Pub Date : 2023-11-06DOI: 10.1097/bco.0000000000001240
José María García López, Jorge Gómez Alcaraz, Juan Carlos García de la Blanca, Alexis D. Iliadis
The lateral approach is one of the most frequently used surgical procedures in total hip arthroplasty, being its main disadvantage the postsurgical abductor muscle weakness that many patients present, which may lead to Trendelenburg gait in a high percent of cases. For this reason we propose a surgical variation which consists in using a suture reference for the gluteus minimus just before its tenotomy, that allows a better repair of the abductor musculature during the closure. It also facilities muscles mobilization during the dissection, reducing the risk of neurovascular damage if we place an additional retractor, and also protects the gluteus minimus and gluteus medium during the insertion of the prosthetic components. With these advantages, we aim to reduce the most frequent complication of the lateral approach as it is the abductor muscle weakness. This modification only consists in a new suture, so it does not implies additional complications in contrast with the classical approach. However, in some patients can be difficult to place the suture if they have a tendinous deterioration of the gluteus minimus or a chronic break.
{"title":"Reference suture of gluteus minimus muscle: a modification of the lateral approach in total hip arthroplasty","authors":"José María García López, Jorge Gómez Alcaraz, Juan Carlos García de la Blanca, Alexis D. Iliadis","doi":"10.1097/bco.0000000000001240","DOIUrl":"https://doi.org/10.1097/bco.0000000000001240","url":null,"abstract":"The lateral approach is one of the most frequently used surgical procedures in total hip arthroplasty, being its main disadvantage the postsurgical abductor muscle weakness that many patients present, which may lead to Trendelenburg gait in a high percent of cases. For this reason we propose a surgical variation which consists in using a suture reference for the gluteus minimus just before its tenotomy, that allows a better repair of the abductor musculature during the closure. It also facilities muscles mobilization during the dissection, reducing the risk of neurovascular damage if we place an additional retractor, and also protects the gluteus minimus and gluteus medium during the insertion of the prosthetic components. With these advantages, we aim to reduce the most frequent complication of the lateral approach as it is the abductor muscle weakness. This modification only consists in a new suture, so it does not implies additional complications in contrast with the classical approach. However, in some patients can be difficult to place the suture if they have a tendinous deterioration of the gluteus minimus or a chronic break.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"23 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135679338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-06DOI: 10.1097/bco.0000000000001241
Blaine Oldham, Dustin Rinehart, Tyler Youngman, Michael Huo
Background: Morbid obesity has been identified as a risk factor for complications in total hip arthroplasty (THA). However, the impact of the adipose tissue distribution near the surgical site has not been adequately studied. We aimed to characterize the complication rates associated with varying soft tissue depth around the operative hip as measured on plain films. Methods: We performed a retrospective review of primary THAs at our institution from 2009 to 2020. A total of 106 patients met inclusion criteria. Propensity score matching was used to match the patients that required reoperation (n=13) to a cohort of those that did not (n=33) based upon demographics, BMI, and age. Four standardized measurements were taken, and statistical analyses were performed to determine if complication differences existed between cohorts. Results: There was no statistical difference between the non-reoperation cohort or the reoperation cohort in age (65.0 vs. 65.4, P =0.462) or BMI (39.4 vs. 40.9, P =0.108). There was no significant difference between the two cohorts for all four measurements ( P =0.296, P =0.369, P =0.463, P =0.321). A subgroup analysis of patients with BMI ≥40 (n=23) demonstrated that individuals in the reoperation cohort had a higher value of measurements 3 and 4 (237.2 vs. 274.6, P =0.041; 236.5 vs. 284.1, P =0.015). Conclusions: A standardized measurement of thigh width on an AP pelvis plain film may help surgeons identify a subset of patients (BMI ≥40) at elevated risk for complication in primary THA.
