Does the Day of the Week or the Time of Day Affect the Length of Stay or Readmission Rate for Pediatric Orthopedic Admissions?

Purpose: Health care institutions are searching for system-wide approaches to reduce costs while maintaining quality and improving patient outcomes. Hospital length of stay (LOS) and readmission rate (RR) are variables that significantly impact health care costs. This investigation aimed to determine if there was a difference in the LOS and the RR for pediatric orthopedic patients admitted overnight or during the weekend.

Ethical Considerations of Declining Surgical Intervention: Balancing Patient Wishes with Fiduciary Responsibility.

Orthopaedic surgeons face increasing pressure to meet quality metrics due to regulatory changes and payment policies. Poor outcomes, including patient mortality, can result in financial penalties and negative ratings. Importantly, adverse outcomes often increase surgeon stress level and lead to job dissatisfaction and burnout.

Temporal, Seasonal, and Monthly Effects on Total Knee Arthroplasty Surgical Site Infection Rates.

Background: Deep surgical site infections (dSSI) following total knee arthroplasty (TKA) are associated with morbidity and poor outcomes. Although numerous patient and non-patient factors have been correlated with dSSI development, the temporal and seasonal variability of dSSI is unclear. The purpose of this study was to investigate the monthly and seasonal variability of dSSI rates following TKA.

Rapid Adoption of Telemedicine Increases Opioid Prescribing in Orthopedic Surgery.

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Lack of Seasonal and Temporal Variability in Total Hip Arthroplasty Surgical Site Infections.

Background: Surgical site infections (SSIs) are a signifi- cant cause of morbidity and mortality following total joint arthroplasty (TJA). While many risk factors are known, the seasonal and temporal associations of SSI are less under- stood. Understanding the associations can help reduce SSI rates.

Assessing the Adequacy and Readability of Surgical Consents in Orthopedic Surgery.

Background: Handwritten consent forms for medical treatment are commonly used despite the associated risk of documentation errors. We performed an internal audit of handwritten surgical consent forms to assess the quality of consenting practices within the department of hand surgery at our orthopedic specialty hospital.

Methods: A sample of 1,800 charts was selected.

A Surgeon-Volume Comparison of Opioid Prescribing Patterns to Adolescents Following Outpatient Shoulder, Hip, and Knee Arthroscopy.

Purpose: Given the wide variation that exists in the amount and duration of postoperative opioid medication prescribed by orthopedic surgeons, the purpose of the current study was to analyze the opioid prescribing patterns at our institution for adolescent patients undergoing outpatient sports medicine procedures Methods: A total of 468 adolescent patients (between the ages of 13 and 18 years old) who underwent outpatient shoulder, hip, or knee arthroscopy (including ACL reconstruction) between 2016 and 2018 were retrospectively identified, and demographic data were collected. Opioid prescriptions following surgery were converted to morphine milligram equivalents (MME) for direct comparison. Prescribing patterns of the 44 surgeons included in our cohort were evaluated with respect to procedures performed and overall surgical volume.

Opioid Prescribing Patterns Among Orthopedic Hand Surgeons After Implementation of a Divisional Protocol.

Introduction: Overprescribing contributes to the misuse and overuse of narcotics. We hypothesized that implementation of postoperative prescribing guidelines would consistently reduce the amount of opioids prescribed after ambulatory hand surgery.

Methods: A divisional protocol was instituted in November 2018.

Trends in Pain Medication Prescriptions and Satisfaction Scores in Spine Surgery Patients at a Single Institution.

Background: As the opioid crisis has gained national attention, there have been increasing efforts to decrease opioid usage. Simultaneously, patient satisfaction has been a crucial metric in the American health care system and has been closely linked to effective pain management in surgical patients. The purpose of this study was to examine rates of pain medication prescription and concurrent patient satisfaction in spine surgery patients.

The Effect of Medicare's Bundled Payments for Care Initiative on Patient Risk Factors Prior to Total Knee Arthroplasty.

Background: Medicare's Bundled Payments for Care Initiative (BPCI) is a risk-sharing alternative payment model. There is a concern that BPCI providers may avoid operating on obese patients and active smokers to reduce costs. We sought to understand if increased focus on these patient factors has led to a change in patient demographics in Medicare-insured patients undergoing total knee arthroplasty (TKA).

Telemedicine Utilization by Orthopedic Patients During COVID-19 Pandemic: Demographic and Socioeconomic Analysis.

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The Utility of Preoperative Labs in Predicting Postoperative Complications Following Primary Total Hip and Knee Arthroplasty.

Background: Preoperative testing costs billions of dollars despite little evidence supporting its utility. The purpose of this study was to determine the relationship between abnormal preoperative laboratory tests and postoperative complications following total joint arthroplasty.

