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April 2013 Briefing - Surgery

Here are what the editors at HealthDay consider to be the most important developments in Surgery for April 2013. This roundup includes the latest research news from journal articles, as well as the FDA approvals and regulatory changes that are the most likely to affect clinical practice.

Risk Factors ID'd for Scoliosis Surgery Complications

TUESDAY, April 30 (HealthDay News) -- Increases in the upper thoracic scoliotic curve, thoracic kyphosis, and number of rod-lengthening procedures are risk factors for postoperative complications associated with growing-rod (GR) surgery for early-onset scoliosis (EOS), according to a study published in the April 15 issue of Spine.

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Novel System Proposed for Accountable Cancer Care

TUESDAY, April 30 (HealthDay News) -- A novel structural and payment-reform system is proposed to foster accountable cancer care, according to a viewpoint piece published online April 29 in JAMA Internal Medicine.

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Renewed Efforts From AAFP to Repeal OTC Provision in ACA

TUESDAY, April 30 (HealthDay News) -- Members of the American Academy of Family Physicians (AAFP) and other medical associations are urging further consideration of Section 9003 of the Patient Protection and Affordable Care Act (ACA) that requires holders of tax-preferred health care accounts to obtain a physician's prescription to use funds from those accounts to pay for over-the-counter (OTC) medications. The concerns have been laid out in a letter to the chair and the ranking member of the House Committee on Ways and Means.

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Comprehensive Analysis Supports SERMs for Cutting Breast Cancer

TUESDAY, April 30 (HealthDay News) -- Treatment with selective estrogen receptor modulators (SERMs) is associated with a significant reduction in the incidence of breast cancer, especially for the first five years after treatment, according to research described as the first comprehensive analysis, published online April 30 in The Lancet.

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Multicenter Study Links Peri-Op SSRI Use to Adverse Outcomes

TUESDAY, April 30 (HealthDay News) -- Perioperative use of selective serotonin reuptake inhibitors (SSRIs) is associated with adverse outcomes, including in-hospital mortality, bleeding, and 30-day readmission, according to a multicenter study published online April 29 in JAMA Internal Medicine.

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FDA Announces New Network to Focus Exclusively on Patients

MONDAY, April 29 (HealthDay News) -- The U.S. Food and Drug Administration has announced the launch of a new interactive tool for educating patients, their advocates, and consumers about the processes involved in medication development.

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Medical Interns Spending Less Time With Patients

FRIDAY, April 26 (HealthDay News) -- Medical interns are spending less time with patients and more time at a computer since new rules limiting total work hours were instituted in 2011, according to a study published online April 18 in the Journal of General Internal Medicine.

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Collagenase Clostridium Histolyticum OK in Peyronie's

FRIDAY, April 26 (HealthDay News) -- For patients with Peyronie's disease, treatment with collagenase clostridium histolyticum (CCH) intralesional injections is efficacious and tolerable, according to research published online Feb. 1 in The Journal of Urology.

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Physicians Less Empathetic in Talking to Heavy Patients

THURSDAY, April 25 (HealthDay News) -- Primary care physicians (PCPs) are less likely to bond with overweight and obese patients, according to research published online March 20 in Obesity.

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Breast CA Tx Delays Still More Common for Poor, Uninsured

WEDNESDAY, April 24 (HealthDay News) -- For young women with breast cancer, a longer treatment delay time (TDT) is associated with decreased survival, especially for African-American women, those with public or no insurance, and those with low socioeconomic status; and women with early-stage breast cancer with Medicaid are more likely to undergo mastectomy than those with private insurance, according to two studies published online April 24 in JAMA Surgery.

Abstract - Smith
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Diagnostic Errors Are the Leading Type of Malpractice Claim

WEDNESDAY, April 24 (HealthDay News) -- In the past 25 years, diagnostic errors have been the leading type of malpractice claim and account for the highest proportion of total payments, according to a study published online April 22 in BMJ Quality & Safety.

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Peri-Noncardiac Op Exposure to β-Blockers Improves Outcome

TUESDAY, April 23 (HealthDay News) -- For patients undergoing major noncardiac surgery with two or more Revised Cardiac Risk Index factors, early exposure to β-blockers is associated with improved 30-day postoperative outcome, according to research published in the April 24 issue of the Journal of the American Medical Association.

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Patient Characteristics Impact CABG-PCI Treatment Effect

TUESDAY, April 23 (HealthDay News) -- In the community setting, coronary artery bypass graft (CABG) surgery is associated with reduced mortality versus percutaneous coronary intervention (PCI), with the association affected by patient-level characteristics, according to a study published in the April 23 issue of the Annals of Internal Medicine.

