Hospitals may be misleading their patients about the superiority of robotic surgery over conventional surgery, according to new research from Johns Hopkins.

Robotic surgery is the latest high tech thing, and many facilities are investing heavily in equipment that they then tout on their websites. But much of the information and images are provided by the manufacturers, said Dr. Marty Makary, an associate professor of surgery at Hopkins’s School of Medicine and the study leader.

Four in 10 hospital websites out of 400 analyzed were publicizing the use of robotic surgery for minimally invasive surgery, and most said it’s better, though there have been no randomized, controlled studies, Makary said. And the hospitals don’t even say to what surgery the robotics are being compared.

“The public regards a hospital's official website as an authoritative source of medical information in the voice of a physician,” Makary said in a statement. “But in this case, hospitals have outsourced patient education content to the device manufacturer, allowing industry to make claims that are unsubstantiated by the literature. It's dishonest and it's misleading.”

Use of robotics has grown 400 percent in the last four years for common procedures such as gynecological, heart and prostate surgeries, Makary said. He said manufacturers can’t back up claims that robotics are more precise and make smaller incisions and lead to shorter hospitals stays and less pain. 

Makary, reporting online in the Journal for Healthcare Quality, said they take more time so they keep patients under anesthesia longer. They also are more expensive.

Anyone have robotic surgery?

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Categories: Surgery
        

By adopting environmentally-friendly approaches to surgery, hospitals can reduce their carbon footprint, cut health care costs and keep patients safe, according to a new study by Johns Hopkins researchers that offers some strategies for going green.

Health care facilities produce more than 6,600 tons of waste each day and more than 4 billion pounds every year. Only the food industry produces more waste, according to background information in the article. Cleaning and reusing tools once labeled for one-time use is one way to save costs and cut down on waste and Meredith wrote last year about hospitals efforts to do so.

But this new study appearing in the latest Archives of Surgery zeros in on the waste in surgical rooms. Consider that operating rooms and labor and delivery suites account for about 70 percent of hospital waste, according to the researchers. ORs are known for keeping sterilized equipment open -- even if it's never used -- and using expensive overhead lights.

They also do a poor job at disposing of medical waste. 

Surgical rooms often use two types of bags to dispose of waste: red bags for pathologic waste and clear bags for noninfectious waste, explains a release about the study. Nearly 90 percent of what ends up in the red bags -- which cost more to process -- could be tossed elsewhere, according to Dr. Martin A. Markey, an associate professor of surgery at the Johns Hopkins University School of Medicine and the study's author.

After a while that gets super expensive. "Although hazardous and regulated medical waste (equivalent to infectious waste) makes up only 24 percent of medical waste, it accounts for 86 percent of costs," the study concluded.

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Categories: Surgery
        

Diabetics who undergo weight-loss surgery can often get off their drugs, according to a new study from Johns Hopkins researchers.

The large national study showed that three-quarters of obese diabetics can ditch the insulin and other sugar-controlling drugs within six months.

That not only frees them of daily shots but can save on medical spending. The study found three years after surgery, average costs dropped more than 70 percent annually.

 “The cost to care for the average obese diabetic person in America is $10,000 a year, which could be cut to $1,800 with a very safe operation that eliminates more than 80 percent of the medications these individuals have depended on,” said Dr. Marty Makary, an associate professor of surgery at the Johns Hopkins University School of Medicine and the study's leader, in a statement. “The results show that bariatric surgery has huge implications for public health and control of health care costs.”

For the study, published in the Archive of Surgery this month, the researchers followed 2,235 adults covered by Blue Cross-Blue Shield insurance who underwent bariatric surgery between 2002 and 2005. Half were taking metformin hydrochloride and 23 percent were on insulin.

They each had bariatric surgery, which makes the stomach smaller with staples. It carries risks – though they are smaller than those associated with diabetes. And it’s costly – about $30,000 – but could save money over the long run, the researchers said.

“Until a successful nonsurgical means for preventing and reversing obesity is developed, bariatric surgery appears to be the only intervention that can result in a sustained reversal of both obesity and type 2 diabetes in most patients receiving it,” Makary said.

Photo of a needle in a bottle of insulin/Los Angeles Times

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Categories: Surgery
        

A doctor at Northwest Hospital in Randallstown recently became the first surgeon in the country to perform a specialized robotic hand surgery.

Stacey Berner, medical director of the Hand Center at Northwest, used the Da Vinci Surgical System to fix the nerves on a 20-year-old who had put his hand through glass while on vacation. One of the man's nerves had been cut in half and had large amounts of scar tissue by the time he came to Berner. 

The Da Vinci system allows for more precise cuts and other movements during surgery, Berner said. It allows the surgeon to use more steady robotic "hands" elminating the tremors and shaking that are natural in human hands.

Sitting at a console looking through a view screen, Berner used two robotic arms during the operation that he operated with each of his hands. He contolled a third robotic arm using a foot pedal. Berner viewed the operation in 3D using the Da Vinci system.

