Reducing  Poor Surgical  Oncology Practices

Reducing Poor Surgical Oncology Practices

As part of the American Board of Internal Medicine Foundation’s “Choosing Wisely” campaign, the American College of Surgeons (ACS) and the Commission on Cancer (CoC) have developed lists of five measures focusing on tests or procedures that are commonly ordered but not always necessary in surgery and surgical oncology. Although the ACS and CoC developed their own sets of measures, each organization strongly supports the other, according to Stephen B. Edge, MD, FACS, an executive committee member of the CoC. “These measures address the care of different patients,” he says. “The CoC addresses cancer patients in many parts of their care, whereas the ACS addresses all surgical patients.” The Commission on Cancer Measures After vetting a long list of potential measures, the CoC arrived at the measures listed in Table 1. Strong evidence supports using needle biopsy to determine if an abnormal finding may be indicative of breast cancer. Needle biopsy for a worrisome finding on breast imaging or examination improves treatment outcomes when compared with a diagnostic surgical lumpectomy, says Dr. Edge. In 2006, the Institute of Medicine recommended that all patients completing cancer treatment be given a summary of the therapies they received as well as a survivorship care plan. “This recommendation, however, is not being followed for most cancer patients,” Dr. Edge says. “The reasons are multi-faceted and include the time and effort it takes to create these plans and the difficulty in defining exactly how they should be constructed.” He adds that a survivorship plan explaining what tests patients should expect—and informing them that having more tests performed will not help—may reduce anxiety, uncertainty, and...
ATS 2014

ATS 2014

New research is being presented at ATS 2014, the American Thoracic Society’s annual meeting, from May 16 to 21 in San Diego. Meeting Highlights Risk Factors for Near-Fatal Asthma Maternal Smoking, Pediatric Asthma, & ED Visits Predicting Pediatric Sepsis in the ED Examining Mortality After LVRS Positive Airway Pressure Helpful in Bariatric Surgery Subclinical COPD & Comorbidities in Surgical Patients Patients Miss Signs of Severe Asthma Counseling Patients About Tobacco Use Gender Differences in COPD   News From the Meeting Sleep Apnea: Skipping Sleep Lab Found Cost-Effective PTSD Common Following ICU Stay Cystic Fibrosis: Once-A-Day Antibiotic Durable Sepsis a Factor in Many Hospital Deaths, Investigators Say Pirfenidone Slows Decline in Idiopathic Pulmonary Fibrosis Novel Biologic Promising for Allergic Asthma Vitamin C May Save Newborn’s Lungs When Mom Smokes Bronchial Gene Test Rules Out Lung Cancer Lung Foam Disappoints in COPD Does Tylenol Protect Kidneys in Sepsis? Vitamin D Flops as Asthma Therapy Booster Sepsis Contributes to Half of all Hospital Deaths Antioxidant No Help in IPF Nintedanib Slows IPF Progression IPF Survival Better With Novel Drug? Statins Flop in Sepsis and COPD ATS: New Leader to Push for Clinicians in Research Pulmonary Fibrosis, COPD, and Asthma Highlight ATS Meeting IPF Takes Stage at ATS   More From the Meeting Welcome Letter Registration General Information Program Overview Program At-a-Glance Abstracts Search & Itinerary CME & Nursing CE Enduring Materials Maintenance of Certification Meetings & Events Programs for Trainees Specialty Tracks Housing Information Travel Information Resource Centers Tours During ATS 2014 Twitter Scavenger Hunt ATS Convention Camp Exhibit Hall Foundation Research Program Benefit Navy Bay Bridge Run/Walk Physician Payments Sunshine...

Surgical Site Infection Rates: Good or Bad?

Postoperative acute care visits for clinically significant surgical site infections (SSIs) occurred within 14 days after 3.09 of every 1,000 ambulatory operations performed and within 30 days in 4.84 of every 1000 operations, according to a study, published in a recent issue of JAMA. The study involved 282,086 selected ambulatory surgical procedures that took place in eight states, comprising about one-third of the population of the United States in 2010. A clinically significant infection was defined as one that resulted in at least one subsequent ambulatory surgery visit or inpatient stay within 14 or 30 days. Visits to doctors offices and those sent home from emergency departments were not included. The operations included clean cases, such as anterior cruciate ligament repairs, spine surgery, various hernia repairs, and so-called clean-contaminated cases like laparoscopic cholecystectomy and hysterectomy. The authors acknowledged that the rates of clinically SSI were relatively low but were concerned that the number of infections collectively was substantial. They suggested that unspecified quality improvement efforts to prevent infections should be considered. When I first read this paper’s abstract, I was struck by just how low the rate of serious infections was, and the feeling was reinforced after reading the full text of the paper. If you look at the numbers more closely, you will find that of the 12 types of procedures investigated, there were only 867 infections within 14 days and 1,276 within 30 days. In other words, those are percentages of 0.3% and 0.48%, respectively. For comparison, a recent paper in the Journal of Surgical Research by surgeons from Johns Hopkins found that in over 600,000 operations, the...