Breaking News
April 23, 2018 - CDC seeking $400 million to replace lab for deadliest germs
April 23, 2018 - Sensirion to present single-use liquid flow sensor at COMPAMED 2017
April 23, 2018 - FDA approves contact lenses that shade the sun
April 22, 2018 - Concussion recovery and symptom severity found to vary between men and women
April 22, 2018 - C. Difficile Risk Higher With Stoma Reversal Versus Colectomy
April 22, 2018 - Repeated ranibizumab doesn’t impair macular perfusion
April 22, 2018 - New microscope reveals how cells behave in 3D and real time inside living organisms
April 22, 2018 - Study shows clinical benefit and monetary gains of weight-loss surgery
April 22, 2018 - GNA Biosolutions launches world’s first Laser PCR platform at Medica Trade Fair
April 22, 2018 - Researchers present simulation model to investigate hospital responsiveness to mass casualty incidents
April 22, 2018 - Does Pot Really Dull a Teen’s Brain?
April 22, 2018 - Controversial pregnancy test drug shows deformities in zebrafish embryos within hours of exposure
April 22, 2018 - New research partnership makes childbirth safer in Mozambique
April 22, 2018 - Brief bedside visual art intervention reduces pain, anxiety in cancer patients
April 22, 2018 - The memory part of the brain may also hold clues for anxiety and depression
April 22, 2018 - AYOXXA to develop multiplex immunoassay to support treatment of sepsis patients
April 22, 2018 - New Drug Combo Ups Survival in HER2/neu Uterine Serous Cancer
April 22, 2018 - Researchers chart a new way to look at concussion
April 22, 2018 - Every parent needs to know fundamental red flags for autism
April 22, 2018 - Anatotemp expands anatomic dental implant healing abutments with 4Side anti-rotational connection
April 22, 2018 - Gene Twist Can Make Your Blood Pressure Spike From Salt
April 22, 2018 - Study suggests failed osteoarthritis drug could help treat opioid addiction
April 22, 2018 - More Americans aware of growing problem of opioid addiction
April 22, 2018 - KHN’s ‘What the Health?’ Nothing in health care ever goes away
April 22, 2018 - BGS to promote high-quality sterilization services at Health GB in Manchester
April 22, 2018 - New integrated POC tool detects biomarkers of heart failure rapidly and precisely
April 22, 2018 - Direct electrical current can be delivered to nerves for blocking pain signals
April 22, 2018 - Newly Published Phase 2 Study Found Esketamine Demonstrated Significantly Rapid Improvements in Depressive Symptoms and Suicidality
April 22, 2018 - Healthy red blood cells owe their shape to muscle-like structures
April 22, 2018 - Researchers present case study of management of rheumatic mitral regurgitation in woman contemplating pregnancy
April 22, 2018 - New black Porvair Krystal UV Quartz microplates for Circular Dichroism measurements
April 22, 2018 - Advanced flow chemistry modules enhance control of nanoprecipitation
April 22, 2018 - Look! Down in the petri dish! It’s a superplatelet!
April 22, 2018 - Research reveals why people with tetraplegia more likely to suffer from sleep apnea
April 21, 2018 - New non-invasive nerve stimulation may offer relief for people with hand tremor
April 21, 2018 - Smartphone App May Up Medication Adherence in HTN
April 21, 2018 - Western diet depletes artery-protecting immune cells
April 21, 2018 - Excelitas Technologies launches new powerful LED light source for fluorescence microscopy
April 21, 2018 - Academia and high tech companies join forces to increase production capacity for microfluidic systems
April 21, 2018 - Developing cooking skills as young adult may have long-term health benefits
April 21, 2018 - Study compares survival outcomes of different drugs for type 2 diabetes
April 21, 2018 - More Than 40 Percent of Americans Breathe Dirty Air: Report
April 21, 2018 - Obstructive sleep apnea – Genetics Home Reference
April 21, 2018 - More evidence shows exposure to traffic and outdoor air pollution increases risk of asthma
April 21, 2018 - Novel gold nanoparticle technology could guide cancer treatment in real-time
April 21, 2018 - News coverage of Ebola impacted public’s perception on disease and survivors
April 21, 2018 - S.Africa’s DIY battle against HIV
April 21, 2018 - Children with autism have gastrointestinal and immune system deregulation, research finds
April 21, 2018 - Human brain processes sight and sound in the same way, shows study
April 21, 2018 - Evolutionary history of tumor helps predict severity of prostate cancer
April 21, 2018 - Pepper plant metabolizes antibiotic in personal care products
April 21, 2018 - Tradeshow Talks with Integra
April 21, 2018 - EPFL becomes part of Chan Zuckerberg’s project to develop Human Cell Atlas
April 21, 2018 - Pfizer Announces Positive Topline Results From Phase 3 ATTR-ACT Study Of Tafamidis In Patients With Transthyretin Cardiomyopathy
April 21, 2018 - Breaking through the HIV vaccine ‘logjam’
April 21, 2018 - IntelliCyt introduces new QSol buffer to enable robust, consistent sampling
April 21, 2018 - Scientists publish comprehensive lineage tree of whole adult animal in Science journal
April 21, 2018 - Innovative method based on FluidFM technology could revolutionize biological research
April 21, 2018 - Americans world’s biggest TV addicts, watching four hours a day
April 21, 2018 - Investigational drug may help increase protein levels in babies with spinal muscular atrophy
April 21, 2018 - Study shows distinctions between age groups in predicting and responding to stress at home
April 21, 2018 - Aziyo Biologics, BIOTRONIK enter into US co-distribution agreement
April 21, 2018 - Opiate Use Linked to Early Mortality in IBD Patients
April 21, 2018 - Online ads help pregnant smokers quit
April 21, 2018 - Opioid pain medications may not be safe for hemodialysis patients
April 21, 2018 - Rare variants in non-coding DNA inherited from parents heighten autism risk
April 21, 2018 - A needleless glucose monitor for diabetes patients
April 21, 2018 - BD introduces new informatics and automation solutions for clinical laboratories
April 21, 2018 - Turn Chores Into a Fitness Routine
April 21, 2018 - DNA methylation plays key role in stem cell differentiation
April 21, 2018 - Scientists find link between soil metals and cancer mortality
April 21, 2018 - Experts discuss implications of low calcium intake in global population
April 21, 2018 - GNA Biosolutions to display Pharos V8 Laser PCR instrument at Analytica trade fair
April 21, 2018 - People with vitamin D deficiency may be at greater risk of diabetes
April 21, 2018 - Study findings could open new possibilities for treating cancer with adenovirus
April 21, 2018 - People who use medical marijuana have higher rates of prescription drug use, study finds
April 21, 2018 - Study debunks ‘myth’ that strenuous exercise dampens immunity
April 21, 2018 - FDA approves marijuana based medication for epilepsy treatment
April 21, 2018 - Researchers find novel genes for longevity in mammals
April 21, 2018 - GNA Biosolutions and project partners launch new research project to develop TB diagnostic platform for POC applications
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