Earlier today, the U.S. House Ways and Means Committee unanimously passed the Improving Seniors’ Timely Access to Care Act to reform the burdensome prior authorization process. Building support for final passage of this legislation will be one of AAOS’ main priorities during Orthopaedic Advocacy Week, Aug. 1 to 5. The final day to sign up for this event is Friday, July 29 The event kicks off Aug. 1 and is completely virtual, requiring only a few minutes each day to help advocate for priority healthcare policy issues such as prior authorization reform. During the week, AAOS will also be running a campaign on the economic impact of orthopaedic surgeons nationwide and encouraging members to join the Orthopaedic Political Action Committee.
Study: No Significant Improvements Found after Additional IV and Regional Interventions in TKA
A study published online in Anesthesiology found that adding five IV and regional interventions did not reduce opioid consumption, pain scores, or improve functional outcomes 24 hours after total knee arthroplasty (TKA). Seventy-eight patients were randomized to either a control group or study group that received local anesthetic infiltration between the popliteal artery and capsule of the posterior knee, intraoperative IV dexmedetomidine and ketamine, IV dexamethasone bolus, and adductor canal block injections, in addition to a set of analgesic treatments. No major differences between groups were found in opioid consumption, pain scores, or quality of recovery after TKA.
Study: Preoperative Leukocytosis Does Not Predict Poor Outcomes following Hip Surgery in Geriatric Patients
A study evaluating the impact of preoperative leukocytosis on the prognosis of geriatric patients with hip fractures after surgery was published online in Current Orthopaedic Practice. The retrospective cohort included 1,007 patients aged >65 years. Outcome measures included surgical-site infections and 30-day and one-year mortality. Leukocytosis was not a significant predictor of poorer outcomes following surgery; however, delays in surgery longer than 48 hours, dementia, male gender, hypoalbuminemia, and use of anticoagulant or antiaggregant medications were associated with worse outcomes.
Study: Comparison of Ankle Ultrasonography versus MRI in Patients with Acute Ankle Sprains
A study comparing the diagnostic performance of ankle ultrasonography versus MRI in patients with acute ankle sprains was published online in Archives of Orthopaedicand Trauma Surgery. The study population included 30 patients who arrived at the hospital within 48 hours after ankle sprain. Ankle ultrasonography and MRI took place on the same day. Anterior talofibular ligament injury, calcaneal fibular ligament injury, and anterior inferior tibia-fibular ligament injury appeared to have a high degree of correlation between the ankle ultrasonography and MRI.
The Impact of Race and Insurance Type on Access to Nonoperative Treatments for Pediatric Scoliosis
The Journal of Pediatric Orthopaedics published a retrospective review of potential disparities in access to nonoperative treatment for adolescent idiopathic scoliosis (AIS). A total of 341 patients were divided into two groups based on whether they had public or private insurance. The primary variables were patient race, Area Deprivation Index, major curve magnitude, and treatment recommendation at the initial presentation. Major curve magnitude was significantly higher in patients with public insurance compared to those with private insurance (50 degrees versus 45.1 degrees) and higher in Black patients compared with white patients (51.8 degrees versus 47 degrees).
Surgical training is necessary to transfer skills to the next generation of surgeons. The practical needs of surgical training are sometimes at odds with primum non nocere—first, do no harm. At times, ethical duties to the patient, the trainee, the expert, and society have competing ideals and goals. This article outlines the difference between benefits to future surgeons and risks to society.
July Podcast Episodes Discuss Violence in the Healthcare Workplace and Research during Medical Training
The latest episode of the AAOS Advocacy Podcast features an important dialogue around the surge in assault and violence in the healthcare workplace, including legislation moving through Congress to address the behavior and practical tools to mitigate risks both at the individual physician and clinic level. The July episode of the AAOS Career Podcast discusses aspects of research during medical training such as finding mentors, being successful with projects and limited time, as well as applying the experience and knowledge learned to patient care.
