Today’s Top Story
ACS updates Statements on Principles to address concurrent surgeries.
On April 14, 2016, the American College of Surgeons (ACS) announced it had revised its Statements on Principles to specifically cover concurrent surgeries. “Concurrent or simultaneous operations occur when the critical or key components of the procedures for which the primary attending surgeon is responsible are occurring all or in part at the same time….A primary attending surgeon’s involvement in concurrent or simultaneous surgeries on two different patients in two different rooms is not appropriate,” the statement reads in part. It also provides that during multidisciplinary operations, “it is appropriate for surgeons to be present only during the part of the operation that requires their surgical expertise. However, the attending surgeon must be immediately available for the entire operation.” In addition, ACS states that for a complex procedure at an academic medical center, multiple qualified medical providers in addition to the primary attending surgeon may be involved, and the patients should be informed “of the different types of qualified medical providers that will participate in their surgery and their respective role explained.” “The performance of overlapping procedures should not negatively impact the seamless and timely flow of either procedure,” states ACS.
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Read the ACS Statements on Principles…
Other News
Study: Rebound pain seen in use of brachial plexus blockade versus general anesthesia for distal radius fixation.
Pain control during the immediate perioperative period in patients undergoing surgical fixation for distal radius fracture was not significantly different in those receiving brachial plexus blockade versus those receiving general anesthesia, a study in Clinical Orthopaedics and Related Research reports. However, the patients who received a brachial plexus blockade did experience an increase in pain 12 to 24 hours after surgery. The authors of the randomized control trial involving a final group of 36 patients write that “acknowledging ‘rebound pain’ after the use of regional anesthesia coupled with patient counseling regarding early narcotic administration may allow patients to have more effective postoperative pain control.“
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Study finds no added benefit to decompression with fusion versus decompression alone for lumbar spinal stenosis.
A Swedish study found that, compared to decompression surgery alone, decompression with fusion did not result in superior clinical outcomes in patients with lumbar spinal stenosis, with or without degenerative spondylolisthesis. The results of the study, published in the New England Journal of Medicine, were based on 228 patients between the ages of 50 and 80 years with lumbar spinal stenosis at one or two adjacent vertebral levels. Patients had been randomly assigned to receive either decompression surgery alone (n = 117) or decompression with fusion (n = 111). The primary outcome was the Oswestry Disability Index (ODI) score. The researchers found no significant difference in the mean ODI score between the two groups at 2-year follow-up. In addition, decompression plus fusion was associated with longer surgical times, more blood loss, and higher costs, compared to decompression alone.
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Study: Surgical residency program directors report benefits from more flexible duty restrictions.
Faculty overseeing general surgery residency programs with duty restrictions more flexible than those operating under the standard Accreditation Council for Graduate Medical Education requirements reported that the more flexible duty hours programs had a more positive effect on the safety of patient care, continuity of care, and resident ability to attend educational activities. The “FIRST Trial“—the Flexibility In duty hour Requirements for Surgical Trainees trial—as reported in the Journal of the American College of Surgeons, surveyed all directors of programs participating in the trial (n = 117, of 252 accredited U.S. programs; 100 percent response rate). All the directors in the flexible-policy group indicated that “residents utilized their additional flexibility in duty hours to complete operations they started or to stabilize a critically ill patient.“
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California.
The California Senate Business, Professions, and Economic Development Committee passed a measure this week that would require certain healthcare providers on probation to share that information with patients before providing care, KQED News reports. The measure would apply to physicians, podiatrists, acupuncturists, and chiropractors. Although physicians on probation in California are already required to report the disciplinary status to their malpractice insurers and hospitals, there is no rule requiring proactive notifications of patients. The bill—opposed by the California Medical Association—needs to be passed by the appropriations committee and then by the full state Senate by June 3 before proceeding to the Assembly.
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Florida.
Yesterday, Florida Gov. Rick Scott signed a bipartisan bill that will exempt patients from having to pay for medical care performed by out-of-network providers in certain situations, Modern Healthcare reports. Under the legislation, patients who receive emergency or, in some cases, non-emergency healthcare services from an out-of-network provider at an in-network facility would only be responsible for paying their usual in-network costs. The bill also sets up a dispute-resolution process for providers and insurers to work out payment issues, based on the geographic area’s usual and customary rates.
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AAOS seeks comments for Management of Rotator Cuff Problems CPG.
AAOS is conducting a survey regarding an upcoming clinical practice guideline (CPG) on the management of rotator cuff problems. The purpose of the survey is to collect clinician topic suggestions for the CPG, which is in the early stages of development. Aggregated suggestions from the survey will be anonymously presented to the guideline workgroup.
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