December 23, 2019 | Today’s News

Study Analyzes Hemiarthroplasty Outcomes Based on Hospital and Surgeon Volume

A study published online in The Journal of Arthroplasty evaluated complication rates following hemiarthroplasty for femoral neck fracture treated at high-volume hospitals and by high-volume surgeons. The New York Statewide Planning and Research Cooperative System 2001–2015 dataset was queried for hemiarthroplasty patients aged 60 years or older. Hospitals with fewer than 50 annual hip arthroplasty cases and surgeons with fewer than 10 annual cases were excluded. The remaining cases were stratified into two volume (50–70 annual cases versus more than 245 annual cases) and surgeon (10–15 annual cases versus 60 or more annual cases) groups. Final analysis included 48,809 patients. Very high-volume hospitals had a slightly lower rate of pneumonia (6 percent versus 7 percent), while very high-volume surgeons had slightly increased rates of inpatient mortality (3 percent versus 2 percent), revision surgery (3 percent for both), and implant failure (1 percent versus less than 1 percent).

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Study: How Do Patient Characteristics Affect Rotator Cuff Repair Outcomes?

A study published online in The American Journal of Sports Medicine assessed the correlation between patient- and disease-specific characteristics and baseline patient-reported outcome measures (PROMs) in rotator cuff repair patients. The authors identified 12 patient- and 12 disease-specific factors as potential predictors of baseline PROMs in operative superior-posterior rotator cuff tear patients. Final analysis included 1,442 patients treated by 23 surgeons at a single institution. The median baseline total Penn Shoulder Score (PSS) was 38.5: pain, 12.0; function, 24.2; and satisfaction, 2.0. The 24 possible predictive factors constituted between 22 percent and 24 percent of the variability in total PSS, as well as the pain and function subscale scores. Patients with large/massive tears had significantly worse total PSS and function score, but larger tears did not correlate with pain or satisfaction scores. A lower Veterans RAND 12-Item Health Survey mental component score (VR-12 MCS) was largely predictive of poorer total PSS and all three subscales. The most significant factors that correlated with baseline PROMs were lower VR-12 MCS, preoperative opioid use, female sex, and black race.

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A study published online in BMC Musculoskeletal Disorders compared different strategies for assessing foot muscle strength. Seven measurements were calculated in 40 healthy patients with a custom toe flexion dynamometer (seated), custom doming dynamometer (standing), and pressure mat (standing). All three measurements were evaluated for reliability; the doming dynamometer was further assessed for a learning effect, and the toe flexion dynamometer and pressure mat were assessed for comparability. Reliability in the doming measurement was considered excellent, but a learning effect was observed through increased muscle activity and strength between sessions. Excellent reliability was observed in all toe flexion tests. A moderate relationship was observed between seated toe flexion tests with the dynamometer and standing toe flexion tests on a pressure mat, but muscle activity differences were observed. Reciprocal motion on the pressure mat presented somewhat greater forces and reliability compared to isolated toe flexion.

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A study published in the December issue of The Journal of Hand Surgery described outcomes using a patient-specific opioid requirement calculator. Eligible patients treated at a single center were identified before (n = 305) or after (n = 225) implementing a postoperative pain control program. Patients filled out an opioid use and pain control satisfaction survey at their first postoperative visit. These data were used to create the patient-specific opioid calculator and pain plan, which was applied to the second group. Predictors of higher opioid consumption were younger age; baseline opioid use; regional block use; unemployment; procedures involving bony, tendinous, or ligamentous work (versus soft tissue alone); and longer procedure time. The number of opioids prescribed decreased 63 percent from a mean 32.0 pills/surgery (194.5 morphine milligram equivalents [MMEs]) preintervention to 11.7 pills/surgery (86.4 MMEs) post-intervention. Opioid consumption decreased 58 percent: preintervention, 21.7 pills/surgery (137.7 MMEs) versus post-intervention, 9.3 pills/surgery (64.4 MMEs). Wasted opioids decreased 62 percent from the pre- (13.8 pills/surgery [62.8 MMEs]) to post-intervention (5.2 pills/surgery [24.8 MMEs]) periods. The pain plan and calculator did not increase the rates of unsatisfactory patient-rated pain control or unplanned opioid refills.

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According to a report published by Foley & Lardner LLP, 42 states and the District of Columbia have a telehealth commercial payer statute in place; however, reimbursement/payment parity is lacking. While 16 states have laws that address reimbursement for telehealth services, only 10 provide true payment parity.

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Orthopaedic Surgeon Shines During Fall Classic

The Washington Nationals clinched their first World Series win on Oct. 31, and Robin West, MD, lead team physician, helped keep the team healthy all season. She also is the director of sports medicine and head team physician for the Washington Redskins, as well as president of Inova Musculoskeletal Service Line and chairman of Inova Sports Medicine. Dr. West is the only female serving as head team physician for both a professional football and baseball team. In an interview with AAOS Now, she discussed the recent win and what it’s like working with professional sports teams. Dr. West also provided advice for women in medicine.

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Apply for Volunteer Opportunities

Consider applying for the following positions:

• Adult Reconstruction Knee Program Committee member positions—applications are accepted until Dec. 27
• Committee On Devices, Biologics, and Technology chair and member positions—applications are accepted until Dec. 27
• Diversity Advisory Board resident and member-at-large positions—applications are accepted until Dec. 30
• Education Assessments and Examinations Committee member position—applications are accepted until Dec. 31
• Foot & Ankle Program Committee member positions—applications are accepted until Dec. 27
• Foot and Ankle Instructional Course Committee chair position—applications are accepted until Dec. 27
• Health Care Systems Committee section leader positions—applications are accepted until Dec. 30
• Membership Council candidate member position—applications are accepted until Dec. 30
• Musculoskeletal Tumor & Metabolic Disease Program Committee member position—applications are accepted until Dec. 27
• Orthopaedic Video Theater Committee member position—applications are accepted until Jan. 5, 2020
• Practice Management/Rehabilitation Program Committee member positions—applications are accepted until Dec. 27
• Research Development Committee member-at-large position—applications are accepted until Dec. 30
• Trauma Program Committee member positions—applications are accepted until Dec. 27

Learn more and submit applications…(member login required)