February 12, 2018 | Today’s News

Study: Rapid rise in INR after warfarin linked to increased risk of VTE in TJA patients

Data from a study published in the Feb. 15 issue of the Journal of the AAOS suggest that rapid increase in international normalized ratio (INR) after warfarin initiation may be associated with increased risk of venous thromboembolism (VTE) in patients who undergo total joint arthroplasty (TJA). Members of the research team conducted a retrospective study of 948 patients (715 total knee arthroplasty, 233 total hip arthroplasty), of whom 4.4 percent experienced symptomatic VTE within 30 days postoperatively. They found that change in INR from postoperative day 1 to postoperative day 2 was significantly greater among patients with symptomatic VTE compared to those without VTE. The researchers argue that further research should be conducted into the early effects of warfarin therapy.

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Study: Antibiotic prophylaxis may not reduce SSI risk for certain hand procedures

According to a study published online in the journal Clinical Orthopaedics and Related Research, antibiotic prophylaxis may not reduce risk of postoperative surgical site infection (SSI) following common soft tissue procedures of the hand. The researchers conducted a retrospective analysis of two large commercial claims databases covering 516,986 patients who underwent either carpal tunnel release, trigger finger release, ganglion and retinacular cyst excision, de Quervain’s release, or soft tissue mass excision. Overall, 58,201 patients (11 percent) received antibiotic prophylaxis. After controlling for factors such as patient demographics, hand procedure type, medication use, existing comorbidities, and postoperative events, they found that the risk of SSI did not differ significantly between prophylaxis and no-prophylaxis cohorts.

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Findings from a study conducted in Northern Ireland and published in the February issue of the Journal of Orthopaedic Trauma suggest that use of a cephalomedullary nail (CMN) for treatment of unstable intertrochanteric hip fractures may offer improved outcomes compared to sliding hip screw (SHS) with or without a trochanteric stabilization plate (TSP). Members of the research team reviewed prospectively collected data on 3,230 patients who met inclusion criteria. Among them, 2,474 patients were treated with SHS, 158 patients were treated with SHS plus TSP, and 598 patients were treated with CMN. At 12-month follow-up, the researchers found no significant difference across cohorts in functional outcome. However, patients treated with CMN displayed significantly lower 12-month mortality rates, and the highest revision rate was seen among patients treated with SHS alone.

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A study published conducted in Switzerland and published online in the Journal of Bone and Mineral Research suggests that poor functional performance as assessed by the Short Physical Performance Battery (SPPB) test may be an independent predictor of serious injurious falls in patients admitted to a geriatric hospital. The authors conducted a prospective study of 807 patients who were subjected to an array of functional tests administered by physiotherapists within 3 days of admission, including SPPB, simplified Tinetti, and Timed Up and Go tests. They found that 329 falls occurred in 189 patients (23.4 percent) during a median hospital stay of 23 days. Overall, there were 161 injurious falls, of which 24 were determined to be serious. The authors note that compared with non-fallers, in-hospital fallers displayed significantly poorer functional performance at admission on all tests, but only SPPB significantly predicted serious injurious falls.

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The U.S. Centers for Medicare & Medicaid Services is reminding providers of several data submission deadlines for the 2017 Merit-based Incentive Payment System (MIPS) performance period. The following deadlines are forthcoming:

• March 16, 2018, 8:00 p.m. ET, for group reporting via the CMS web interface
• March 31, 2018, for all other MIPS reporting

The agency states that providers who are unsure of their MIPS reporting status should enter their National Provider Identifier in the MIPS Lookup Tool Providers who are unsure if they are participating in a MIPS Alternative Payment Model (APM) or Advanced APM should use the APM Lookup Tool.

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Verify MIPS participation status…

Verify APM participation status…

An article in Modern Healthcare points to a 2017 report from the American Medical Association that found that for the first time, less than half of U.S. physicians are independent, and resources required to comply with quality payment programs have been cited as a major factor for that shift. The writer notes that some independent-practice providers have chosen ACO participation as a way to successfully adapt to payment reform while retaining autonomy In addition, some health systems and hospitals have chosen to form ACO partnerships with independent physicians as a way of working together without direct employment.

Read more…  (registration may be required)

Call for volunteers: Instructional Course Committees

March 30, 2018, is the last day to submit an application for a position on an Instructional Course Committee. Instructional Course Committee members grade Instructional Course Lecture applications in May and evaluate courses at the AAOS Annual Meeting in March. The following openings are available:

• Hand and Wrist (chair)
• Practice Management (chair)

Applicants for these positions must be active fellows with a practice emphasis in the relevant topic.

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