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Outcomes No Worse With Home Call for Surgical Interns

MONDAY, April 22 (HealthDay News) -- For surgical interns, being on call from home is not associated with increased rates of postoperative morbidity or mortality, according to a study published in the April issue of JAMA Surgery.

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More Than Two-Thirds of Surgeons Are 'Employed'

FRIDAY, April 19 (HealthDay News) -- There is a substantial shift in practice environment occurring among surgeons in the United States, with more surgeons becoming employees, according to a study published in the April issue of JAMA Surgery.

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Tonsillectomy Pre-Radiation Ups Survival in Early Tonsil CA

FRIDAY, April 19 (HealthDay News) -- For patients with stage I and II primary tonsil carcinoma, radiotherapy after tonsillectomy is associated with improved overall survival (OS) and disease-specific survival (DSS), compared with radiotherapy after biopsy, according to a study published in the April issue of JAMA Otolaryngology-Head & Neck Surgery.

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Patient Satisfaction Poor Indicator of Quality Surgical Care

FRIDAY, April 19 (HealthDay News) -- For surgical patients, satisfaction is not associated with performance on process measures or on overall hospital safety culture scores, according to a study published in the April issue of JAMA Surgery.

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Racial Disparity in Head and Neck Cancer Outcomes

FRIDAY, April 19 (HealthDay News) -- Among Medicaid beneficiaries diagnosed with head and neck cancer, considerable racial disparities exist in treatment patterns and survival, according to a study published online April 18 in JAMA Otolaryngology-Head & Neck Surgery.

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Patient-Centered Decision Making Ups Health Outcomes

FRIDAY, April 19 (HealthDay News) -- Patient-centered decision making (PCDM) is associated with improved health care outcomes, according to a study published in the April 16 issue of the Annals of Internal Medicine.

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Outcomes Vary for Diverticular Disease After Surgery

THURSDAY, April 18 (HealthDay News) -- After elective colectomy, patients with diverticular disease (DD) have worse outcomes and higher costs than patients with colon cancer (CC) but better outcomes and lower costs than patients with inflammatory bowel disease (IBD), according to a study published in the April issue of JAMA Surgery.

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Relative Proportion of MRSA Increasing in S. aureus Isolates

THURSDAY, April 18 (HealthDay News) -- The relative proportion of methicillin-resistant Staphylococcus aureus (MRSA) is increasing in S. aureus isolates, and methicillin-sensitive S. aureus (MSSA) is becoming increasingly resistant to antibiotics, according to a study published in the April issue of JAMA Dermatology.

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Guidelines Issued Relating to Online Medical Professionalism

THURSDAY, April 18 (HealthDay News) -- Physicians should be aware of the benefits on online media and should recognize the implications for patient confidentiality and public perception, according to a position paper published in the April 16 issue of the Annals of Internal Medicine.

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Family-Centered Teaching Rounds Good for Patients, Students

THURSDAY, April 18 (HealthDay News) -- Teaching and conducting rounds in the presence of patients and their families can be beneficial for patients and learners, according to research published online April 15 in Pediatrics.

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Community Benefit Spending Varies for Tax-Exempt Hospitals

WEDNESDAY, April 17 (HealthDay News) -- There is considerable variation in the level of community benefit expenditure by tax-exempt hospitals, according to a study published in the April 18 issue of the New England Journal of Medicine.

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Glutamine, Antioxidants No Benefit to Critically Ill Patients

WEDNESDAY, April 17 (HealthDay News) -- For critically ill patients with multiorgan failure, early supplementation with glutamine or antioxidants does not improve clinical outcomes, according to a study published in the April 18 issue of the New England Journal of Medicine.

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Effect of Surgical Complications on Hospital Finances Analyzed

WEDNESDAY, April 17 (HealthDay News) -- The occurrence of surgical complications is associated with higher hospital contribution margins, which vary by payer types, according to research published in the April 17 issue of the Journal of the American Medical Association.

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Presenting Fee Data to Docs Cuts Number of Tests Ordered

WEDNESDAY, April 17 (HealthDay News) -- Presenting fee data to providers at the time of laboratory test orders is associated with a small reduction in the number of tests ordered, according to a study published online April 15 in JAMA Internal Medicine.

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USPSTF: Offer Preventive Meds to Women at Risk of Breast Cancer

TUESDAY, April 16 (HealthDay News) -- The U.S. Preventive Services Task Force recommends that women who are at increased risk of primary breast cancer consider taking preventive medications such as tamoxifen. This Recommendation Statement is based on an evidence review published in the April 16 issue of the Annals of Internal Medicine.

