Today’s Top Story
Study: Outpatient THA may be safe and effective for certain patients, but overnight facilities should be available.
Data from a study published online in the journal Clinical Orthopaedics and Related Research suggest that outpatient total hip arthroplasty (THA) may be safe and effective for certain patients. The authors conducted a prospective, randomized study of 220 patients younger than 75 years who underwent THA at one of two centers. Of 112 patients randomized to outpatient surgery, 85 (76 percent) were discharged as planned. Of the remaining 27 patients, 26 were discharged after one night in the hospital and one was discharged after two nights. Of 108 patients randomized to inpatient surgery with an overnight hospital stay, 81 (75 percent) were discharged as planned. Of the remaining 27, 18 met discharge criteria on the day of their surgery and elected to leave the same day, and nine patients stayed 2 or more nights. The authors note that, on the first day following surgery, outpatients had more pain (at home) as measured by the visual analog scale than inpatients. However, at 4-week followup, they found no difference across cohorts in the number of phone calls and emails with the surgeon’s office. As 24 percent of patients planning to have outpatient surgery were unable to be discharged the same day, the authors recommend that facilities that can accommodate an overnight stay should be available.
Read the abstract…
Study: Increased lateral tibial slope may help predict ACL injury among college football players.
According to a study published in the June 15 issue of The Journal of Bone & Joint Surgery, increased lateral tibial slope may be associated with increased risk of anterior cruciate ligament (ACL) injury in male college football players. The research team reviewed data on 90 male U.S. National Collegiate Athletic Association (NCAA) Division I college football players who underwent magnetic resonance imaging (MRI) for a knee injury. A univariable analysis found that increased medial tibial plateau slope, increased lateral tibial plateau slope, and narrower lateral femoral condyle were significantly associated with ACL injury. However, multivariable analysis revealed that increased lateral tibial slope was the sole independent predictor of ACL injury.
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MedPAC report offers comments on MACRA; alternative payment models.
The U.S. Medicare Payment Advisory Commission (MedPAC) has released its June 2016 Report to the Congress: Medicare and the Health Care Delivery System. Among other things, the report examines alternative payment models called for under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The agency argues that eligible alternative payment entities should be responsible for total Part A and B spending for their enrollees, should have opportunities to share savings with beneficiaries, and should receive some regulatory relief from the U.S. Centers for Medicare & Medicaid Services (CMS). In addition, the report addresses:
- The use of competitive pricing to set beneficiary premiums in Medicare
- Preserving access to emergency care in rural areas
- Medicare payment for drugs under Medicare Part B and Part D
- Telehealth services
AMA to ask CMS to add physician work-life balance to “Triple Aim” quality measure.
MedPage Today reports that the American Medical Association (AMA) will request that CMS add physician work-life balance to provider experience measures designed to evaluate how well alternative payment models function. As originally conceived, the “Triple Aim” quality measure seeks to improve patient experience of care, health of populations, and reduction in per capita costs. At the annual meeting of the AMA House of Delegates, the organization voted to ask CMS to include work-life balance and adopt the “Quadruple Aim” measure when evaluating accountable care organizations and other practices.
Study: Prescription of long-acting opioids linked to increased all-cause mortality for chronic noncancer pain.
Data from a study published in the June 14 issue of The Journal of the American Medical Association suggest that prescription of long-acting opioids for chronic noncancer pain may be associated with significantly increased risk of all-cause mortality compared to anticonvulsants or cyclic antidepressants. The researchers conducted a retrospective cohort study of 22,912 new episodes of prescribed therapy for both long-acting opioids and control medications, with the long-acting opioid group followed up for a mean 176 days and the control treatment group followed up for a mean 128 days. Compared to controls, they found that the hazard ratio (HR) for total mortality among opioid patients was 1.64, with a risk difference of 68.5 excess deaths per 10,000 person-years. In addition, the HR during the first 30 days of therapy was 4.16, with a risk difference of 200 excess deaths per 10,000 person-years.
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Report calls for increased cooperation between military and civilian trauma care systems.
A report released by the National Academies of Sciences, Engineering, & Medicine argues that transferring lessons learned from treating injury in the wars in Afghanistan and Iraq could potentially save thousands of civilian lives in the United States each year. The writers propose increased cooperation between military and civilian trauma care systems, including rotating military physicians through civilian trauma centers, as well as a number of systematic changes, including improved sharing of data and research. The writers argue that drawing on lessons learned within the military trauma system will help prevent death from survivable injuries in both military and civilian systems and ensure a ready military medical force for future combat.
Download the report for free (PDF)…
Call for volunteers: Leadership Development Committee.
Aug. 10 is the last day to submit your application for a position on the Leadership Development Committee (three member openings). The Leadership Development Committee oversees the continuing development of the AAOS Leadership Fellows Program and the annual selection of the William Tipton Leadership Award recipient. Applicants for this position must be active fellows with experience in mentoring and leadership.
Learn more and submit your application…