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https://www.readbyqxmd.com/read/28108823/which-clinical-and-patient-factors-influence-the-national-economic-burden-of-hospital-readmissions-after-total-joint-arthroplasty
#1
Steven M Kurtz, Edmund C Lau, Kevin L Ong, Edward M Adler, Frank R Kolisek, Michael T Manley
BACKGROUND: The Affordable Care Act of 2010 advanced the economic model of bundled payments for total joint arthroplasty (TJA), in which hospitals will be financially responsible for readmissions, typically at 90 days after surgery. However, little is known about the financial burden of readmissions and what patient, clinical, and hospital factors drive readmission costs. QUESTIONS/PURPOSES: (1) What is the incidence, payer mix, and demographics of THA and TKA readmissions in the United States? (2) What patient, clinical, and hospital factors are associated with the cost of 30- and 90-day readmissions after primary THA and TKA? (3) Are there any differences in the economic burden of THA and TKA readmissions between payers? (4) What types of THA and TKA readmissions are most costly to the US hospital system? METHODS: The recently developed Nationwide Readmissions Database from the Healthcare Cost and Utilization Project (2006 hospitals from 21 states) was used to identify 719,394 primary TJAs and 62,493 90-day readmissions in the first 9 months of 2013 based on International Classification of Diseases, 9th Revision, Clinical Modification codes...
January 20, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/28102165/occupational-activity-in-patients-10-years-after-hip-replacement-surgery
#2
Teresa Pop, Ewelina Czenczek-Lewandowska, Bogumił Lewandowski, Justyna Leszczak, Justyna Podgórska-Bednarz, Joanna Baran
BACKGROUND: Advanced hip osteoarthritis requires total joint replacement surgery to improve daily activity, including occupational activity. The purpose of this study was to evaluate employment status among patients 10 years after hip replacement surgery. MATERIAL AND METHODS: A total of 63 patients who underwent total hip replacement surgery at the Department of Orthopedics and Traumatology between 2003 and 2005 were enrolled in the study. At the time of the study (2014), all patients from the study group were of working age...
August 30, 2016: Ortopedia, Traumatologia, Rehabilitacja
https://www.readbyqxmd.com/read/28089185/joint-replacement-volume-positively-correlates-with-improved-hospital-performance-on-centers-for-medicare-and-medicaid-services-quality-metrics
#3
Rachel A Sibley, Vanessa Charubhumi, Lorraine H Hutzler, Albit R Paoli, Joseph A Bosco
BACKGROUND: The Center for Medicare and Medicaid Services (CMS) is transitioning Medicare from a fee-for-service program into a value-based pay-for-performance program. In order to accomplish this goal, CMS initiated 3 programs that attempt to define quality and seek to reward high-performing hospitals and penalize poor-performing hospitals. These programs include (1) penalties for hospital-acquired conditions (HACs), (2) penalties for excess readmissions for certain conditions, and (3) performance on value-based purchasing (VBP)...
December 21, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28079735/incidence-of-local-anesthetic-systemic-toxicity-in-orthopedic-patients-receiving-peripheral-nerve-blocks
#4
Eva E Mörwald, Nicole Zubizarreta, Crispiana Cozowicz, Jashvant Poeran, Stavros G Memtsoudis
BACKGROUND AND OBJECTIVES: Peripheral nerve blocks are increasingly used. However, despite low complication rates, concerns regarding local anesthetic systemic toxicity remain. Although recent studies suggest that this severe complication has decreased considerably, there is a paucity of data about it on a national level. We sought to elucidate the incidence of local anesthetic systemic toxicity on a national level and therefore provide guidance toward the need for preparedness in daily anesthetic practice...
January 9, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28070864/factors-that-affect-the-content-of-cadmium-nickel-copper-and-zinc-in-tissues-of-the-knee-joint
#5
Wojciech Roczniak, Barbara Brodziak-Dopierała, Elżbieta Cipora, Agata Jakóbik-Kolon, Joanna Kluczka, Magdalena Babuśka-Roczniak
Osteoarthritis causes the degradation of the articular cartilage and periarticular bones. Trace elements influence the growth, development and condition of the bone tissue. Changes to the mineral composition of the bone tissue can cause degenerative changes and fractures. The aim of the research was to determine the content of cadmium (Cd), nickel (Ni), copper (Cu) and zinc (Zn) in the tibia, the femur and the meniscus in men and women who underwent a knee replacement surgery. Samples were collected from 50 patients, including 36 women and 14 men...
