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Occupational Injuries Among Orthopedic Surgeons

Occupational Injuries Among Orthopedic Surgeons

Orthopedic surgery requires surgeons to spend many hours per week in body positions that are known to contribute to musculoskeletal injuries. Although efforts have been made to improve ergonomics and reduce strains that occur during surgery, these techniques are often not widely adopted. Adherence to ergonomic guidelines can be difficult, and many surgeons are unaware of current guidelines. “The combination of these factors suggests that surgeons are at high risk for occupational injuries, such as carpal tunnel syndrome, back sprains, and torn ligaments,” says Manish K. Sethi, MD. “The demand for orthopedic services is growing, but we’re in the midst of a shortage of orthopedic surgeons. Injuries to orthopedists could have substantial consequences for the healthcare system.” Examining the Issue In the Journal of Bone & Joint Surgery, Dr. Sethi and colleagues assessed occupational injuries among orthopedic surgeons using an electronic survey that was sent to orthopedists in Tennessee. “There have been very few studies that have explored occupational injuries in physicians, and no studies to our knowledge have specifically involved orthopedics,” says Dr. Sethi. “Our analysis is among the first contributions to the literature on injuries among orthopedists, an area that clearly needs greater awareness.” The survey was designed to capture information about respondents’ subspecialty, practice setting, and length of time in practice as well as basic information about any injuries that were sustained. Information was also collected on how injuries affected surgeons with regard to days of work lost and if any institutional resources were made available during recovery. The study team found that 44% of respondents had sustained one or more injuries at the workplace at...
Relieving Pain in Colorectal Surgery

Relieving Pain in Colorectal Surgery

Researchers have developed enhanced recovery pathways (ERP) to improve outcomes and reduce readmissions in colorectal surgery patients. “ERP protocols use a set of standardized pre- and postoperative orders,” explains Conor P. Delaney, MD, PhD, FACS, FASCRS. “Research clearly shows that these protocols can help speed recovery and improve outcomes.” ERP protocols emphasize early mobilization after surgery, optimal analgesia, and control of intravenous fluid volumes. Patients are also encouraged to eat the day after their procedure rather than wait several days. To further improve outcomes, it has been hypothesized that adding a transversus abdominis plane (TAP) block to ERP protocols may allow patients to bypass or reduce narcotics use after surgery. TAP blocks are usually administered with ultrasound guidance, but a laparoscopic technique has been developed in which regional analgesia is injected into the abdominal wall between the oblique muscles and the transversus abdominis. “The TAP block can be given after surgery to reduce pain in the operative area,” says Dr. Delaney. “While narcotics help alleviate pain, they can slow recovery. The TAP block is different in that it wears off in time for patients to avoid the worst pain that typically occurs immediately after surgery.” Encouraging Data In a study of 100 patients published in the Journal of the American College of Surgeons, Dr. Delaney and colleagues tested the use of a laparoscopically administered TAP block as part of ERP protocols. After the block, patients were also given intravenous painkillers. According to findings, the average hospital stay after surgery dropped to less than 2.5 days for those receiving the TAP block. This was significantly lower than the 3.7 days...

The Pros & Cons of Robotic Bladder Cancer Surgery

Robotic-assisted surgical removal of the bladder is becoming increasingly popular for treating bladder cancer, despite being more expensive than traditional surgery. Benefits of the robotic approach include smaller incisions and less blood loss for patients. In addition, surgeons have a better three-dimensional view and more freedom of wrist movement when compared with conventional laparoscopy. The procedure eliminates hand tremors, making tasks like suturing easier. However, robotic surgery for this patient group is fairly new. We’re only now beginning to gather larger, more comprehensive studies comparing outcomes of traditional open surgeries with robot-assisted procedures. [polldaddy poll=7559190] A New Analysis: Robotic Surgery In the March 30, 2012 issue of European Urology, my colleagues and I had a study  published that compared perioperative outcomes and costs of open robot-assisted laparoscopic radical cystectomy. Previous comparisons have been limited to reports from high-volume referral centers and have not made direct comparisons with regard to inpatient morbidity and mortality, lengths of stay, and costs. Using a national database of in-patient information from 1,050 hospitals in 44 states, our research team examined 1,444 traditional open surgeries and 224 robotic-assisted laparoscopic procedures in 2009. Robotic surgery for bladder cancer resulted in fewer deaths during hospitalization (0% vs 2.5%) and fewer in-patient complications (49.1% vs 63.8%) when compared with open surgery. It also reduced the need for intravenous nutrition after the procedure (6.4% vs 13.3%). Patients who underwent both types of surgery spent about 8 days in the hospital. Costs of Robot-Assisted Cystectomy The costs for robot-assisted laparoscopic radical cystectomy were significantly higher, amounting to nearly $3,800 more than traditional open surgery. This may be due to longer...

Exploring Single-Incision Laparoscopic Colectomy

Single-incision laparoscopic colectomy (SILC), when performed by highly skilled surgeons, appears to be safe and feasible in highly selected patients. A review of 23 studies found an overall mortality of 0.5% and an overall morbidity of 12.9%. Just 1.6% of SILC cases were converted to open colectomy, 1.6% to handassisted laparoscopic colectomy, and 4.0% to conventional laparoscopic colectomy.   Abstract: Annals of Surgery, April 2012....
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