AAOS Leadership to Address the COVID-19 Response: Webinar Update

Join AAOS Wednesday, May 13, at 8 p.m. C.T. (9 p.m. E.S.T.) for an update on the Academy’s response to the COVID-19 pandemic. AAOS President Joseph A. Bosco III, MD, FAAOS, along with First Vice President Daniel K. Guy, MD, FAAOS, and Second Vice President Felix H. Savoie III, MD, FAAOS, will be on hand live to discuss current efforts to support AAOS members during this challenging time and answer questions from attendees. Programming will cover advocacy efforts, updated return to surgery guidelines, patient frequently asked questions, and new details on the Annual Meeting Virtual Experience. Registration is free, and the webinar will be recorded and made available to watch again after the event.

Register for the webinar…

In Other News

Study Assesses Use of AAOS AUC on Operative Knee OA Management in Clinical Practice

A study published online in Knee Surgery, Sports Traumatology, Arthroscopy evaluated the use of AAOS’ appropriate use criteria (AUC) for the surgical treatment of osteoarthritis (OA) of the knee in clinical practice. Researchers retrospectively reviewed medical charts and radiographs for operative knee OA patients at a single institution between January 2017 and December 2017. Data were put into the AUC application to determine the treatments’ appropriateness, and then the agreement between the actual treatment provided was compared to the AUC recommendation. Final analysis included 100 patients (mean age, 63.1 years); 61 percent had left knee OA. Most patients were middle-aged and had functioning-limiting pain at short distances, no mechanical symptoms or functional instability with full range of motion, severe knee multicompartmental radiographic features, and varus or valgus malalignment Patients were treated with total knee arthroplasty (TKA; n = 85), unicompartmental knee arthroplasty (UKA; n = 11), or high tibial osteotomy (HTO; n = 4). Per the AUC, 90 percent of cases received the appropriate surgical treatment, and 10 percent were treated with a “maybe appropriate” treatment. The actual surgical treatment performed was in agreement with the AUC recommendation in 100.0 percent of TKAs, 90.9 percent of UKAs, and 100.0 percent of HTOs.

Read the study…

Access AAOS’ AUC on surgical treatment of OA of the knee…

Study: Complications, Risk Factors for Mortality in Operative Hip Fracture Centenarians

A study published online in Injury determined risk factors associated with mortality in centenarians receiving operative hip fracture treatment. A total of 69 patients (average age, 101.3 years; 58 were female) aged 100 years or older admitted to a tertiary hospital for hip fracture between 1999 and 2018 were retrospectively reviewed. Extracapsular fractures were observed in 62.3 percent of patients. The most common complications were delirium (52.3 percent) and urinary retention (27.7 percent). The most common surgical complication was hematoma (9.2 percent). After admission, three patients (7.3 percent) changed their place of residence. The in-hospital mortality rate was 13.8 percent; 30-day and one-year rates were 21.5 percent and 54.2 percent, respectively. Risk factors for in-hospital mortality were a high Charlson Comorbidity Index and baseline Functional Ambulation Classification (FAC) < 3. Having more than three comorbidities and baseline FAC < 3 were predictors for 30-day mortality. Dementia was predictive of 30-day and one-year mortality.

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Study Assesses Outcomes of Arthroscopic Stabilization for Shoulder Instability in Young Athletes

A study published in the May issue of the Journal of Shoulder and Elbow Surgery evaluated young athletes who underwent anterior shoulder instability for arthroscopic stabilization surgery. A total of 67 athletes (mean age, 17.5 years; 48 were male) were included and followed for at least 24 months. The main outcomes were return to sport (RTS) and revision surgery. Patients were excluded if they had more than three preoperative episodes of instability, significant bone loss, or primary posterior instability. The RTS rate was 88.0 percent at an average 71 months, and 75.0 percent returned to the same level or higher. The most common sports were football and lacrosse. Revision stabilization was required in four athletes (6 percent), all of whom were males, at 11 to 36 months due to recurrent instability. The overall mean Single Assessment Numeric Evaluation score was 88.

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CMS Issues Final 2021 Payment Notice

The Centers for Medicare & Medicaid Services (CMS) issued the final Notice of Benefit and Payment Parameters for the 2021 benefit year, also referred to as the 2021 Payment Notice. The final rule helps issuers design healthcare plans that give patients access to high-value services at lower costs. The 2021 Payment Notice keeps in place the lower user fee rates on issuers taking part in the federal exchange platform put into effect in the 2020 Payment Notice.

Read the CMS press release…

Health Care Lost 1.4 Million Jobs in April

The healthcare industry lost 1.4 million jobs in April, according to preliminary data from the Bureau of Labor Statistics, as the national unemployment rate rose to 14.7 percent. The April losses follow the estimated 42,500 lost in March. About 82 percent of healthcare jobs lost were in the ambulatory sector; 243,000 jobs were lost in physicians’ offices, and 205,000 were lost in offices of other health practitioners.

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The Bottom Line: The Cost of Canceling Elective Cases

COVID-19 was declared a pandemic by the World Health Organization on March 11. Although it may seem that the time for the conversation about elective surgeries is fading amidst efforts to responsibly lift existing precautions, it is still relevant. Resource utilization will remain a potent concern as we anticipate future needs during secondary waves of infection. By resuming elective cases, we are making the case that the best way to currently use those resources is to support elective practice rather than use them for COVID-19 care. This article discusses the bottom line of continuing elective surgeries in ambulatory surgery centers.

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