Litigation related to casting in Orthopaedics—An analysis of claims against the National Health Service in England

Orthopaedic casts have been used to treat musculoskeletal conditions for hundreds of years and are still a fundamental component of treating a variety of disorders. As surgical techniques have advanced the frequency of use of orthopaedic casts has declined. With Orthopaedics being is one of the most litigious specialties in medicine we sough to evaluate how this related to casting in Orthopaedics and how we could learn from past mistakes.We analysed litigation claims related to Orthopaedic casts from 1995 to 2010 in which the claims were closed. 43 cases were related to orthopaedic casts. The total costs of these claims were over £2.3 million with an average total cost of £48,500 per claim. The most common cause for claim was harm caused when a cast was applied too tight and secondly from removing the cast. This is the first study to evaluate litigation claims related to Orthopaedic casts and highlights potential complications that if avoided will certainly improve the care of the patients and avoid unnecessary litigation.     

Tender to touch–Prevalence and impact of concomitant fibromyalgia and enthesitis in spondyloarthritis: An ancillary analysis of the ASAS PerSpA study

ObjectivesThe primary objective was to evaluate the co-existence of fibromyalgia (FM) & enthesitis in individuals with spondyloarthritis (SpA). Secondary objectives were to identify clinical features associated with the presence of FM in enthesitis and analyse sex-specific differences.MethodsThis was an ancillary analysis of the Assessment of SpondyloArthritis International Society Peripheral Involvement in SpA (PerSpA) study. Enthesitis was defined as the presence of enthesitis ever. Clinical FM was defined as the rheumatologist's confirmation of the presence of FM. A score of ≥ 5/6 on the Fibromyalgia Rapid Screening Test (FiRST) defined a positive screening test for FM.ResultsEnthesitis ever and FM (EFM) co-existed in 10.3% (n = 425) of the cohort using FiRST criteria and 5.3% using clinical diagnosis of FM. More individuals with FM by clinical diagnosis had imaging-confirmed enthesitis ever than by FiRST criteria. More females had EFM than males, defined clinically (76.9% vs 23.1%) or by FiRST criteria (62.6% vs 37.4%). Individuals with EFM had more severe disease across all measures compared to those with enthesitis only, with no significant difference between sexes. EFM was significantly associated with age, female sex, BMI, BASDAI and region.ConclusionFM is an important comorbidity in the setting of enthesitis in SpA. While EFM is more common in females, it is not a rare condition in males. EFM is associated with worse disease severity measures in SpA in both males and females. Recognition of FM in the setting of enthesitis is essential to prevent overtreatment and optimise patient outcomes.     

The impact of modulator therapy in cystic fibrosis on patterns of hospitalization related to age. Results from an analysis of US inpatient episodes 2006–2016

The approval and subsequent reimbursement of CFTR modulator therapies from 2012 have provided a potential “game-changing” treatment for patients with cystic fibrosis (CF), especially among younger patients.We used HCUP-NIS and HCUP-KID data in 2006, 2009, 2012 and 2016 to compare the number of admissions, hospital charges/cost, length of stay (LOS) and other clinical outcomes between inpatient admissions aged over and below 20 with CF before and after the approval of CFTR therapies.We found the number of hospitalizations with CF dropped among those aged 0–20 but increased among those aged over 20. We found the average LOS and charges/costs increased among the former and decreased among the later.These findings support the hypothesis that modulator therapies have impacted on patterns of hospital care, contributing to a reduction in the number of young people treated in hospital albeit with an increase in their complexity relative to those aged over 20.     

Fracture patterns and bone mass in South African adolescent–mother pairs: the Birth to Twenty cohort

Summary

The associations of fracture prevalence and bone mass in adolescents with maternal fracture history and bone mass have not been investigated previously in South Africa. Maternal bone mass has a significant inverse association with their adolescents' fracture rates and bone mass across all ethnic groups.

Introduction

Differences in fracture rates and bone mass between families and individuals of different ethnic origins may be due to differing lifestyles and/or genetic backgrounds. This study aimed to assess associations of fracture prevalence and bone mass in adolescents with maternal fracture history and bone mass, and sibling fracture history.

