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In The News

Surgeon Burnout: A Systematic Review

Francesca Dimou, MD is interviewed by MedicalResearch.com on the epidemic of burnout among surgeons. Read the full story here.


PREOP-gallstones: Surgeon Develops Prediction Model For Elective Gallbladder Removal

Taylor S. Riall, MD, PhD is interviewed by Marie Benz, MD, FAAD about her study on a prediction model for elective colecystectomy on MedicalResearch.com. Read the full story here.


Failure to Perform Cholecystectomy for Acute Cholecystitis in Elderly Patients Is Associated with Increased Morbidity, Mortality, and Cost

Taylor S. Riall, MD, PhD, Dong Zhang, PhD, Courtney M.S. Townsend Jr. MD, FACS, Yong-Fang Kuo, Ph.D., and James S. Goodwin, M.D.
Read the article on the Wall Street Journal.

Surgery: Delaying gallbladder removal for elderly patients resulted in higher hospital readmissions and hastened death, according to a study in the Journal of the American College of Surgeons. Every year, about 1% to 4% of the 20 million Americans with gallstones develop further complications. Researchers analyzed Medicare data for nearly 30,000 patients hospitalized with one of the most common complications, gallbladder inflammation known as acute cholecystitis. Though cholecystectomy—removal of the gallbladder— is the recommended treatment, only 75% of patients got the surgery during their first hospitalization. Of the remaining patients, 38% returned to the hospital for gallstone-related problems during the following two years, compared to just 4% of the initial cholecystectomy patients. The delayed-cholecystectomy patients were also 56% more likely to die during those two years.

Caveat: Medicare records don't reveal many clinical details, such as how long patients waited to present their acute cholecystitis to the hospital or the specific reasons a doctor gave for delaying surgery.


Growth in the Care of Older Patients by Hospitalists in the United States

Yong-Fang Kuo, Ph.D., Gulshan Sharma, M.D., M.P.H., Jean L. Freeman, Ph.D., and James S. Goodwin, M.D.
Read the article in Reuters.

Abstract

Background National and population-based information on the increase in patient care by hospitalists in the United States is lacking. Methods Using a 5% sample of Medicare beneficiaries in 1995, 1997, 1999, and the period from 2001 through 2006, we identified 120,226 physicians in general internal medicine who were providing care to older patients in 5800 U.S. hospitals. We defined hospitalists as general internists who derived 90% or more of their Medicare claims for evaluation-and-management services from the care of hospitalized patients. We then calculated the percentage of all inpatient Medicare services provided by hospitalists and identified patient and hospital characteristics associated with the receipt of hospitalist services. Results The percentage of physicians in general internal medicine who were identified as hospitalists increased from 5.9% in 1995 to 19.0% in 2006, and the percentage of all claims for inpatient evaluation-and-management services by general internists that were attributed to hospitalists increased from 9.1% to 37.1% during this same period. Accompanying the increase in care by hospitalists was an increase in the percentage of all hospitalized Medicare patients who were treated by general internists (both hospitalists and traditional, non-hospital-based general internists), from 46.4% in 1995 to 61.0% in 2006. In a multilevel, multivariable analysis controlling for patient and hospital characteristics, the odds of receiving care from a hospitalist increased by 29.2% per year from 1997 through 2006. In 2006, there was marked geographic variation in the rates of care provided by hospitalists, with rates of more than 70% in some hospital-referral regions. Conclusions These analyses of data from Medicare claims showed a substantial increase in the care of hospitalized patients by hospitalist physicians from 1995 to 2006.


Unnecessary Colon Screenings for Elderly Patients

New York Times "The New Old Age" Blog, May 25, 2011 NYT blogger Paula Span enumerates the multitude of overtreatments the country's elderly are unnecessarily subjected to — from pointless mammograms for elderly women with advanced dementia to very low blood sugar level requirements for older diabetics — and now, as shown in UTMB's Dr. James Goodwin's latest research, the overprescribing of colonoscopies for elderly patients.