Convention Issue:
SAGES & ASCRS
April 2013 • Volume 40 • Number 4
GeneralSurgeryNews.com
The Independent Monthly Newspaper for the General Surgeon
Opinion
Can Hospital-Owned Practices Survive in The Long Run?
Study Rekindles Debate Over Bariatric Centers of Excellence No Difference in Outcomes With CoE Designation; Researchers Say Policy May Hinder Access; Others Poke Holes in Study
B y A rthur G ale , MD
B y C hristina F rangou
[Editor’s note: The following article was published in Missouri Medicine, January/ February 2013 issue, page 21.]
D
octors are becoming hospital employees. Private practice, which has been the dominant way physicians have practiced since the country was founded, may be a thing of the past. Doctors are closing their offices for the simple reason that
Increasing health care costs may give private practice the upper hand.
T
he debate over bariatric The report, published in the Feb. centers of excellence (CoE) pro- 27 issue of the Journal of the Amerigrams is ramping up once again with can Medical Association, submits that the publication of a study that calls on perioperative complications and reopthe Centers for Medicare erations fell over the last O R F E T N E C & Medicaid decade but not because of IATRIC CE N BAR E L L E Services(CMS) the CMS policy EXC to reconsid(309:792-799). er its policy of “We could restricting covernot attribute age to designatany outcome ed centers.
hospitals give them a hefty signing bonus for the first year or two, and the government and insurance companies reimburse them at higher levels as hospital employees than they can obtain in private practice. Hospitals buy doctors’ practices in order to lock in referral sources for inpatient
see Bariatric page 16
Laparoscopy: The Controversial Beginnings of a Surgical Revolution
see Private Practice page 32
B y V ictoria S tern
T
REPORT ®
Teflaro (ceftaroline fosamil) for the Treatment of Acute Bacterial Skin and Skin Structure Infections Caused by Designated Susceptible Bacteria See insert at page 8
he emergence of laparoscopy and laparoscopic technologies has represented one of the most essential paradigm shifts in the practice of surgery. Surgical practice has witnessed the introduction of the aseptic technique, general anesthesia and antibiotics, all of which
decreased patients’ pain and the rate of infection during surgery. “There are milestones in the progress of modern surgery that cannot be denied,” said Robert Sewell, MD, a general surgeon at the Master Center for Minimally Invasive Surgery,
INSIDE Tumor Board
4
Experts Discuss: Is Lap Distal Pancreatectomy ‘Gold Standard’ for Pancreatic Cancer?
In the News
Clinical Review
6
20
In the News
Opinion
Molecular Subtyping of Colorectal Cancer Shows Early Promise
14
Incidence of ARDS Declining in Trauma
Systemic Strategies for Reducing Blood Loss in Surgery
34
‘Bitter Pill’ Should Be A Wake-Up Call
see Laparoscopic Beginnings page 8
®
Hospitals Battle Surge in Superbugs Klebsiella Takes the Lead B y K aren B lum
H
ospital clinicians face several challenges in helping manage antibiotic-resistant, gram-negative superbugs that produce carbapenemases. One of the most worrisome is Klebsiella pneumoniae (KPC). A report in the March issue of Infection Control and Hospital Epidemiology (2013;34:259268) found that the proportion of K. pneumoniae cases resistant to carbapenems increased from 0.1% in 2001 to 4.5% in 2010. “That is huge,” said Robert Rapp, PharmD, professor of pharmacy and surgery emeritus at the University of Kentucky Medical Center in Lexington, one of many pharmacists concerned about KPC. Those concerns were compounded by the Centers for Disease Control and Prevention’s own report on the rising prevalence of carbapenem-resistant enterobacteriaceae (CRE). According to the
see Superbugs page 28
Procedural Breakthrough Innovations in Fully Wristed Vessel Sealers for Robotic Surgery see page 10
New Product
see page 38