Who gets better after surgery for degenerative cervical myelopathy? A responder analysis from the multicenter Canadian spine outcomes and research network.

Background Context: Degenerative cervical myelopathy (DCM) is the most common cause of acquired nontraumatic spinal cord injury worldwide. Surgery is a common treatment for DCM; however, outcomes often vary across patients.

Purpose: To inform preoperative education and counseling, we performed a responder analysis to identify factors associated with treatment response.

Satisfaction in surgically treated patients with degenerative cervical myelopathy: an observational study from the canadian spine outcomes and research network.

Background Context: Healthcare reimbursement is evolving towards a value-based model, entwined and emphasizing patient satisfaction. Factors associated with satisfaction after degenerative cervical myelopathy (DCM) surgery have not been previously established.

Purpose: Our primary objective was to ascertain satisfaction rates and satisfaction predictors at 3 and 12 months following surgical treatment for DCM.

Machine learning models can predict subsequent publication of North American Spine Society (NASS) annual general meeting abstracts.

Background Context: Academic meetings serve as an opportunity to present and discuss novel ideas. Previous studies have identified factors predictive of publication without generating predictive models. Machine learning (ML) presents a novel tool capable of generating these models.

In-office needle arthroscopy is a cost-effective alternative for operating room diversion in medial meniscectomy: a financial analysis.

Background: In-office needle arthroscopy (IONA) has been described as a diagnostic alternative to magnetic resonance imaging (MRI) for intra-articular pathology. However, few studies have analyzed its impact on cost and wait times when used as a therapeutic intervention. The purpose of this study was to investigate the impact on cost and wait times associated with offering IONA for partial medial meniscectomy as an alternative to traditional operating room (OR) arthroscopy for patients with irreparable medial meniscus tears on MRI.

Key Stakeholder Perceptions of Standard vs. Total Cost of Ownership: A Procurement Analysis for Orthopaedic-Powered Instruments.

This study compares standard procurement methodology (SPM) with total cost of ownership (TCO) methodology for the procurement of orthopaedic-powered instruments. The authors conducted semi-structured standardized interviews with key hospital procurement stakeholders following consolidated criteria for reporting qualitative research. Of the 33 hospital procurement stakeholders interviewed, all (100%) reported that SPM would be easier to use than TCO.

Optimizing spine surgery instrument trays to immediately increase efficiency and reduce costs in the operating room.

Background: Over-crowded surgical trays result in perioperative inefficiency and unnecessary costs. While methodologies to reduce the size of surgical trays have been described in the literature, they each have their own drawbacks. In this study, we compared three methods: (1) clinician review (CR), (2) mathematical programming (MP), and (3) a novel hybrid model (HM) based on surveys and cost analysis.

Improving Resource Utilization for Arthroplasty Care by Leveraging Machine Learning and Optimization: A Systematic Review.

Background: There is a growing demand for total joint arthroplasty (TJA) surgery. The applications of machine learning (ML), mathematical optimization, and computer simulation have the potential to improve efficiency of TJA care delivery through outcome prediction and surgical scheduling optimization, easing the burden on health-care systems. The purpose of this study was to evaluate strategies using advances in analytics and computational modeling that may improve planning and the overall efficiency of TJA care.

Standardization of laparoscopic trays using an inventory optimization model to produce immediate cost savings and efficiency gains.

Perioperative services comprise a large portion of hospital budgets; the procurement and processing of surgical inventories can be an area for optimization in operational inefficiency. Surgical instrument trays can be customized as procedure-specific or standardized as trays that can be used in numerous procedure types. We conducted an interventional study to determine the cost savings from standardizing laparoscopic surgery instrument trays.

An Anesthesia Block Room Is Financially Net Positive for a Hospital Performing Arthroplasty.

Introduction: Regional anesthesia is increasingly used in total joint arthroplasty (TJA). It has shown efficiency benefits as it allows parallel processing of patients in a dedicated block room (BR). However, granular quantification of these benefits to hospital operations is lacking.

Clinical applications of augmented reality in orthopaedic surgery: a comprehensive narrative review.

Purpose: The development of augmented reality (AR) technology allows orthopaedic surgeons to incorporate and visualize surgical data, assisting the execution of both routine and complex surgical operations. Uniquely, AR technology allows a surgeon to view the surgical field and superimpose peri-operative imaging, anatomical landmarks, navigation guidance, and more, all in one view without the need for conjugate gaze between multiple screens. The aim of this literature review was to introduce the fundamental requirements for an augmented reality system and to assess the current applications, outcomes, and potential limitations to this technology.

