Today’s Top Story
Study: Less than half of elective ACDF patients readmitted for surgical site-related issues.
A study published in the Dec. 1 issue of the journal Spine argues for the importance of careful patient selection, aggressive preoperative medical optimization, and appropriate postoperative management for patients undergoing elective anterior cervical discectomy and fusion (ACDF). The researchers reviewed information on 17,088 patients from the National Surgical Quality Improvement Program database. Of 545 patients (3.2 percent) readmitted within 30 days, they noted that 53.8 percent (n = 293) were readmitted for nonsurgical site-related reasons, with neuropsychiatric (n = 44), cardiovascular (n = 39), and pneumonia (n = 37) being the most common reasons. Overall, 33.8 percent (n = 184) were readmitted for surgical site-related reasons, with surgical site infection (n = 42), hemorrhage/hematoma (n = 42), and dysphagia (n = 32) being the most common reasons. The researchers state that 15.6 percent (n = 84) had undocumented reasons for readmission. In multivariate analysis, only older age and higher American Society of Anesthesiologists class were independently associated with readmissions. Read the abstract…

Other News

Study: Organization-directed interventions may help reduce physician burnout.
Findings published online in the journal JAMA Internal Medicine suggest that the effectiveness of physician burnout intervention programs may be improved through adoption of organization-directed approaches. The research team conducted a systematic review and meta-analysis of 19 randomized trials and controlled before-after studies of interventions targeting burnout in physicians. They found that interventions were associated with small significant reductions in burnout. However, subgroup analyses suggested that organization-directed interventions displayed significantly improved effects compared with physician-directed interventions. Read the abstract…

Study: Cost information and financial incentives linked to reductions in use of surgical supplies.
According to a study published online in the journal JAMA Surgery, cost feedback to surgeons along with a small financial incentive may help reduce surgical supply costs with no negative effect on patient outcomes. The authors reviewed data from a prospective, controlled study of 63 attending surgeons in departments that received standardized monthly surgical supply cost scorecards and 186 attending surgeons in departments that did not. All surgical departments were eligible for a financial incentive if they met a 5 percent cost reduction goal. The authors found that median surgical supply direct costs per case decreased 6.54 percent in the intervention group, while median surgical supply direct costs increased 7.42 percent in the control group. After controlling for surgeon, department, patient demographics, and clinical indicators in a mixed-effects model, the authors noted a 9.95 percent surgical supply cost decrease in the intervention group over 1 year. Overall, patient outcomes were equivalent or improved following intervention, and surgeons who received scorecards reported higher levels of cost awareness on the healthcare value survey compared with controls. Read the complete study…

Polls suggests most long-term users come to opioids via prescription, but many lack information on risks.
A poll conducted by The Washington Post and the Kaiser Family Foundation suggests that as many as one-third of Americans who have taken prescription opioids for at least 2 months may have become addicted to or physically dependent on the drugs. Most long-term users said that they were introduced to opioids via physician prescription, but more than 6 in 10 said physicians offered no advice on how or when to stop taking the drugs, and 1 in 5 said physicians provided insufficient information about the risk of side effects, including addiction. Read more…
Read the complete report…

GAO report notes challenges faced by small and rural practices in participating in Medicare value-based payment models.
A report from the U.S. Government Accountability Office (GAO) identifies challenges faced by small and rural physician practices regarding participation in new Medicare payment models. Based on information from interviews conducted with stakeholders, GAO notes there are a variety of services to help small and rural physician practices with challenges to participating in Medicare value-based payment models, but not all such practices can access those services. The writers identify challenges in five key topic areas, including:

  • Financial resources and risk management
  • Health information technology and data
  • Population health management care delivery
  • Quality and efficiency performance measurement and reporting
  • Effects of model participation and managing compliance with requirements

Read more…
Read the complete report (PDF)…

Study: Many medical students suffer from depression or related symptoms.
A study published in the Dec. 6 issue of The Journal of the American Medical Association suggests that many medical students may suffer from depression or depressive symptoms. The researchers conducted a systematic review and meta-analysis of data from 167 cross-sectional studies (116,628 participants) and 16 longitudinal studies (5,728 participants) from 43 countries. They found that the overall pooled crude prevalence of depression or depressive symptoms was 27.2 percent, and suicidal ideation was 11.1 percent. In addition, based on nine longitudinal studies covering 2,432 participants that assessed depressive symptoms before and during medical school, the researchers found that the median absolute increase in symptoms was 13.5 percent. Read more…
Read the abstract…

Call for volunteers: Central Evaluation Committee.
Dec. 27 is the last day to submit your application for a position on the Central Evaluation Committee (one member opening—hand and wrist). Members of the Central Evaluation Committee write questions for the Orthopaedic In-Training Examination. Applicants for this position must be active or emeritus fellows with a practice emphasis in hand and wrist. Learn more and submit your application…(member login required)