Orthopaedic Residency Compensation and Cost of Living: Are Orthopaedic Residents Financially Strained?

Introduction: Medical education imposes a financial burden on trainees. Given that cost-of-living varies across geographical regions, understanding its relationship with resident compensation can inform about the finances of residents. We investigated: (1) How does compensation for orthopaedic surgery residents vary across regions? (2) How does compensation for orthopaedic surgery residents vary with respect to cost of living? (3) What is the extent of surplus income for residents after accounting for hours worked? (4) What are the predictors of annual income for orthopaedic residents?

Material And Methods: Using the American Medical Association FREIDA database, we collected weekly work hours, location, program type, moonlight allowance, and geographic region for 190 nonmilitary orthopaedic programs.

Erector Spinae Plane Block with Liposomal Bupivacaine for Adolescent Idiopathic Scoliosis Surgery: No Patient Controlled Analgesia Needed.

Study Design: Retrospective Controlled Cohort.

Objective: To evaluate the effect of intraoperative liposomal bupivacaine (LB) via Erector Spinae Plane Block (ESPB) on postoperative adolescent idiopathic scoliosis (AIS) patients with and without patient-controlled analgesia (PCA).

Summary Of Background Data: Pain control after posterior spinal fusion (PSF) for AIS includes opioids and other modalities.

Use of a Standardized Perioperative Care Path for Adolescent Idiopathic Scoliosis Leads to Decreased Complications and Readmissions.

Study Design: Retrospective review of patients ages 10-18 who underwent posterior fusion for adolescent idiopathic scoliosis (AIS) at a single institution from 2014 to 2019.

Objective: The aim was to evaluate a standardized Care Path to determine its effects on perioperative outcomes in patients undergoing spinal fusion for AIS.

Summary Of Background Data: AIS is the most common pediatric spinal deformity and thousands of posterior fusions are performed annually.

Liposomal Bupivacaine Is Both Safe and Effective in Controlling Postoperative Pain After Spinal Surgery in Children: A Controlled Cohort Study.

Study Design: Retrospective comparative cohort study.

Objective: To evaluate: (1) pain relief efficacy; (2) opioid consumption; (3) length of stay (LOS); (4) discharge disposition (DD); and (5) safety and adverse effects of liposomal bupivacaine (LB) in pediatric patients who underwent spinal deformity correction.

Summary Of Background Data: LB is a long-acting, locally injectable anesthetic.

Utilization of Telemedicine Virtual Visits in Pediatric Spinal Deformity Patients: A Comparison of Feasibility and Patient Satisfaction at a Large Academic Center.

Background: Telemedicine platforms have been developed to support the convenient delivery of health care services to their patients while maintaining appropriate quality of care. However, it is unclear whether they can be utilized effectively in patients with pediatric spinal deformity (PSD). Therefore, this study aimed to evaluate the feasibility and patient satisfaction associated with virtual visit (VV) utilization in PSD patients in comparison to general pediatric orthopaedic indications.

Correction to: Removal of a urinary catheter before discontinuation of epidural analgesia is associated with an increased risk of postoperative urinary retention and hospital episode costs in patients undergoing surgical correction for adolescent idiopathic scoliosis.

The original version of this article unfortunately contained a mistake. The spelling of Erin Ohliger's name was incorrect.

Removal of a urinary catheter before discontinuation of epidural analgesia is associated with an increased risk of postoperative urinary retention and hospital episode costs in patients undergoing surgical correction for adolescent idiopathic scoliosis.

Objectives: In adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal instrumented fusion (PSIF), we aimed to answer these questions: (1) is there a difference in postoperative urinary retention (UR) rates among patients who had removal of their Foley catheters before vs. after discontinuation of epidural analgesia (EA)? (2) Can the timing of Foley catheter removal be an independent risk factor for postoperative UR requiring recatheterization? (3) Is there an incurred cost related to treating UR?

Study Design: Retrospective cohort.

Background: EA has been widely used for postoperative pain control after PSIF for AIS.

Influence of Intraoperative Neuromonitoring on the Outcomes of Surgeries for Pediatric Scoliosis in the United States.

Background: Intraoperative neuromonitoring (IONM) is used to detect impending neurologic damage during complex spinal surgeries. Although IONM is increasingly used during pediatric scoliosis surgeries in the United States, the effect of IONM on the outcomes of such surgeries at a national level is unclear.

Methods: Using National Inpatient Sample (NIS) from 2009 to 2012, 32,305 spinal fusions performed in children 18 years old or younger of age with scoliosis were identified using ICD-9 procedure and diagnosis codes.

Predictors of Extended Length of Hospital Stay in Adolescent Idiopathic Scoliosis Patients Undergoing Posterior Segmental Instrumented Fusion: An Analysis of 407 Surgeries Performed at a Large Academic Center.

Study Design: Retrospective cohort study.

Objective: The aims of this study were to (1) compare patient and procedure-specific characteristics among those who had short versus long hospital stays and (2) identify independent risk factors that may correlate with extended length of hospital stay (LOS) in patients with adolescent idiopathic scoliosis (AIS) who underwent posterior segmental instrumented fusion (PSIF).

