Local recurrence rates of superficial versus deep soft tissue sarcoma.

Introduction: Soft tissue sarcomas are a group of malignancies that commonly occur in the extremities. As deep lesions may exist within the confines of the muscular fascia, we postulate that local recurrence rates are higher for superficial soft tissue sarcomas managed by the standard of care.

Materials And Methods: A retrospective review was performed on 90 patients who underwent surgical resection of soft tissue sarcomas of the extremity from 2007 to 2015.

Interspecialty Variation in Perioperative Health Care Resource Usage for Carpal Tunnel Release.

Background: We investigated whether any interspecialty variation exists, regarding perioperative health care resource usage, in carpal tunnel releases (CTRs).

Methods: The 2010 to 2021 PearlDiver Mariner Database, an all-payer claims database, was queried to identify patients undergoing primary CTRs. Physician specialty IDs were used to identify the specialty of the surgeon-orthopedic versus plastic versus general surgery versus neurosurgery.

Editorial Commentary: Increasing Patient Out-of-Pocket Expense Does Not Increase Value of Outpatient Surgery.

In a value-based care environment, a goal is to favor outpatient surgery to reduce costs. Unfortunately, while outpatient (as compared to inpatient) surgery reduces overall cost, recent research shows that by including patient out-of-pocket expense (POPE), the proportion of overall cost born by the patient can greatly increase, which is unjust. The primary contributors to high outpatient surgery POPE are out-of-network facilities, out-of-network surgeons, and high-deductible insurance.

Total elbow arthroplasty cases involving orthopaedic residents do not affect short-term postoperative complications.

Background: Impact of resident participation on short-term postoperative outcomes after total elbow arthroplasty has not been studied. The aim was to investigate whether resident participation affects postoperative complication rates, operative time, and length of stay.

Methods: The American College of Surgeons National Surgical Quality Improvement Program registry was queried from 2006 to 2012 for patients undergoing total elbow arthroplasty.

Declining Trend in Anti-osteoporotic Treatment, Despite a Rise in DEXA Screening Following "Sentinel" Distal Radius Fractures.

Purpose: To understand national trends and costs associated with the utilization of anti-osteoporotic medication and DEXA screening within the year following a sentinel/primary distal radius fracture.

Methods: The 2008-2015Q1 Humana Administrative Claims database was queried to identify patients aged ≥50 years, with a "sentinel" occurrence of a primary closed distal radius fracture. Linear regression models were used to report and assess for significant trends in utilization of anti-osteoporotic medication and DEXA screenings within the year following the fracture.

Firework Injuries to the Hand in the United States: An Epidemiological and Cost Analysis.

Although prior literature has evaluated firework injuries broadly, there are no focused investigations examining trends, etiology, and costs associated with firework injuries to the hand. The 2006 to 2014 National Emergency Department Sample (NEDS) was used. () codes identified patients presenting to the emergency department with a firework-related injury of the hand that resulted in a burn, open wound, fracture, blood vessel injury, or traumatic amputation.

Are Foot & Ankle Surgeons Being Adequately Compensated for Ankle Fractures? - An Analysis of Relative Value Units.

The current relative value units (RVU)-based system is built to reflect the varying presentation of ankle fractures (uni-malleolar vs bi-malleolar vs tri-malleolar) by assigning individual RVUs to different fracture complexities. However, no study has evaluated whether the current RVUs reflect an appropriate compensation per unit time following open reduction internal fixation for uni-malleolar versus bi-malleolar versus tri-malleolar ankle fractures. The 2012 to 2017 American College of Surgeons - National Surgical Quality Improvement Program files were queried using current Procedural Terminology (CPT) codes for patients undergoing open reduction internal fixation for uni-malleolar (CPT-27766,CPT-27769,CPT-27792), bi-malleolar (CPT-27814), and tri-malleolar (CPT-27822,CPT-27823) ankle fractures.

Is Outpatient Anterior Lumbar Fusion (ALIF) Safe? An Analysis of 30-day Outcomes.

Study Design: Review of publicly available database.

Objective: To compare 30-day outcomes of single-level ALIF procedures performed in outpatient and inpatient settings.

Summary Of Background Data: Despite a growing interest in performing standalone anterior lumbar interbody fusions (ALIFs) as an outpatient procedure, no study has evaluated the safety or efficacy of this procedure outside an inpatient setting.

Posterior Cervical Fusion for Fracture Is Not the Same as Fusion for Degenerative Cervical Spine Disease: Implications for a Bundled Payment Model.

Study Design/setting: Retrospective.

Objective: To understand differences in 30-day outcomes between patients undergoing posterior cervical fusion (PCF) for fracture versus degenerative cervical spine disease.

