Today’s Top Story

Study: Chronic opioid therapy may increase risk of complication after one- to two-level PLF

Data from a study published online in the journal Spine suggest that preoperative chronic opioid therapy may increase risk of complication and adverse events following primary one- to two-level posterior lumbar fusion (PLF) for degenerative spine disease. Members of the research team reviewed information on 24,610 patients (mean age 65.6 years), of whom 5,500 (22.3 percent) had documented opioid use for more than six months prior to surgery. After adjustment, they found that preoperative chronic opioid therapy was associated with an increased risk of 90-day wound complications, pain diagnoses, emergency department visits, readmission, and continued use postoperatively. In addition, long-term opioid users displayed an increased utilization of epidural/facet joint injections, risk for revision fusion, and increased incidence of new onset constipation within one year postsurgery.

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Other News

Study: OARA screening tool may help identify candidates for rapid discharge after THA

According to a study published online in The Journal of Arthroplasty, use of the Outpatient Arthroplasty Risk Assessment (OARA) screening tool may help identify candidates for safe and early discharge following total hip arthroplasty (THA). The researchers conducted a retrospective review of 332 consecutive patients who underwent primary THA at a single center. They found that OARA score demonstrated high accuracy in identifying next-day discharge patients at risk for failure of discharge by postoperative day one.

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Study: Percutaneous suturing may be safe and effective for acute Achilles tendon rupture

Findings from a study published online in the journal Foot & Ankle International suggest that percutaneous suturing may be a safe and effective treatment for patients with acute Achilles tendon rupture. The researchers conducted a prospective, case series study of 82 patients treated with either open repair or percutaneous suturing. They found that both techniques were associated with similar results regarding complication rates and return-to-work time. Major complications in the open repair cohort were superficial infection (7 percent) and skin necrosis (3 percent), while three patients in the percutaneous suturing cohort developed paresthesias due to sural nerve entrapment. The researchers note that, at 12-month follow-up, patients in the percutaneous suturing group had better American Orthopaedic Ankle & Foot Society hindfoot scores and Achilles tendon Total Rupture Scores compared to those in the open repair group, but the difference was not significant.

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Female physicians note challenges with surgical training, harassment

A survey published online in the journal JAMA Surgery highlights the challenges of female surgeons who have children during training. Members of the research team surveyed 347 female surgeons (452 pregnancies) regarding perceptions of work schedule during pregnancy, maternity leave policies, lactation and childcare support, and career satisfaction after childbirth. They found that 297 women (85.6 percent) worked an unmodified schedule until birth, while 220 (63.6 percent) voiced concerns that their work schedule adversely affected their health or the health of the unborn child. Overall, 251 women (78.4 percent) received maternity leave of six weeks or less, and 250 (72.0 percent) perceived the duration of their leave to be inadequate. In addition, 231 (66.8 percent) reported a desire for greater mentorship on integrating a surgical career with motherhood and pregnancy, 135 (39.0 percent) strongly considered leaving surgical residency, and 102 (29.5 percent) would discourage female medical students from a surgical career, specifically due to the difficulties of balancing pregnancy and motherhood with training.

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An article in Kaiser Health News profiles the experiences of several women working in the medical field who have dealt with sexual harassment in the workplace. The writer notes that a survey published in the May 17, 2016, issue of The Journal of the American Medical Association found that 30 percent of women on medical faculties reported experiencing sexual harassment at work within the previous two years, and the U.S. Equal Employment Opportunity Commission reported 4,738 cases of sexual harassment filed in the healthcare and social assistance field from FY 2005 through 2015.

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Study: How do resident duty hour restrictions affect education?

Findings published online in The New England Journal of Medicine suggest that restrictions on medical resident hours may not negatively impact resident training, but flexible duty hours may reduce resident satisfaction. The authors conducted a prospective, randomized study of 63 internal medicine residency programs in the United States to be governed by standard duty-hour policies of the 2011 Accreditation Council for Graduate Medical Education (ACGME) or by more flexible policies that did not specify limits on shift length or mandatory time off between shifts. They found no significant between-group differences in mean percentages of time spent in direct patient care and education, nor in trainees’ perceptions of appropriate balance between clinical demands and education or assessments by program directors and faculty of whether trainees’ workload exceeded their capacity. However, a survey of interns revealed that those in flexible programs were more likely to report dissatisfaction with multiple aspects of training, including educational quality and overall well-being, compared to those in programs with standard ACGME policies.

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Physicians encouraged to warn patients of Medicare card scam

The California Medical Association is encouraging physicians to warn their Medicare patients about a scam in which beneficiaries are told they must purchase a temporary Medicare card prior to receiving their new, permanent card. The new cards will be mailed to beneficiary mailing addresses on file with Social Security between April and June 2018. The new cards are free and Medicare will not call patients regarding the new card.

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Your AAOS

Public comments sought on Management of Surgical Site Infections Systematic Literature Review

The Management of Surgical Site Infections Systematic Literature Review has completed peer review and is entering the public commentary stage. Public comments on the review will be accepted through Wednesday, April 4, 2018. For more information, the necessary materials, and to provide comments, please contact Mary DeMars at:

demars@aaos.org

 

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