Презентация на тему Hot Topics in Surgery 2015

READMISSION RATES American Society of Metabolic and Bariatric Surgery

The issue of unnecessary hospital readmissions is now front and center in the national conversation about the quality of healthcare. The first national quality improvement project for the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) is “DROP,” or Decreasing Readmission through Opportunities Provided.

The program is specifically aimed at reducing 30-day readmission rates following bariatric surgery. The program will establish national standards for facilities and surgeons performing bariatric surgery based upon a registry of more than 700 bariatric programs to establish best practices and recommendations for quality improvement.

READMISSION RATES American Society of Metabolic and Bariatric Surgery

The bariatric program at Stanford University saw hospital readmission rates drop by 75% and surgical-site infections decline by 60% after changes in patient education, discharge planning and pre-operative procedures.

READMISSION RATES American Society of Metabolic and Bariatric Surgery

The society has a target of reducing 30-day readmission rates by 20% in 2015. With an average price tag of $30,000 per patient, if readmissions were decreased 20% nationwide, it would decrease healthcare costs by $50-60 million.

READMISSION RATES American Society of Metabolic and Bariatric Surgery

Bile duct injury (BDI) can be a devastating complication of cholecystectomy, one of the most commonly performed surgical procedures in the world. It has been reported to occur in 0.2 to 1% of laparoscopic cholecystectomies.

BILE DUCT INJURIES Society of American Gastrointestinal and Endoscopic Surgeons

While the human costs of BDI cannot easily be measured, the economic burden associated with BDI has been reported to range from $613,588 to $788,586 per million population.

BILE DUCT INJURIES Society of American Gastrointestinal and Endoscopic Surgeons

The SAGES Safe Cholecystectomy Program offers strategies for minimizing bile duct injuries, while the SAGES Task Force on Safe Cholecystectomy will look to establish a universal culture of safety for cholecystectomy in an effort to reduce billary injuries.
There will also be a half-day session devoted to preventing BDI and improving safety in cholecystectomy during the 2015 SAGES meeting.

BILE DUCT INJURIES Society of American Gastrointestinal and Endoscopic Surgeons

Technology, such as power morcellation, has allowed minimally invasive hysterectomies to be performed in 50,000 – 150,000 patients annually. Without it, most hysterectomy cases would convert to open procedures and robotic single site hysterectomies would be impossible.

POWER MOCCELLATION
American Association of Gynecologic Laparoscopists

However, this technique has come under scrutiny because of the risk of exposing the peritoneal cavity to an undetected uterine malignancy during morcellation.

It is the AAGL’s position that power morcellation should improve but not be abandoned, and that power morcellation with appropriate informed consent should remain available to appropriately screened, low-risk women.

POWER MOCCELLATION
American Association of Gynecologic Laparoscopists

In 2012, the U.S. Preventive Services Task Force (USPSTF) said prostate-specific antigen (PSA) tests to screen for prostate cancer should not be used regardless of risk and gave PSA-based screening a grade of “D.”
The recommendation prompted the AUA to formally support the USPSTF Transparency and Accountability Act, which would ensure that Medicare or other payers cannot deny payment for a preventive service solely based on the Task Force grade.

COVERAGE FOR PSA SCREENING
American Urology Association

According to the AUA, instead of instructing primary care physicians to discourage men from having a PSA test, the Task Force should focus on how best to educate primary care physicians regarding targeted screening and how to counsel patients about their prostate cancer risk.

COVERAGE FOR PSA SCREENING
American Urology Association

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