August 23, 2017

oday’s Top Story
Study: NSQUIP risk tool predicts SNF discharge but not other events.
A study evaluating the Surgical Risk Tool Calculator, the online tool of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), found that for total joint arthroplasty procedures, the tool is an adequate predictor of discharge to a skilled nursing facility (SNF) or rehabilitation but has limited usefulness for adverse events of 90-day readmission, return to operating room, deep vein thrombosis, and prosthetic joint infection. The study, in press with The Journal of Joint Arthroplasty, is a single-center retrospective review of 909 patients who underwent primary total knee or hip arthroplasty, with patient characteristics entered into the risk calculator and predicted outcomes compared with observed results. The authors write that the findings point to the need for a reliable risk calculator specific to total joint arthroplasty that can accurately predict adverse outcomes using simple and clearly defined input variables.
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Other News

Study: Liposomal bupivacaine provides good pain control in shoulder arthroplasty.
A study comparing outcomes with the use of liposomal bupivacaine (LB) versus continuous interscalene nerve block (CISB) in patients undergoing shoulder arthroplasty found that the LB patients experienced excellent postoperative pain relief with fewer complications and at a lower cost than the CISB group. These results, appearing in the Journal of Shoulder and Elbow Surgery, position LB as “a promising addition to a multimodal pain regimen for shoulder arthroplasty,” the authors write. The prospective, randomized controlled study followed 70 patients receiving one of the two pain management modalities. Preoperatively, all patients received standard analgesia consisting of 1,000?mg of oral acetaminophen and 200?mg of celecoxib. The 34 patients in the LB group had good pain control and similar narcotic use to the CISB group in the initial postoperative period, and they reported equivalent pain control and slightly better patient satisfaction after discharge from the hospital.
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Study: Walking problems may account for link between knee/hip OA and cardiovascular disease.
Patients with hip or knee arthritis have a greater risk of cardiovascular events, and the risk increases with the number of hips and knees affected, according to a study published in Osteoarthritis and Cartilage. The population-based cohort study involved 18,490 participants; of these, 24.4 percent had osteoarthritis in the hip, knee, and/or hand. Over 13.4 years, 31.9 percent experienced a cardiovascular event. When all but walking limitation was controlled, a dose–response relationship was observed between number of joints affected by knee/hip osteoarthritis and cardiovascular risk. The effect of hand osteoarthritis was not significant. Self-reported difficulty walking was associated with a 30 percent increase in hazard for development of cardiovascular events. “These findings provide compelling evidence to suggest that hip/knee osteoarthritis-related walking difficulty is a clinically relevant and potentially modifiable risk factor for cardiovascular disease,” the authors write.
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Study: New treatment approach for osteoporosis suggested by findings.
A mouse study published online in Nature Medicine investigating the role of sensescent cells in age-related bone loss found that in aged mice, treatment with senolytic drugs (dasatinib and quercetin) to eliminate sensecent cells resulted in higher bone mass and strength and better bone microarchitecture than in mice treated by genetic vehicle. The investigators also achieved a similar result with a JAK inhibitor that inhibited the production of the proinflammatory secretome of senescent cells. The authors write that the beneficial effects of targeting senescent cells arose from lower bone resorption with either maintained (trabecular) or higher (cortical) bone formation as compared with the vehicle-treated mice. The authors note that vitro studies demonstrated that senescent-cell conditioned medium impaired osteoblast mineralization and enhanced osteoclast-progenitor survival, leading to increased osteoclastogenesis. “Collectively, these data establish a causal role for senescent cells in bone loss with aging, and demonstrate that targeting these cells has both anti-resorptive and anabolic effects on bone,” they write. The findings may lead to treatment strategies for other age-related comorbidities.
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Study: Are American surgeons adequately prepared for humanitarian caseloads?
Findings from a study published online in the World Journal of Surgery suggest that increased specialization in surgical education may leave American surgeons on humanitarian missions ill equipped to perform the basic procedures commonly needed in war zones and disaster sites. The research team retrospectively analyzed cases performed by American College of Graduate Medical Education (ACGME) general surgery graduates from 2009 to 2015 and cases performed at select Médecins Sans Frontières (MSF) facilities from 2008 to 2012. Just one-third of major surgery performed in MSF projects corresponds to typical ACGME general surgical training. The authors report that ACGME general surgery residents spend a majority of their training (56 percent) engaged in advanced general surgical or specialty procedures with no direct corollary in MSF projects. Furthermore, U.S. surgeons working in humanitarian environments may be unaccustomed to working with alternative, low-technology methods for completing the same general surgical procedures they may perform at home with advanced equipment and supplies.
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Study: Twitter is a useful tool for tracking opioid misuse.
According to a study published in the Journal of Medical Toxicology, opioid misuse within a particular city or state can be tracked using Twitter. The researchers created software to acquire publicly available tweets from Twitter that contained keywords related to prescription opioid use between 2012 and 2014 (n = 3,611,528). Twitter metadata was used to estimate the location of each tweet. In comparing their estimated geographic distribution with data from the 2013–2015 National Surveys on Drug Usage and Health (NSDUH), the researchers found that the state-by-state correlation between Twitter and NSDUH data was highly significant across all of the survey years and was strongest among individuals aged 18 to 25 years. The correlation was driven by discussions of opioid use, even after controlling for geographic variation in Twitter usage.
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Call for volunteers: Council on Research and Quality.
Oct. 23, 2017, is the last day to submit applications for a position on the Council on Research and Quality (one opening—Communications Cabinet liaison). The liaison is responsible for representing the Council on Research and Quality’s issues and concerns to the Communications Cabinet. Applicants for this position must be active fellows with interest in both member communications and public relations and issues related to research and quality.
Learn more and submit your application…(member login required)

 

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