Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Reblog] How hospitals recoup the cost of buying robotic surgery systems (& questions to ask surgeon before consenting to robotic surgery)

A laparoscopic robotic surgery machine. Patien...

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The blogger known only as the Skeptical Scalpel (self-described as a surgeon for 40 years and a surgical department chairman and residency program director for over 23 of those years) continueshis thread of posts raising questions about the proliferation of robotic surgery.

The latest is entitled “Study: Robotic surgery financials explained.” It’s his take on a paper presented at the annual meeting of the American Association of Gynecologic Laparoscopists.  Excerpts:

The headline, “Robotic Hysterectomy Cuts Blood Loss in Obese,” is certainly catchy. Let’s look deeper. 

The lead author said, “The robotic hysterectomy does … offer lower rates of conversion to laparotomy but does cause higher facility and total charges, as well as higher reimbursement rates.” The mean total hospital charge for robotic hysterectomy was $44,700 versus $25,557, a statistically significant difference. The average charge for the robotic instruments was $8,322 compared to $3,762 for standard laparoscopy equipment, also a significant difference. In response to a question about why there was such a disparity, the lead author said: “The charges are likely to recoup the cost of the robot purchase. We have multiple robots … four at our main institution and several others at other sites.”

The reimbursement actually received for robotic hysterectomy was $19,000 and for standard laparoscopic, a mere $$8,000.

I congratulate the authors for their candor [though no doubt inadvertent] in sharing the financial data and the reasons why robotic surgery is more costly. I am gobsmacked* at the differential in charges and reimbursement for the two types of hysterectomy and that the secret would be so openly shared.

I guess someone has to help the hospital “recoup the cost of the robot purchase.” But I wonder why third party payers are shelling out almost two-and-a half times more money for a procedure that has not been proven more effective than standard laparoscopic surgery?

And you wonder why health care costs are skyrocketing?

Comments

Walter Lipman posted on February 13, 2012 at 9:25 am

Using this “pay as you use” logic, I wouldn’t be the least bit surprised to see one set of charges for your bed being located in the hospital’s parking lot versus another and higher set of charges for your bed being located in a room inside the hospital.

Reply

Michelle Luthringshausen, MD posted on February 21, 2012 at 8:54 am

As a surgeon, I am fascinated by this shallow analysis of cost and complete disregard for what is best for the patient. An open hysterectomy has a complication rate of 11%, highest in obese patients. A robotic hysterectomy done by an experienced surgeon in an obese patient has a complication rate of 3%. Complications are expensive for hospitals, health systems and especially patients. According to the American College of Surgeons NSQIP data, one complication’s DIRECT costs are around $12,000.
My second comment is that “charges” are only relevant in the uninsured patient, which will rarely be recouped anyway. The “cost” is what the insurance company and patients actually pay or reimburse, which is a contracted price based on the procedure done, NOT the way it was done, in an insured patient. In most cases, the hospital and surgeon get paid the same fee whether the robot was used or not…..

Related article

A 27 February 2012 article at HealthNewsReview.org summarizes a recent Chicago Tribune article on the evidence (sorely lacking) that robotic surgery allows for quicker healing and less pain.

Excerpts

Despite a flood of scientific papers associated with the da Vinci, there is a dearth of randomized, controlled studies showing patients do best if procedures are performed with the da Vinci. Federal oversight of medical devices such as the da Vinci is light. There have been voluntary recalls — more than a dozen since 2005 — involving problems with software and surgical instruments. Lawsuits have helped raise concerns that some surgeons are using the devices before the doctors are adequately trained.

Here are some questions patients should ask their surgeon when considering a robot-assisted procedure:

•When did you do your first robot-assisted procedure? How were you trained? How many robot-assisted cases have you done? How often do you do them? How many robot-assisted cases have you done of my procedure?

•Are you more comfortable doing this type of procedure laparoscopically, robot-assisted or the traditional open approach? What are the pros and cons of each?

•What happens if the robot malfunctions during surgery or you have to convert to open surgery? How many open cases of my procedure have you performed? How often do you do them?

•What kind of training on the da Vinci do the nurses and other surgeons in the operating room get? How experienced are they? How experienced are they in converting to an open procedure mid-surgery?

•Will you be mentoring another surgeon during my procedure? Will he or she be doing any of it? If so, how many cases has he or she performed?

 

Related articles

“When hospitals buy robots they also use them as a marketing tool in direct-to-consumer marketing. That startedwith the drug companies and it worked well. It’s very effective,” said Dr. Hugh Lavery, a urologist at Mount Sinai Medical Center in New York who authored the study.”