Summary Of Background Data: Current bundled payment models for cervical fusions, such as the Bundled Payments for Care Improvement revolve around the use of diagnosis-related groups to categorize patients for reimbursement purposes.

Cognitive Appraisal of Job Autonomy by Nurses: A Cross-Sectional Study.

Introduction: Job autonomy (JA), a task-level job resource has the potential to motivate individual behavior; it is indecisive, however, whether JA promotes or hinders extra-role behavior.

Objective: The study aims to examine the effect of JA on innovative work behavior (IWB) directly and indirectly through cognitive appraisal and work engagement (WE) while considering the organization type and age as control variables.

Methods: Self-administered questionnaires were used to collect the data from 326 nurses.

Does a Reported Penicillin Allergy Affect Outcomes Following Elective Posterior Lumbar Fusions?

Background: Patients with a reported penicillin allergy (PA) receive alternative antibiotics that may not be as effective as cephalosporins for surgical site infection (SSI) prophylaxis. While patient-reported PA has been correlated to increased complications in other fields, this has not been conclusively shown in spine surgery. We investigate the impact of PA on 90-day complications and inpatient charges/costs after elective posterior lumbar fusion between PA and non-PA cohorts.

Anemia Severity and the Risks of Postoperative Complications Following Total Ankle Arthroplasty.

Background: Although studies have demonstrated the effect of anemia severity on postoperative complications after arthroplasties of the shoulder, hip, and knee, no studies have investigated the effect on total ankle arthroplasty (TAA). The objective was to determine the influence of preoperative anemia severity on complications following TAA.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried from 2006 to 2019 for patients undergoing TAA.

Cultivating Innovative Work Behavior of Nurses Through Diversity Climate: The Mediating Role of Job Crafting.

Introduction: Innovative work behavior of nurses is essential to deliver affordable quality healthcare services. Diversity climate and job crafting are a few of the supportive managerial strategies that can be applied to cultivate the innovative capacity of nurses.

Objective: Aim for the current study is to: (a) examine the role of diversity climate in cultivating innovative work behavior of nurses directly; and (b) indirectly through job crafting.

Trends of hand injuries presenting to US emergency departments: A 10-year national analysis.

Background: The purpose was to observe current incidence and trends of hand and wrist injuries presenting to U.S. emergency departments (EDs) over a decade.

Cost Analysis of Medical Students Applying to Orthopaedic Surgery Residency: Implications for the 2020 to 2021 Application Cycle During COVID-19.

Unlabelled: Although studies have evaluated the economic burden to medical students desiring an orthopaedic residency broadly, no study has evaluated in detail the application costs, away rotation costs, interview costs, and total costs. Given that the Association of American Medical Colleges and the American Orthopaedic Association's Council of Orthopaedic Residency Directors have recommended orthopaedic surgery residency programs for the 2021 residency application cycle cancel away rotations and in-person interviews, our objective was to evaluate the cost savings to medical students applying during this time and the potential implications.

Methods: Using the 2019 to 2020 Texas STAR Dashboard database, we queried responses from applicants applying to orthopaedic surgery residency.

Increasing Frailty in Geriatric Emergency General Surgery: A Cause for Concern.

Background: Emergency general surgery (EGS) presents a challenge for frail, geriatric individuals who often have extensive comorbidities affecting postoperative recovery. Previous studies have shown an association between increasing frailty and adverse outcomes following elective and EGS; no study has explored the same for the geriatric patient population using the modified 5-item frailty index (mFI-5) score.

Materials And Methods: A retrospective cohort study was performed using the 2012-2017 American College of Surgeons - National Surgical Quality Improvement Program database to identify geriatric patients (≥65 years) undergoing EGS procedures within 48 h of admission.

Robotic-Assisted Versus Conventional Posterior Lumbar Fusion-An Analysis of 90-Day Complications and Readmissions.

Objective: To evaluate medical and surgical complication rates between robotic-assisted versus conventional elective posterior lumbar fusions.

Methods: The Symphony Integrated DataVerse was queried using International Classification of Diseases, 10th Edition, Clinical Modification procedure codes to identify patients undergoing elective posterior lumbar fusions for degenerative spine pathologies between 2015 and 2018. International Classification of Diseases, 10th Edition, Clinical Modification procedure codes (8E0W4CZ, 8E0W0CZ, 8E0W3CZ) were used to identify patients undergoing a robotic-assisted spinal fusion.

Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF of Ankle Fractures.

Introduction: Despite an increasing number of elderly individuals undergoing surgical fixation for ankle fractures, few studies have investigated peri-operative outcomes and safety of surgery in an octogenarian and nonagenarian population (age >80 years).

