Today’s Top Story

Study: Opioids may be overprescribed for nonoperative fractures and dislocations

A study published in the July issue of The Journal of Bone & Joint Surgery found that opioids may be commonly overprescribed after nonoperative fracture and dislocation treatments. Researchers analyzed 1,513 consecutive patients in China who underwent nonsurgical fracture and/or dislocation treatment and were prescribed opioids. Over three months, they observed opioid use, alcohol consumption, smoking status, injury location, volume of prescriptions, and consumption patterns. The mean number of pills prescribed was 14.7, and patients reported using an average of 7.2 pills. Ten percent of patients (n = 152) used no opioids, while 61.1 percent (n = 923) stopped taking opioids before the prescription was up. Location of injury, alcohol consumption, and type of injury were significantly associated with opioid use. Patients with injuries to the wrist, forearm, ankle, tibia, fibula, elbow, and humerus consumed more opioids, on average, than those with other injuries. Opioid use was higher among those with increased alcohol consumption and displaced fractures. The researchers recommend that surgeons avoid prescribing opioids to this patient population.

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Other News

Study: Perioperative ketorolac may lead to high rates of fracture union

Perioperative use of ketorolac may yield high rates of fracture union, according to a retrospective study published online in Foot & Ankle International. Researchers assessed patients who received perioperative ketorolac for lateral malleolar, bimalleolar, and trimalleolar open reduction and internal fixation (ORIF) by the same surgeon between 2010 and 2016, with a minimum follow-up of four months. Patients were given 20 tabs of 10 mg ketorolac every six hours. Two orthopaedic foot and ankle surgeons assessed radiographs for healing. Of the 281 patients, 94 percent (n = 265) were deemed clinically healed within 12 weeks, and 92 percent (n = 261) were deemed radiographically healed. Among patients who did not heal by 12 weeks, the mean time to clinical healing was 16.9 weeks, while the mean time to radiographic healing was 17.1 weeks. In patients who received ketorolac, no cases of nonunion occurred and no significant difference between fracture patterns and healing or complications was found. The researchers said, “Additional studies are necessary to determine whether ketorolac helps reduce opioid consumption and improves pain following ORIF of ankle fractures.”

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Study: National database studies may be missing significant data

Missing data may present a problem for hip fracture studies that use national databases, according to research published online in The Bone & Joint Journal. The authors identified the frequency of missing data for demographics, comorbidities, and laboratory values in 26,066 patients from the National Surgical Quality Improvement Program (NSQIP) database who underwent surgical repair of a hip fracture between 2005 and 2013. These variables, many of which had missing data rates of 77.9 percent, were then tested for their association with adverse events. Multivariate regressions comparing three methods of handling missing data found that risk factors differed among postoperative adverse events. Of the 35 identified risk factors, only seven (20 percent) were common in all three analyses.

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Inpatient hospitalizations decrease while outpatient visits increase

A survey of close to 50 not-for-profit hospital executives released by investment bank Leerink Partners indicates that the number of inpatients continues to decrease as patients move toward less expensive outpatient options, per a report in Modern Healthcare. The survey found that inpatient utilization increased 0.7 percent in the second quarter of 2018, down from a 1 percent increase in 2017. Ambulatory surgery center utilization was up 1.4 percent in the second quarter, but down from the 2.2 percent seen in 2017. Outpatient utilization growth fell from 2.5 percent in 2017 to 1.1 percent. Hip procedures performed in the outpatient setting are expected to increase from 17 percent in the past year to 19 percent in the coming year, while inpatient hip procedures will likely decrease from 77 percent to 75 percent.

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Study: Sitting may be linked to increased risk of musculoskeletal disease and death

A study conducted by the American Cancer Society found that sitting for six hours or more each day may increase the risk of death by 19 percent compared to sitting for three hours per day, the Chicago Tribune reports. Musculoskeletal disorders are among the potentially fatal consequences of prolonged sitting, with an associated 60 percent increased mortality risk. Researchers noted that the musculoskeletal diseases could be the source of time spent sitting. Those who spend excessive time seated may also engage in more unhealthy behaviors.

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AAOS Now

On the rise: What is driving the cost of medical malpractice insurance?

When the latest medical malpractice premium notice arrives at a physician’s office, it is not often for a small amount. Even practices that have avoided expensive lawsuits or claims are not shielded from rising premiums. Often, it seems that rising medical malpractice premiums are like death and taxes: inevitable. Medical malpractice premiums differ from one state to another and among specialties, yet they are all driven by the same factor: the cost of risk. Insurance carriers evaluate the cost of risk by actuarially assessing the probability of errors, the cost associated with defending claims, the cost of potential settlements, and organizational operational costs.

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Your AAOS

Apply for Trauma Evaluation Committee member position

The Trauma Evaluation Committee has an open member position, a three-year term that runs from March 18, 2019, to March 25, 2022. The committee prepares the Musculoskeletal Trauma Self-Assessment Examination triennially and acts as a resource as requested for providing examination questions for other AAOS educational programs. The last day to submit an application is Aug. 3.

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

 

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