February 14, 2012 Posted by | health care | , , , , , | Leave a comment

Depleted Uranium Weapons – A Short Introduction on the Adverse Health Effects to Soldiers and Others

Last week my “cousin” [actually it is more complicated than that] asked me for information about the effects of depleted uranium weapons.
She had read about a soldier who died from uranium poisoning.
Here is a portion of the email she sent me

There was an obit in our local newspaper,  2/4/12  of a young man who died, and had some Tiffin connection.
Here I quote from his obit:
“Travis Carson, age 25, died Feb. 2, 2012 of uranium poisoning lung cancer….Travis was serving active duty in the U.S.Army from 2006 until his death. He had served one tour of duty I Iraq.” (he is survived by his wife and four children.)
Approximate area and major clashes in which DU...

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My cousin also asked me to look up information on depleted uranium which could be used to present to members at her local (Tiffin, OH)  Pax Christi meeting. (I am also a member of Pax Christi here in Toledo, OH)
This is what I sent her. It is a bit sketchy, I admit. But I hope it does give one an idea of what DU can do not only to our military members, but civilians and the environment in general.
I find it distressing that time and time again war materials are used without due regard to long term effects to people (military and civilians alike) and the environment. Agent Orange is another example.
English: Sites in Kosovo and southern Central ...

Sites in Kosovo and southern Central Serbia where NATO aviation used forbidden munition with depleted uranium during 1999 bombing.

                                                   

   

Depleted Uranium (DU)  Weapons- A  Short Introduction 

What is DU and where does it come from ? Depleted Uranium (DU) is nuclear waste that is a product of uranium processing. Uranium found in nature occurs in different isotopes: U234, U235, and U238. Each isotope has a different number of neutrons, but the same number of electrons.

Image from http://www.world-nuclear.org/eduation.uran.htm (What is Uranium, How Does It Work- World Nuclear Association)This Web site also has great basic information on uranium and how reactor fuel is extracted from uranium ore

When uranium ore is processed for nuclear fuel, the product is usually pellets made containing the isotopes U-238 and U-235. Most of the fuel is made of the stable isotope U-238 which is barely radioactive.  U-238 is also called a “fertile” fuel; it is acted upon by the U-235 isotope to create energy. The U-235 isotope is much more volatile, radioactive, and “fissile”. When neutrons are fired at it, it produces a self-sustaining series of nuclear reactions, releasing huge amounts of energy. The U-238 atoms can capture neutrons shot off during the U-235 nuclear reactions, and split to become unstable plutonium atoms which also emit energy.

All this energy is converted to steam to produce electricity.   U-235 is one of the waste products of nuclear reactors (as Davis Bessie). Nuclear waste products can be processed for disposal at storage sites or reused as a fuel component or in manufacturing (as weapons).

[For a fuller detailed descriptions, please go to http://www.world-nuclear.org/education.uran.htm and http://www.world-nuclear.org/education/wast.htm]

 What are DU weapons and why are they used?   Depleted Uranium itself is a chemically toxic and radioactive compound, which is used in armour piercing munitions because of its very high density. It is 1.7 times denser than lead, giving DU weapons increased range and penetrative power. They belong to a class of weapons called kinetic energy penetrators. The part of the weapon that is made of DU is called a penetrator: this is a long dart weighing more than four kilograms in the largest examples: it is neither a tip nor a coating. The penetrator is usually an alloy of DU and a small amount of another metal such as titanium and molybdenum. These give it extra strength and resistance to corrosion.

In addition to armour-piercing penetrators, DU is used as armour in US M1A1 and M1A2 battle tanks and in small amounts in some types of landmines (M86 PDM and ADAM), both types contain 0.101g of DU in the resin cases of the individual mines. 432 ADAM antipersonnel landmine howitzer shells were used on the Kuwaiti battlefields during the 1991 Gulf War. Both M86 PDM and ADAM mines remain in U.S. stockpiles.

Where have DU weapons been used?    Governments have often initially denied using DU because of public health concerns. It is now clear that DU was used on a large scale by the US and the UK in the Gulf War in 1991, then in Bosnia, Serbia and Kosovo, and again in the war in Iraq by the US and the UK in 2003. It is suspected that the US also used DU in Afghanistan in 2001, although both the US and UK governments have denied using it there.

While we have a reasonable idea how much DU was used in the Balkans (12,700kg) and the 1991 Gulf War (290,300kg), there is little data on the extent of its use following the 2003 invasion in Iraq. One estimate put the total at 140,000kg by early 2004; with far more being used in urban areas than in 1991. This was chiefly a product of a move towards asymmetric warfare but also an increasingly casual approach to DU’s use. The US consistently refused to release data on the locations of DU strikes to UNEP and post-conflict instability has made assessing the true extent of contamination virtually impossible.

