Saturday, August 27, 2016

Women in Orthopedic Surgery - Progress Report

Gender diversity is occuring in Orthopedic Surgery.

There are currently 270 women orthopedic surgeons in training and 1,273 practicing female orthopedic surgeons (doubled from only 600 in 2007).

The number of female orthopedic surgery residents is 105 in 2015, up from 67 in 2007 (a 40 % increase in less than 10 years).

14 % of Orthopedic Surgery residents in 2014 are female, up from  11 % in 2007.

Women applicants to orthopedic surgery programs are accepted at the same rate as their male colleagues.

Most importantly, women are satisfied with their orthopedic careers (93% satisfaction), 77 % would choose orthopedic surgery again, 62 % had children, and 73 % were in a relationship.

This is a great trend which I expect to continue into the future.  

Sunday, August 21, 2016

ACL Surgical Reconstruction - Current trends

The surgical technique for ACL reconstruction has evolved significantly from 2007.  This is the result of an improved understanding of ligament biomechanics, anatomy, device development and assessment of surgical failures.

So here is what we can tell you today (based on JBJS publication in 2016 by Tibor et al.).

Nearly 22,000 reconstructions were studied.  72 % of procedures were performed by sportsmedicine fellowship trained surgeons.  Transtibial femoral tunnel drilling (now considered a less successful technique) decreased by 26 %.  Medial portal drilling of the femoral tunnel (now considered the more favorable technique) increased to 65 % (up from 41 %).

There was no change in the frequency of graft use - the three most common are hamstring autograft (34 %), patellar tendon autograft  (25 %) and tibialis anteror allograft (20 %).

                                                      Revision ACL surgery rates remained stable at 2.4 % at 2 years.

Sunday, July 24, 2016

Total Knee Patient Experience Survey for Dr. Tarlow

The quality department at an inpatient surgical facility has provided the following survey summary.

1.  88 % of patients found the preop phone call from the hospital nurse helpful, and none of the patients would have preferred to come to the facility for an in person information session.  In 2016 the need for face to face communication for certain tasks is not desirable.  

2.  3 months after Total Knee Replacement 37 % of patients rated their pain as worse than expected.  The average Total Knee patient needs 9-12 months of healing time so this survey result is expected.

3.  One year after Total Knee Replacement 90 % of people believe the surgery met their expectation and 10 % have not had their expectations met.  This is better than most scientific studies that report 80 % of patients had expectations met.

Friday, July 15, 2016

Insurers Join to Fight Opioid Epidemic

Health Insurers have a large financial role in the delivery of healthcare.  As such, the following actions by Cigna, Blue Cross and Aetna may help decrease opioid addiction.

These insurers will flag customers deemed high risk for abuse.  High risk is defined as patients prescribed large quantities of oxy or hydrocodone or morphine, patients receiving opioid Rx from more than one provider, or long term opioid users.

This is a step in a positive direction.  Society should benefit and accidental death could decrease.

Saturday, July 9, 2016

Low Complication Rate Reported from New Outpatient TJA Facility

Bottom Line
  • The study examined results for 432 patients undergoing TJA at a newly opened outpatient surgery facility over approximately 13 months. 
  • The overall rate of hospital readmission was 1.2 percent.
  • The rate of unplanned access of the healthcare system was 10.9 percent.
  • A statistically significant lower rate of unplanned access to care was seen in the concluding 4.5-month period of the survey versus that in the first 9 months.
This study appeared in the July AAOS Now.  

Our results at SurgCenter of Greater are similar, with no hospital admissions of our series of Outpatient Joint replacements and high patient satisfaction from being able to sleep in their own beds with reasonable pain management.  

Lead author Daniel P. Hoeffel, MD, a surgeon at Summit Orthopaedics in Woodbury, Minn., which opened the ambulatory surgery center in 2014, said that the study represented one of the largest series to date on outpatient total TJA. He said the rates of hospital readmission reported in the study are "lower than those historically reported" for inpatient TJA

The study, presented in a scientific poster at the AAOS Annual Meeting, reported results for 432 patients who underwent either total hip arthroplasty (THA; n = 177) or total knee arthroplasty (TKA; n = 255) in the outpatient surgery center over 13 months. A total of 12 adverse events occurred, with five patients (1.2 percent) requiring hospital readmission. Two of these were due to swelling with pain or hematoma, and three were for dislocation, pneumonia, or infection.