Today’s Top Story
ACS/SIS release guidelines to reduce incidence of SSI.
The American College of Surgeons (ACS) and the Surgical Infection Society (SIS) have released new guidelines for the prevention, detection, and management of surgical site infection (SSI). Among other things, the guidelines note that control of high blood sugar prior to surgery may be more important than the presence of diabetes and use of diabetic medications, although both are still considered risk factors. In addition, the guidelines cite research that finds that smokers have the highest risk of SSI, and that former smokers are at greater risk of infection than nonsmokers. The guidelines are published in the January issue of the Journal of the American College of Surgeons.
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View the preview of the guidelines…
Other News
Open Payments may be kept in the face of ACA repeal.
An article in Modern Healthcare looks at the future of the U.S. Centers for Medicare & Medicaid Services (CMS) Open Payments (Sunshine Act) system if the Affordable Care Act (ACA) is repealed. The program, which is called for under Section 6002 of the ACA, requires public reporting of certain fees paid to physicians and teaching hospitals by medical device and pharmaceutical manufacturers and group purchasing organizations. The writer notes that current ACA repeal efforts in Congress focus on budget considerations, as budget resolutions cannot be filibustered in the U.S. Senate. As the Sunshine Act is not a budgetary item, it could be protected from early repeal. In addition, at least one Republican congressperson, Rep. Chuck Grassley (R-Iowa), has stated that the Open Payments system should be retained.
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Visit the CMS Open Payments website…
Study: Outpatient THA may be safe and effective for certain patients.
Data from a study published in the February issue of the journal Clinical Orthopaedics and Related Research suggest that outpatient total hip arthroplasty (THA) may be safe and effective for certain patients. The researchers conducted a prospective, randomized study of 220 THA patients at two centers, 112 of whom were treated as outpatients and 108 of whom were treated as inpatients. They found that, of 112 patients randomized to outpatient surgery, 85 (76 percent) were discharged as planned, while 26 were discharged after one night in the hospital, and one was discharged after two nights. Of the 108 patients randomized to inpatient surgery with an overnight hospital stay, 81 (75 percent) were discharged as planned, 18 met discharge criteria on the day of their surgery and elected to leave the same day, and nine stayed two or more nights. On the day of surgery, the researchers noted no difference in visual analog scale (VAS) pain among patients randomized to same-day discharge or overnight stay. However, on the first day after surgery, outpatients had higher VAS pain than inpatients. Overall, the researchers found no difference between cohorts in number of reoperations, hospital readmissions without reoperation, emergency department visits without hospital readmission, or acute office visits. In addition, at 4-week follow-up, they found no difference in number of phone calls and emails with the surgeon’s office.
Read the abstract…
Study: Is it necessary to surgically repair stable ramp lesions of the medial meniscus during ACL reconstruction?
A study published online in The American Journal of Sports Medicine compares outcomes for patients who undergo anterior cruciate ligament (ACL) reconstruction and surgical or nonsurgical treatment of stable ramp lesions of the medial meniscus. The authors conducted a randomized, controlled trial of 91 consecutive patients with complete ACL injuries and concomitant stable ramp lesions of the medial meniscus. During ACL reconstruction, 50 patients underwent surgical repair of the stable ramp lesions and 41 were treated with abrasion and trephination alone. Among 73 patients available with minimum 2-year follow-up, the authors found no significant difference across cohorts in mean Lysholm score, mean subjective International Knee Documentation Committee score, pivot-shift test results, Lachman test results, KT-1000 arthrometer side-to-side difference, or KT-1000 arthrometer grading. In addition, at final follow-up, the authors found no significant difference between groups in healing status of the ramp lesions.
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Study: Anesthetic plus steroid may reduce pain more than anesthetic alone for patients with multilevel LDP and chronic LBP.
According to a study published in the February issue of The Spine Journal, interlaminar epidural steroid injections may help reduce pain for patients with multilevel lumbar disc pathology (LDP) and chronic low back pain (LBP). The research team conducted a randomized, controlled trial of 98 patients with multilevel LDP who received either 10?mL 0.25% bupivacaine or 10?mL 0.25% bupivacaine plus 40?mg methylprednisolone. All treatments were administered at the L4–L5 intervertebral space in prone position under the guidance of C-arm fluoroscopy. At 1-, 3-, 6-, and 12-month follow-up, they found that visual analog scale and Oswestry Disability Index scores were higher in the anesthetic-only group, compared with the anesthetic plus steroid group. The research team writes that “further studies are required to establish a robust conclusion on the dispersion of [interlaminar] epidural injections in the epidural area and the dose of steroid.”
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CMS tells insurers to clean up their provider directories.
Kaiser Health News reports that CMS has warned 21 Medicare Advantage insurers with high rates of errors in their online network directories that they could face heavy fines or have to stop enrollment if the problems are not fixed by Feb. 6. A CMS report released in October found that nearly half of the 5,832 physicians listed had incorrect information, including wrong addresses and wrong phone numbers. Overall, most health plans had inaccurate information for between 30 percent to 60 percent of providers’ offices. The individual plans that received warning letters cover more than 1.4 million beneficiaries.
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Learn more about the CMS report…
Call for volunteers: U.S. Office of the Assistant Secretary for Preparedness and Response panel.
AAOS seeks to nominate one member to a panel sponsored by the U.S. Office of the Assistant Secretary for Preparedness and Response. The goal of the panel is to develop an inventory of emergency care/trauma and burn centers in the United States, and to publish this information on a publicly available interactive map. Applicants for this position must be active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic. In addition, all applicants must provide the following: an online AAOS CAP application and a current curriculum vitae. All supporting materials must be submitted by Jan. 25, 2017 at 11:59 p.m. (CT), to Kyle Shah at shah@aaos.org.
Learn more and submit your application…(member login required)