How does the DU in weapons get into the body?   The DU oxide dust produced when DU munitions burn has no natural or historical analogue. This toxic and radioactive dust , which can travel many kilometres when “kicked up” in arid climates, are readily inhaled and retained in the lungs by civilians and the military alike. From the lungs they travel to and are deposited in the lymph nodes, bones, brain and testes.

It is thought that DU is the cause of a sharp increase in the incidence rates of some cancers, such as breast cancer and lymphoma, in areas of Iraq following 1991 and 2003. It has also been implicated in a rise in birth defects from areas adjacent to the main Gulf War battlefields. A Balkan focused UNEP reported that these corroding penetrators were likely to contaminate groundwater and drinking water supplies and should be removed.

What are the radioactive hazards of uranium weapon? Radiation has three basic forms, all are emitted when DU “burns” as in munitions being fired

Alpha -fast moving atoms that are slowed by a few inches of air or piece of paper because of their relatively large size

Beta – fast moving electrons with higher energy than alpha because they are lighter and faster, can go through several feet of air or thin metal

Gamma- most damaging radiation, made of photons (much like light), their high energy can penetrate up to several inches of lead
The chief radiological hazard from uranium 238 is alpha radiation. When inhaled or ingested, alpha radiation is the most damaging form of ionising radiation. However, as U238 decays into its daughter products thorium and protactinium, both beta and gamma radiation are released, increasing the radiation burden further. Therefore DU particles must be considered as a dynamic mixture of radioactive isotopes.

Inside the body alpha radiation is incredibly disruptive. The heavy, highly charged particles leave a trail of ionised free radicals in their wake, disrupting finely tuned cellular processes. In one day, one microgram, (one millionth of a gram), of pure DU can release 1000 alpha particles. Each particle is charged with more than four million electron volts of energy; this goes directly into whichever organ or tissue it is lodged in. Ionizing radiation is a human carcinogen at every dose-level, not just at high doses; there is no threshold dose and any alpha particle can cause irreparable genetic damage.

What are the chemical toxicity hazards of uranium weapons?  While many studies have only investigated the possibility of kidney damage, since 1991, and triggered by concerns over DU, dozens of papers have highlighted other, more worrying effects of uranium toxicity. Repeated cellular and animal studies have shown that uranium is a kidney toxin, neurotoxin, immunotoxin, mutagen, carcinogen and teratogen. Compared to the uranium naturally present in the environment and the ore in mine workings, DU dust is a concentrated form of uranium. Uranium has been shown to cause oxidative damage to DNA. Recent studies in hamsters found that uranium formed uranium-DNA adducts (bonds),these make it more likely that the DNA will be repaired incorrectly. If this occurs, adducts can lead to genetic mutations that may be replicated leading to carcinogensis.  In 2007 DU compounds were shown to damage experimental human lung cells and disrupt DNA repair.

Are there any organizations addressing DU health and environment concerns?

The International Coalition to Ban Uranium Weapons [http://www.world-nuclear.org/education/wast.htm] has information on current legal status, their campaign (news, events, timeline, projects), how to take action, and resources. They have a social media presence via YouTube, Twitter, and Facebook. Most of the information on this page came from this organization.

 

Related Resource

  • Uranium (ToxTown – summaries of environmental concerns and toxic chemicals where you work, live, and play)
              Excerpts

Military personnel may be exposed to uranium if they work on a ship or submarine, or handle ammunition or nuclear weapons. They can be exposed through shrapnel that contains depleted uranium or dust from ammunition. Personnel may be exposed if their armored vehicle is penetrated by uranium munitions, or if they salvage vehicles that have been in contact with uranium munitions. When a depleted uranium projectile hits a vehicle, the projectile forms particles of varying sizes. Personnel in or near such vehicles may breathe or swallow depleted uranium, or have tiny uranium fragments in their bodies.

 

How can uranium affect my health?
The health effects of natural and depleted uranium are caused by its chemical properties as a heavy metal and not by radiation.

Eating or breathing very high levels of uranium can cause acute kidney failure and death. Exposure to high levels of uranium may lead to increased cancer risk, liver damage, and internal irradiation. Exposure to uranium can damage the kidneys and respiratory tract, and cause dermatitis and blood changes.

The National Institute for Occupational Safety and Health considers uranium compounds to be potential occupational carcinogens. Uranium is not listed as a known or anticipated carcinogen in the Twelfth Report on Carcinogens published by the National Toxicology Program.

Radon is listed as a human carcinogen in the Twelfth Report on Carcinogens because it causes lung cancer. Exposure to high levels of radon can cause other lung diseases such as emphysema and thickening of lung tissues. Simultaneous exposure to radon and cigarette smoking can increase the incidence of lung cancer and lung disease.

February 14, 2012 Posted by | Consumer Health, environmental health, Workplace Health | , , , , , , , , | Leave a comment

   

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