Materials And Methods: The 2012-2017 American College of Surgeons database was queried for patients undergoing open reduction internal fixation for isolated uni-malleolar, bi-malleolar and tri-malleolar ankle fractures. The study cohort was divided into 3 comparison groups (age <65 years, 65-75 and >80).

Are Orthopaedic Trauma Surgeons Being Adequately Compensated for Treating Nonunions of the Femoral Shaft?: An Analysis of Relative Value Units.

Introduction: We evaluated differences in reimbursement rates between native femoral shaft fractures treated with an intramedullary nail versus those undergoing repair of nonunion of femoral shaft fractures.

Methods: The 2016 to 2017 American College of Surgeons-National Surgical Quality Improvement Program database was queried using International Classification of Diseases 10th Edition diagnosis codes and Current Procedural Terminology codes to identify patients undergoing surgery for native femoral shaft fractures and/or repair of nonunion of femoral shaft fracture with/without grafts.

Results: The mean total relative value unit (RVU) and surgical time for each group were as follows: (1) native (RVU = 19.

Understanding the Value of Total Shoulder Arthroplasties at Physician-Owned Hospitals.

Background: Owing to concerns regarding higher cost, low quality of care and cherry-picking in physician-owned hospitals (POHs), the Affordable Care Act imposed sanctions that prevented the formation of new POHs. With an increasing utilization of total shoulder arthroplasties (TSAs), there is a need for re-evaluation and assessment of quality and cost of TSAs performed at these POHs.

Methods: The 2011 to 2014 Medicare 100% Standard Analytical Files was used to identify patients undergoing a reverse TSA or anatomic TSA at POHs and non-POHs.

Degenerative Adult Cervical Kyphosis With Secondary Diagnosis Codes Are Associated With Higher Cost and Complications After Spinal Fusion: A Medicare Database Study.

Background: Adult cervical deformity (ACD) is a potentially debilitating condition resulting from kyphosis, scoliosis, or both, of the cervical spine. Conditions such as ankylosing spondylitis, rheumatoid arthritis, Parkinson's disease, and neuromuscular diseases are particularly known to cause severe deformities. We describe the 90-day cost and complications associated with spinal fusion for ACD using International Classification of Diseases (ICD) coding terminology and study if secondary diagnoses associated with potential for severe deformity affect the cost and complication profile of ACD surgery.

Which patients are at risk for not receiving anti-osteoporosis treatment following hip fracture?: An ACS NSQIP analysis.

Background: Screening and management of osteoporosis is often only considered by providers when patients present with multiple fragility fractures. The objective was to determine which patients are at risk for not receiving anti-osteoporotic medication and screening immediately following open reduction internal fixation (ORIF) for hip fracture.

Methods: The 2018 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Targeted Hip Fracture Database was queried to identify patients ≥ 50 years old who underwent ORIF of femoral neck, intertrochanteric hip, and subtrochanteric hip fractures.

Costs of U.S. Allopathic Medical Students Applying to Neurosurgery Residency: Geographic Considerations and Implications for the 2020-2021 Application Cycle.

Objective: Although studies have evaluated the economic burden to medical students desiring a neurosurgery residency broadly, a detailed breakdown of costs has not been reported. Given that the Association of American Medical Colleges and Society of Neurological Surgeons have recommended neurosurgery residency programs for the 2021 residency application cycle cancel away rotations and in-person interviews, our objective was to evaluate cost savings to medical students applying during this time and the implications.

Methods: Using the 2019-2020 Texas STAR Dashboard database, we queried responses from neurosurgery residency applicants.

Are we putting ourselves in danger? Occupational hazards and job safety for orthopaedic surgeons.

As physicians, we strive to meet the needs of our patients. In doing so, we are often exposed to hazards that have the potential to not only compromise our health, but also our ability to deliver the best possible healthcare. Occupational hazards specific to the field of orthopaedics include infectious organisms, radiation, surgical smoke, chemicals, hazardous noise, musculoskeletal injury, and psychosocial stressors.

Risk Factors for Discharge to a Non-Home Destination and Reoperation Following Outpatient Total Hip Arthroplasty (THA) in Medicare-Eligible Patients.

Introduction: The Centers for Medicare and Medicaid Services removed total hip arthroplasty (THA) from the inpatient-only (IO) list in January 2020. Given this recommendation, we analyzed Medicare-eligible patients undergoing outpatient THA to understand risk factors for nonroutine discharge, reoperations, and readmissions.

Materials And Methods: The 2015-2018 American College of Surgeons-National Surgical Quality Improvement Program database was queried using Current Procedural Terminology code 27130 for Medicare eligible patients (≥ 65 years of age) undergoing outpatient THA.