Methods: The NSQIP database was used to identify 45,936 primary total hip arthroplasty (THA) and 76,041 pri-mary total knee arthroplasty (TKA) cases performed between 2006 and 2013.

Impact of Value-Based Reimbursement on Health-Care Disparities for Total Joint Arthroplasty Candidates.

As the U.S. Centers for Medicare & Medicaid Services (CMS) implements value-based reimbursement models based on predetermined outcome measures, access to total joint arthroplasty (TJA) is jeopardized for patients who are disproportionately affected by conditions that predispose them to higher odds of complications.

Emergency Department Observation Versus Readmission Following total Joint Arthroplasty: Can We Avoid the Bundle Buster?

Background: As the Center for Medicare and Medicaid (CMS) moves toward bundled payment plans for total joint arthroplasty (TJA), it becomes necessary to reduce factors that increase cost for an episode of care such as readmissions. The goal of this study is to evaluate the payment for observation stay versus readmission for patients who present to the emergency department.

Methods: A retrospective review from 2014-2019 was conducted identifying all Medicare patients who had a primary, elective TJA and visited the ED within 90 days postoperatively.

Opioid Stewardship in Orthopaedic Surgery: Principles and Practice.

The abuse of prescription opioid pain medication has contributed to the U.S. opioid crisis.

The Relationship Between Medicaid Coverage and Outcomes Following Total Knee Arthroplasty: A Systematic Review.

Background: Access to elective total knee arthroplasty is important in the treatment of end-stage arthritis, and numerous initiatives, including Medicaid expansion, have sought to improve patients' ability to undergo this procedure. However, despite this, the role of Medicaid insurance in patient outcomes remains unclear. The purpose of this study was to perform a systematic review of the literature to explore the relationship between preoperative Medicaid insurance status and outcomes following primary total knee arthroplasty.

Opioid Prescribing Patterns in Orthopaedic Surgery Patients: the Effect of New York State Regulations and Institutional Initiatives.

Background: The opioid epidemic in the United States is a public health crisis. As a result, regulatory agencies, including state governments, have enacted initiatives to decrease the use of opioids in the perioperative setting. The purpose of this study was to compare opioid utilization in orthopaedic surgery patients at discrete points after implementation of State regulatory and institution/physician-led initiatives to decrease opioid utilization in the perioperative period.

Applying Systems Engineering to Increase Operating Room Efficiency.

Systems engineering is an interdisciplinary approach to creating, evaluating, and managing a complex process in order to increase reliability, cost-effectiveness, and quality. The operating room is a complex environment that requires human-human interaction, human-device interaction, planning, and coordination of scarce resources for the purpose of providing surgery to patients in a safe and efficient manner. The operating room is an important revenue generator, but it can also be responsible for unsustainable costs if not managed effectively.

Ethics of Opioid Prescriber Regulations: Physicians, Patients, and Pain.

Background: Opioid addiction affects patients of every race, sex, and socioeconomic status. Overprescribing is a known cause of the opioid crisis. Various agencies have implemented requirements and programs to combat practitioner overprescribing; however, there can be adverse ethical consequences when regulations are used to influence physician behavior.

Total Hip Arthroplasty for Secondary Causes of Arthritis An Increase in Time and Money.

Background: Total hip arthroplasty (THA) is a frequently performed, highly successful orthopedic procedure. Although primary osteoarthritis (PA) is the most common reason for (THA), there are several secondary conditions that lead to degenerative hip disease that are successfully treated with THA. The purpose of this study was to examine the incidence of these secondary causes of arthritis (SA) leading to THA and to compare the relative surgical costs, operating times, and hospital length of stay (LOS) for THA done for PA versus SA.

Seasonal, monthly, and yearly variability of surgical site infections at a single institution-A report of more than 95,000 procedures.

To determine whether deep surgical site infection (dSSI) rate exhibits temporal variability, dSSI rates following 98,068 cases were analyzed. The overall dSSI rate decreased significantly between 2009 and 2018. Summer had a significantly greater rate of dSSI than winter.

Outcomes of Same-Day Discharge After Total Hip Arthroplasty in the Medicare Population.

Background: There is an increasing utilization of same-day discharge total hip arthroplasty (SDD THA). As the Center for Medicare and Medicaid Services considers removing THA from the inpatient-only list, there is likely to be a significant increase in the number of Medicare patients undergoing SDD THA. Thus, there is a need to report on outcomes of SDD THA in this population.

Readmissions Are Not What They Seem: Incidence and Classification of 30-Day Readmissions After Orthopedic Trauma Surgery.

Objectives: To evaluate the causes of 30-day readmissions after orthopedic trauma surgery and classify them based on their relation to the index admission.

Design: Retrospective chart review.

Setting: One large, academic, medical center.