背景:病态肥胖已被确定为全髋关节置换术(THA)并发症的危险因素。然而，手术部位附近脂肪组织分布的影响尚未得到充分研究。我们的目的是描述在平片上测量的与手术髋关节周围软组织深度变化相关的并发症发生率。方法:我们对我院2009年至2020年的初级tha进行了回顾性分析。共有106例患者符合纳入标准。根据人口统计学、BMI和年龄，使用倾向评分匹配将需要再手术的患者(n=13)与不需要再手术的患者(n=33)进行匹配。采用四项标准化测量，并进行统计分析以确定队列之间是否存在并发症差异。结果:非再手术组与再手术组在年龄(65.0 vs. 65.4, P =0.462)、BMI (39.4 vs. 40.9, P =0.108)方面差异无统计学意义。两个队列间所有四项测量值均无显著差异(P =0.296, P =0.369, P =0.463, P =0.321)。BMI≥40患者(n=23)的亚组分析显示，再手术队列中个体的测量值3和4更高(237.2 vs 274.6, P =0.041;236.5 vs 284.1, P =0.015)。结论:AP骨盆平片上大腿宽度的标准化测量可以帮助外科医生识别原发性THA并发症风险升高的患者亚群(BMI≥40)。
{"title":"Surgical Implications of Soft Tissue Depth in Primary Total Hip Arthroplasty","authors":"Blaine Oldham, Dustin Rinehart, Tyler Youngman, Michael Huo","doi":"10.1097/bco.0000000000001241","DOIUrl":"https://doi.org/10.1097/bco.0000000000001241","url":null,"abstract":"Background: Morbid obesity has been identified as a risk factor for complications in total hip arthroplasty (THA). However, the impact of the adipose tissue distribution near the surgical site has not been adequately studied. We aimed to characterize the complication rates associated with varying soft tissue depth around the operative hip as measured on plain films. Methods: We performed a retrospective review of primary THAs at our institution from 2009 to 2020. A total of 106 patients met inclusion criteria. Propensity score matching was used to match the patients that required reoperation (n=13) to a cohort of those that did not (n=33) based upon demographics, BMI, and age. Four standardized measurements were taken, and statistical analyses were performed to determine if complication differences existed between cohorts. Results: There was no statistical difference between the non-reoperation cohort or the reoperation cohort in age (65.0 vs. 65.4, P =0.462) or BMI (39.4 vs. 40.9, P =0.108). There was no significant difference between the two cohorts for all four measurements ( P =0.296, P =0.369, P =0.463, P =0.321). A subgroup analysis of patients with BMI ≥40 (n=23) demonstrated that individuals in the reoperation cohort had a higher value of measurements 3 and 4 (237.2 vs. 274.6, P =0.041; 236.5 vs. 284.1, P =0.015). Conclusions: A standardized measurement of thigh width on an AP pelvis plain film may help surgeons identify a subset of patients (BMI ≥40) at elevated risk for complication in primary THA.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135679340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-17DOI: 10.1097/BCO.0000000000001237
Rebekah Kleinsmith, Stephen A. Doxey, Fernando A. Huyke-Hernández, Nizar Mikhael, Brian P. Cunningham
Background: As healthcare costs continue to rise, there has been increasing emphasis placed on providing value-based care. In orthopaedics, one way to influence cost is through the use of generic implants. The purpose of this study was to evaluate cost-savings and surgical outcomes with the implementation of generic orthopaedic trauma implant use. Methods: This was a retrospective case series of 154 primary orthopaedic trauma patients from April – December 2022 within a level II trauma center. Patients were included if treated solely with generic implants. Exclusion criteria consisted of revision procedures for any reason, and the use of conventional name brand implants. Eleven different primary orthopaedic trauma procedures in which generic implants were evaluated. Main outcome measurements included operative time, perioperative complications, reoperation rates, patient mortality, implant cost, cost-savings. Results: Cost-savings per procedure with the use of generic implants in eleven different primary orthopaedic trauma procedures ranged from 16% to 73%. The average cost-savings was 48.8% among the 11 procedures evaluated, with a yearly cost-savings of 56.0% when case volume is considered. Maintaining the 2021 case volume for one surgeon constant, an overall savings of $256,794 could be generated. Conclusions: This study demonstrated that generic implants can provide an opportunity for relatively good patient outcomes with minimal overall risk. Generic implants are a valid alternative to decrease costs while maintaining acceptable patient outcomes. Future studies should seek to provide patient-reported outcome measures for generic implants and compare them to conventional implant use.
