An international study published in today’s Journal of the American Medical Association finds that following a simple checklist of steps can cut surgery deaths nearly in half and reduce complications by more than a third. When surgical teams used a checklist that contained such simple steps as confirming the patient’s name, marking the part of the body to be operated on, and checking that all instruments are accounted for at the end of the procedure, the rate of surgical deaths dropped from 1.5 percent of patients to 0.8 percent, a 47 percent decrease.

The large study of how to avoid blatant operating room mistakes was conducted at hospitals in Seattle; Toronto; London; New Delhi; Auckland, New Zealand; Amman, Jordan; Manila, Philippines; and Ifakara, Tanzania. The largest decreases in deaths and complications were in the developing countries, with the combined death rate for Jordan, India, Tanzania and the Philippines falling 52 percent. The study excluded heart surgeries and pediatric cases.

The World Health Organization developed the 19-point checklist as a way to standardize surgical procures, especially in developing countries where surgical environments may not be as well regulated as in the developed world. The checklist included checks on anesthesia, blood supply, sterile equipment, drugs, and even a roll call of the surgical team.

Most of the items on the list are elementary and not all the surgical teams were thrilled at the idea of using a list filled with blatantly obvious checkpoints. However, those who were initially skeptical became strong supporters of the checklist after seeing the outcome. Even the lead researcher in the study, a Harvard surgeon, was shocked by the results.

The study demonstrates that the process of painstakingly checking potential errors can help prevent careless mistakes. The study authors think that worldwide adoption of surgical checklists has the potential to prevent huge numbers of deaths and complications. The researchers also believe that such checklists could be used in other areas of medicine, such as everyday checkups and cancer treatment.

The surgical checklist has already been adopted by several countries including Britain, Ireland, Jordan, and the Philippines. In the U.S., the current standard is to use a three point checklist, but the Joint Commission that sets standards for hospitals says it is considering adopting more of the steps.

Have a question about surgery? Ask the experts at Healia Health Communities.


_{Photo: crucially, Flickr, Creative Commons}

A woman who had suffered severe facial trauma received the first face transplant in U.S history, a team of doctors announced this week. The woman had at least 80% of her face replaced by donor tissue from a cadaver, leaving only her upper eyelids, forehead, lower lip, and chin in their original form.

The 22-hour procedure performed by surgeons from the Cleveland Clinic in Ohio is the fourth face transplant ever performed and is the most extensive to date. This was the first face transplant to have included bones, along with muscle, skin, blood vessels, and nerves.

Doctors did not release the patient's name or the details of how she was injured, but said the injuries were so severe that she could not eat or breathe on her own. The woman is reportedly doing well and showing no signs of rejecting the new face two weeks after the surgery was performed.

Since a face transplant is not considered a life-saving procedure (as a heart or liver transplant would be), there are ethical issues surrounding the procedure. The patient must remain on anti-rejection drugs for the rest of her life and there is a risk of serious, even life-threatening complications. For this reason, transplants that improve the quality of life are unlikely to be common.

However, since the first partial face transplant performed in France in 2005 has proved to be very successful, surgeons now seem more comfortable with the idea of face transplants. In the near future, the procedure may become a standard in facial reconstruction, though it will likely be reserved for cases in which all other attempts at reconstructive surgery have failed.

Do you have a story about dealing with a facial injury or reconstructive surgery? Share your story on Healia Health Community for Facial Injuries and Disorders.

 

_{Photo: Crucially, Flickr, Creative Commons}

In what could be a major breakthrough for the use of tissue engineered organs, doctors from four European universities report replacing portions of a woman’s trachea (windpipe) with a new trachea made with the woman’s own stem cells. The technique will allow the woman, named Claudia Castillo, to avoid a lifetime of anti-rejection drugs and may also mark a turning point in the quest to grow new organs for use in transplants.

The procedure involved obtaining a donor trachea from a deceased patient, then used a special technique to strip away all the living, cellular material from it leaving behind only a scaffold of non-living connective tissue. The doctors used a sample of Castillo’s bone marrow to obtain adult stem cells then coaxed them to become cartilage-producing cells called chondrocytes. These cells were then used to seed the donor trachea on the outside, allowing the cells to migrate into the donor tissue and take up residence. The researchers used a similar process in order to line the inside of the donor trachea with epithelial cells.

Castillo elected to receive the transplant after a case of tuberculosis destroyed part of her trachea and one of the tubes that connect it to the lungs (bronchus), making it difficult for her to breathe and leaving her prone to infections. Her only other option was to have her lung removed, which would significantly reduce her respiratory capacity. Now, four months after the transplant, the 30 year old patient has near normal respiratory function and is showing no signs of rejecting the transplant.