A Dedicated Orthopaedic Trauma Room Improves Efficiency While Remaining Financially Net Positive.

Objectives: To determine the impact of dedicated orthopaedic trauma room (DOTR) implementation on operating room efficiency and finances.

Design: Retrospective cost-analysis.

Setting: Single midsized academic-affiliated community hospital in Toronto, Canada.

The efficacy of primary sacroiliac joint fusion for low back pain caused by sacroiliac joint pathology: a systematic review and meta-analysis.

Purpose: Conduct a systematic review to quantify the effect of primary sacroiliac joint fusion (SIJF) for the treatment of sacroiliac (SI) joint pathology on patient reported outcomes.

Methods: Medline, Embase, Cochrane, PubMed, and Scopus databases were searched prior to August 18th, 2020 for all English-Language studies involving the treatment of SIJ pathology through SIJF and/or conservative management (CM). The quality of included studies was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Optimizing the surgical instrument tray to immediately increase efficiency and lower costs in the operating room.

Background: Surgical trays are often poorly configured and can be ongoing sources of frustration and excess costs. We conducted an observational study to determine if the use of a customized mathematical inventory optimization model would result in a greater reduction in the number of instruments on a surgical tray than a clinician review of the tray.

Methods: Utilization of instruments on the major orthopedic tray at a large academic hospital was documented over 80 procedures.

Machine learning using preoperative patient factors can predict duration of surgery and length of stay for total knee arthroplasty.

Background: Total knee arthroplasty (TKA) is one of the most resource-intensive, high-volume surgical procedures. Two drivers of the cost of TKAs are duration of surgery (DOS) and postoperative inpatient length of stay (LOS). The ability to predict TKA DOS and LOS has substantial implications for hospital finances, scheduling, and resource allocation.

Inventory Optimization in the Perioperative Care Department Using Kotter's Change Model.

Background: Perioperative services have been scrutinized in the context of cost containment in health care, particularly in the procurement and reprocessing of surgical instruments. Although solutions such as surgical instrument inventory optimization (IO) have been proposed, there is a paucity of literature on how to implement this change. The purpose of this project was to describe the implementation of an IO using Kotter's Change Model (KCM).

Using Return on Investment Operational and Monte Carlo Modeling Techniques to Predict Financial Performance in a Tertiary Care Outpatient Clinic.

Introduction: The vast majority of health care quality improvement studies provide inadequate financial analysis to accurately predict a return on investment. We hypothesized that using return on invested capital operational mapping combined with a Monte Carlo simulation financial model could accurately predict institutional costs and operational metrics within an outpatient urology clinic.

Methods: A process map of a typical outpatient clinic visit was developed, and time studies were performed by following a sample of patients while considering all operational and financial variables that contributed to patient care.

The unique impact of COVID-19 on orthopedic surgery residency applicants and program directors in Canada.

The COVID-19 pandemic led to the cancellation of visiting medical student electives and in-person residency interviews in Canada. Orthopedic surgery residency programs are now curtailed in their ability to self-promote and select optimal applicants. Online and social media tools should be adopted to promote programs.

Saturated Salt Solution Cadaver-Embalming Method Improves Orthopaedic Surgical Skills Training.

Background: Human cadaver surgical skills training offers the highest-fidelity simulation of the operative environment, with the potential to enhance surgeon training and to reduce operative risks to patients. Embalming extends the duration that a cadaveric specimen may be used for surgical skills training and reduces the risk of disease transmission, but it can alter the properties of the cadaver tissue, reducing the simulation fidelity and training quality. The purpose of this controlled laboratory study was to evaluate 3 embalming methods, formaldehyde solution, alcohol-glycol solution, and saturated salt solution, and to compare their relative performance in a 2-week orthopaedic surgical skills training course.

Pediatric Burns from Glass-Fronted Fireplaces in Canada: A Growing Issue Over the Past 20 Years.

There is an alarming lack of public awareness surrounding the safety of glass-fronted fireplaces. This has resulted in an active campaign from the American Burn Association Prevention Committee. One issue encountered while advocating for prevention among manufacturers is the lack of corroborating and accurate data.