{"title":"Generic orthopaedic trauma implants: implementation, outcomes, and cost savings","authors":"Rebekah Kleinsmith, Stephen A. Doxey, Fernando A. Huyke-Hernández, Nizar Mikhael, Brian P. Cunningham","doi":"10.1097/BCO.0000000000001237","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001237","url":null,"abstract":"Background: As healthcare costs continue to rise, there has been increasing emphasis placed on providing value-based care. In orthopaedics, one way to influence cost is through the use of generic implants. The purpose of this study was to evaluate cost-savings and surgical outcomes with the implementation of generic orthopaedic trauma implant use. Methods: This was a retrospective case series of 154 primary orthopaedic trauma patients from April – December 2022 within a level II trauma center. Patients were included if treated solely with generic implants. Exclusion criteria consisted of revision procedures for any reason, and the use of conventional name brand implants. Eleven different primary orthopaedic trauma procedures in which generic implants were evaluated. Main outcome measurements included operative time, perioperative complications, reoperation rates, patient mortality, implant cost, cost-savings. Results: Cost-savings per procedure with the use of generic implants in eleven different primary orthopaedic trauma procedures ranged from 16% to 73%. The average cost-savings was 48.8% among the 11 procedures evaluated, with a yearly cost-savings of 56.0% when case volume is considered. Maintaining the 2021 case volume for one surgeon constant, an overall savings of $256,794 could be generated. Conclusions: This study demonstrated that generic implants can provide an opportunity for relatively good patient outcomes with minimal overall risk. Generic implants are a valid alternative to decrease costs while maintaining acceptable patient outcomes. Future studies should seek to provide patient-reported outcome measures for generic implants and compare them to conventional implant use.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"17 1","pages":"38 - 42"},"PeriodicalIF":0.3,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139317799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-09DOI: 10.1097/bco.0000000000001238
Mahmoud Fahmy, Ebeed Yasin
Background: The aim of the study is to detect whether platelet rich plasma (PRP) is equal to tranexemic acid (TXA) in reducing blood loss and transfusion rates following total knee arthroplasty (TKA), and compare clinical outcomes, complications, and cost effectiveness between the two groups. This is one of the first randomized, controlled trials that compare both materials in elective knee arthroplasty. Methods: 120 patients were randomized. Postoperative blood loss was determined and compared by measuring the total drainage suction together with the hemoglobin level and blood transfusion rate. Thromboembolic complications and knee society score were recorded. Results: The mean total drain output was 469 mL in the TXA group compared with 698 mL in the PRP group, with statistical significance. There were significant differences in reduction of hemoglobin level (TXA: 1.21 vs. PRP: 2.08). The rate of deep vein thrombosis (DVT) in patients given TXA was higher than those given PRP, however, there were no significant differences. No transfusions were required in either group, and no significant differences were found in the length of hospital stay, pain assessment and knee society score. Conclusions: Though the blood loss was significantly bigger in the custom-made PRP group, no transfusions were required. Meanwhile, the rate of DVT in the PRP group tends to be lower than those in TXA group. We concluded that PRP was not superior to TXA in reducing perioperative blood loss, however further large-scale randomized trials are crucial to confirm these results to be added to the calling literature.
