Today’s Top Story
Study: What factors are associated with postoperative C. difficile?
A study published online in the journal JAMA Surgery examines factors associated with postoperative Clostridium difficile infection (CDI). The authors conducted a retrospective, observational study of 468,386 surgical procedures from the Veterans Affairs Surgical Quality Improvement Program database and the Decision Support System pharmacy database. They found that the postoperative CDI rate was 0.4 percent per year and varied by VHA Surgery Program and surgical specialty. Overall, 30-day CDI rates were higher in emergency procedures, procedures with greater complexity and higher relative value units, and those with a contaminated or infected wound classification. In addition, patients with postoperative CDI were significantly older, more frequently hospitalized after surgery, had longer preoperative hospital stays, and had received three or more classes of antibiotics. The authors note that postoperative CDI was linked to higher rates of other postoperative morbidity, 30-day mortality, and longer postoperative hospital stays. Read more…
Read the abstract…

Other News

ACA remains controversial as implementation sees shifts.
Two articles in The New York Times report on recent concerns with the Affordable Care Act (ACA). The first notes that the closing of 12 of 23 nonprofit insurance cooperatives, ongoing instability in the insurance market, and a recent announcement by UnitedHealth Group that the company may not participate in insurance exchanges during 2017 have caused critics of the healthcare law to urge its repeal, while supporters argue that such factors support the creation of a so-called “public option” to serve as an alternative to private insurers. Read more…
     The second article looks at Kentucky, the only Southern state to fully implement the ACA, which now faces a rollback following the election of a governor who ran on a platform of repealing the state’s Medicaid expansion. Read more…

Studies examine effect of body changes on joint cartilage.
Two studies presented at the annual meeting of the Radiological Society of North America look at the effect of body changes on joint cartilage. In the first, the research team investigated the association between different degrees of weight loss and the progression of knee cartilage degeneration among 506 overweight and obese patients from the Osteoarthritis Initiative, and found that patients with >10 percent weight loss displayed significantly reduced cartilage deterioration as measured via magnetic resonance imaging (MRI). Read more…
Read the abstract (PDF)…
     In the second, the research team conducted continuous, mobile MRI surveillance of cartilage integrity of 44 runners participating in a transcontinental ultramarathon covering more than 4,486 km (approximately 2,787 miles). They found that, with the exception of the patellar joint, nearly all cartilage segments showed a significant initial mean T2 signal increase within the first 1500 km run. However, they noted an unexpected secondary T2 decrease in ankle and hindfoot joints, but not in the first tarsometatarsal joint. “After initial significant intrachondral matrix changes,” the research team writes, “a subsequent T2 value recovery indicates the ability of the cartilage matrix to regenerate under ongoing running burden in ankle and hindfoot joints.” Read more…
Read the abstract (PDF)…

Study: Periarticular injection of analgesia linked to reduced TKA recovery time compared to femoral nerve block.
Data from a small study published in the November issue of The Journal of the American Osteopathic Association suggest that periarticular injection of analgesia may reduce postoperative recovery time compared to femoral nerve block for patients undergoing total knee arthroplasty (TKA). The researchers reviewed records of 16 patients who had undergone bilateral primary TKA, in which femoral nerve block was administered at the first operation and periarticular injection of an extended-release bupivacaine liposome mixture at the second operation, performed at an average of 2.3 years later. They found that periarticular injection of analgesic medication was associated with fewer inpatient physical therapy sessions and shorter hospital stays. Read more…
Read the complete study…

Study: Reducing referral to acute care after major surgery may not increase readmissions.
According to findings published online in the journal JAMA Internal Medicine, reducing the number of post-hospital referrals to acute care facilities after major surgery may not be linked to an increase in readmission rates. The research team reviewed Medicare claims data on 3,070 patients during a nearly 3-year baseline period and 1,594 patients during a “risk-bearing” period after launch of a bundled payment program. After implementation, they found a 34 percent reduction in the number of patients discharged to an acute care facility after undergoing lower extremity joint arthroplasty, with no corresponding increase in readmission rate. Readmission rates were similarly stable in patients undergoing spinal fusion, although post-acute care facility rates were unchanged. The research team notes that the study did not evaluate outcomes such as functional status or whether patients fully recovered from surgery. Read more…
Read the abstract…

Study: Dual-task motion capture system could help identify concussion in sports.
Data presented at the International Congress on Sport Sciences Research and Technology Support suggest that a combined approach made up of biomechanical and cognitive tests may be used to help identify concussion. The researchers developed a dual-task assessment in which football players simultaneously walked while avoiding obstacles and executed cognitive tasks while being tracked by a markerless motion capture system. The system allowed researchers to establish a baseline profile that they say could detect concussion symptoms more quickly than medical personnel. Read more…

Enhance the reception area experience with a free copy of AAOS TV DVD.
AAOS TV is a patient-focused DVD featuring educational and inspiring bone and joint health content. The looping DVD, which is designed to be played in reception areas, includes 30 segments on injury prevention, advocacy-related calls to action, orthopaedic health messages, and public awareness campaigns. Run-time is approximately 1 hour and 20 minutes. AAOS TV is available at no charge to all Academy members. The DVD can be played for patients in the reception area and this new patient engagement resource can be shared with your colleagues. To order the free DVD, contact the AAOS public relations department at: media@aaos.org

Last call: Adult Spine Evaluation Committee.
Dec. 4 is the last day to apply for the chair position on the Adult Spine Evaluation Committee. The chair of this committee acts as primary physician medical editor for the Adult Spine Self-Assessment Examination triennially, and mentors and leads volunteers through the item-writing process. Applicants for this position must be active fellows, candidate members, or candidate member applicants for fellowship who have served at least one term on an Evaluation Committee. Learn more and submit your application…(member login required)