Breaking News
March 20, 2019 - Leaky valve repair improves quality of life in heart failure patients
March 20, 2019 - Diattenuation Imaging offers structural information of difficult to access brain regions
March 20, 2019 - Early sports specialization linked to increased injury rates during athletic career
March 20, 2019 - Study brings clarity about milk intake for children with Duarte galactosemia
March 20, 2019 - Allergan Announces FDA Acceptance of New Drug Application for Ubrogepant for the Acute Treatment of Migraine
March 20, 2019 - Maternal smoking during pregnancy increases risk of ADHD among offspring up to three-fold
March 20, 2019 - Pioneering pediatric kidney transplant surgeon Oscar Salvatierra dies at 83 | News Center
March 20, 2019 - F.D.A. Approves First Drug for Postpartum Depression
March 20, 2019 - TB remains a major public health challenge in the European region
March 20, 2019 - Most pills contain common allergens, warn experts
March 20, 2019 - Researchers discover previously unknown mechanism by which cells can sense oxygen
March 20, 2019 - World’s leading source of data on diagnosis, treatments for aortic dissection
March 20, 2019 - Breast cancer relapse predictor may soon be a reality
March 20, 2019 - Researchers identify origin of chronic pain in humans
March 20, 2019 - Two-drug combinations containing calcium channel blocker significantly lowers BP
March 20, 2019 - King’s scientists to monitor air quality exposure of 250 children
March 20, 2019 - Preventative cardioverter defibrillator implantation is of little benefit to kidney dialysis patients
March 20, 2019 - Merck to collaborate with GenScript for plasmid and virus manufacturing in China
March 20, 2019 - FDA Approves Zulresso (brexanolone) for the Treatment of Postpartum Depression
March 20, 2019 - Study examines long-term opioid use in patients with severe osteoarthritis
March 20, 2019 - Retired Stanford professor Edward Rubenstein, pioneer in intensive care medicine, dies at 94 | News Center
March 20, 2019 - Aaron Diamond AIDS Research Center to Join Columbia University
March 20, 2019 - Call for halt to human gene editing and designer babies experiments
March 20, 2019 - Study illuminates how hot spots of genetic variation evolved in the human genome
March 20, 2019 - Roundworm study suggests alternatives for treatment of schizophrenia
March 20, 2019 - Sphingotec reports new applications of bio-ADM at 39th ISICEM
March 20, 2019 - Preventing falls through free community-based screenings for older adults
March 20, 2019 - AAOS: Supplement Use Low in Patients With Osteoporosis, Hip Fracture
March 20, 2019 - Does intensive blood pressure control reduce dementia?
March 20, 2019 - Nut consumption could be key to better cognitive health in older people
March 20, 2019 - Drinking hot tea associated with increased risk of esophageal cancer
March 20, 2019 - Androgen receptor plays vital role in regulating multiple mitochondrial processes
March 20, 2019 - NIH announces funding boost for Detroit Cardiovascular Training Program
March 20, 2019 - Study reveals another surgical option for patients with irreparable rotator cuff tears
March 20, 2019 - New robot-guided video game may be effective and low-cost solution for caregivers
March 20, 2019 - Heart Attacks Fall By One-Third Among Older Americans
March 20, 2019 - Data sharing uncovers five new risk genes for Alzheimer’s disease
March 20, 2019 - Does It Make Sense To Delay Children’s Vaccines?
March 20, 2019 - Lack of health insurance may increase Aging immigrants’ risk for cardiovascular disease
March 20, 2019 - Piece of puzzle unlocked in what drives alcohol addiction
March 20, 2019 - Researchers investigate whether Zika reservoirs are found in the Americas
March 20, 2019 - Compounds found in coffee may inhibit growth of prostate cancer
March 20, 2019 - Lab Innovations returns to the NEC on 30 & 31 October 2019
March 20, 2019 - How genes affect tobacco and alcohol use
March 20, 2019 - Osteoarthritis and rheumatoid arthritis have similar impacts on patients
March 20, 2019 - Individuals with infection history have higher risk of developing Sjögren’s syndrome
March 20, 2019 - Nursing home residents benefit from individualized multi-component exercise program
March 20, 2019 - Plant cellulose bone implants are “viable” option to support new bone growth, study finds
March 20, 2019 - Older people living in retirement communities benefit from improved health
March 20, 2019 - UTSA professor helps train first responders to detect prescription opioid overdoses
March 20, 2019 - Biohaven’s Verdiperstat Receives Orphan Drug Designation From FDA For Multiple System Atrophy
March 20, 2019 - Smoking may limit body’s ability to fight dangerous form of skin cancer
March 20, 2019 - Researchers receive $9.7-million grant to develop new hearing-loss treatments for deaf
March 20, 2019 - TGen and ABL sign agreement to distribute new TB test technology
March 20, 2019 - UCD researchers lead development of new urine test to detect prostate cancer
March 20, 2019 - Miniature brains that can move muscles, grown in the lab
March 20, 2019 - Servier and Oncodesign announce research and drug development partnership
March 20, 2019 - FDA warns marketer of unapproved products claiming to treat addiction, chronic pain
March 20, 2019 - TB Medicine Pretomanid Enters Regulatory Review Process in the United States
March 20, 2019 - Breastfeeding can erase effects of prenatal violence for newborns
March 20, 2019 - Tens of Thousands of Heart Patients May Not Need Open-Heart Surgery
March 20, 2019 - Space worries – shingles affecting astronauts says NASA
March 20, 2019 - Study shows how AI can improve physicians’ diagnostic accuracy
March 20, 2019 - Dolomite Bio launches new scRNA-Seq Reagent Kit at AGBT 2019
March 20, 2019 - World’s oldest semen viable for artificial insemination
March 20, 2019 - FDA Approves Zulresso (brexanolone) for the Treatment of Post-Partum Depression
March 19, 2019 - How it manipulates us to tribalism
March 19, 2019 - How can doctors encourage patients to adopt healthier behaviors?
March 19, 2019 - Meet Hal: He's One Sick Robot
March 19, 2019 - Blood test and mathematical model can estimate preterm birth rate in low-resource countries
March 19, 2019 - TAVR procedure safe in patients with unusual valve anatomy
March 19, 2019 - Proteins in the eye may be potential source for cost-effective test to predict Alzheimer’s disease
March 19, 2019 - Opioid Prescriptions Dropped for New Users From 2012 to 2017
March 19, 2019 - New method may better predict the best treatment for burn wounds
March 19, 2019 - “Asian” isn’t specific enough for health data, research suggests
March 19, 2019 - ColumbiaDoctors Presents Honors for Outstanding Commitment to Patient Safety
March 19, 2019 - Innovative model identifies primate species with potential to transmit Zika in the Americas
March 19, 2019 - One-off surgery could offer hope to patients with high blood pressure
March 19, 2019 - Many pet owners interested in feeding their pets with plant-based diet
March 19, 2019 - How to Protect Your Kids From Drowning
Minimally invasive surgeries underused in older patients, new study finds

