Today’s Top Story

U.S. hospitals face injectable opioid shortage

U.S. hospitals frequently run out of injected opioids due to manufacturer shortages, according to a report from the Associated Press. To compensate, doctors and pharmacists report rationing injectable opioids, using slower-acting or less effective pain medications, or sedating patients. The American Medical Association said the drug shortages are a public health crisis, and other medical groups have asked regulators to step in, as some patients undergoing surgery, those with cancer, or patients with severe burns are not receiving optimal pain control. The shortage began last year and is expected to carry over into 2019, making it more severe than previous shortages. An April survey of 343 hospital pharmacists, conducted by the American Society of Health-System Pharmacists, found that 98 percent of respondents reported moderate or severe shortages of morphine, fentanyl, and hydromorphone.

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Other News

Study compares intravenous versus topical tranexamic acid use in TKA patients

Use of intravenous (IV) and topical tranexamic acid (TXA) in patients undergoing total knee arthroplasty (TKA) are both effective in reducing perioperative bleeding, according to a study published in the June 20 issue of Journal of Bone & Joint Surgery. Researchers randomized 640 patients who underwent unilateral TKA for osteoarthritis at two large academic centers to receive 1 g of IV TXA before tourniquet application and 1 g at closure, or 3 g of TXA diluted in 45 mL of saline and topically applied following cementation. Researchers found that blood loss and drain output were significantly greater in patients who received topical TXA compared to those who received IV TXA, although they said these differences may not be clinically important. Rates of transfusion and thrombotic events were not significant in either group.

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Study: Laminectomy with fusion may lead to higher rates of transfusion and reoperation for spinal epidural abscess

For the treatment of spinal epidural abscess (SEA), laminectomy with fusion may lead to higher rates of transfusion and reoperation during the perioperative period, according to a study published online in the journal Spine. The retrospective study compared risk factors and perioperative complications among 738 patients undergoing laminectomy with (n = 130) and without (n = 608) fusion. Although both treatment options effectively treat SEA, patients who underwent fusion experienced significantly higher rates of reoperation, mostly due to differences in cervical spine operations. The most common reason for reoperation in both groups was infection. Fusion patients also had significantly higher rates of blood transfusions. “In operative situations where either procedure is reasonable, surgeons should consider that fusion nearly doubles the odds of reoperation in the short-term, and weigh this risk against the benefit of added stability,” the researchers advised.

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CDC study evaluates concussion prevalence in high school athletes

A study from the Centers for Disease Control and Prevention (CDC) indicates that 15.1 percent of high school students (approximately 2.5 million) reported having a minimum of one concussion in the past year due to sports or physical activity. Researchers analyzed high school student response data (n = 14,765) from the 2017 national, cross-sectional Youth Risk Behavior Survey and found that rates of concussion were significantly higher in male students and in those who played sports compared to those who did not. A total of 9.1 percent of students self-reported experiencing one concussion in the past year, while 6.0 percent reported having two or more concussions in that period. Concussion rates increased significantly based on the number of sports teams a student participated in, regardless of demographic factors. Black and Hispanic students were more likely to report four or more concussions compared to white students.

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In the States

Wisconsin Supreme Court decision may impact medical liability caps

The Wisconsin Supreme Court voted to restore a $750,000 cap on noneconomic damages for victims of medical malpractice, reversing the state appellate court and overturning a 2005 Supreme Court decision. In a 5-2 decision written by Chief Justice Patience Roggensack, the court declared the 1986 legislation capping noneconomic damages in medical liability cases was constitutional.

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AAOS Now

Clinical trials for cervical disk replacement

Each of the seven cervical total disk replacements (cTDR) currently available in the United States has undergone a clinical trial providing evidence of safety and efficacy that supports Food and Drug Administration premarket approval. Given a decade of clinical experience in the United States with these devices and the absence of recalls, the question now is whether cTDR clinical trials should still be structured in this fashion.

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Your AAOS

Apply for Education Assessments and Examinations Committee member position

The Education Assessments and Examinations Committee has an open member position, a three-year term that runs from March 18, 2019, to March 25, 2022. The committee prepares and administers the annual Orthopaedic In-Training Examination, the triennial Orthopaedic Self-Assessment Examination, and the Orthopaedic Special Interest Examinations. The last day to submit an application is Aug. 3.

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

 

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