And dealing with the harms of medical malpractice by the incompetent and abusive can require courage and vigilance.

  • Perhaps a new, streamed Hollywood serial — starring the likes of Alec Baldwin, Christian Slater, AnnaSophia Robb, and Joshua Jackson — can underscore for the public how grisly the results can be until a rare criminal prosecution derails the likes of Christopher Duntsch, a Dallas surgeon so grim he is nicknamed “Dr. Death?”

devicemakerdocpay-300x225Billions of dollars have flown from medical device makers to specialists performing back, spine, knee, and hip surgeries, with unsavory cash and practices also accompanying that fiscal tide.

Industry officials and doctors defend the sizable and growing payment program, saying it results in better medical hardware that ultimately benefits patients, the independent, nonpartisan Kaiser Health News service reported. Data show the bulk of payments from medical-device makers to doctors were for royalties and licensing of products and consulting on them.

But investigative reporters Fred Schulte and Elizabeth Lucas have found that the enriching bonanza concerns regulators, ethicists, and patient advocates:

surgerylown-300x196When it comes to hospitals performing low-value tests or procedures and putting older patients at increased risk, Dixie may have little to whistle about.

The Lown Institute, a respected and nonpartisan think tank that says it “believes a radically better American health system is possible,” has published a new hospital index that puts dozens of southern institutions in a dubious light.

That’s because institute researchers scrutinized federal Medicare records on more than 1.3 million fee-for-services provided to older patents at more than 3,300 hospitals nationwide. They reported in findings published in an online part of the Journal of the American Medical Association that “hospitals in the South, for-profit hospitals, and nonteaching hospitals were associated with the highest rates of overuse” of health care services.

cookmizzoudmv-150x150It’s long been routine, if often controversial, for operating rooms to welcome medical device sales people and surgical trainees to watch the work of surgeons and nurses. But now the University of Missouri health system may have reset the bar with its $16.2 million settlement with almost two dozen patients over questionable knee surgeries.

The contested procedures were performed in part by a veterinarian.

That vet, James Cook, is listed on the university’s web site as the William & Kathryn Allen Distinguished Chair in Orthopaedic Surgery. The explanatory text online and a posted video has him describing how his chief role at the school focuses on research in people and animals in joint disorders. He says he is experimenting with techniques, notably in dogs, in which live materials can be used to replace problem joints.

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