January 9, 2017: Biological Trace Element Research
https://www.readbyqxmd.com/read/28057478/developments-in-ambulatory-surgery-in-orthopedics-in-france-in-2016
#6
REVIEW
C Hulet, G Rochcongar, C Court
Under the new categorization introduced by the Health Authorities, ambulatory surgery (AS) in France now accounts for 50% of procedures, taking all surgical specialties together. The replacement of full hospital admission by AS is now well established and recognized. Health-care centers have learned, in coordination with the medico-surgical and paramedical teams, how to set up AS units and the corresponding clinical pathways. There is no single model handed down from above. The authorities have encouraged these developments, partly by regulations but also by means of financial incentives...
November 15, 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
https://www.readbyqxmd.com/read/28055062/cost-of-joint-replacement-using-bundled-payment-models
#7
Amol S Navathe, Andrea B Troxel, Joshua M Liao, Nan Nan, Jingsan Zhu, Wenjun Zhong, Ezekiel J Emanuel
Importance: Medicare launched the mandatory Comprehensive Care for Joint Replacement bundled payment model in 67 urban areas for approximately 800 hospitals following its experience in the voluntary Acute Care Episodes (ACE) and Bundled Payments for Care Improvement (BPCI) demonstration projects. Little information from ACE and BPCI exists to guide hospitals in redesigning care for mandatory joint replacement bundles. Objective: To analyze changes in quality, internal hospital costs, and postacute care (PAC) spending for lower extremity joint replacement bundled payment episodes encompassing hospitalization and 30 days of PAC...
January 3, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28053389/is-pre-operative-assessment-of-coagulation-profile-with-thrombelastography-teg-useful-in-predicting-venous-thromboembolism-vte-following-orthopaedic-surgery
#8
Apurve Parameswaran, Vignesh P Krishnamoorthy, Anil T Oommen, Anita Jasper, Ravi J Korula, Sukesh C Nair, Pradeep M Poonnoose
INTRODUCTION: Epidemiologic data on the incidence of venous thromboembolism (VTE) in Indian population vary widely. Most studies show that the incidence of VTE is lower in Asian patients than in Western population. Screening tools to identify high-risk patients should enable us to reduce this complication. METHODS: The incidence of VTE in 101 patients who underwent knee or hip arthroplasty, or surgery for hip fractures, without chemoprophylaxis for deep vein thrombosis (DVT) was documented...
October 2016: Journal of Clinical Orthopaedics and Trauma
https://www.readbyqxmd.com/read/28052811/short-term-outcomes-of-mandibular-reconstruction-in-oncological-patients-using-a-cad-cam-prosthesis-including-a-condyle-supporting-a-fibular-free-flap
#9
Achille Tarsitano, Salvatore Battaglia, Valerio Ramieri, Piero Cascone, Leonardo Ciocca, Roberto Scotti, Claudio Marchetti
PURPOSE: Condylar reconstruction and replacement using alloplastic materials currently attracts much surgical interest. The major challenge is to functionally reconstruct the anatomical region; this is crucial in terms of correct mandibular function. The goal of the present study was to evaluate the clinical outcomes of and complications experienced by a series of oncological patients who underwent computer-aided design/computer-aided manufacturing (CAD/CAM) condylar reconstruction following resection-disarticulation of the mandible...
December 16, 2016: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/28043850/allergies-in-orthopaedic-and-trauma-surgery
#10
REVIEW
C H Lohmann, R Hameister, G Singh
Hypersensitivity reactions to implants in orthopaedic and trauma surgery are a rare but devastating complication. They are considered as a delayed-type of hypersensitivity reaction (type IV), characterized by an antigen activation of sensitized T-lymphocytes releasing various cytokines and may result in osteoclast activation and bone resorption. Potential haptens are originated from metal alloys or bone-cement. A meta-analysis has confirmed a higher probability of developing a metal hypersensitivity postoperatively and noted a greater risk of failed replacements compared to stable implants...