Summary Of Background Data: Reducing the LOS and identifying risk factors associated with extended admission have become increasingly relevant to healthcare policy makers.

Cervical sagittal alignment and the impact of posterior spinal instrumented fusion in patients with Lenke type 1 adolescent idiopathic scoliosis.

Background: Clinical decision making, preoperative planning, and surgical correction for adolescent idiopathic scoliosis (AIS) has traditionally focused on obtaining the maximum coronal plane correction to improve cosmesis and function. More recently, restoring sagittal alignment has also received increasing attention in AIS patients, correlating with positive health-related quality of life (HRQOL) outcomes in multiple studies. In this realm, cervical sagittal alignment (CSA) has also emerged as one of the variables that may correlate with clinical and functional outcomes in AIS patients undergoing surgical correction.

Influence of Prior Hip Salvage Surgery on Outcomes After Total Hip Arthroplasty in Young Patients.

Background: As the indications for total hip arthroplasty (THA) have expanded, this procedure is being increasingly performed in young patients. Oftentimes, this population has undergone one or more salvage procedures in an attempt to delay or forestall a THA. However, it is unclear whether patients with prior salvage procedure have higher risk of adverse events.

Personality Factors Associated With Resident Performance: Results From 12 Accreditation Council for Graduate Medical Education Accredited Orthopaedic Surgery Programs.

Objectives: To understand the personality factors associated with orthopedic surgery resident performance.

Design: A prospective, cross-sectional survey of orthopedic surgery faculty that assessed their perceptions of the personality traits most highly associated with resident performance. Residents also completed a survey to determine their specific personality characteristics.

BUILDING PHYSICIANS WITH SELF-AWARENESS.

Learn how three training programs used personality assessment - and shared the results with the participants - to assess and facilitate leadership development in orthopedic surgery.

Balloon Kyphoplasty for Managing Intractable Pain in Pediatric Pathologic Vertebral Fractures.

Background: Vertebral compression fractures are a common result of osteoporosis and osteopenia secondary to steroid use and chemotherapy treatment. Balloon kyphoplasty is a treatment option with good to excellent results well described in adults. Although a few recent studies have been published regarding the use of kyphoplasty in children, no formal indication exists for the pediatric population.

Effect of Minimalist Footwear on Running Efficiency: A Randomized Crossover Trial.

Background: Although minimalist footwear is increasingly popular among runners, claims that minimalist footwear enhances running biomechanics and efficiency are controversial.

Hypothesis: Minimalist and barefoot conditions improve running efficiency when compared with traditional running shoes.

Study Design: Randomized crossover trial.

Epidural analgesia for postoperative pain control after adolescent spinal fusion procedures which violated the epidural space.

Study Design: Retrospective chart review.

Objective: To determine the effectiveness of epidural analgesia in scoliosis patients with an opened (violated) spinal canal.

Background: Postoperative continuous epidural analgesia using local anesthetics and/or opioids has been described with good success after posterior scoliosis correction.

Pediatric elbow and forearm fractures requiring surgical treatment.

In the modern pediatric orthopedic practice, operative management plays a vital and not infrequent role in the management of significant and difficult forearm and elbow fractures in the skeletally immature. Although the majority of forearm and many elbow fractures can be treated successfully by nonoperative measures, operative intervention is warranted in selected cases to optimize outcomes. Anatomic reconstruction of articular surfaces, along with obtaining and maintaining a stable, anatomic fracture reduction, are the goals of any operative treatment.

Radiographic outcomes using freeze-dried cancellous allograft bone for posterior spinal fusion in pediatric idiopathic scoliosis.

The senior author (A.G.) has gained extensive experience using freeze-dried cancellous allograft chips to obtain solid posterior fusion in patients with adolescent idiopathic scoliosis.

Proximal Femoral Focal Deficiency(PFFD): More Than An Abnormal Hip.

As the name implies, proximal femoral focal deficiency (PFFD) is a failure in development of the proximal femur and acetabulum of varying degrees. This article reviews the classification schemes with illustrated examples. Clinical findings, associated anomalies, imaging, and treatment are discussed.

Superficial venous thrombosis presenting as a painful popliteal fossa mass in a child.

We report an unusual case of superficial venous thrombosis in a cyanotic 12-year-old child who had undergone recent appendectomy. Although compression, color Doppler, and duplex ultrasound techniques remain the keys to the diagnosis of venous thrombosis, SieScape sonography was beneficial in demonstrating the extent of the thrombi and their location along a superficial thrombosed vein.

Graft fixation strength with arthroscopic anterior cruciate ligament reconstruction. Two-incision rear entry technique compared with one-incision technique.

To compare the fixation strengths of two arthroscopic anterior cruciate ligament reconstruction techniques, we harvested 10-mm bone-patellar tendon-bone grafts with 25-mm bone plugs from 12 fresh-frozen cadaveric knees. One knee of each pair was fixed using Acufex instruments and the two-incision technique; one knee was fixed using Arthrotek instruments and the one-incision technique. We used cannulated 9 x 25 mm Kurosaka screws for femoral and tibial tunnel fixation.