背景:本研究的目的是检测富血小板血浆(PRP)与氨戊西酸(TXA)在减少全膝关节置换术(TKA)后的失血量和输血率方面是否相等，并比较两组的临床结果、并发症和成本效益。这是比较两种材料在选择性膝关节置换术中的首次随机对照试验之一。方法:随机选取120例患者。术后出血量通过测量总引流吸力、血红蛋白水平及输血率来确定并比较。记录血栓栓塞并发症及膝关节社会评分。结果:TXA组平均总排液量为469 mL, PRP组为698 mL，差异有统计学意义。两组血红蛋白水平降低差异有统计学意义(TXA: 1.21 vs. PRP: 2.08)。TXA组深静脉血栓形成(DVT)发生率高于PRP组，但差异无统计学意义。两组均不需要输血，住院时间、疼痛评估和膝关节社会评分均无显著差异。结论:虽然定制PRP组出血量明显较大，但无需输血。同时，PRP组DVT发生率较TXA组低。我们得出结论，PRP在减少围手术期失血量方面并不优于TXA，但进一步的大规模随机试验对于证实这些结果并将其添加到相关文献中至关重要。
{"title":"Platelet rich plasma could replace tranexemic acid in total knee replacement? A comparative study between their postoperative- bleeding hemostatic effects","authors":"Mahmoud Fahmy, Ebeed Yasin","doi":"10.1097/bco.0000000000001238","DOIUrl":"https://doi.org/10.1097/bco.0000000000001238","url":null,"abstract":"Background: The aim of the study is to detect whether platelet rich plasma (PRP) is equal to tranexemic acid (TXA) in reducing blood loss and transfusion rates following total knee arthroplasty (TKA), and compare clinical outcomes, complications, and cost effectiveness between the two groups. This is one of the first randomized, controlled trials that compare both materials in elective knee arthroplasty. Methods: 120 patients were randomized. Postoperative blood loss was determined and compared by measuring the total drainage suction together with the hemoglobin level and blood transfusion rate. Thromboembolic complications and knee society score were recorded. Results: The mean total drain output was 469 mL in the TXA group compared with 698 mL in the PRP group, with statistical significance. There were significant differences in reduction of hemoglobin level (TXA: 1.21 vs. PRP: 2.08). The rate of deep vein thrombosis (DVT) in patients given TXA was higher than those given PRP, however, there were no significant differences. No transfusions were required in either group, and no significant differences were found in the length of hospital stay, pain assessment and knee society score. Conclusions: Though the blood loss was significantly bigger in the custom-made PRP group, no transfusions were required. Meanwhile, the rate of DVT in the PRP group tends to be lower than those in TXA group. We concluded that PRP was not superior to TXA in reducing perioperative blood loss, however further large-scale randomized trials are crucial to confirm these results to be added to the calling literature.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135092961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-22DOI: 10.1097/bco.0000000000001235
Mehdi Moghtadaei, Abolfazl Bagherifard, Hooman Yahyazadeh, Mehdi Mohammadpour, Khazar Adibmoradi Langroudi, Ali Mousapour
Background: Suture pullout during arthroscopic transtibial pullout repair of the meniscal root tear is generally performed using a Scorpion. In this study, we introduce a suture passing technique using a simple angiocath and compare its results with that of a Scorpion. Patients and Methods: In a retrospective series, 28 patients for whom an angiocath was used to pass the suture and 28 group-matched patients for whom a Scorpion was used were included. The outcomes of the patients were evaluated radiologically by assessment of ghost sign, cleft sign, and meniscal extrusion in knee MRI, and clinically by the assessment of the International Knee Documentation Committee (IKDC) score, Lysholm scale, and VAS for pain, which were obtained in the last follow-up. Results: The baseline characteristics of the two groups were not significantly different. After the operation, no patient had a positive ghost or cleft sign. The change of meniscal extrusion was not statistically different between the two groups (P=0.24). At the last follow-up, the mean Lysholm scale was 84.7±7.3 in the case group and 83.7±7.4 in the control group (P=0.61). The mean IKDC score was 84.6±6.8 in the case group and 85.3±4.9 in the control group (P=0.33). The mean VAS for pain was 3.2±0.9 in the case group and 3.3±0.9 in the control group (P=0.44). Conclusion: Using an angiocath to pass the suture in transtibial pullout repair is a cost-effective and efficient substitute for the Scorpion suture passer and could be used alternatively. Level of evidence: Level IV.
