October 18, 2019
 
Today’s Top Story

Study: Incidence, Risk Factors for SSIs Performed in ASCs

The incidence of surgical site infections (SSIs) following orthopaedic surgery performed in ambulatory surgical centers (ASCs) could be low, according to a study published in the Oct. 15 issue of the Journal of the AAOS; however, certain patients may be at higher risk. The single-center, retrospective chart review included surgeries performed between April 21, 2009, and Oct. 31, 2015, by surgeons representing five subspecialties. Final analysis included 22,267 surgeries; the average patient age was 42.6 years (54 percent were male). Overall, 71 patients (0.32 percent) sustained an SSI. The following risk factors were independently associated with SSI: anatomic area (odds ratio [OR] = 18.60, 11.24, 6.75, and 4.01 for the hip, foot/ankle, knee/leg, and hand/elbow versus shoulder, respectively), anesthesia type (OR = 4.49 combined general and regional anesthesia versus general anesthesia), age ≥ 70 years (OR = 2.85), diabetes mellitus (OR = 2.27), and tourniquet time (OR = 1.01 per minute tourniquet time).

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In Other News

Study: Effect of Steroids on Fusion Rate in Anterior Cervical Diskectomy and Fusion

A study published online in The Spine Journal found that the use of retropharyngeal steroids in anterior cervical diskectomy and fusion (ACDF) patients to alleviate postoperative dysphagia decreased radiographic fusion. The study included 42 ACDF patients who received local retropharyngeal steroids during surgery who were matched to a group of controls based on age, number of spinal levels treated, and smoking status. Final analysis included 121 total patients. The fusion rate in the steroid group was 64.7 percent compared to 91.0 percent in the control group. When analysis was conducted at each attempted fusion level, the fusion rate increased in the steroid (81 percent) and control (93 percent) groups. One case of esophageal rupture and retropharyngeal abscess was recorded, and the patient underwent operative intervention with irrigation, débridement, and repair.

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Study: Does Age Impact Outcomes of Posterior Elbow Release in Arthrogryposis?

A retrospective chart review published in the October issue of The Journal of Hand Surgery compared the effects of posterior elbow release in children with arthrogryposis at different ages. Children who underwent a posterior elbow release to treat an elbow extension contracture at a single institution between 2007 and 2014 were stratified into three groups based on age at time of surgery: less than two years, two to three years, and more than three years. Final analysis included 18 procedures in 13 patients. The average preoperative arc of motion was 16.0 degrees in those less than two years, 33.5 degrees for those two to three years, and 45.0 degrees for those more than three years; the average postoperative arc of motion was 88.2 degrees, 60.0 degrees, and 54.3 degrees, respectively. The difference in postoperative arc of motion was of clinical importance between the less than two years and both the two to three years and more than three years groups.

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Study: Concussion Patterns in 20 High School Sports

A study published in the October issue of Pediatrics examined the incidence and distribution of concussions in 20 high school sports. Researchers reviewed a convenience sample of injury and athlete exposure (AE) data from the National High School Sports-related Injury Surveillance Study (High School Reporting Information Online). Data spanning from 2013–2014 to 2017–2018 school years were analyzed, and concussion rates per 10,000 AEs were calculated. Sex differences were determined in soccer, basketball, baseball and softball, cross country, track, and swimming. A total of 9,542 concussions were reported; the overall rate was 4.17 per 10,000 AEs, with highest rate observed in football (10.40 per 10,000 AEs). Competition-related concussion rates in football increased during the study period (33.19 to 39.07 per 10,000 AEs), while practice-related concussion rates declined (5.47 to 4.44 per 10,000 AEs). Recurrent concussion rates decreased from 0.47 to 0.28 per 10,000 AEs across all sports. In sex-comparable sports, females had a higher concussion rate than males (3.35 versus 1.51 per 10,000 AEs), as well as a higher rate of recurrent concussions (9.3 percent versus 6.4 percent, respectively).

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Medicare Recipients Moving to Higher-rated Plans

Medicare Part D and Medicare Advantage Part C members are gravitating toward plans with higher Star ratings, according to data released by the Centers for Medicare & Medicaid Services (CMS). In 2020, 27.6 percent of Medicare Part D prescription drug plan members will be enrolled in plans with four stars or more—a 3.5 percent increase from last year. The percentage of Medicare Advantage Part C plan members with at least four-star plans will grow from 75.3 percent in 2019 to 81.1 percent in 2020. The Medicare Payment Advisory Commission has previously criticized the Star rating system and suggested that at least $6 billion could be saved by redesigning it.

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AAOS Now

Key Changes Proposed in CMS’ 2020 Rules

Although August was a slow month for Congress, the AAOS regulatory team was busy analyzing the provisions set forth by CMS in its two proposed payment rules for fiscal year 2020: the Outpatient Prospective Payment System/ASC and the Medicare Physician Fee Schedule. The Academy submitted formal comments prior to the Sept. 27 deadline, but if finalized, the proposed changes will have significant impact on physician practice and reimbursement. This article describes key takeaways of the proposals.

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Your AAOS

Personalize Your OVT Member Profile

Take five minutes to update your member profile on the newly expanded Orthopaedic Video Theater (OVT). Click on the person icon in the top right corner of the OVT landing page, select “My Profile,” and choose the specialty topics of most interest to you. You can also update your contact information and add an image and brief biography. By keeping your profile current, you get a much more personalized learning experience that addresses your needs, interests, and preferences.

Update your profile…(member login required)

 

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