Minimally invasive surgeries underused in older patients, new study finds

image_pdfDownload PDFimage_print
Minimally invasive surgeries are associated with improved outcomes, but older patients undergo far fewer of them than the general population, a new study finds. Credit: iStock

A study of more than 200,000 Medicare patients who had common surgical procedures shows that, compared to the general population, they underwent far fewer minimally invasive operations, whose benefits include lower rates of complications and readmissions, along with shorter hospital stays.

A report of the findings, published Feb. 26 in Surgical Endoscopy, suggests that the disparities short-circuit the potential for better care and cost savings, researchers say.

“This study shows there is an opportunity for Medicare and other payers to spend health care dollars more wisely so that they reward high-value care over low-value care” says Martin Makary, M.D., M.P.H., professor of surgery at the Johns Hopkins University School of Medicine and a widely published expert on health care disparities and quality improvement programs.

The Centers for Medicare & Medicaid Services accounts for the second largest government expenditure (the military is first), and Medicare—the federal insurance program for those over 65, younger disabled people and those with end-stage kidney disease—insures roughly a quarter of all Americans, says Makary. All told, Medicare expenditures were nearly $600 billion in 2016.

In an effort to highlight potential efficiencies and cost savings, Makary and his team focused on the use of minimally invasive surgery (MIS) in elderly patients. Previous studies have shown that MIS is associated with lower postoperative complication rates, readmission rates, mortality and health care costs, as well as shorter lengths of stay. These improved outcomes stand to benefit elderly patients as much as nonelderly patients, yet MIS is still underused. For select operations, the use of MIS nearly eliminates the risk of a wound infection, and for others, it halves the overall complication rate.

Makary says that complication prevention is a key goal in older, sometimes frail patients because a single complication can lead to a cascade of harmful and costly events. The new study provides a comprehensive review of data for seven surgical procedures: cholecystectomy (gallbladder removal), bariatric, colectomy, hysterectomy, inguinal hernia, thoracic and ventral hernia.

For the study, Makary and colleagues used the 2014 Medicare Provider Analysis and Review Inpatient Limited Data Set to identify patients who underwent the seven common procedures. The research team also evaluated odds of complications and readmissions for any cause within 30 days.

Data from 233,984 patients (102,729 who underwent standard operations and 131,255 who underwent MIS procedures) showed that MIS complication rates were lower for five of seven procedures examined. Readmission rates after MIS were lower for six procedures (with the exception of inguinal hernia) and MIS was associated with less time in the hospital for six procedures.

An analysis of Medicare costs also showed that MIS costs were lower for four procedures. And overall, MIS use was greater in the general population than in Medicare population for all procedures.

One limitation of the study was that candidacy for MIS can be difficult to determine on a population level. But, he said, he believes that the study supports the idea that “underuse of MIS for eligible candidates in the Medicare population is an example of low-value care.”


Explore further:
Common knee operation in elderly constitutes low value care, new study concludes

More information:
Caleb J. Fan et al. Minimally invasive versus open surgery in the Medicare population: a comparison of post-operative and economic outcomes, Surgical Endoscopy (2018). DOI: 10.1007/s00464-018-6126-z

Provided by:
Johns Hopkins University

Tagged with:

About author

Related Articles