July 10, 2020 | Today’s News

Apply for the Committee on Evidence-based Quality and Value Open Positions

The Committee on Evidence-based Quality and Value has two open member-at-large positions. These two positions are two-year terms that run from March 15, 2021, through March 10, 2023. Committee members plan, organize, direct, and evaluate evidence-based initiatives, including clinical practice guidelines, appropriate use criteria, systematic reviews, and performance measures, as well as oversee related education, dissemination, validation, and implementation activities. Applicants should have experience with evidence-based practice principles. The application deadline is Aug. 7.

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Study Analyzes Trends in 30-day AEs for Black TKA Patients

A study published online in The Journal of Arthroplasty examined recent annual trends in 30-day adverse events (AEs) after total knee arthroplasty (TKA) in Black patients. Data were collected on demographic variables; comorbid conditions; perioperative characteristics; length of stay (LOS); and 30-day readmissions, reoperations, medical complications, surgical complications, and mortality in Black primary TKA patients between 2011 and 2017 (n = 19,496). During the study period, improved comorbidity profiles, decreased LOS, and lower AE rates were observed. AE risk factors included male sex, tobacco smoking, American Society of Anesthesiologists (ASA) score > 2, bilateral TKA, and operative time > 100 minutes.

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A study published in the July 1 issue of the Journal of the AAOS ® detailed the development of a machine learning model to select candidates for outpatient total shoulder arthroplasty (TSA). The machine learning model was applied to 2,400 TSA patients to predict which patients had a LOS of one day or less. It successfully identified short-stay patients, with an area under the receiver operator curve of 0.77. Factors associated with shorter LOS included age less than 70 years and male sex; factors associated with a longer LOS included diabetes, chronic obstructive pulmonary disease, and ASA score > 2.

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A study published in the July issue of The Journal of Hand Surgery compared the Single Assessment Numeric Evaluation (SANE) to the Patient-reported Outcomes Measurement Information System Upper Extremity (PROMIS-UE) and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) to measure hand surgery outcomes. In an analysis of 214 patients, the SANE score had a moderate to strong correlation with the PROMIS-UE and QuickDASH scores. SANE responsiveness was acceptable for carpal tunnel release, carpometacarpal arthroplasty, wrist arthroscopy, and trigger finger release.

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A study published in the July issue of the Journal of Pediatric Orthopaedics identified risk factors for developing cerebrospinal fluid (CSF) leakage after intrathecal baclofen (ITB) pump placement in pediatric patients with cerebral palsy (CP). A total of 720 ITB procedures in 341 CP patients were retrospectively reviewed; 85 patients (24.9 percent) experienced 90 CSF leak episodes. CSF leakage led to 72 headache episodes in 61 patients (71.7 percent). CSF leak risk was correlated with epilepsy/seizure history, feeding tube, mixed type CP, and dystonic type CP. CSF leak risk was 5.8 percent after primary ITB procedures and 242 percent after secondary procedures.

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A study published in the July issue of the Journal of Orthopaedic Trauma compared immediate internal fixation with primary wound closure to temporary fixation/stabilization versus delayed fixation and wound closure in open ankle fracture. A total of 88 open ankle fracture patients were stratified into early or staged groups. The overall infection incidence was 6.8 percent, with no significant between-group differences. The early group had a significantly shorter hospital LOS and fewer reoperations. Pain, ambulation, and radiographic evidence of osteoarthritis for patients followed for more than 12 months did not differ between the groups.

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Mandatory Requirements for Taking Call

Although many specialties are not required to be on emergency room (ER) call, surgical specialists are often still required to take call as a result of medical staff bylaws or employment contracts. Although the trend is that both independent and employed surgeons may be compensated for ER call, it does not change the fact that this creates a certain liability for surgeons This article explores the liability issues associated with mandatory requirements for orthopaedic surgeons covering ER call—even when they are actively engaged in other patient care in a clinic or the operating room

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