Cataract Benchmarks
How Do You Compare to These Stats?
Every summer for the last 20 years, David Leaming, MD, a practicing ophthalmologist in Palm Springs, Calif., has mailed out the Practice Styles and Preferences of ASCRS Members survey. Dr. Leaming found that cataract surgeons are:

• Continuing to perform cataract procedures at rates similar to 2006. Last year, 11% of surgeons performed 76 or more phaco procedures per month, while 12% did 51 to 75 cases; 33% did 26 to 50 cases; 24% did 16 to 25 cases; and 20% did 15 or fewer cases.
• Concerned about TASS. One in five surgeons has seen a case of TASS in the last year.
• Loyal to phaco machine manufacturers. Market share has changed little, says Dr. Leaming. The Alcon Infiniti with Ozil is the machine most often used (33%), followed by the Bausch & Lomb Millennium (15%) and the AMO Sovereign Whitestar (12%).
• Comfortable using a capsular tension ring to stabilize the lens. About 40% have used one in the last year, although most (79%) inserted fewer than five of them during the year.
• Embracing coaxial micro-incision phacoemulsification. Nearly 31% of respondents used the technique most of the time in 2007.
• Interested in toric IOLs. About 32% have a more-than-neutral interest and 28% have a high interest in toric lenses.

Dr. Leaming mailed 4,658 surveys and received 691 responses. See more at www.analeyz.com.

— Kent Steinriede

Gliding Around

• Daniel Rowland, MD, an OB/GYN surgeon, drives his electric-powered Segway Personal Transporter the eight miles from his home to Banner Baywood Medical Center in Mesa, Ariz. Although it takes him about twice as long to get there as it would if he drove his Buick Enclave, Dr. Rowland estimates the Segway saves him about $5 on gas each day. The "Segway Surgeon" drives it straight into his first-floor office and sometimes uses it to run errands between cases. As an added bonus, the iPod-equipped two-wheeler "makes the commute so much more fun," says Dr. Rowland.

(Hand) Size Matters
Getting a Grip Can Be a Challenge for Female Surgeons
Here's something to keep in mind as more female surgeons pass through your ORs: The laparoscopic instruments currently on the market might be too big for comfortable handling by women users.

According to a study published online in Surgical Endoscopy, the journal of the Society of American Gastrointestinal and Endoscopic Surgeons, instruments designed by medical device manufacturers to fit the hands of male surgeons can cause female surgeons hand and upper extremity discomfort. They can also make the equipment awkward and challenging to use while making cases longer to perform, say researchers, who asked surgery residents at four universities to rate their comfort level with such common disposable laparoscopic instruments as surgical staplers, harmonic scalpels and sealing systems.

They found that as the respondents' glove sizes increased, so did the level of ease with which they used the instruments. Female respondents (whose average surgical glove size is 6.5) reported that they frequently needed to use two hands to effectively use the instruments. In contrast, male respondents (whose average glove size is 7.5) required only one hand to accomplish the same maneuvers.

— Dan O'Connor

When Opioids Backfire
It's a rare and challenging pain management paradox: Opioids, designed to relieve acute and chronic pain, can have the reverse effect in some patients and actually exacerbate it. A new study offers strategies for combating this complication, called opioid-induced hyperalgesia (OIH). For a paper published in Pain Treatment Topics, Peggy Compton, RN, PhD, an associate professor of nursing at the University of California Los Angeles School of Nursing, examined decades of laboratory and clinical evidence of OIH, including research showing a higher incidence of post-operative OIH in patients who had received short-acting opioids during various abdominal surgeries.

Theories for why opioids reduce some patients' tolerance for pain range from genetic factors to the pain's type and source. Noting that increasing the opioid dose worsens the pain associated with OIH, Dr. Compton recommends these strategies for preventing or minimizing OIH's effects:

• keeping the opioid dosage as low as possible without impeding its effectiveness;
• using adjuvant medications (dextromethorphan, propofol or COX-2 inhibitors);
• using long-acting rather than short-acting opioids;
• rotating different types of opioids; and
• combining low-dose opioid antagonists (such as naltrexone) with opioid agonists.

Dr. Compton also suggests you closely monitor patients' responses to opioid therapy and differentiate between OIH and such opioid-related conditions as tolerance, withdrawal, addiction and pseudoaddiction.

— Irene Tsikitas

InstaPoll Update
You'll find a new InstaPoll on www.outpatientsurgery.net every Monday morning. Here's a look back at the results of recent polls.

• Laundering scrubs. How do you handle the purchase and reuse of scrubs? Out of 231 responses, 55% buy scrubs and hire a laundry service, 21% make staff buy and wash their scrubs, 23% do both and 1% use disposable scrubs.
• Safety scalpels. Rare is the safety scalpel that survives a surgeon trial and actually makes it into the OR. Out of 57 responses, nearly three-fourths reported futility in trying to convert their surgeons to safety scalpels — 25% can't even get surgeons to trial them and another 44% say their surgeons tried them, but didn't like them. The news wasn't all grim, as 7% say they've converted a few of their surgeons and another 12% say they've converted all of their surgeons.
• Working on the weekends. Despite the many reasons to do cases on the weekends, most of our respondents would rather not work on a Saturday. Out of 69 responses, only 12% reported that their facility does cases on the weekends — and half of those said it's working out great, while the other half said that doctors and nurses dread it. Another 7% said they're seriously considering doing so. A whopping 81% said they hope they never see the (Satur)day when they're working on the weekends.
• Your salary. Facility administrators are an underpaid and overworked lot and generally not pleased with what they're being paid, according to the 42 responses we received. When we asked which statement best describes how readers feel about their salary, only 19% felt they were compensated fairly. Another 17% felt they were paid well, but that the stress was unbearable, and 2% said that they're paid generously. Meanwhile, 38% said some of their OR nurses make more than they do once overtime and bonuses were considered and 24% said they're long overdue for a raise.

Marble Mania

• Surgeons-in-training at Banner Good Samaritan Medical Center in Phoenix, Ariz., who spent an hour playing Marble Mania, a Nintendo Wii game, before being tested for instrument control and performance experienced a nearly 50-percent improvement in skill level during the test. Research shows that the slight hand maneuvers used in the game have a 92-percent correlation to the movements a surgeon makes when performing laparoscopic surgery, and actually hone fine motor skills, says Marshall "Mark" Smith, MD, director of the hospital's Simulation Education and Training Center.