Today’s Top Story

Study: Heart Failure Increases Short-term Mortality in Hip Fracture

According to a study published online in Injury, older hip fracture patients with heart failure have a greater risk for short- and long-term postoperative mortality. Between January 2004 and June 2018, 1,992 patients (1,992 hips) who received hip fracture surgery at one of two hospitals were stratified into two groups: nonheart failure (n = 1,782) and heart failure (n = 210; mild [n = 119], moderate-to-severe [n = 91]). Researchers determined the cumulative crude mortality rate and assessed between-group differences at different time points. The heart failure group had higher mortality rates than the nonheart failure group at every measured time point: 30 days, 5.7 percent versus 1.6 percent; 60 days, 9.5 percent versus 3.6 percent; three months, 12.4 percent versus 5.1 percent; six months, 17.1 percent versus 8.4 percent; and one year, 25.2 percent versus 12.9 percent.

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In Other News

Study: Shoulder Injury Data in Collegiate Collision Athletes

A retrospective cohort study published in the January issue of Arthroscopy assessed the types, mechanisms, and severity of shoulder instability injuries in collegiate collision athletes and made sex- and division-based comparisons. Data from the National Collegiate Athletic Association Injury Surveillance Program spanning the 2009–2010 to 2013–2014 academic years were collected for men’s football, wrestling, ice hockey, and lacrosse and women’s ice hockey and lacrosse. During the study period, 445 shoulder instability injuries requiring attention from a healthcare professional occurred in 1,421,561 athlete exposures (AEs), for an incidence rate of 31.30 injuries per 100,000 AEs. Most injuries (59.1 percent) were attributed to subluxation, the most common of which was anterior subluxation (35.3 percent). The mean time loss for all injuries was 8.17 days, with dislocation resulting in the greatest time loss (17.58 days). Mean time loss varied greatly among divisions: I, 4.77 days; II, 20.52 days; and III, 11.23 days. Rates of surgery also varied by division: 32.9 percent, 38.1 percent, and 19.4 percent, respectively. Overall, 29.3 percent of injuries warranted operative treatment. Men’s ice hockey and lacrosse players were more than twice as likely as their female counterparts to sustain shoulder instability.

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Study Explores Reasons Surgeons Choose Anterior Cervical Diskectomy and Fusion over Total Disk Replacement

A study published online in the European Spine Journal evaluated the reasons total disk replacement (TDR) specialty surgeons choose to perform anterior cervical diskectomy and fusion (ACDF) instead of TDR. Three TDR surgeons performed cervical spine surgery on 464 consecutive patients over a five-year period. In about three-quarters of patients (n = 356, 76.7 percent), surgeons performed TDR, while the remaining 23.3 percent of patients (n = 108) received ACDF. The primary reason surgeons chose ACDF over TDR was anatomical: They believed TDR may not successfully address the condition or could interfere with device function (n = 64, 13.79 percent). The second most commonly reported reason was due to lack of insurance or denial of coverage (n = 17, 3.23 percent); 13 patients (2.80 percent) presented deformity/kyphosis that could not be addressed with TDR. Three patients received ACDF due to pseudoarthrosis, two did not undergo TDR due to osteoporosis, and two other patients were at high risk of heterotopic ossification. One case each had a nickel allergy, trauma with posterior element fracture, TDR removal, multiple prior cervical spine surgeries, concern regarding artifact on future imaging studies, benign osteoblastic bone, and limitation to adequate surgical approach for TDR.

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Study: Correlation Between Hindfoot Malalignment and Periprosthetic Cyst Volume after Ankle Replacement

A retrospective study published in the January issue of Foot & Ankle International examined the relationship between hindfoot residual malalignment determined through weight-bearing CT (WBCT) images and periprosthetic cysts (PPCs) following total ankle replacement (TAR). PPC volumes were classified as total cyst volume (TCV), medial cyst volume (MCV), central cyst volume, and lateral cyst volume (LCV). Hindfoot alignment was calculated as Foot and Ankle Offset (FAO) to compare varus and valgus groups. Final analysis included 48 TARs; 81 percent had at least one PPC. The mean FAO was 0.12 percent. Greater residual malalignment and longer follow-up were predictors of increased TCV. In the varus group, the MCV was greater than the LCV, while the opposite was true in the valgus group.

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CMS Calls for Patient Education, Engagement in New Payment Models

Members of the Centers for Medicare & Medicaid Services (CMS) Advisory Panel on Outreach & Education said that the creation of new alternative payment models should focus on patient education and engagement. Panel chair Margot Savoy, MD, MPH, explained that without being given the necessary knowledge, patients may not understand that their doctors are recommending treatment that is in their best interest as opposed to what would provide physicians with the biggest reimbursement.

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HHS: Relaxed Fraud and Abuse Rules Create Flexibilities for Value-based Models

Currently, Stark law and the Antikickback Statute restrict the ability of hospitals to reward or penalize nonemployed physicians for their efforts to improve patient outcomes, such as decreasing hospital-acquired infections. AAOS has worked with Congress on bipartisan legislation and provided significant input to the administration, urging changes that recognize value-based delivery models. In October 2019, historic proposed rules were released to reform these cumbersome, outdated laws. CMS and the Department of Health and Human Services (HHS) Office of Inspector General issued reform proposals that will facilitate innovative arrangements for coordinating care. The changes are consistent with the healthcare industry’s ongoing shift toward a value-based payment and delivery model and away from the traditional fee-for-service model.

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NCCI Update Addresses Shoulder Revision

CMS issued its National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services for 2020, which includes an update to the arthroscopy section regarding the shoulder. In the update, the line stating that CMS considers the shoulder to be a “single anatomic structure” has been removed. AAOS supports this change, which it has long pushed for along with the American Shoulder and Elbow Surgeons, the Arthroscopy Association of North America, and the American Orthopaedic Society for Sports Medicine

Access the 2020 NCCI policy manual…