Today’s Top Story
Senate passes 21st Century Cures Act.
In a 94-5 vote, the U.S. Senate has passed the 21st Century Cures Act. Among other things, the act allocates $4.8 billion for biomedical research over a decade and includes provisions to streamline the U.S. Food and Drug Administration (FDA) drug and device approval process. Supporters of the legislation say that it will streamline the federal drug regulatory structure to keep up with advances in biotechnology and medical research, but some critics have argued that the bill lowers FDA drug and device approval standards in exchange for increases in funding for the National Institutes of Health. The bill passed the U.S. House of Representatives last week and now goes to President Obama, who is expected to sign it. Read more…
     The American Association of Orthopaedic Surgeons (AAOS) released a statement in the wake of the House passage of the bill. Read more…

Other News

Survey: Many treatments prescribed despite little evidence of high value to patients.
Information from a research letter published in the Dec. 6 issue of the journal Annals of Surgery suggests an overuse of certain antibiotics, aggressive non-palliative treatment in patients with limited life expectancy, treatment of chronic pain, and dietary supplements. The researchers randomly surveyed 5,000 members of the American College of Physicians and asked them to identify two treatments frequently used by internists but unlikely to provide high value care to patients. They found that many physicians continue to prescribe more costly treatments, despite evidence highlighting the efficacy and efficiency of generic medications, and a lack of evidence supporting the use of newer and more expensive medications compared to older medications. Read more…
Read the abstract…

Study: Bioabsorbable screws offer similar short-term outcomes as steel for ORIF treatment of Lisfranc injury.
Data from a study published in the December issue of the Journal of Orthopaedic Trauma suggest that bioabsorbable screws may offer similar short-term results as steel screws for the treatment of Lisfranc injuries. The authors conducted a prospective, randomized trial of 40 patients with acute Lisfranc injury who were amenable to open reduction and internal fixation (ORIF). At latest follow-up, they found that, among patients with steel screws, the mean Foot and Ankle Ability Measures (FAAM) score increased from 24.9 to 89.6 of 100 and pain score decreased from 6.5 to 1.9 of 10; among patients with bioabsorbable screws, the mean FAAM score increased from 32.5 to 91.2 while pain score decreased from 4.7 to 1.3. The authors write that final radiographs showed no Lisfranc instability in any study patients, but four patients with steel screws and two patients with bioabsorbable screws displayed midfoot arthritis. In addition, no patients in the steel screw cohort had hardware-related problems, but one patient who received absorbable fixation developed an inflammatory reaction at a nonresorbed screw head at 2 years after surgery. Read the abstract…

Study: End-of-rotation care transition associated with increased risk of mortality.
According to a study published in the Dec. 6 issue of The Journal of the American Medical Association, end-of-rotation transition in care may be linked with increased risk of in-hospital mortality. The research team conducted a retrospective cohort study of 230,701 patients admitted to internal medicine services at 10 university-affiliated U.S. Veterans Health Administration hospitals. Among 230,701 patient discharges, they found that 25,938 intern-only, 26,456 resident-only, and 11,517 intern + resident end-of-rotation transitions occurred. The research team found that adjusted hospital mortality was significantly greater in transition vs. control patients for the intern-only group and the intern + resident group, but not for the resident-only group. In addition, duty hour changes were associated with greater adjusted hospital mortality for transition patients in the intern-only group and intern + resident group compared to controls. The research team notes that alternative analyses did not demonstrate any significant differences in mortality between transition and control groups. Read more…
Read the abstract…

Overlapping surgery may be safe; Senate committee report offers concerns regarding the practice.
Findings from a study published online in the journal Annals of Surgery suggest that overlapping surgery may be safe, at least in concept. The researchers reviewed data on 10,765 overlapping surgical cases, of which 10,614 (98.6 percent) were matched to 16,111 non-overlapping procedures at a single center. They found that 30-day mortality, morbidity, and length of stay were not statistically different across cohorts, and that adjusted risk for inpatient mortality was greater for non-overlapping surgery compared to overlapping surgery. However, the researchers write that the findings “support the safety of overlapping surgical procedures at this center but may not extrapolate to other centers.” Read more…
Read the abstract…
     In related news, the U.S. Senate Finance Committee has issued a report on the practice of concurrent and overlapping surgeries. The committee contacted 20 teaching hospitals regarding the practice and examined guidance from the U.S. Centers for Medicare & Medicaid Services and the American College of Surgeons. Among the recommendations in the report, the committee suggests that surgical records or notes document the following:

  • That the primary surgeon was immediately available for the entirety of the case
  • The portion of the procedure performed by the backup surgeon, if applicable
  • The names of all staff who participated in the surgery or were present in the operating room
  • Surgical times—including the start and end of the procedure and the times staff entered and exited the operating room

Read more…
Read the report (PDF)…

Court puts ACA suit on hold, giving incoming administration time to consider strategy.
CNN reports that the U.S. District Court of Appeals for the District of Columbia Circuit has agreed to temporarily pause a House lawsuit challenging a program implemented through the Affordable Care Act (ACA) and designed to help lower-income people pay deductibles, co-payments, and other out-of-pocket expenses under the ACA. The House argues, and a judge previously ruled, that Congress never provided explicit authority for the spending. The judge blocked further spending under the program, but suspended the order pending appeal. The temporary stay provides President-elect Donald Trump time to consider dropping the appeal. Should the appeal be ended, health insurance companies would legally be allowed to drop their ACA health plans, potentially destabilizing the ACA exchange market and effectively eliminating a fundamental portion of the healthcare law. Even opponents of the ACA, however, have argued for caution in proceeding with that scenario, as millions of people could effectively lose their health insurance with little notice. Read more…

Call for volunteers: Bylaws Committee.
Dec. 21 is the last day to submit your application for a position on the Bylaws Committee (two member openings). The Bylaws Committee recommends amendments to the AAOS bylaws and standards of professionalism. Applicants for this position must be active or emeritus fellows who are familiar with the AAOS governance structure and decision-making processes. Learn more and submit your application…(member login required)