Study: Timing of Adverse Events within 90 Days of Hip Fracture Surgery
A database study in the Journal of the AAOS® found that 30 percent of adverse events following hip fracture surgery occurred 31 to 90 days postoperatively in patients aged >65 years. Median, interquartile range, and middle 80 percent for time of diagnosis was calculated from the 90-day incidence and time of diagnosis of 10 common adverse events, and the number of events occurring before and after 30 days was recorded. Patients with 31- to 90-day adverse events had higher average Elixhauser Comorbidity Index scores (8.6 versus 7.8) and were more likely to be male (31.5 percent versus 30.2 percent)
Study Assesses Visceral Fat as a Risk Factor for PJI following THA and TKA
The Journal of Arthroplasty published a retrospective study assessing the relationship between visceral fat area (VFA) and periprosthetic joint infection (PJI) in total knee (TKA) and hip arthroplasty (THA). The body compositions of 484 patients were calculated, and a multivariable logistic model was created to determine the relationship between VFA and PJI. The rate of PJI in THA patients with VFA in the top quartile versus bottom quartile was 5.6 percent and 10.6 percent, respectively. TKA patients with a VFA in the top quartile had a 30.5 times greater risk of PJI than TKA in patients in the bottom quartile of VFA.
Study Investigates Risk Factors and Long-term Survivorship following Medial UKA
Implant design and patient age were risk factors for revision of medial unicompartmental knee arthroplasty (UKA), according to a prognostic study in the Journal of Bone and Joint Surgery. The survivorship, risk factors, and reasons for revision in a cohort of 2,015 medial UKAs with a mean follow-up of eight years were assessed. At 15 years postsurgery, the implant survivorship was 92 percent for cemented fixed-bearing, 91 percent for uncemented mobile-bearing, and 80 percent for cemented mobile-bearing UKAs. Cemented implants had a higher cumulative frequency of revision due aseptic loosening compared with uncemented (3 to 4 percent versus 0.4 percent).
Study Evaluates the Effect of IV Magnesium on Postoperative Pain after Shoulder Reconstruction
In a blinded randomized trial in Shoulder & Elbow, IV magnesium prior to single injection ropivacaine interscalene anesthesia and Latarjet open shoulder reconstruction resulted in less rebound pain following ropivacaine block. Forty patients were randomized to receive either 50 mg/kg of IV magnesium sulphate or normal saline before induction. Verbal numerical rating assessment scores and requirements for injected opioid analgesia were collected postoperatively. Twenty-four hours postsurgery, magnesium was associated with lower pain intensity and improved analgesia.
MedPAC Calls for Physician Payments to Be Tied to Inflation-based Index
For the first time, the Medicare Payment Advisory Commission is recommending that physician payments be updated by tying them to 50 percent of the Medicare Economic Index, essentially adjusting for inflation. The independent advisory agency made the recommendation in an annual report to Congress, which would result in a 1.45 percent payment increase via the Medicare Physician Fee Schedule. Healthcare organizations, including AAOS, view the move as a critical first step toward reforming Medicare to make it more rational and serve patients better.
Update Details Coding for Non-face-to-face and Indirect Patient Optimization Work in the Presurgical Period
The American Medical Association (AMA) states that principal care management codes are the appropriate codes for reporting presurgical optimization management services for non-face-to-face and indirect interactions with the patient. Patient presurgical optimization requires ongoing communication with a care team, coordination of management of comorbidities (e.g., diabetes, hypertension), advocacy of lifestyle changes (e.g., smoking cessation), and adjustment of medications as needed. These services help minimize operative complications and maximize patient outcomes; the work spent by physicians on these care plans can and should be reported, the AMA advises.
OrthoInfo: Orthopaedic Patient Education at Your Fingertips
OrthoInfo, the Academy’s patient education website, is here to provide your patients with trustworthy, in-depth information covering more than 450 topics—all written, reviewed, and regularly updated by orthopaedic specialists. In addition to printing OrthoInfo content, you can connect to OrthoInfo from your practice website, free of charge. Simply choose which topics are helpful for your patients and add the page links to your site. You can also include relevant links in each patient’s after-visit summary for a personalized educational experience. Visit orthoinfo.org to see the full range of content and start sharing it with your patients.
