September 21, 2018 | Today’s News

Study Compares Orthopaedic Specialty Hospital to Tertiary Referral Center for Shoulder Arthroplasty

An orthopaedic specialty hospital (OSH) may be more efficient than a tertiary referral center (TRC) for shoulder arthroplasty, according to a study published online in the Journal of Shoulder and Elbow Surgery. Researchers assessed 136 shoulder arthroplasties each from an OSH and TRC between 2013 and 2015 and recorded anesthesia preparation time (APT) (patient in room to skin incision), surgical time (ST) (skin incision to skin closed), and conclusion time (CT) (skin closed to patient out of room). STs were similar at both centers (OSHs, 110.0 minutes; TRCs, 113.4 minutes). At OSHs, APT (39.2 minutes) and CT (7.6 minutes) were shorter than TRCs’ APT (46.3 minutes) and CT (11.2 minutes). OSHs’ total nonoperative time (sum of APT and CT) was shorter than at the TRC (46.8 minutes versus 57.5 minutes).

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Senate Passes Legislation Eliminating ‘Gag Clause’ for Pharmacists

Earlier this week, the U.S. Senate passed a bill making it illegal for insurance companies to prevent pharmacists from telling patients when their prescriptions would cost less out-of-pocket than under their insurance plan. Representatives said getting rid of “gag clauses” will allow for more transparency in the pharmaceutical industry. The legislation pertains to all health insurance plans. On Sept. 4, the Senate passed legislation eliminating “gag clauses” for Medicare Part D drug plans The House Commerce Committee previously approved similar legislation, but, currently, no vote is scheduled in the House of Representatives.

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According to a study published in the September issue of Clinical Orthopaedics and Related Research, pasteurized autografts may not be the best long-term reconstructive option for managing bone defects after tumor resection. Of 1,358 tumor reconstructions performed between 1988 and 2013, 353 used pasteurized autograft. Patients were grouped by type of pasteurized bone use: pasteurized autograft-prosthesis composites (PPCs) (n = 149), intercalary grafts (n = 71), hemicortical grafts (n = 15), osteoarticular (n = 12), and fusion of a joint (n = 31). Other methods included endoprostheses (n = 508), instant arthrodesis using an intramedullary nail and bone cement (n = 286), allografts (n = 97), and resection only (n = 114). At five, 10, and 20 years of follow-up, the survival of 278 autografts was 73 percent, 59 percent, and 40 percent, respectively. Of those, 105 (38 percent) were removed with complications, including infection (13 percent, n = 33), nonunion (7 percent, n = 18), graft fracture (6 percent, n = 16), graft resorption (5 percent, n = 14), and local recurrence (4 percent, n = 11). Patient age ≤ 15 years, male sex, and pelvic location were all associated with graft removal. After 20 years, survival rates for osteoarticular and hemicortical reconstructions were 92 percent and 80 percent, respectively. Intercalary, PPC, and fusion survival rates were 46 percent, 37 percent, and 28 percent, respectively.

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Recovery audit contractors (RACs) are trying to reverse a decision by the Centers for Medicare & Medicaid Services (CMS) that imposed a limit on how many claims they can review. A report revealed that RACs recovered $473.92 million in improper payments in fiscal year (FY) 2016, up from $440.69 million in FY 2015. RACs are also no longer allowed to review inpatient status claims. CMS removed some of these privileges after hospital industry executives noted that RACs may be incentivized to deny claims and that many of their decisions are overturned on appeal.

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A study published online in the International Journal of Geriatric Psychiatry found that arthritis may be common among patients with mild, moderate, and severe depression. Researchers used 2011 to 2014 data from the National Health and Nutrition Examination Survey and identified 4,792 patients aged ≥ 50 years. They screened for symptoms of depression and self-reported, doctor-diagnosed arthritis. Patients without depression had the lowest rates of arthritis (38.2 percent, n = 1,345). Fifty-five percent of patients with minor depression reported arthritis (n = 413/754). Among patients with moderate and severe depression, 62.9 percent (n = 195/310) and 67.8 percent (n = 141/208), respectively, reported an arthritis diagnosis.

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AAOS Communications Cabinet Balances Focus on ‘External’ and ‘Internal’ Audiences

You, the orthopaedic surgeons who make up the AAOS membership, are the experts in musculoskeletal medicine, and it is our mission to ensure that the public knows this, as well as how to best access excellent care. We interviewed the public again in 2012 to determine whether we had made any progress. This time, most of the people interviewed could explain what orthopaedic surgeons do and what they treat.

Although public education continues to be a priority in our work, we now understand there may be an internal knowledge gap. According to membership surveys, members are not aware of all the benefits the Academy offers.

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Academy Endorses Musculoskeletal Tumor Society’s AUC for Post-surgery Surveillance

On Sept. 14, the Academy’s Board of Directors endorsed appropriate use criteria (AUC) developed by the Musculoskeletal Tumor Society for surveillance of local recurrence and distant metastasis after surgical treatment of bone and soft-tissue sarcomas. The online AUC tool, available through OrthoGuidelines, aids in determining the use of various imaging modalities and the timing of modalities following surgical resection of these tumors. However, it does not provide recommendations for patients who have not had surgery, benign bone tumors, or tumors of unknown malignant or metastatic potential.

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