December 30, 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
https://www.readbyqxmd.com/read/28040091/reconstruction-of-patellar-tendon-following-implantation-of-proximal-tibia-megaprosthesis-for-the-treatment-of-post-traumatic-septic-bone-defects
#11
Giorgio M Calori, Emilio Luigi Mazza, Luca Vaienti, Simone Mazzola, Alessandra Colombo, Luca Gala, Massimiliano Colombo
INTRODUCTION: Latest advances made in joint replacement implants allows reconstruction of entire limbs. These special prostheses or megaprostheses were originally designed for the treatment of severe oncological bone loss. Nowadays, however, the indications and applications of these devices are expanding to other orthopaedic and trauma clinical conditions. Since 2008 we have implanted 152 megaprostheses in non-oncological conditions: 87 were implanted for post-traumatic failures aseptic/septic (represented by complex non-unions and critical size bone defects); 26 total femur, 52 distal femur and 9 proximal tibia...
December 2016: Injury
https://www.readbyqxmd.com/read/28034774/the-use-of-the-risk-assessment-and-prediction-tool-in-surgical-patients-in-a-bundled-payment-program
#12
James Slover, Kathleen Mullaly, Raj Karia, John Bendo, Patricia Ursomanno, Aubrey Galloway, Richard Iorio, Joseph Bosco
OBJECTIVES: The purpose of this study was to evaluate the relationship between the Risk Assessment and Predictor Tool (RAPT) and patient discharge disposition in an institution participating in bundled payment program for total joint replacement, spine fusion and cardiac valve surgery patients. METHOD: Between April 2014 and April 2015, RAPT scores of 767 patients (535 primary unilateral total joint arthroplasty; 150 cardiac valve replacement; 82 spinal fusions) were prospectively captured...
December 26, 2016: International Journal of Surgery
https://www.readbyqxmd.com/read/28032699/an-analysis-of-paravertebral-ossification-in-cervical-artificial-disc-replacement-a-novel-classification-based-on-computed-tomography
#13
Wei Tian, Ming-Xing Fan, Ya-Jun Liu, Xiao Han, Kai Yan, Han Wang, Yan-Wei Lyu
OBJECTIVE: Cervical artificial disc replacement (CADR) is a new technology in cervical spine surgery. However, CADR may result in paravertebral ossification (PO) after surgery and affect the mobility of the related spinal segments. The present widely used assessment method based on X-ray tomography cannot provide the position information of PO, and also PO detection rates by X-ray are low. The incidence of PO varies dramatically between studies. This study built a novel classification system based on cervical computer tomography (CT) scan to re-evaluate the incidence of PO and its influence on CADR, and also analyzed the predisposing factors of PO...
November 2016: Orthopaedic Surgery
https://www.readbyqxmd.com/read/28032030/lessons-learned-from-study-of-congenital-hip-disease-in-adults
#14
REVIEW
George Hartofilakidis, Kalliopi Lampropoulou-Adamidou
Orthopaedic surgeons specialising in adult hip reconstruction surgery often face the problem of osteoarthritis secondary to congenital hip disease (CHD). To achieve better communication among physicians, better treatment planning and evaluation of the results of various treatment options, an agreed terminology is needed to describe the entire pathology. Furthermore, a generally accepted classification of the deformities is necessary. Herein, the authors propose the use of the term "congenital hip disease" and its classification as dysplasia, low dislocation and high dislocation...
December 18, 2016: World Journal of Orthopedics
https://www.readbyqxmd.com/read/28027387/impact-of-smoking-cessation-counseling-prior-to-total-joint-arthroplasty
#15
Sina Akhavan, Long-Co Nguyen, Vanessa Chan, Jamal Saleh, Kevin J Bozic
Perioperative smoking has been linked to surgical complications including poor wound healing, infection, myocardial infarction, prolonged length of stay, need for mechanical ventilation, and death. This study evaluated the effectiveness of preoperative counseling on smoking cessation for patients undergoing elective total joint arthroplasty. Thirty smokers with hip or knee osteoarthritis seeking hip or knee replacement surgery were enrolled prospectively. Interventions included counseling, referrals to smoking cessation programs including the California Smokers' Helpline and the Fontana Tobacco Treatment Program, nicotine replacement therapy (NRT), or instructing patients quit through the "cold turkey" method of abstinence...