Draft Recommendation Statement
Comment on Recommendations
Background Review

Computer-Aided Detection Tied to Increase in DCIS Diagnoses

TUESDAY, April 16 (HealthDay News) -- The use of computer-aided detection (CAD) for screening mammography has increased in prevalence and is associated with increased diagnosis of ductal carcinoma in situ (DCIS), according to a study published in the April 16 issue of the Annals of Internal Medicine.

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Endocrine Therapy Often Incomplete after Breast Cancer

TUESDAY, April 16 (HealthDay News) -- About 25 percent of women with breast cancer either never initiate adjuvant endocrine treatment or stop treatment prematurely, according to a study published in the March issue of Breast Cancer Research and Treatment.

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Endometriosis Surgery Linked to Lower Ovarian Cancer Risk

TUESDAY, April 16 (HealthDay News) -- Women who undergo surgical treatment for endometriosis have a significantly lower risk of developing ovarian cancer, according to a study published online April 8 in Acta Obstetricia et Gynecologica Scandinavica.

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Similar Outcomes for Robotic, Laparoscopic Prostatectomy

TUESDAY, April 16 (HealthDay News) -- For men undergoing routine surgical treatment for localized cancer of the prostate, robot-assisted radical prostatectomy (RALP) does not result in better functional outcomes compared to laparoscopic radical prostatectomy (LRP), according to a study published in the April issue of Urology.

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Review Addresses Need for 'Sharps' Injury Prevention Efforts

TUESDAY, April 9 (HealthDay News) -- Injuries caused by needles and other sharp instruments are a major occupational hazard for health care providers, particularly surgeons, with significant health risks and cost impact, and there is a need for enhanced preventive efforts, according to a special article published in the April issue of Plastic and Reconstructive Surgery.

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In-Transit Melanoma Advance Is Difficult to Predict

MONDAY, April 15 (HealthDay News) -- Progressive disease cannot be reliably predicted by patient, clinical, or procedural factors in patients receiving regional therapy for advanced melanoma of the extremities, according to a study published online April 3 in JAMA Surgery.

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Laparoscopic Hysterectomy Rates on Rise Over Past Decade

MONDAY, April 15 (HealthDay News) -- The rate of laparoscopic hysterectomy has greatly increased over the past decade and is now higher than that of abdominal hysterectomy, according to a study in the April issue of the American Journal of Obstetrics & Gynecology.

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Re-Op Rates ID'd for Herniated Intervertebral Disc Disease

MONDAY, April 15 (HealthDay News) -- For patients undergoing surgery for lumbar herniated intervertebral disc disease, reoperation rates reach 13.4 percent after five years, with more than half of reoperations occurring in the first year, according to a study published in the April 1 issue of Spine.

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Transgastric Appendicectomy Is Feasible for Select Patients

FRIDAY, April 12 (HealthDay News) -- A minimally invasive surgical technique for acute appendicitis that uses one transumbilical 5-mm incision seems feasible for select patients with acute appendicitis, according to a study published online April 11 in the British Journal of Surgery.

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Surgeons Reach Radiation Limits With 291 PELDs Per Year

FRIDAY, April 12 (HealthDay News) -- Surgeons performing minimally invasive transforaminal percutaneous endoscopic lumbar discectomy (PELD), involving fluoroscopy, are exposed to the maximum allowable radiation dose after 291 procedures performed without protective shielding, according to a study published in the April 1 issue of Spine.

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Surgeons Support Nonphysician Screens for Low Back Pain

FRIDAY, April 12 (HealthDay News) -- Most spine surgeons are interested in a nonphysician clinician (NPC) model of care for screening of low back or low back-related leg pain for patients referred for a surgical assessment, according to a study published in the April 1 issue of Spine.

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ACS: Room for Improvement in Cancer Prevention, Detection

THURSDAY, April 11 (HealthDay News) -- Despite improvements in aspects of cancer prevention and early detection, more systematic efforts to reduce tobacco use and obesity, and expand the use of screening tests could prevent much of the suffering and death of cancer, according to a report published online April 11 by the American Cancer Society.

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Speech Details Practices to Improve U.S. Health Systems

THURSDAY, April 11 (HealthDay News) -- There are specific steps health care providers and policymakers should take to create high-quality, patient-centered care at lower costs, according to remarks made in an April 9 speech to the National Press Club.

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Readmission Rates ID'd After Spine Stenosis Decompression

THURSDAY, April 11 (HealthDay News) -- For patients undergoing lumbar spine stenosis decompression surgery with or without fusion, the one-year readmission rate is 9.7 or 7.2 percent, respectively, according to a study published in the April 1 issue of Spine.

