Assessing the variation and drivers of cost in 1-level lumbar fusion: a time-driven activity-based costing analysis.

Background Context: As value-based health care arrangements gain traction in spine care, understanding the true cost of care becomes critical. Historically, inaccurate cost proxies have been used, including negotiated reimbursement rates or list prices. However, time-driven activity-based costing (TDABC) allows for a more accurate cost assessment, including a better understanding of the primary drivers of cost in 1-level lumbar fusion.

Is There an Implicit Racial Bias in the Case Order of Elective Total Joint Arthroplasty?

Introduction: Identifying ways to improve equitable access to healthcare is of the utmost important. In this study, we analyzed whether patient race was negatively associated with surgical start times for total joint arthroplasties (TJA).

Methods: The surgical case order and start times of all primary TJAs performed at a large academic medical center between May 2014 and May 2018 were retrospectively reviewed.

Effect of Insurance Status on Mortality in Adults With Sarcoma of the Extremities and Pelvis: A SEER-Medicare Study.

Introduction: Previous studies have highlighted the association between insurance status and poor outcomes after surgical treatment of sarcomas in the United States.1-3 It is unclear how much of this disparity is mediated by confounding factors such as medical comorbidities and socioeconomic status and how much can be explained by barriers to care caused by insurance status.

Methods: Surveillance, Epidemiology, and End Results-Medicare linkage data were procured for 7,056 patients undergoing treatment for bone and soft-tissue sarcomas in the extremities diagnosed between 2006 and 2013.

Strategies reducing risk of surgical-site infection following pediatric spinal deformity surgery.

Background: Identifying beneficial preventive strategies for surgical-site infection (SSI) in individual patients with different clinical and surgical characteristics is challenging. The purpose of this study was to investigate the association between preventive strategies and patient risk of SSI taking into consideration baseline risks and estimating the reduction of SSI probability in individual patients attributed to these strategies.

Methods: Pediatric patients who underwent primary, revision, or final fusion for their spinal deformity at 7 institutions between 2004 and 2018 were included.

A Clinical Risk Model for Surgical Site Infection Following Pediatric Spine Deformity Surgery.

Background: Despite tremendous efforts, the incidence of surgical site infection (SSI) following the surgical treatment of pediatric spinal deformity remains a concern. Although previous studies have reported some risk factors for SSI, these studies have been limited by not being able to investigate multiple risk factors at the same time. The aim of the present study was to evaluate a wide range of preoperative and intraoperative factors in predicting SSI and to develop and validate a prediction model that quantifies the risk of SSI for individual pediatric spinal deformity patients.

Intraoperative Scrub Nurse Handoffs Are Associated with Increased Operative Times for Lower Extremity Orthopaedic Sports Procedures.

Purpose: The purpose of this study was to evaluate the effect of intraoperative scrub nurse handoffs on surgical times for arthroscopically-assisted anterior cruciate ligament (ACL) reconstructions and hip arthroscopies.

Methods: A retrospective chart review was done at a major, urban academic medical center for all patients who underwent arthroscopically-assisted ACL reconstructions and hip arthroscopies for femoroacetabular impingement syndrome between May 2014 and May 2020. All ACL reconstructions were performed by 1 of 6 sports medicine fellowship-trained surgeons, and all hip arthroscopies were performed by a single surgeon.

Intraoperative Scrub Nurse Handoffs Are Associated With Increased Operative Times for Total Joint Arthroplasty Patients.

Background: Surgeons typically remain scrubbed in for the duration of a surgical case, while scrub nurses are shift-workers who handoff mid-operation. These handoffs can intuitively create inefficiencies, but currently, no orthopedic research has studied the impact of these handoffs. This study analyzed the effect of intraoperative scrub nurse handoffs on operative times for total joint arthroplasties (TJAs).

Surgical site infections in pediatric spinal surgery after implementation of a quality assurance program.

Study Design: Retrospective cohort study.

Objective: To assess the effectiveness of two infection-reducing programs in mitigating the incidence of post-operative surgical site infections (SSI) in pediatric patients after spinal deformity surgery at our institution. Infections following spinal deformity surgery are associated with higher morbidity as well as significantly increased healthcare costs.

In Vivo Evaluation of Wearable Head Impact Sensors.

Inertial sensors are commonly used to measure human head motion. Some sensors have been tested with dummy or cadaver experiments with mixed results, and methods to evaluate sensors in vivo are lacking. Here we present an in vivo method using high speed video to test teeth-mounted (mouthguard), soft tissue-mounted (skin patch), and headgear-mounted (skull cap) sensors during 6-13 g sagittal soccer head impacts.