{"title":"Using a simple angiocath instead of scorpion suture passer in transtibial pullout repair of the meniscal root tear","authors":"Mehdi Moghtadaei, Abolfazl Bagherifard, Hooman Yahyazadeh, Mehdi Mohammadpour, Khazar Adibmoradi Langroudi, Ali Mousapour","doi":"10.1097/bco.0000000000001235","DOIUrl":"https://doi.org/10.1097/bco.0000000000001235","url":null,"abstract":"Background: Suture pullout during arthroscopic transtibial pullout repair of the meniscal root tear is generally performed using a Scorpion. In this study, we introduce a suture passing technique using a simple angiocath and compare its results with that of a Scorpion. Patients and Methods: In a retrospective series, 28 patients for whom an angiocath was used to pass the suture and 28 group-matched patients for whom a Scorpion was used were included. The outcomes of the patients were evaluated radiologically by assessment of ghost sign, cleft sign, and meniscal extrusion in knee MRI, and clinically by the assessment of the International Knee Documentation Committee (IKDC) score, Lysholm scale, and VAS for pain, which were obtained in the last follow-up. Results: The baseline characteristics of the two groups were not significantly different. After the operation, no patient had a positive ghost or cleft sign. The change of meniscal extrusion was not statistically different between the two groups (P=0.24). At the last follow-up, the mean Lysholm scale was 84.7±7.3 in the case group and 83.7±7.4 in the control group (P=0.61). The mean IKDC score was 84.6±6.8 in the case group and 85.3±4.9 in the control group (P=0.33). The mean VAS for pain was 3.2±0.9 in the case group and 3.3±0.9 in the control group (P=0.44). Conclusion: Using an angiocath to pass the suture in transtibial pullout repair is a cost-effective and efficient substitute for the Scorpion suture passer and could be used alternatively. Level of evidence: Level IV.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136095035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01Epub Date: 2023-06-14DOI: 10.1097/bco.0000000000001224
Kaitlyn R Julian, Nicole M Truong, Chelsea Leversedge, Jeffrey W Kwong, Alexander Rosinski, Robin N Kamal, Lauren M Shapiro
Distal radius fractures are one of the most common upper extremity fractures across all age groups. Although the American Academy of Orthopaedic Surgery (AAOS) Clinical Practice Guidelines have defined recommendations for the treatment of distal radius fractures, the optimal time to surgery was not included. There remains relatively little guidance or consensus regarding the optimal timing of surgical intervention for distal radius fractures and the impact of time to surgery on outcomes. As such, the purpose of this investigation is to systematically review clinical and radiographic outcomes associated with time to surgical management of distal radius fractures.
{"title":"Does Time to Surgery for Distal Radius Fractures Impact Clinical and Radiographic Outcomes? A Systematic Literature Review.","authors":"Kaitlyn R Julian, Nicole M Truong, Chelsea Leversedge, Jeffrey W Kwong, Alexander Rosinski, Robin N Kamal, Lauren M Shapiro","doi":"10.1097/bco.0000000000001224","DOIUrl":"10.1097/bco.0000000000001224","url":null,"abstract":"<p><p>Distal radius fractures are one of the most common upper extremity fractures across all age groups. Although the American Academy of Orthopaedic Surgery (AAOS) Clinical Practice Guidelines have defined recommendations for the treatment of distal radius fractures, the optimal time to surgery was not included. There remains relatively little guidance or consensus regarding the optimal timing of surgical intervention for distal radius fractures and the impact of time to surgery on outcomes. As such, the purpose of this investigation is to systematically review clinical and radiographic outcomes associated with time to surgical management of distal radius fractures.</p>","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"229-235"},"PeriodicalIF":0.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10802167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44187324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1097/bco.0000000000001234
Aaron K. Hoyt, Ryan C. LeDuc, H. Castillo, John R. Miller