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Fusion Doesn't Up Reoperation Risk With Spinal Stenosis

THURSDAY, April 11 (HealthDay News) -- For patients undergoing surgical treatment of spinal stenosis, lumbar fusion and instrumentation do not increase the rate of reoperation at index or adjacent levels compared with nonfusion techniques, according to a study published in the April 1 issue of Spine.

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Calorie Reduction, Not Bypass Surgery, Ups Diabetes Control

THURSDAY, April 11 (HealthDay News) -- Calorie reduction rather than the actual Roux-en-Y gastric bypass (RYGB) surgery seems to account for the improvement in glucose homeostasis in obese patients with type 2 diabetes who undergo RYGB, according to a study published online March 25 in Diabetes Care.

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Review Supports Fusion for Disc-Related Chronic Low Back Pain

WEDNESDAY, April 10 (HealthDay News) -- Clinical outcomes are positive for patients with chronic low back pain due to degenerative disc disease who undergo lumbar fusion, according to a review published in the April 1 issue of Spine.

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Clinical Practice Guidelines for Bariatric Surgery Are Updated

WEDNESDAY, April 10 (HealthDay News) -- Based on a review of relevant evidence, 74 recommendations have been issued in updated clinical practice guidelines for bariatric surgery, according to a study published in the March issue of Surgery for Obesity and Related Diseases.

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Radiation-Linked Heart Disease Ups Death in Cardiothoracic Sx

TUESDAY, April 9 (HealthDay News) -- Radiation-associated heart disease (RAHD) correlates with an increased risk of death in patients undergoing cardiothoracic surgery (CTS), according to a study published online April 8 in Circulation.

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Lumbar Disc Herniation Surgery Is Effective for Octogenarians

MONDAY, April 8 (HealthDay News) -- For octogenarian patients with lumbar disc herniation, unilateral laminectomy and discectomy seems safe and effective, according to a study published in the April issue of the Journal of Spinal Disorders & and Techniques.

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Degeneration Doesn't Progress to Discs Adjacent to Burst Fracture

FRIDAY April 5 (HealthDay News) -- For patients with traumatic burst fractures of the thoracolumbar spine who are treated with pedicle screw fixation and direct end-plate restoration, adjacent intervertebral discs do not routinely progress to severe degeneration at 12 to 18 months post-injury, according to a study published in the March issue of The Spine Journal.

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"Never Events" Rare After Bladder Cancer Surgery

THURSDAY, April 4 (HealthDay News) -- "Never events", ten hospital-acquired conditions deemed by the Centers for Medicare and Medicaid Services as being reasonably preventable, are rare in patients with bladder cancer who have undergone radical cystectomy, according to a study published in the March issue of Urology.

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Use of S. Aureus Vaccine Is Ineffective Before Surgery

WEDNESDAY, April 3 (HealthDay News) -- A vaccine against Staphylococcus aureus is ineffective in preventing post-operative S. aureus infection and has serious safety problems when given pre-operatively to patients undergoing cardiothoracic surgery, according to a study published online April 2 in the Journal of the American Medical Association.

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Bone Density Can Improve in Spine, Femur Post-Spine Surgery

WEDNESDAY, April 3 (HealthDay News) -- Following successful lumbar spine surgery, the bone mineral density (BMD) of the vertebral body and femoral neck can increase but appears to related to post-operative walking ability, according to a study published in the March 15 issue of Spine.

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Tonsillectomy Benefits Adults With Recurrent Pharyngitis

WEDNESDAY, April 3 (HealthDay News) --Adult patients with recurrent pharyngitis who underwent tonsillectomy had fewer symptoms of pharyngitis, thus reducing the number of medical visits and missed days from work or school, according to research published online April 2 in CMAJ, the journal of the Canadian Medical Association.

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Diabetes Affects Improvements After Lumbar Spine Surgery

TUESDAY, April 2 (HealthDay News) --Patients with diabetes who have longstanding diabetes, poor glycemic control, and use insulin had suboptimal improvements in clinical outcomes after lumbar spine surgery, according to research published March 15 in Spine.

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Most Partners of U.S. Docs Satisfied in Their Relationships

MONDAY, April 1 (HealthDay News) -- Most spouses/partners of U.S. physicians report being satisfied with their relationships, with satisfaction linked to time spent together each day, according to research published in the March issue of the Mayo Clinic Proceedings.

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Preoperative Warming Does Not Appear to Be Beneficial

MONDAY, April 1 (HealthDay News) -- Prewarming devices do not seem to affect patients' postoperative temperatures, nor do they reduce the proportion of patients who experience postoperative hypothermia, according to two studies published in the March issue of the AORN Journal.

Abstract - Fettes
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Physician's Briefing