The doctors believe the same technique might be used to engineer other hollow organs such as the intestine, bladder, or reproductive tract. If so, science will be that much closer to achieving the holy grail of tissue engineering: growing entire new organs in the lab.

To find out more about tuberculosis or other lung diseases, join the Healia Health Community for TB or the Healia Health Community on Lung Diseases.

 

_{Photo: NASA Kennedy Space Center (NASA-KSC)}

A new study published in the current issue of the New England Journal of Medicine (NEJM) has concluded that arthroscopic knee surgery for osteoarthritis is not more effective than physical therapy and medical management in relieving pain and stiffness associated with osteoarthritis of the knee. The study involved 178 men and women and found that those who received surgery did not have better outcomes than those who only received physical therapy and medicines.

Arthroscopy of the knee is commonly performed to treat moderate to severe osteoarthritis with hundreds of thousands of such surgeries conducted in the US every year. This and other studies call into question the necessity of knee arthroscopy for many thousands of people.

For more information, search for osteoarthritis on the Healia Search Engine or join the Healia Community on Arthritis.

Last week, the Food and Drug Administration (FDA) reinstated warnings about LASIK surgery and its potential side effects. The FDA emphasized that LASIK surgery may have certain associated risks such as lost vision, painful dry eye, glare, and other night-vision problems.

The Mayo Clinic suggests that consumers be aware of what the surgery entails and what could go wrong. There are also other vision correction options or surgeries to consider. As with all surgical procedures, make sure to weigh all the options and confirm with your doctor that you are a good candidate for whichever procedure you choose. There are several kinds of vision correction surgeries and they all have associated risks.

Do you have a question about LASIK surgery? Visit Healia Communities and Ask an Expert. If you need additional information about LASIK surgery, you can also search LASIK surgery or vision correction on healia.com.

LASIK FDA vision correction

Researchers at the University of Texas M.D. Anderson Cancer Center released a report last week stating that high-dose chemotherapy (followed by a stem-cell transplant to rebuild the immune system) after surgery may not extend the lives of breast cancer patients. Experts discovered that women who received this aggressive treatment had a few extra cancer-free months, but that they ultimately did not survive any longer than women who never underwent this surgery.

These results confounded many researchers, including Donald Berry, chair of biostatistics and study leader at the University of Texas M.D. Anderson Cancer Center:       

I was surprised by the results. I was expecting some subsets of women to show some survival benefit. Many studies had been suggesting that there were some patients, such as young patients and women with triple negative cancer (cancer cells that lack receptors for estrogen, progesterone or HER2, which makes them difficult to treat with drugs) that would benefit. But our analysis shows that's not true, said Berry. 

 

The therapy involves multiple steps beginning with the extraction of bone-marrow stem cells from the patient prior to surgery. After the tumor has been removed, the patient is given very high doses of chemotherapy, and then re-infused with their stem cells, which restore immune cells destroyed by the chemotherapy. According to the study, these ultra-high doses of chemo are extremely toxic. Many of the 20,000 women who have received the treatment in the U.S. have died from the toxicity.

The study consisted of 15 trials (6,200 patients) and included women with all types of breast cancer at the beginning stages of disease. Each woman had tested positive for cancer in lymph nodes upon surgery. None of the women in the study had been diagnosed with cancer that had metastasized (spread) to anywhere else in the body.

High-dose chemotherapy was very popular in the 1980s and 1990s when many doctors believed that high doses of chemotherapy was better following cancer surgery. Although it was painful for patients, oncologists believed that high chemo levels would ultimately benefit patients by destroying any cancer cells that could still be in the body.

When making a decision on a particular cancer therapy, the American Cancer Society recommends learning what types of treatment are available, their risks and benefits, the possible side effects, and how to manage them. Learning about your options and discussing them with your doctor can help you with these important decisions. For more information on breast cancer treatment, visit healia.com.

high dose chemotherapy breast cancer breast cancer treatment

Today is National Minority Donor Awareness Day. Why are minorities being urged to donate organs and tissue? Blood and tissue are usually matched within ethnic groups. Patients are less likely to reject an organ if it is donated by an individual who is genetically similar. People are usually more genetically similar to others of their own ethnicity than to people of other ethnicities. The more minority donors there are, the greater the likelihood that minority patients will find an organ that matches their tissue type.

Members of racial and ethnic minority groups, particularly African Americans, American Indians, Alaska Natives, and Hispanic Americans, are disproportionately afflicted with end-stage renal disease (ESRD). The best therapy for ESRD is kidney transplantation because it improves patients' quality of life and survival rates. However, the number of organs and tissues donated by members of these groups and other underserved populations is low; therefore, the likelihood of a good match between donor and recipient and, ultimately, survival of the transplanted organ is reduced.

To learn more about how you can help, visit OrganDonor.gov.

National Minority Donor Awareness Day organ donor end-stage renal disease ESRD