Clinic no-shows are common throughout all medical specialties and can be used as a potential surrogate marker for access to care and have a significant impact on patients and providers. While anecdotally, orthopaedic surgeons have noticed unprecedented changes in the delivery of care as a result of the COVID-19 pandemic, the effect on no-show rates has not been quantified. An analysis of the rates of outpatient clinic no-shows within a multispecialty, academic orthopaedic surgery practice was completed. Encounters were sub-classified into designated periods based on a “pre-COVID-19” period, a “COVID-19” period, and a “post-COVID-19” period. A univariate analysis was performed to comment on differences amongst insurance payer status. A multivariate regression was completed to assess which variables contributed to no-show rates among this orthopaedic practice. The overall no-show rate over the course of the study was 8.5%. These rates differed significantly between insurance groups, with the lowest no-show rate among Workers’ Compensation/Liability Insurance (WC/LI; 6.4%) and the highest among uninsured patients (21.4%). Additionally, no-show rates differed significantly by COVID period (pre-COVID=7.3%, COVID=8.6%, P<.0001). These rates further increased in the post-COVID period (9.6%, P<.0001) In response to the COVID-19 pandemic, medical practice habits have altered out of necessity. Despite a relaxation of social distancing guidelines, no-show rates have continued to increase at our institution. Our results suggest a disproportionate effect on those of lower socioeconomic status. The specific needs of the patient population should be considered when implementing strategies to improve clinic attendance.
{"title":"Increasing rates of clinic no-shows during and following the COVID-19 pandemic at an academic orthopaedic multispecialty group","authors":"Aaron K. Hoyt, Ryan C. LeDuc, H. Castillo, John R. Miller","doi":"10.1097/bco.0000000000001234","DOIUrl":"https://doi.org/10.1097/bco.0000000000001234","url":null,"abstract":"\u0000 \u0000 Clinic no-shows are common throughout all medical specialties and can be used as a potential surrogate marker for access to care and have a significant impact on patients and providers. While anecdotally, orthopaedic surgeons have noticed unprecedented changes in the delivery of care as a result of the COVID-19 pandemic, the effect on no-show rates has not been quantified.\u0000 \u0000 \u0000 \u0000 An analysis of the rates of outpatient clinic no-shows within a multispecialty, academic orthopaedic surgery practice was completed. Encounters were sub-classified into designated periods based on a “pre-COVID-19” period, a “COVID-19” period, and a “post-COVID-19” period. A univariate analysis was performed to comment on differences amongst insurance payer status. A multivariate regression was completed to assess which variables contributed to no-show rates among this orthopaedic practice.\u0000 \u0000 \u0000 \u0000 The overall no-show rate over the course of the study was 8.5%. These rates differed significantly between insurance groups, with the lowest no-show rate among Workers’ Compensation/Liability Insurance (WC/LI; 6.4%) and the highest among uninsured patients (21.4%). Additionally, no-show rates differed significantly by COVID period (pre-COVID=7.3%, COVID=8.6%, P<.0001). These rates further increased in the post-COVID period (9.6%, P<.0001) In response to the COVID-19 pandemic, medical practice habits have altered out of necessity.\u0000 \u0000 \u0000 \u0000 Despite a relaxation of social distancing guidelines, no-show rates have continued to increase at our institution. Our results suggest a disproportionate effect on those of lower socioeconomic status. The specific needs of the patient population should be considered when implementing strategies to improve clinic attendance.\u0000","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49288050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-29DOI: 10.1097/bco.0000000000001236
José María García López, D. Cecilia López, María Concepción Merino Sánchez
{"title":"Median nerve compression by a reversed palmaris longus in the distal forearm: a case report","authors":"José María García López, D. Cecilia López, María Concepción Merino Sánchez","doi":"10.1097/bco.0000000000001236","DOIUrl":"https://doi.org/10.1097/bco.0000000000001236","url":null,"abstract":"","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41737812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-25DOI: 10.1097/bco.0000000000001226
