Today’s Top Story
Study: Low serum albumin levels, more than morbid obesity, linked to major perioperative complications after TKA.
Research published in Clinical Orthopaedics and Related Research finds that low serum albumin levels, more than morbid obesity, may be associated with increased mortality and major perioperative complications after total knee arthroplasty (TKA). The investigators, who analyzed data from the National Surgical Quality Improvement Program (NSQIP) database from 2006 to 2013, studied 77,785 patients, including 35,573 patients with a serum albumin level of 3.5 g/dL or greater (normal) and 1,570 patients with a serum albumin level of less than 3.5 g/dL. There were 66,382 patients with a body mass index (BMI) between 18.5 kg/m2 and 40 kg/m2 and 11,403 patients with a BMI greater than 40 kg/m2, defined as morbidly obese. Morbidly obese patients had a higher rate of progressive renal insufficiency, superficial infection, and sepsis, but morbid obesity was not linked to the other 21 perioperative complications recorded in the NSQIP database, nor did the morbidly obese have a higher rate of mortality compared to those with lower BMIs. Low serum albumin, however, was associated with major perioperative complications, including (but not limited to) superficial surgical site infection, deep surgical site infection, organ space surgical site infection, and pneumonia. Patients with low serum albumin also had a higher mortality rate than patients with normal serum albumin. Read the abstract…
Other News
Study: Anti-TNF and NSAID therapies may protect against bone loss in SpA patients with early inflammatory back pain.
Patients with early axial spondyloarthritis (SpA) may benefit from therapies employing anti-tumor necrosis factor (anti-TNF) and NSAIDs to protect against bone loss, according to findings of a French study in the journal Rheumatology. Researchers studied 265 patients (54 percent male, mean age 34.4 years) with early inflammatory back pain suggestive of axial SpA, taking bone mineral density (BMD) measurements at baseline and at 2 years. The investigators defined low BMD as a Z score of less than or equal to -2 (at at least one site) and significant bone loss as a decrease in BMD of greater than or equal to 0.03g/cm2. In all, 39 patients (14.7 percent) had low BMD at baseline, while 112 patients (42.3 percent) had a 2-year significant bone loss. Patients treated with anti-TNF had significant increases in BMD at the lumbar spine but their BMD levels at the hip did not change from baseline. Hip BMD levels decreased in patients not treated with anti-TNF, and the difference between the two groups was significant. In addition, multivariate analysis suggested that baseline use of NSAIDs had a protective effect on hip bone loss. Read more…
Read the abstract…
Study: Postoperative telehealth visits may be an option following some surgeries.
Telehealth visits may be a viable alternative to in-person office visits following surgery, Reuters reports. The study, published online in the journal JAMA Surgery, involved 23 veterans who underwent a range of low-complexity surgeries between May and July 2014. Each patient was evaluated on general recovery and follow-up needs using a standard rubric at three sequential visits (telephone, in-person, and video). Telehealth visits were preferred to in-office visits by 69 percent of the patients, and at no time did a video or telephone visit fail to detect a postoperative complication. Read more…
Read the abstract…
DePuy claims surgical funder made inflated claims for plaintiffs’ bills.
DePuy Orthopaedics has filed an action against a so-called surgical funder, claiming that the funder, Texas-based MedStar Funding, sought to reap payments that are far in excess of reasonable cost for revision surgeries it financed, Reuters reports. The procedures in the dispute were performed on patients who were plaintiffs in the litigation against DePuy over its recalled ASR metal-on-metal hip implants. As a surgical funder, MedStar pays for revision operations for plaintiffs at a deep discount and then profits by placing a lien on the settlement for the full amount of the surgical bill. DePuy says that MedStar, in submitting claims of $1.5 million for 11 surgeries that should have cost no more than a total of $336,000, is trying to collect twice as much as it paid for the discounted medical bills and four times what is considered reasonable for the procedures performed. Due to the way the implant litigation was settled, MedStar is seeking payment directly from DePuy rather than from the patients whose surgery it funded. The patients face the possibility of being liable for the full cost of their care if MedStar’s claims are found to be improper and DePuy is relieved of an obligation to pay MedStar for the surgeries. Read more…
Study: In pediatric patients, 14- to 16-year-olds most at risk for primary anterior shoulder dislocations.
A study of patients aged 10 to 16 years found that the rate of primary and recurrent anterior shoulder dislocations among 14- to 16-year-old patients was similar to that in a high-risk group of adults aged 17 to 20 years; the rate was considerable lower in patients aged 10 to 13 years. The study, published in American Journal of Sports Medicine, involved 1,937 patients aged 10 to 16 years (median age 15.0 years; 79.7 percent male) who underwent primary closed reduction (CR) for anterior shoulder dislocation. The incidence of primary CR was highest among 16-year-old male patients (164.4 per 100,000 person-years), while primary dislocations were relatively rare in 10- to 12-year old patients (5.9 percent of all dislocations). The incidence of repeat CR was highest among 14- to 16-year-old patients (37.2 to 42.3 percent) and markedly lower among 10- to 13-year olds (0 to 25.0 percent). The authors concluded: “Clinicians should counsel male patients and those aged 14 to 16 years regarding their increased risk of recurrence after the nonoperative management of a primary anterior shoulder dislocation.” Read the abstract…
Report: Medical practices are spending more on technology, increasing their use of NPPs.
A survey released by the Medical Group Management Association (MGMA) indicates that multispecialty physician practices have increased their spending on operating costs associated with technology by 11.87 percent since 2010 as they try to keep up with mandated electronic health record requirements. Medical practices also say they are increasing their use of nonphysician providers (NPPs), per FTE physician. According to the report, many medical practices are using NPPs to address the physician shortage and the influx of new patients resulting from the Affordable Care Act. Read more…
AAOS to host free webinar on Comprehensive Care for Joint Replacement model.
AAOS will host a free webinar to assist members with understanding the Comprehensive Care for Joint Replacement model, proposed by the Centers for Medicare and Medicaid Services (CMS). The CMS proposal would apply to all hip and knee arthroplasty procedures performed at hospitals in 75 randomly selected geographic areas. Most hospitals in those regions would be required to participate. Under the proposal, the hospital in which the procedure is performed would be accountable for costs associated with the entire episode of care, from the time of surgery through 90 days postoperative. The webinar will take place Sept. 29, at 7:15 p.m. CT. Read more…
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OrthoGuidelines free mobile app for AAOS CPG, AUC is now available.
The OrthoGuidelines platform is now available as a mobile app and can be downloaded for free from the Google Play store or iOS App Store. Launched in March 2015, OrthoGuidelines places all AAOS clinical practice guidelines (CPGs), appropriate use criteria (AUC), and related resources in one place. With keyword searches, users can now search all CPGs for any recommendation containing a keyword. Users can also sort recommendations by topic, stage of care, or recommendation strength. For more information about OrthoGuidelines…
