Unstated factors in orthopaedic decision-making: a qualitative study

Background  

Total joint replacement (TJR) of the hip or knee for osteoarthritis is among the most common elective surgical procedures. There is some inequity in provision of TJR. How decisions are made about who will have surgery may contribute to disparities in provision. The model of shared decision-making between patients and clinicians is advocated as an ideal by national bodies and guidelines. However, we do not know what happens within orthopaedic practice and whether this reflects the shared model. Our study examined how decisions are made about TJR in orthopaedic consultations.     

CD4 count is associated with postoperative infection in patients with orthopaedic trauma who are HIV positive

Background  

Since the advent of effective antiretroviral therapy, the number of people with AIDS has increased and a certain percentage of these patients will require emergent orthopaedic surgery. Little is known regarding orthopaedic infections and the association of CD4 counts with postoperative infection in patients with HIV infection who experience orthopaedic trauma.     

Minimizing Disparities in Osteoporosis Care of Minorities With an Electronic Medical Record Care Plan

Background  

Ethnic disparities in care have been documented with a number of musculoskeletal disorders including osteoporosis. We suggest a systems approach for ensuring osteoporosis care can minimize potential ethnic disparities in care.     

Orthopaedic Surgeons Receive the Most Industry Payments to Physicians but Large Disparities are Seen in Sunshine Act Data

Background

Industry payments made to physicians by drug and device manufacturers or group purchasing organizations are now reported to the Centers for Medicare and Medicaid Services (CMS) as a part of the Physician Payments Sunshine Act. Initial reports from the program show that orthopaedic surgeons lead all physician specialties in total and average industry payments. However, before further discussion of these payments and their implications can take place, it remains to be seen whether these figures are a true reflection of the field of orthopaedic surgery in general, rather than the result of a few outlier physicians in the field. In addition, the nature and sources of these funds should be determined to better inform the national dialogue surrounding these payments.

Questions/Purposes

We asked: (1) How do industry payments to orthopaedic surgeons compare with payments to physicians and surgeons in other fields, in terms of median payments and the Gini index of disparity? (2) How much do payments to the highest-receiving orthopaedic surgeons contribute to total payments? (3) What kind of industry payments are orthopaedic surgeons receiving? (4) How much do the highest-paying manufacturers contribute to total payments to orthopaedic surgeons?

Materials and Methods

We reviewed the most recent version of the CMS Sunshine Act Open Payments database released on December 19, 2014, containing data on payments made between August 1, 2013 and December 31, 2013. Data on total payments to individual physicians, physician specialty, the types of payments made, and the manufacturers making payments were reviewed. The Gini index of statistical dispersion was calculated for payments made to orthopaedic surgeons and compared with payments made to physicians and surgeons in all other medical specialties. A Gini index of 0 indicates complete equality of payments to everyone in the population, whereas an index of 1 indicates complete inequality, or all income going to one individual.

Results

A total of 15,376 orthopaedic surgeons receiving payments during the 5-month period were identified, accounting for USD 109,846,482. The median payment to orthopaedic surgeons receiving payments was USD 121 (interquartile range, USD 34–619). The top 10% of orthopaedic surgeons receiving payments (1538 surgeons) received at least USD 4160 and accounted for 95% of total payments. Royalties and patent licenses accounted for 69% of all industry payments to orthopaedic surgeons.

Conclusions

Even as a relatively small specialty, orthopaedic surgeons received substantial payments from industry (more than USD 110 million) during the 5-month study period. Whether there is a true return of value from these payments remains to be seen; however, future ethical and policy discussions regarding industry payments to orthopaedic surgeons should take into account the large disparities in payments that are present and also the nature of the payments being made. It is possible that patients and policymakers may view industry payments to orthopaedic surgeons more positively in light of these new findings.

Level of Evidence

Level III, Economic and Decision Analysis.     