{"title":"Does a medial mini-incision decrease the risk of iatrogenic ulnar nerve injury in pediatric supracondylar humeral fractures treated with closed reduction and percutaneous pinning?: A retrospective cohort study: Erratum","authors":"","doi":"10.1097/bco.0000000000001226","DOIUrl":"https://doi.org/10.1097/bco.0000000000001226","url":null,"abstract":"","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135286073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-10DOI: 10.1097/bco.0000000000001231
A. Drtil, Revanth K. Poondla, Lauren N. Bockhorn, W. Dunn, C. Hryc, M. Laughlin, B. Morris
Major joint/limb reattachment procedures of upper extremities (Diagnosis-related group 483, DRG-483) are increasingly utilized, while average costs have increased yearly. This study seeks to determine the influence of volume, neighborhood demographics, and orthopedic specialization on the cost of DRG-483. Utilization and cost data for DRG-483 was extracted from Centers for Medicare and Medicaid Services (CMS) inpatient charge data from 2014-2018. Neighborhood demographic data was queried as USDA Rural-Urban Commuting Area codes (RUCA) from the United States 2010 census and Esri’s ArcMap software. Orthopedic specialization ratios for each hospital (OSR = Musculoskeletal discharges/Total Discharges) was utilized to compare Orthopedic Specialty Hospitals (OSH) = OSR>0.99 and Nonspecialty Hospitals (NSH) = OSR≤0.99. The cost of DRG-483 procedures and the influence of volume, hospital demographics, and orthopedic specialization was analyzed using linear regression models. OSH performed DRG-483 procedures at lower average Medicare payments (AMP) than NSH in all years studied (P<0.001), averaging 15% saved per surgery. DRG-483 volume was weakly negatively correlated with AMP, averaging $2.95 saved per discharge. Finally, population density of hospital location was inversely proportional to DRG-483 AMP with metropolitan centers performing the procedure at the lowest cost to the CMS. CMS payments are optimized at urban orthopedic specialty hospitals. Eliminating the AMP difference for the 222,519 DRG-483 performed at NSH would have saved CMS over 480 million dollars between 2014-2018.
{"title":"Cost-effectiveness of upper extremity arthroplasties at orthopedic specialty hospitals","authors":"A. Drtil, Revanth K. Poondla, Lauren N. Bockhorn, W. Dunn, C. Hryc, M. Laughlin, B. Morris","doi":"10.1097/bco.0000000000001231","DOIUrl":"https://doi.org/10.1097/bco.0000000000001231","url":null,"abstract":"\u0000 \u0000 Major joint/limb reattachment procedures of upper extremities (Diagnosis-related group 483, DRG-483) are increasingly utilized, while average costs have increased yearly. This study seeks to determine the influence of volume, neighborhood demographics, and orthopedic specialization on the cost of DRG-483.\u0000 \u0000 \u0000 \u0000 Utilization and cost data for DRG-483 was extracted from Centers for Medicare and Medicaid Services (CMS) inpatient charge data from 2014-2018. Neighborhood demographic data was queried as USDA Rural-Urban Commuting Area codes (RUCA) from the United States 2010 census and Esri’s ArcMap software. Orthopedic specialization ratios for each hospital (OSR = Musculoskeletal discharges/Total Discharges) was utilized to compare Orthopedic Specialty Hospitals (OSH) = OSR>0.99 and Nonspecialty Hospitals (NSH) = OSR≤0.99. The cost of DRG-483 procedures and the influence of volume, hospital demographics, and orthopedic specialization was analyzed using linear regression models.\u0000 \u0000 \u0000 \u0000 OSH performed DRG-483 procedures at lower average Medicare payments (AMP) than NSH in all years studied (P<0.001), averaging 15% saved per surgery. DRG-483 volume was weakly negatively correlated with AMP, averaging $2.95 saved per discharge. Finally, population density of hospital location was inversely proportional to DRG-483 AMP with metropolitan centers performing the procedure at the lowest cost to the CMS.\u0000 \u0000 \u0000 \u0000 CMS payments are optimized at urban orthopedic specialty hospitals. Eliminating the AMP difference for the 222,519 DRG-483 performed at NSH would have saved CMS over 480 million dollars between 2014-2018.\u0000","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44818534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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