May 30, 2018 | Today’s News

Report: Wide variation in costs found for joint replacement implants

Consulting agency Premier assessed joint-replacement costs among 15 implant vendors and found what appeared to be wide variation. Among 350 hospitals studied, the average cost of primary knee implants was $4,464, but 50 percent of hospitals paid between $4,066 and $5,609 for the devices. In addition, those hospitals paid an average of $5,252 for primary hip implants, with 50 percent paying between $4,759 and $6,463. The analysis indicated that the hospitals could save $23.7 million on knee implants and $19.1 million on hip implants if they paid the same amount as the top 25th percentile of hospitals. Premier used its database of 1,100 hospitals to compare costs.

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Study: When is it appropriate to perform complete blood count tests in primary THA patients?

Results of a single-center, retrospective study published online in The Journal of Arthroplasty indicate that routine complete blood count (CBC) tests performed following total hip arthroplasty (THA) in the patients with normal preoperative hemoglobin (who did not receive tranexamic acid [TXA]) did not contribute to actionable information. The authors identified 352 patients who underwent primary THA between 2012 and 2014 and collected pre- and postoperative CBC values, demographic data, transfusion rates, and the use of TXA. The researchers reported transfusion in 54 patients (15.3 percent) and that patients who did not receive TXA were 3.7 times more likely to receive a transfusion. Patients who did receive transfusion had a lower preoperative hemoglobin count (12.0 g/dL) than those who did not undergo transfusion (13.5 g/dL). Hemoglobin values less than 11.94 g/dL among patients who were anemic preoperatively or did not receive TXA were predictive of postoperative transfusion.

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According to a study published online in JAMA Internal Medicine, surgically repairing hip fractures in nursing home residents with advanced dementia may be associated with decreased mortality rates. Researchers conducted a retrospective cohort study and identified 3,083 patients (average age, 84 years; 79.2 percent female) using nationwide Medicare claims data linked with Minimum Data Set assessments from Jan. 1, 2008, through Dec. 31, 2013. Of this patient cohort, 2,615 (84.8 percent) received surgery. At six-month follow-up, 824 (31.5 percent) of the surgically and 252 (53.8 percent) of the nonsurgically managed residents died, indicating that surgically managed residents were less likely to die (adjusted hazard ratio, 0.88; 95 percent confidence interval, 0.79-0.98). Of the 2,007 residents who were alive at six months, those who underwent surgery experienced slightly less pain than those who did not (29 percent versus 30.9 percent); however, the prevalence of pain in both cohorts suggests the need for improvements in care, according to the investigators.

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Patients with hip or knee arthritis significantly underreport the use of narcotics to physicians, according to a study published online in The Journal of Arthroplasty. Researchers obtained data from electronic health records (EHRs) of 502 patients, and then performed a subsequent search using the Arkansas Prescription-Drug Monitoring Program for previously prescribed narcotics for those patients. According to the results, 170 patients (34 percent) were prescribed narcotics within three months of a clinic visit, but just 111 (22 percent) had reported use of the narcotic in their EHRs. Additionally, only 92 of 170 patients (54 percent) who were prescribed a narcotic within three months reported it.

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Study examines readmission risk factors, cost drivers in ankle fractures

A study that sought to determine the independent clinical variables associated with increasing total costs in a 90-day episode of care (EOC) for the management of isolated ankle fractures requiring surgery found that patients with an American Society of Anesthesiologists physical status classification score ≥ 3 and patients treated by the podiatry service as opposed to the orthopaedic team were at an increased risk of hospital readmission at both 30- and 90-days post discharge. Such patients, along with male patients, were independently associated with increasing total post-discharge costs in the 90-day EOC, according to the study that was presented at the AAOS 2018 Annual Meeting.

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Last call – Apply for member-at-large position of Research Development Committee

The AAOS Research Development Committee has an open position for member-at-large, a term that runs through March 2020. The committee promotes orthopaedic research through advocacy, education, and recognition of excellence. The position develops strong relationships with research funding organizations and advocacy groups, advocates for musculoskeletal research funding on a federal level, and creates and oversees programs that encourage development of young orthopaedic investigators. The last day to submit an application is tomorrow, May 31, 2018.

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Studies show that injuries resulting from overuse in children happen gradually and can have a lifelong effect on athletes’ quality of life. The AAOS is working to prevent overuse injuries in young athletes through the OneSport™ public service advertising campaign. Help raise awareness by displaying free OneSport injury easel backs and posters in your office If interested in these materials, please contact: media@aaos.org.

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