November 29, 2017 | Today’s News

Study: Earlier hip fracture surgery linked to decreased risk of mortality and complication for older patients

According to a study published in the Nov. 28 issue of The Journal of the American Medical Association, increased wait time prior to hip fracture surgery may be associated with increased risk of mortality and complication for older patients. The researchers reviewed data on 42,230 hip fracture patients with a mean age of 80.1 years and found that overall risk of complication increased when wait times were longer than 24 hours. Comparing a subset of 13,731 patients who received surgery within 24 hours against a matched cohort of 13,731 patients who received surgery after 24 hours, they found that patients who waited longer were at significantly increased risk of 30-day mortality and complication risk.

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Study: Steroid/anesthetic hip injection linked to risk of increased osteonecrosis

Findings presented at the annual meeting of the Radiological Society of North America (RSNA) suggest that injection of steroid and anesthetic into the hip may be linked to increased risk of osteonecrosis and collapse. The authors conducted a retrospective, matched cohort study of 102 adult patients who received injection of 40 mg triamcinolone/4 mL 0.5% preservative free ropivacaine, along with a control cohort of patients who underwent hip radiography without injection and a control cohort of patients who received glenohumeral joint injection. Based on independent reviews of radiographs taken at 3- to 9-month follow-up, they found that, compared to controls, patients who received hip injection were at significantly increased risk of new osteonecrosis and collapse, but not of increased osteoarthritis.

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Data from a paper presented at the RSNA annual meeting suggest that computed tomography (CT)-guided pulsed radiofrequency (PRF) may be an effective treatment for patients with acute or subacute neuroradicular low back pain. Members of the research team conducted a prospective study of 80 patients treated with pulsed radiofrequency under CT guidance. They found that mean visual analog scale scores decreased from 7.8 at baseline to 3.5 at 1 week after treatment, to 2.6 at 1 month, and 1.3 at 3 months. In addition, median Oswestry Disability Index (ODI) scores decreased from 78.0 at baseline to 12.5 at 1 week, to 6.0 at 1 month, and 5.5 at 3 months; Roland-Morris score decreased from 16 at baseline to 3 at 1 month, and 1.5 at 3 months. The researchers noted that 90 percent of patients reached a 0 VAS score within the first month after treatment and 97.5 percent of patients had a decrease of at least 20 points in ODI score over the same period. Overall, six patients were considered partial responders and required a second PRF session.

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A study published online in the journal Annals of Internal Medicine suggests that implementation of the Medicare Value-Based Payment Modifier (VBPM) may not have significantly impacted performance on certain program measures. The authors reviewed data on a random sample of Medicare beneficiaries and found that phase-in of the VBPM was not associated with statistically significant changes in hospitalization for ambulatory care-sensitive conditions, all-cause 30-day readmissions, Medicare spending, and mortality among practices with 10 or more clinicians or 100 or more clinicians. However, they note that performance differences between practices serving higher- or lower-risk patients were affected by additional adjustments, suggesting a potential for pay-for-performance programs to exacerbate healthcare disparities.

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According to a study published online in the journal JAMA Internal Medicine, clinician denial of certain patient requests may negatively impact patient satisfaction. The researchers conducted a cross-sectional, observational study of 1,319 outpatient visits (1,141 adult patients) to family physicians at a single center. They found that 897 (68 percent) of visits included at least one request. Requests by category included the following:

• referral, 294 (21.1 percent)
• pain medication, 271 (20.5 percent)
• antibiotic, 107 (8.1 percent)
• other new medication, 271 (20.5 percent)
• laboratory test, 448 (34 percent)
• radiology test, 153 (11.6 percent)
• other tests, 147 (11.1 percent)

The researchers found that clinician denials of requests for referral, pain medication, other new medication, and laboratory test were associated with worse satisfaction scores. “In an era of patient satisfaction-driven compensation,” the researchers write, “the findings suggest the need to train clinicians to deal effectively with requests, potentially enhancing patient and clinician experiences.”

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JAAOS to expand to 24 issues in 2018

Beginning in January 2018, the Journal of the AAOS ( JAAOS) will expand from 12 to 24 issues per year, with new issues appearing online on the 1st and 15th of every month. Additional changes will include the following:

• an expanded “green” section of evidence-based research articles
• a wider selection of trusted articles, including systematic reviews and summaries of AAOS Clinical Practice Guidelines and Appropriate Use Criteria
• select Orthopaedic Video Theater abstracts from the AAOS Annual Meeting, with associated video trailers available on the JAAOS.org website

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Call for volunteers: PCORI physician specialty society roundtable

AAOS seeks to nominate one member to participate in the upcoming physician roundtable hosted by the Patient-Centered Outcomes Research Institute (PCORI). The discussion will offer an opportunity for PCORI to share its progress and identify new ways the organization can collaborate with physician specialty societies, particularly regarding dissemination and implementation of PCORI-funded evidence into physician practice. Applicants for this position must be active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic with either spine or total joint expertise. In addition, all applicants must provide the following: an online AAOS CAP application, a current curriculum vitae, and a 100-word biography. All supporting materials must be submitted to Kyle Trivedi by Dec. 17, 2017, at 11:59 p.m. CT, at:

trivedi@aaos.org

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