The American College of Surgeons held its 2011 Clinical Congress from October 23-27 in San Francisco. The features below highlight just some of the studies that emerged from the meeting.  

» Predicting Post-Colectomy Readmissions
» Post-Mastectomy Breast Reconstruction Use 
» Timed Walking Test Predicts Outcomes in Elderly
» The Effect of P4P on Patient Care
» Getting a Faster Bacterial Infection Identification

Predicting Post-Colectomy Readmissions

The Particulars: In clinical studies, rehospitalization rates for patients who have undergone colorectal surgical procedures are as high as 40%. Predicting rehospitalization rates in this patient group may help reduce the burden on the healthcare system.

Data Breakdown: Johns Hopkins investigators reviewed data from nearly 11,000 total or partial colectomies. Of readmitted patients, 25% required reoperation. Major predictors for rehospitalization were incision site infection, need for a colostomy or ileostomy, and severity of illness score in the highest ranges. Strategies for reducing rehospitalization include: coordinatation of care at discharge among physicians, nurses, and social workers; asking patients with infections to follow-up sooner with their physicians; and increased patient education on ostomy care and nutrition.

Take Home Pearls: Researchers have identified three major predictors of rehospitalization among patients who have undergone partial or total colectomy. These three strategies appear to help reduce rehospitalization rates.

Post-Mastectomy Breast Reconstruction Use [back to top]

The Particulars: Published data have indicated that immediate (within 90 days) post-mastectomy breast reconstruction has been underutilized. Examining disparities in receipt of this surgery may improve utilization rates.

Data Breakdown: A large database review sought to characterize disparities in breast reconstruction procedures in 396,434 women who underwent mastectomy. Both autologous and implant-based breast reconstruction procedures increased in use from 12% in 1998 to 23% in 2007. However, rates seem to differ between groups of women. Women who were not African American, had private insurance, received care in an academic medical center, lived in large metropolitan communities, and lived in higher-income areas were up to twice as likely to undergo breast reconstruction.

Take Home Pearls: There appears to have been an overall increase in utilization of post-mastectomy breast reconstruction from 1998 to 2007. However, disparities remain between women that undergo these procedures and those who do not.

Timed Walking Test Predicts Outcomes in Elderly [back to top]

The Particulars: More than half of all operations in the United States are performed on patients aged 65 and older. Accurate tools are needed to predict postoperative adverse outcomes.

Data Breakdown: In a study, preoperative timed-up-and-go tests were performed on elderly patients scheduled for cardiac or colorectal surgery. Among cardiac surgery patients whose walking speed was slow, 73% were discharged to an institutional care facility, compared with 17% for those with a fast walking speed. Length of stay (LOS) was 2 days longer for the slow-walking group. Just 13% of the fast-walking group experienced more than one postoperative complication, compared with 37% for the slow-walking group. Among colorectal patients, rates of discharge to an institutional care facility were 59% for the slow-walking group and 5% for the fast-walking group. LOS was 8 days longer for the slow-walking group. More than one postoperative complication was experienced by 56% of the slow-walking group and 20% of the fast-walking group.

Take Home Pearl: The timed-up-and-go test appears to accurately predict postoperative adverse outcomes in elderly cardiac and colorectal surgery patients.

The Effect of P4P on Patient Care [back to top]

The Particulars: More and more healthcare centers throughout the United States are initiating pay-for-performance (P4P) programs to cut costs. Data are lacking on whether P4P programs lead to better or worse patient care.

Data Breakdown: A data review was conducted of 1,768 cases for eight types of major operations, including gastric bypass, appendectomy, colorectal operations, carotid artery endarterectomy, and pneumonectomy. After initiation of P4P programs at several hospitals, complications—136 variables, including pre- and perisurgical risk factors— and death rates did not change appreciably. For example, colorectal operation complication rates dropped from 30% before P4P to 22% after. While lung operation complication rates rose slightly, death rates declined slightly. No evidence of physician avoidance of sicker, frailer patients emerged in the analysis.

Take Home Pearl: P4P programs appear to have no statistically significant impact on quality of care when quality variables are implemented.

Getting a Faster Bacterial Infection Identification [back to top]

The Particulars: Patients currently must wait up to 6 hours before Staph infections can be identified by diagnostic tests. Another 24 to 72 hours are needed to determine which antibiotics may treat the infection. Treatment of patients with antibiotics that are hoped to work during these wait times has been blamed for the rise in antibiotic resistance.

Data Breakdown: Raman spectroscopy was used in a study to distinguish MSSA from MRSA. It had 90.2% accuracy. For MRSA from reduced susceptibility to vancomycin-MRSA, the accuracy was 96.3%. After creating a performed model of the Raman spectra through a statistical program, investigators classified the bacteria as one of four strains with 98% accuracy. Efforts are underway to allow for diagnosis in as little as 10 minutes.

Take Home Pearls: Raman spectroscopy appears to identify Staph infections much earlier than current methods. Earlier identification may allow for cost savings through earlier treatment when compared with using antibiotics that are hoped to work and then switching to others when they fail.