December 13, 2017
Today’s Top Story

CMS updates Hospital Compare websites with new quality measures

Modern Healthcare reports that the U.S. Centers for Medicare & Medicaid Services (CMS) has added four new quality measures each to its Inpatient Rehabilitation Facility and Long-Term Care Hospital Compare websites. Among other things, both sites have been updated to include facility-wide data on incidence of methicillin-resistant Staphylococcus aureus and Clostridium difficile, percentage of patients with pressure ulcers, and unplanned 30-day readmissions.

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Other News

FDA plans to update 510(k) medical device approval pathway

The U.S. Food and Drug Administration (FDA) plans to publish guidance to refine the 510(k) medical device approval process. Devices approved under the 510(k) pathway must demonstrate comparable efficacy to existing devices. “FDA recognizes that such direct comparison testing creates burdens for 510(k) applicants, especially when many new devices are designed in novel ways, using more advanced technologies,” wrote FDA Commissioner Scott Gottlieb, MD, on the agency website. In response, FDA intends to publish a draft guidance outlining a voluntary, alternative pathway designed to allow more flexibility using modern criteria as the reference standard. The draft guidance is expected to be released in the first quarter of 2018.

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Read the FDA statement…

Study: Perioperative gabapentin may improve likelihood of opioid cessation after surgery

Data from a study published online in the journal JAMA Surgery suggest that perioperative administration of gabapentin may have a modest effect on promoting opioid cessation following surgery The authors conducted a randomized, double-blind, placebo-controlled trial of 410 surgery patients who received either 1200 mg of gabapentin preoperatively followed by 600 mg of gabapentin three times a day postoperatively (n = 208) or active placebo (n = 202). In an intention-to-treat analysis, they found that perioperative gabapentin did not affect time to pain cessation. However, patients in the gabapentin cohort saw a 24 percent increase in the rate of opioid cessation after surgery. The authors found no significant difference across cohorts in number of adverse events or rate of medication discontinuation due to sedation or dizziness.

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Study: Does the definition of “outpatient” procedures affect study findings?

According to a study published in the December issue of the journal Clinical Orthopaedics and Related Research, the definition of “outpatient” status following total hip arthroplasty (THA) and total knee arthroplasty (TKA) may be inconsistent, potentially influencing outcomes data. Members of the research team reviewed information on 72,651 THA patients and 117,454 TKA patients from the National Surgical Quality Improvement Program (NSQIP) database. They found that 529 THA patients were identified as “outpatients” but only 63 (12 percent) had a length of stay (LOS) equal to 0 days. Similarly, 890 TKA patients were identified as “outpatients” but only 95 (11 percent) had a LOS equal to 0 days. After controlling for potential confounders, the researchers found “inpatient” procedures to be associated with increased risk of any adverse event, serious adverse event, and readmission compared to “outpatient” procedures. However, given the same procedure and controlling for the same factors, patients who had LOS >0 were not associated with any increased risk compared with patients who had LOS of 0 days.

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Study: Animal data suggest strategy for promoting neural regeneration in the spinal cord

A study conducted in the United Kingdom and published online in the journal PLOS One suggests a potential strategy for promoting neural regeneration following spinal cord injury. In a rodent model of spinal cord injury, the researchers demonstrated that chondroitinase-producing canine olfactory ensheathing cells survived at 4 weeks following transplantation into the spinal cord lesion, and noted evidence of sprouting within the corticospinal tract rostral to the lesion and an increase in the number of corticospinal axons caudal to the lesion, suggesting axonal regeneration.

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In the States

Arkansas

Insurance Journal reports that the Arkansas State Medical Board has approved draft regulations targeted at reducing opioid abuse. Under the new rules, opioid prescriptions for treatment of acute pain will be limited to a 7-day supply, and providers who prescribe more than 50 morphine milligram equivalents per day will be required to explore alternative treatment plans and document objective findings to support the need for such treatment.

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Your AAOS

Last call: Research Development Committee

Dec. 15, 2017, is the last day to submit your application for a position on the Research Development Committee (two member openings). This committee oversees the annual research symposia, the Kappa Delta orthopaedic research awards, the Clinician Scholar Career Development Program, and the Unified Orthopaedic Research Agenda. The committee also serves as the AAOS liaison group to the National Institutes of Health. Applicants for this position must be active fellows or associate members—basic science.

Learn more and submit your application…  (member login may be required)

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