December 27, 2016: Orthopedics
https://www.readbyqxmd.com/read/28026737/-bilateral-total-knee-arthroplasty-short-term-results
#16
S Křivánek, M Hrubina, M Chmúrny, M Rovňák, M Melišík, L Nečas
PURPOSE OF THE STUDY Evaluation of short-term functional results in patients undergoing one-stage surgery involving sequential bilateral total knee arthroplasty (TKA) and comparison with the results of patients after unilateral TKA. MATERIAL AND METHODS The group with bilateral TKA consisted of 171 patients with 342 total knee replacements treated between 2009 and 2013. The control group included 50 patients with 50 TKAs operated on in the years 2010 to 2012. The indications to bilateral knee replacement included bilateral gonarthrosis, grade III or more in patients who were in good health and had a stable knee joint with axis deviation up to 20 degrees...
2016: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
https://www.readbyqxmd.com/read/28010915/the-use-of-tomosynthesis-in-the-global-study-of-knee-subchondral-insufficiency-fractures
#17
Fred Nelson, Omaima Bokhari, Daniel Oravec, Woong Kim, Michael Flynn, Catherine Lumley, Austin McPhilamy, Yener N Yeni
RATIONALE AND OBJECTIVES: Subchondral insufficiency fractures (SIF), previously termed spontaneous osteonecrosis of the knee, are marked by a sudden onset of severe pain. Other than the size of the lesion, prediction for progression to joint replacement is difficult. The objective was to determine if quantitative analysis of bone texture using digital tomosynthesis imaging would be useful in predicting more rapid progression to joint replacement. MATERIALS AND METHODS: Tomosynthesis studies of 30 knees with documented SIF were quantified by fractal, mean intercept length (MIL), and line fraction deviation analyses...
December 20, 2016: Academic Radiology
https://www.readbyqxmd.com/read/28008373/clinical-factors-disease-parameters-and-molecular-therapies-affecting-osseointegration-of-orthopedic-implants
#18
Hilal Maradit Kremers, Eric A Lewallen, Andre J van Wijnen, David G Lewallen
Total hip and knee arthroplasty are effective interventions for management of end-stage arthritis. Indeed, about 7 million Americans are currently living with artificial hip and knee joints. The majority of these individuals, however, will outlive their implants and require revision surgeries, mostly due to poor implant osseointegration and aseptic loosening. Revisions are potentially avoidable with better management of patient-related risk factors that affect the osseointegration of orthopedic implants. In this review, we summarize the published clinical literature on the role of demographics, biologic factors, comorbidities, medications and aseptic loosening risk...
September 2016: Current Molecular Biology Reports
https://www.readbyqxmd.com/read/28008240/a-comparison-between-metatarsal-head-resurfacing-hemiarthroplasty-and-total-metatarsophalangeal-joint-arthroplasty-as-surgical-treatments-for-hallux-rigidus-a-retrospective-study-with-short-to-midterm-follow-up
#19
Musa Ugur Mermerkaya, Houman Adli
PURPOSE: We evaluated the short- to midterm outcomes of metatarsal head-resurfacing hemiarthroplasty and total metatarsophalangeal joint arthroplasty (total joint replacement [TJR]) as surgical treatments for advanced-stage hallux rigidus (HR). PATIENTS AND METHODS: From 2012 to 2014, all data from patients who underwent surgery for the treatment of grades 2-3 HR were retrospectively reviewed, and 45 patients were included in this study. Of these patients, 26 underwent metatarsal head-resurfacing hemiarthroplasty (Group I) and 19 underwent TJR (Group II)...
2016: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/28005124/comprehensive-care-for-joint-replacement-cjr-bundle-expense-in-perioperative-pain-management
#20
Susan D Bear
The implementaion of the Comprehensive Care for Joint Replacement (CJR) model has necessitated value-focused care for a 90-day period. Pain management in joint arthroplasty therefore represents a focused opportunity to achieve lasting change in the delivery of care. To be successful, orthopedic surgeons must integrate approaches that take into account administration route and therapy duration, and various combinations thereof, to achieve improved longer term outcomes for joint arthroplasty patients. In addition, pain management choices must be based on value and not on simple costs, as patient satisfaction scores affect CJR repayments...
November 2016: American Journal of Orthopedics
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