Study: Impact of Subspecialty Fellows on Orthopaedic Resident Caseload
A retrospective study published in the March 15 issue of the Journal of the AAOS ® measured the effect of orthopaedic subspecialty fellows on the resident surgical caseload. Nine years of case log data (n = 51,111 cases) from two orthopaedic residency programs were included, comprising six subspecialty services (trauma, spine, foot, ankle, adult reconstruction, and hand). Surgical volume increased across all sites and services over time, but fellow numbers did not impact average resident caseload. There was an 11 percent decrease in one-on-one resident-attending cases and 17 percent increase in resident-fellow-attending “double-scrubbed” cases during years with more fellows.
The Senate voted Thursday to delay $18 billion in Medicare payment cuts through the end of the year. The 2 percent federally mandated Medicare sequester cuts originally took effect in 2013 but were paused by Congress last year in response to the pandemic and its effect on healthcare providers’ finances. The cuts were scheduled to resume next week absent Congressional action, but organizations like AAOS advocated for an extension of the moratorium, arguing that the pandemic continues to negatively impact the healthcare industry. The bill is expected to pass the House when representatives return in April and then be signed into law by President Joe Biden. Separate from these cuts, AAOS will continue to push Congress to prevent a 4 percent cut to Medicare payments that is scheduled to take place at the end of this year.
Study: Risk Factors of Persistent Opioid Use Following Hip Arthroscopy
A retrospective study published online in Knee Surgery, Sports Traumatology, Arthroscopy calculated rates of persistent opioid use after hip arthroscopy. A total of 1,909 patients who underwent hip arthroscopy between 2013 and 2018 were included (opioid-naïve, 79.9 percent; prior history of opioid use following surgery, 20.1 percent). Between nine and 15 months postoperatively, 11.7 percent showed persistent opioid use, defined as two or more prescriptions filled. Most patients (81.2 percent) who demonstrated persistent opioid use had a prior history of using opioids. Regression analysis showed that preoperative opioid use and older age were associated with higher risk of persistent postoperative opioid use.
Study: BMD Does Not Predict Ankle Fracture Repair Outcomes in Elderly Patients
A study published online in Foot & Ankle International measured the effect of low bone mineral density (BMD) on ankle fracture repair outcomes in elderly patients. Forty-eight patients aged ≥ 65 years who underwent dual-energy X-ray absorptiometry for BMD assessment following surgical fracture were followed for 12 months. Mean BMD was 0.6 ± 0.1 g/cm 2 at the femoral neck and 0.8 ± 0.2 g/cm 2 at the lumbar spine. Osteoporosis was present in 33 percent of female patients and 11 percent of male patients. Clinical and radiographic outcomes were not found to correlate with BMD values.
Study Assesses Risk Factors for Reoperation after Lumbar TDR
A retrospective study published online in The Spine Journal investigated risk factors for reoperation after lumbar total disk replacement (TDR) at short-, mid-, and long-term follow-up. A total of 1,368 patients who underwent TDR between 2005 and 2013 were included. Reoperation occurred in 8.8 percent of patients by two years, 15.8 percent by five years, and 19.5 percent by 10 years. Patients with diabetes had increased risk of reoperation compared to nondiabetic patients (7.5 percent versus 3.8 percent). Surgeries performed at teaching hospitals had lower reoperation rates compared to those at nonteaching hospitals. Lumbar fusion was the most common reoperation.
AAOS members will soon receive the print edition of the March issue of AAOS Now, but the electronic edition is already available on the AAOS Now website. This month’s issue highlights the first AAOS Leadership Institute webinar, orthopaedic care equity in the face of the COVID-19 pandemic, the environmental impact of orthopaedic surgery, and more.
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