What can we learn from patient claims? - A retrospective analysis of incidence and patterns of adverse events after orthopaedic procedures in Sweden

Background  

Objective data on the incidence and pattern of adverse events after orthopaedic surgical procedures remain scarce, secondary to the reluctance for encompassing reporting of surgical complications. The aim of this study was to analyze the nature of adverse events after orthopaedic surgery reported to a national database for patient claims in Sweden.     

The effect of local anaesthetic on post-operative pain with wound instillation via a catheter for paediatric orthopaedic extremity surgery

Purpose  

We aimed to investigate the effects on post-operative pain of local anaesthetic administration via a catheter placed into the operation site in patients who were undergoing upper and lower extremity paediatric orthopaedic surgery.     

Breakout Session: Ethnic and Gender Differences in Diabetic Foot Management and Amputations

Background  

Although the health status of all Americans has improved substantially in the past century, gender and ethnic disparities still persist. Gender and ethnic disparities in diabetic foot management and amputations are an important but largely ignored issue in musculoskeletal health care.     

Disparities in Amputations in Minorities

Background  

As a result of the impact of health disparities on the healthcare system such as their influence on arenas significant to healthcare distribution, including cost, quality, and access, identification and resolution of health disparities is a primary national agenda item. Resolution of disparities in amputation is an area of opportunity that warrants further consideration.     

Defining Racial and Ethnic Disparities in THA and TKA

Background  

For minority populations in the United States, especially African Americans, Hispanics, and Native Americans, healthcare disparities are a serious problem. The literature documents racial and ethnic utilization disparities with regard to THA and TKA.     

Bio-psychosocial determinants of time lost from work following non life threatening acute orthopaedic trauma

Background  

To determine factors predicting the duration of time away from work following acute orthopaedic non life threatening trauma     

Interdisciplinary inter-observer agreement and accuracy of MR imaging of the shoulder with arthroscopic correlation

Introduction  

Differences between radiologists and orthopaedic surgeons in the interpretation of MR images of the shoulder joint are experienced in daily clinical practice. This study set out to evaluate the inter-observer agreement between radiologists and orthopaedic surgeons in assessing pathology on MR imaging of the shoulder joint. Also, we determined the accuracy of the observers with arthroscopy as the standard of reference.     

Orthopaedic Web Links (OWL): A Way to Find Professional Orthopaedic Information on the Internet

Background  

Finding useful high-grade professional orthopaedic information on the Internet is often difficult. Orthopaedic Web Links (OWL) is a searchable database of vetted online orthopaedic resources. OWL uses a subject directory (OWL Directory) and a custom search engine (OWL Web) to provide a list of resources. The most effective way to find readily accessible, full text on-subject material suitable for education of an orthopaedic surgeon or trainee has not been defined.     

Microstructure and biomechanical characteristics of bone substitutes for trauma and orthopaedic surgery

Background  

Many (artificial) bone substitute materials are currently available for use in orthopaedic trauma surgery. Objective data on their biological and biomechanical characteristics, which determine their clinical application, is mostly lacking. The aim of this study was to investigate structural and in vitro mechanical properties of nine bone substitute cements registered for use in orthopaedic trauma surgery in the Netherlands.     

Outcome of limb lengthening in fibular hemimelia and a functional foot

Background  

The decision to recommend either reconstructive or ablative surgery to the parents of children with fibular hemimelia is difficult and debatable in the orthopaedic literature.     

Cost Analysis of a Falls-prevention Program in an Orthopaedic Setting

Background  

Falls by orthopaedic patients may lead to negative outcomes such as injury, prolonged hospitalization, delayed rehabilitation, and increased costs.     

Is there evidence for a superior method of socket fixation in hip arthroplasty? A systematic review

Purpose  

Total hip arthroplasty has been a very succesful orthopaedic procedure. The optimal fixation method of the acetabular component however, has not yet been defined.     

Unsuitability and high perforation rate of latex-free gloves in arthroplasty: a cause for concern

Introduction  

Any increase in perforations in surgical gloves is a concern. We conducted a prospective study to find a clinically acceptable brand of latex-free gloves suitable for orthopaedic surgery.