Today’s Top Story
Study: Evidence-based clinical decision support tools in EHRs may help reduce ordering of high-cost imaging in EDs.
Data from a study published in the July issue of the journal Academic Emergency Medicine suggest that inclusion of evidence-based clinical decision support tools into electronic health records (EHR) systems may help reduce use of high-cost imaging. The researchers conducted a longitudinal, before/after study of 235,858 total patient visits across five emergency departments (EDs) in a healthcare system with a common EHR. They found that embedding validated scoring tools for head injury, C-spine injury, and pulmonary embolism (PE) in the EHR was linked to a 10 percent overall decrease in computed tomography (CT) brain scans and a 6 percent overall decrease in CT C-spine scans. Use of CT PE also decreased but was nonsignificant. Read the abstract…
Study: What factors affect clinical outcome after revision ACL reconstruction?
A study published online in The American Journal of Sports Medicine examines factors that may affect clinical outcomes following revision anterior cruciate ligament (ACL) reconstruction. The authors conducted a case-control study of 989 patients undergoing revision ACL reconstruction, who had a median age of 26 years and a median time of 3.4 years since prior ACL reconstruction. At 2-year follow-up, they found that:
- Compared with 1-incision technique, previous arthrotomy was linked to significantly poorer outcomes for International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) pain, sports/recreation, and quality of life (QOL) subscales.
- Use of a metal interference screw for current femoral fixation was linked to significantly better outcomes for 2-year KOOS symptoms, pain, and QOL subscales, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) stiffness subscale.
- Not performing notchplasty at revision was linked to significantly improved outcomes for IKDC, KOOS activities of daily living (ADL) and QOL subscales, and WOMAC stiffness and ADL subscales.
Factors prior to revision ACL reconstruction associated with poorer clinical outcomes at 2 years included lower baseline outcome scores, a lower Marx activity score at the time of revision, a higher body mass index, female sex, and a shorter time since the patient’s last ACL reconstruction. Read the abstract…
Study: How do open and arthroscopic approaches compare in the first 30 days following RCR?
Findings published online in the journal Arthroscopy assess risk of adverse events and return to the operating room (OR) during the initial 30-day postoperative period for patients undergoing open or arthroscopic rotator cuff repair (RCR). The research team reviewed information on 16,472 RCR patients from the American College of Surgeons National Surgical Quality Improvement Program database. They found that patients undergoing open RCR were more likely to be aged 65 years or older, and have comorbidities such as hypertension, diabetes, chronic obstructive pulmonary disease, smoking, and alcoholism. Overall, patients undergoing open RCR had a higher risk of any adverse event when compared with arthroscopic RCR patients, and were at increased risk of return to the OR within 30 days. The research team notes that open RCR was associated with a longer average hospital stay, while arthroscopic RCR was linked to a longer average operative time. Read the abstract…
Study: Prompt surgery and plate positioning linked to reduced likelihood of volar prominence for certain patients with distal radius fracture.
According to a study published online in the journal Hand, prompt surgery, effective fracture reduction, and careful plate positioning may help avoid volar prominence for patients who undergo volar locking plate fixation for distal radius fracture. The researchers reviewed data on 616 patients who underwent fixation for distal radius fracture. They found that mean time to surgery was 6.0 days. At mean 17.5-week follow-up, the researchers classified quality of reduction as anatomical (46 percent), good (36.3 percent), moderate (13.0 percent), or poor (3.9 percent). They found that 109 patients (17 percent) had complications, and they observed plate prominence in 133 (21 percent). Flexor tendon complications were related to plate prominence, and inferior reduction was associated with increased time to surgery. Read the abstract…
Study: National Academies releases report on opioid epidemic.
The National Academies of Sciences, Engineering, and Medicine has released a report on the state of the science on pain research, care, and education, and to identify actions the U.S. Food and Drug Administration (FDA) and others can take to respond to the opioid epidemic. Among other things, the report offers a series of recommendations on to restrict opioid supply and demand, and to influence prescribing practices. Additional recommendations include:
- FDA should complete a review of the safety and effectiveness of all approved opioids.
- States should convene a public-private partnership to implement improved and more regular drug take-back programs.
- Public and private payers should develop reimbursement models that support evidence-based and cost-effective comprehensive pain management.
- The U.S. Department of Health and Human Services, in concert with state organizations, should support research on how data from prescription drug monitoring programs can be better leveraged to track opioid prescribing and dispensing information.
- Various government agencies and industry should invest in research that examines the nature of pain and opioid use disorder, as well as develop new non-addictive treatments for pain.
How safe is concurrent surgery?
An article in Kaiser Health News discusses the issue of concurrent surgery. The writer notes that Medicare billing rules permit concurrent surgery as long as the attending surgeon is present during the critical portion of each operation. Critics of the practice argue that concurrent surgery may add unnecessary risk and erode patient trust. Supporters say that it can be done safely and improves access to care. Read more…
Call for volunteers: Health Care Systems Committee.
Aug. 1 is the last day to submit your application for a position on the Health Care Systems Committee. This committee helps orthopaedic surgeons develop and improve relationships with other healthcare stakeholders, including other providers, the federal government, private and public payers, and patient groups. The following positions are available:
- Member (two openings)
- Member-at-large (two openings—health information technology)
All applicants must be active fellows with knowledge of healthcare systems, payment mechanisms, and policies that impact quality, access, and resources for musculoskeletal conditions and disorders. Learn more and submit your application…(member login required)