Today’s Top Story
Study: Surgeon specialization may be more important quality factor than volume.
Data from a study published online in the journal The BMJ suggest that surgeon specialization may be a stronger of measure of quality than the number of times a particular procedure is performed. The research team reviewed Medicare data on 25,152 surgeons in the United States who performed at least one of eight procedures (carotid endarterectomy, coronary artery bypass grafting, valve replacement, abdominal aortic aneurysm repair, lung resection, cystectomy, pancreatic resection, or esophagectomy) on 695,987 patients. They found that, for all four cardiovascular procedures and two out of four cancer resections, a surgeon’s degree of specialization was a significant predictor of operative mortality, independent of the number of times the surgeon performed that procedure. In addition, for five procedures, the relative risk reduction from surgeon specialization was greater than that from surgeon volume for that specific procedure. The research team notes that surgeon specialization accounted for 9 percent to 100 percent of the relative risk reduction otherwise attributable to volume in that specific procedure. Read more…
Read the abstract…

Other News

Study: HA-BMAC may offer improved outcomes compared to microfracture for chondral injury.
According to a study published online in The American Journal of Sports Medicine, a hyaluronic acid–based scaffold with activated bone marrow aspirate concentrate (HA-BMAC) may offer improved clinical outcomes and more durable cartilage repair, compared with microfracture for chondral injury repair. The authors conducted a cohort study of 50 physically active patients with a mean age of 45 years, who had a grade IV cartilage injury of the knee, and who were treated with HA-BMAC or microfracture. At 2-year follow-up, 100 percent of patients treated with HA-BMAC were classified as normal or nearly normal according to the International Knee Documentation Committee (IKDC) objective score, compared to 64 percent of patients in the microfracture cohort. At 5-year follow-up, 100 percent of patients in the HA-BMAC cohort had maintained improvement, compared to 28 percent of patients in the microfracture cohort. Read the abstract…

September CORR looks at issues that affect women in orthopaedics.
The September issue of the journal Clinical Orthopaedics and Related Research (CORR) features a number of articles that address the issue of women in orthopaedics. One study notes that although approximately half of the medical students in the United States are women, they represent only 13 percent of orthopaedic surgery residents and 4 percent of the AAOS membership. In addition, “a smaller relative percentage of women pursue careers in orthopaedic surgery than in any other subspecialty.” View the issue…
Read “Women in Orthopaedics: The Attraction Is Mutual” from the August issue of AAOS Now

Study: Patients undergoing bariatric surgery may be at increased risk of fracture.
According to a study conducted in Canada and published online in The BMJ, patients who undergo bariatric surgery may be more likely to experience fractures than obese or non-obese patients. The researchers conducted a retrospective, nested, case-control study of 12,676 patients who underwent bariatric surgery, and 38,028 obese and 126,760 non-obese age and sex matched controls. They found that, prior to surgery, patients undergoing bariatric surgery were more likely to fracture than obese or non-obese controls. This remained true at mean 4.4-year follow-up. The researcher note that prior to surgery, the risk of distal lower limb fracture was higher, upper limb fracture risk was lower, and risk of clinical spine, hip, femur, or pelvic fractures was similar in the bariatric and obese groups compared with the non-obese group. Following surgery, risk of distal lower limb fracture decreased, while risk of upper limb, clinical spine, pelvic, hip, or femur fractures increased. The researchers state that the increase in risk of fracture reached significance only for biliopancreatic diversion. Read more…
Read the abstract…

Settlement reached in spine case that alleged lack of disclosure regarding physician conflict of interest.
Kaiser Health News reports that the University of California has agreed to pay nearly $8.5 million to settle two lawsuits that alleged that a spine surgeon did not disclose conflicts of interest with a device maker before using that company’s products in surgeries that were later associated with complications. Read more…

The Milwaukee Journal-Sentinel reports that the Wisconsin Medical Examining Board has released new guidelines to help reduce opioid addiction in the state. Recommendations include:

  • Addressing pain through alternative treatments prior to prescribing opioids
  • Prescribing opioids at the lowest possible dose and quantity
  • Issuing two smaller prescriptions with specific refill dates as an alternative to one larger prescription
  • Informed consent for patients on chronic opioid therapy

Read more…

Call for volunteers: Instructional Course Committees.
Aug. 17 is the last day to submit your application for a position on an Instructional Course Committee. Members of Instructional Course Committees grade Instructional Course Lecture applications, provide input regarding course curriculum, and evaluate courses at the AAOS Annual Meeting. The following openings are available:

  • Adult Reconstruction Hip (chair, three members)
  • Adult Reconstruction Knee (three members)
  • Foot and Ankle (three members)
  • Hand and Wrist (three members)
  • Pediatrics (three members)
  • Practice Management (one member)
  • Shoulder and Elbow (three members)
  • Spine (five members)
  • Sports Medicine and Arthroscopy (four members)
  • Trauma (one member)
  • Tumor (two members)

Applicants for these positions must be active fellows with a practice emphasis in the relevant area. Learn more and submit your application…(member login required)