Today’s Top Story

Study Measures Impact of Hospital and Surgeon Volume on Tibial Shaft Surgery Outcomes

A study published in the May issue of the Journal of Orthopaedic Trauma assessed the effect of hospital and surgeon volume on outcomes in patients undergoing operative management of tibial shaft fracture. Patients aged ≥ 18 years treated between 2001 and 2015 were identified using the New York Statewide Planning and Research Cooperative System data asset. Comparisons were made across hospital and surgeon volume for reoperation, nonunion, and other adverse events (AEs). Low-volume providers (lowest 20 percent) and high-volume providers (highest 20 percent) were compared. Low volume was defined as fewer than five cases annually for hospitals and one case per year for surgeons; high volume was defined as 40 or more and eight or more annual cases, respectively. Final analysis included 9,147 patients. Low-volume surgeons experienced slightly higher pneumonia and respiratory failure rates. Low-volume hospitals experienced slightly lower compartment syndrome and fasciotomy rates. There were no significant between-group differences for hospitals or surgeons regarding all other reoperations and AEs.

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In Other News

Study Assesses Telemedicine Use in Long-term Musculoskeletal Care Patients

A study published in the April issue of the Journal of the AAOS: Global Research & Reviews ® evaluated the use of a telemedicine musculoskeletal (teleMSK) service for long-term care patients requiring an orthopaedic consultation. The study included 26 long-term care facilities, including 32 long-term care patients assessed via teleMSK and 27 telemedicine liaisons. The teleMSK program’s usefulness was determined using the Telehealth Satisfaction Scale and Telemedicine Usability Questionnaire. Most patients and families felt the voice and visual quality and length of consultation were excellent. The majority of participants also rated explanations from physicians and the carefulness, skillfulness, respect, and sensitivity of the attending physician as excellent. Patients thought privacy and confidentiality were maintained and respected. Telemedicine liaisons tended to think that teleMSK improved accessibility and productivity of consultations; most said they would use teleMSK again in the future.

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Study Evaluates 10-year Outcomes of Anterior Approach to THA

A study published in the May issue of The Journal of Arthroplasty analyzed one tertiary center’s 10-year experience with the anterior approach (AA) to total hip arthroplasty (THA). Data were retrospectively reviewed for 1,087 primary elective hips treated with AA-THA performed between 2006 and 2017 by four senior surgeons. From 2006 to 2016, the prevalence of AA-THA increased from 1.5 percent to 53.2 percent. AEs that occurred included intraoperative events, early postoperative periprosthetic fractures, dislocation, implant failure, early infection, and wound complications. The overall 90-day AE rate was 6.4 percent (of 1,087 hips); in the first 12 months of the study period, the AE rate was 41.6 percent (of 12 hips) versus 3.6 percent (of 166 hips) in the last 12 months. Reoperation was required in 60 hips (5.5 percent); one each was performed in the first (8.3 percent) and last (0.6 percent) 12 months of the study period. The most common indications for reoperation were infection and wound complications. For all surgeons, a correlation was observed between higher AE rates and early procedures, but this did not have a large impact on five-year survival rate.

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Study: Elastic Bandage Versus Cast for Tuberosity Fractures of the Proximal Fifth Metatarsal

A study published online in Foot & Ankle International compared the strength of injured and healthy ankle muscle and functional and clinical outcomes between proximal fifth metatarsal tuberosity fracture patients treated with elastic bandage versus cast immobilization. Patients who presented at a single clinic between February 2018 and April 2019 were randomized into two groups: elastic bandages (group 1; n = 33) and cast immobilization (group 2; n = 32). Follow-up appointments were scheduled at two, four, eight, 12, and 24 weeks Outcomes included visual analog scale foot and ankle (VAS-FA) score, time missed from work, and use of assistive devices. An isokinetic dynamometer was used to measure ankle plantarflexion-dorsiflexion and inversion-eversion muscle strengths (peak torque), which were compared to those of the healthy ankle. Mean missed work was 11.3 days in group 1 and 27.6 days in group 2. Group 1 had a shorter mean duration of assistive devices use than group 2 (6.7 days versus 16.2 days). Mean VAS-FA score was significantly higher in group 1 at weeks two, four, and eight of follow-up, with no significant between-group differences observed at the time of injury and at weeks 12 and 24. In group 1, muscle strength deficits were present at the fourth week, and in group 2, they were determined at weeks four and eight. No significant between-group differences were observed in both extremities at weeks 12 and 24.

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CMS Proposes Changes to IPPS and Long-term Care Hospital PPS

The Centers for Medicare & Medicaid Services (CMS) unveiled recommendations to update Medicare payment policies for hospitals paid under the Inpatient Prospective Payment System (IPPS) and Long-term Care Hospital Prospective Payment System (PPS) for fiscal year 2021. The changes would create a separate hospital payment category for chimeric antigen receptor T-cell therapy, as well as make new antimicrobials more accessible through changes to the new technology add-on payment. AAOS is analyzing the rule and will be providing comments.

Read the CMS press release…


Reporting for Duty: Ethical Considerations of Privacy Protection in Redeployment Strategies

Orthopaedic surgeons have been called to rise up to the challenges presented by COVID-19 and are practicing not only outside our areas of expertise, but also physically in areas outside our usual clinics and operating rooms. However, the duty to serve does not constitute an unlimited ethical obligation. This article discusses ethical considerations related to COVID-19 redeployments, including health disclosures for clinicians and how employers can protect confidentiality and foster trust.

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OrthoPAC Releases 2019 Annual Report

The AAOS Orthopaedic Political Action Committee (OrthoPAC) unveiled its 2019 Annual Report recapping another historic year. In addition to its growth of the Advisors’ Circle and record-breaking resident involvement, OrthoPAC reached its best off-election fundraising year in its 20-year history, having raised $1.9 million. It also had unprecedented access and representation at more than 23 subspecialty and state society meetings and 550 political events in Washington, D.C. OrthoPAC saw a 40 percent increase in events attended in congressional districts and a 51 percent increase in events hosted. In 2019, OrthoPAC also joined the Republican and Democratic Governor’s and State Legislative Committees to increase its political footprint. The strength of the PAC has allowed orthopaedists to have a seat at the table and educate members of Congress about the importance of musculoskeletal care.

Read the Annual Report…