Berner and other doctors believe the robotic surgery will have better outcomes for patients than traditional surgery because it will allow the doctor to reach smaller structures around nerves. Patients may also experience less blood loss and pain. Recovery times may also be shorter.

Berner said it is too soon to tell the results of the surgery on his patient. He performed the surgery July 23.

"I talked to him the next day and he is comfortable," Berner said.

Berner trained on the Da Vinci system under a colleague in France.

The Da Vinci Surgical System has been used for other procedures such as gynecologic and prostate conditions, but has never been used for a hand surgery before.

The system is an alternative to traditional open surgery or laparoscopy surgery.

Posted by Andrea Walker at 7:00 AM | Permalink | Comments (0)
Categories: Surgery
        

If you haven't already, take a look at the fascinating profile of Hopkins kidney transplant surgeon Dr. Robert A. Montgomery that ran in Sunday's Baltimore Sun. Written by our colleague Arthur Hirsch, it's a great tale that mixes vivid description of Montgomery's nonconformist ways with the science behind the multi-way kidney transplants that he's become known for.

Known as kidney-paired donations, the transplants go beyond a mere two-way organ swap. These transplants create a chain of donors and recipients often in multiple hospitals in various locations around the country. Hopkins has been doing the swaps since 2001, and today they're duplicated at other big medical institutions as a way to make more kidneys available to more recipients. With more than 89,000 people waiting for kidneys in the U.S., it's a life-saving strategy. The story explains:

Simply put, kidney paired donation is a way to get around the problem that arises when a donor is not a good match for the intended recipient. What then? Then the names of donors and recipients, along with their blood and tissue types, are fed into a computer database in hopes of finding better matches. Sometimes those matches are with strangers thousands of miles away. In a simple two-way swap, for instance, the donor in pair A gives to the recipient in pair B and vice-versa. The more pairs in the database, the more possible matches.

A donation "chain" is a bit different. This would start with one donor giving a kidney to no one in particular, setting in motion a succession of donor-recipient couplings. At the end, a kidney would be left that could start another chain or go to a patient on the list for a kidney from a deceased donor.

And that's just the medical stuff. The piece is chock-full of Montgomery fun facts: He's married to internationally renowned opera star Denyce Graves, with whom he appears to share a love for the dramatic. He drives a white Shelby Cobra with a blue stripe down the middle. And as early as forth grade his teacher noted: "Bobby doesn't think the rules apply to him." Oh yeah, and there's that mustache!

Baltimore Sun photo

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Categories: Surgery
        

Burnout is common among surgeons and the results can be harmful for patients, new research suggests.

In a survey of 7,900 surgeons, 9 percent said they had committed a major medical error in the last three months, according to the study by researchers from Johns Hopkins and the Mayo Clinic.

Surgeons who reported burnout or depression said they were more likely to commit medical mistakes, according to the study appearing in the Annals of Surgery. Overall, 40 percent of surgeons who responded to the survey said they were burned out.

And here's a fascinating point that drives home the big picture: while surgeons don't appear to make more errors than other doctors, the consequences of these mistakes can be more severe, the article says. Some estimate that as many as 10 percent of patients are affected by such errors.

The survey, commissioned by the American College of Surgeons, asked participants about  emotional exhaustion and questions that screened for depression.

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I've always wondered if doctors are more or less apt to seek treatment for medical conditions. Well, when it comes to plastic surgery, the doctor is often the patient, a new study finds.

In a survey of 276 members of the American Society of Plastic Surgeons, 62 percent said they had gone under the knife for at least one procedure. Most receive minimally invasive procedures such as laser hair removal chemical peels and Botox -- no word of whether they throw Botox parties. A third had gone under a surgical procedure, with liposuction being the most common.

Women surgeons were more likely than men to have cosmetic surgery. The study about the survey -- appearing in the December issue of Plastic and Reconstructive Surgery -- suggests they can be an asset to patients who are trying to decide which kind of reconstructive surgery to receive.

Is this the result of sheer vanity, having all these nifty tools within an arm's reach, or true medical necessity? I wonder.

AP photo

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Posted by Kelly Brewington at 7:08 AM | Permalink | Comments (0)
Categories: Surgery
        

Two weeks ago, I walked into Mercy Medical Center with a gallbladder and was wheeled out without one.

Already, the surgery is minimally invasive. You end up with just a few small scars on your tummy. But this surgeon is among those trying to make the surgery even less invasive than that. He is among the pioneers of single-incision gallbladder surgery -- just one cut into the belly button. That's it. The result is essentially scarless. (I'd take a picture of my navel to show you, but after two children I'm not quite ready to get that personal here.) Aside from the vanity stuff, recovery times are supposed to be better (I was back at work 11 days after surgery and Kelly wants me to tell you I'm doing just fine).

Continue reading "Gallbladder surgery" »

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Categories: Surgery