Today’s Top Story
Study: What happens after removal of an infected TKA device
A study published online in The Journal of Arthroplasty examines trends after removal of an infected total knee arthroplasty (TKA) with spacer placement. The authors reviewed data on 18,533 Medicare beneficiaries who underwent removal of an infected TKA and placement of an antibiotic spacer for periprosthetic infection (PJI). At 1-year follow-up, they found that 691 patients (3.7 percent) had died in a hospital setting, 852 (4.5 percent) had undergone knee arthrodesis, 574 (3.1 percent) had undergone amputation, 2,683 (14.5 percent) had undergone a repeat débridement procedure without being reimplanted, 2,323 (12.5 percent) retained their spacer, and 11,420 (61.6 percent) had undergone spacer removal and reimplantation. The authors note a variety of outcomes following prosthesis removal and antibiotic spacer placement, and state that identification of independent risk factors for such outcomes may help develop and improve existing treatment strategies for such patients.
Read the abstract…

Other News

Study: Preadmission frailty score may predict negative outcomes in geriatric trauma patients.
Results from a study published online in the Journal of the American College of Surgeons suggest that preadmission frailty is independently associated with adverse discharge destination (death or discharge to a long-term, chronic, or acute care facility). The authors conducted a 4-year retrospective cohort study of 260 patients 65 years and older admitted to a level I trauma center. They used the Canadian Study of Health and Aging Clinical Frailty Scale (CFS) and the laboratory Frailty Index (FI-lab) to determine preadmission frailty and on-admission frailty, respectively. They found that patients with a preadmission frailty as per CFS (CFS 6 or 7) experienced adverse discharge, and that severe frailty on admission as determined by FI lab (FI-lab >0.4) was not associated with such outcomes. The authors conclude CFS may be used to triage hospital resources to alleviate adverse events in geriatric trauma patients, while FI-lab determined on admission may not be useful.
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Study: Height is an independent predictor of VTE.
A study published online in Circulation: Cardiovascular Genetics found that venous thromboembolism (VTE) may occur more frequently in taller persons. The researchers used a co-sibling design to rule out any genetic or environmental factors in their study of more than 2.7 million people. They observed male soldiers without previous VTE from enlistment (1969–2010) until 2012 and first-time pregnant women without previous VTE beginning from first pregnancy (1982–2012) until 2012. They found there was a graded decreased risk by lower height for both men and women; the risk of VTE was lowest in men shorter than 160 cm (5 feet, 3 inches) and women shorter than 155 cm (5 feet 1 inch).
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FDA: Sodium polystyrene sulfonate should be taken at least 3 hours before or after other oral medications.
The U.S. Food and Drug Administration (FDA) has issued a recommendation that patients avoid taking sodium polystyrene sulfonate at the same time as any other medicines taken by mouth. Recent data suggest that sodium polystyrene sulfonate binds to many commonly prescribed oral medicines, decreasing the absorption and efficacy of those medications. The agency states that healthcare professionals should advise patients to take other orally administered medicines at least 3 hours before or 3 hours after sodium polystyrene sulfonate. That time should be increased to 6 hours for patients with gastroparesis or other conditions resulting in delayed emptying of food from the stomach into the small intestine.
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Study: Provider market concentration often driven by small mergers below regulatory thresholds.
A study published in the September issue of Health Affairs suggests that many increases in market concentration of physician practices may be driven by many small acquisitions, as opposed to a few large transactions. The research team reviewed proprietary claims data from a group of states covering more than 12 percent of the population in the United States. Based on federal merger guidelines, they determined that 22 percent of physician markets were highly concentrated in 2013. “Among highly concentrated markets that had increases large enough to raise antitrust concerns,” the research team writes, “only 28 percent experienced any individual acquisition that would have been presumed to be anticompetitive under federal merger guidelines.” They note that most acquisitions were below dollar thresholds that would have required the parties to report the transactions to antitrust authorities.
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CMS readmission pilot may be affected by low participation rate.
An article in Modern Healthcare examines a final rule recently issued by the U.S. Centers for Medicare & Medicaid Services (CMS). The rule includes plans for a pilot program to test a new readmissions measure that estimates unplanned hospital readmissions using clinical data from patients’ electronic health records as well as Medicare claims data. The program will be voluntary in 2018, and CMS plans to make it mandatory for all hospitals receiving Medicare reimbursement in 2021. However, the agency now estimates that no more than 100 of 3,000 hospitals now paid under the Medicare inpatient fee schedule will volunteer, and some observers argue that such a low rate of participation could affect the accuracy of the final implementation.
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Read the final rule…

Call for volunteers: Biological Implants Committee.
Oct. 11 is the last day to submit your application for a position on the Biological Implants Committee (two member openings). This committee monitors and reviews scientific and regulatory developments in the field of implantable biologics as they relate to orthopaedic surgery. Applicants for this position must be active fellows, candidate members, or candidate member applicants for fellowship. Preference will be given to surgeons with practice concentrations in trauma, pediatrics, or adult reconstruction that use or study biologic products.
Learn more and submit your application…(member login required)