Methods

Data from 1,389 adolescent–biological mother pairs from the Birth to Twenty longitudinal study were obtained. Questionnaires were completed on adolescent fractures until 17/18 years of age and on sibling fractures. Biological mothers completed questionnaires on their own fractures prior to the age of 18 years. Anthropometric and bone mass data on adolescent–biological mother pairs were collected.

Results

An adolescent's risk of lifetime fracture decreased with increasing maternal lumbar spine (LS) bone mineral content (BMC; 24 % reduction in fracture risk for every unit increase in maternal LS BMC Z-score) and increased if they were white, male, or had a sibling with a history of fracture. Adolescent height, weight, male gender, maternal bone area and BMC, and white ethnicity were positive predictors of adolescent bone mass. White adolescents and their mothers had a higher fracture prevalence (adolescents 42 %, mothers 31 %) compared to the black (adolescents 20 %, mothers 6 %) and mixed ancestry (adolescents 20 %, mothers 16 %) groups.

Conclusion

Maternal bone mass has a significant inverse association with their adolescent off-springs' fracture risk and bone mass. Furthermore, there is a strong familial component in fracture patterns among South African adolescents and their siblings.     

Changes in the natural history of renal cancer: comparison of Estonian data from the periods 1986–1988 and 1996–1998

To explain considerable increase in survival of renal cancer patients in Estonia during last decades, we compared the stage distribution, diagnostic and treatment methods for the patient groups diagnosed in the periods 1986–1988 and 1996–1998. A significant difference in stage distribution was detected with an increase for stages I–II and a decrease for stages III–IV in 1996–1998. There was a shift in primary diagnostic methods from intravenous urography and angiography to ultrasonography and computed tomography. In multivariate analysis the independent prognostic factors for overall survival were age, stage, and operation status. In conclusion, the increase in the survival of renal cancer patients has been due to the larger number of cases with the earlier stage, which is associated with the application of ultrasonography and computed tomography. Another factor for better survival was the higher operation rate among patients with stage IV disease, a possible factor was the change in operation techniques.     

Prevalence and involvement patterns of radiographic hand osteoarthritis in Japanese women: the Hizen–Oshima Study

The prevalence and pattern of joint involvement in radiographic hand osteoarthritis (OA) have been reported in Western populations, but similar data are lacking for Japanese. We examined this issue in 551 Japanese women aged ≥40 years. Radiographs were obtained of both hands and graded according to the Kellgren–Lawrence (K-L) criteria. OA was defined as K-L grade 2 or higher. The prevalence of radiographic OA in the IP, MCP, and CMC joints was distributed similarly in both hands. The most frequent locations of radiographic OA were the distal IP joints of the index finger, the IP joint of the thumb, and the distal IP joints of the middle finger, in this order. The prevalence of radiographic OA in each joint group increased significantly with age, and that in Japanese women was lower in the thumb CMC joint and higher in the thumb IP joint compared to those in Caucasian women reported previously. The strongest predictor for the presence of radiographic OA in a particular joint was the disease status in the same joint of the opposite hand (OR = 18.5; 95% CI; 15.2–22.7), followed by the joints in the same row of the same hand (OR = 15.5; 95% CI, 11.9–20.1), and then by the joints in the same ray of the same hand (OR = 1.3; 95% CI, 1.0–1.6). Although the prevalence of hand OA is likely to show site-specific differences between Japanese and Caucasian women, our results indicate that both groups show similar involvement pattern symmetrically and in the same row of the same hand.     

Transplant quality in Italy: analysis of the 1995–2000 period

Evaluation of outcomes is a major step in quality assessment of any health process. In the transplant field, the evaluation of outcome is extremely important for both patients growing demand for health and for the joint commitment the transplant process requires. In this study, the outcome of 12,647 transplants, carried out between 1995 and 2000 were analysed. Graft survival at 5 years was 79% for kidney, 67% for liver, 72% for heart and 38% for lung. Patient survival was 92% for kidney, 76% for liver, 72% for heart and 38% for lung. In comparison to other international case records [Collaborative Transplant Study (CTS) and The United Network for Organ Sharing (UNOS)], results are similar or even better for all transplant programmes. As a whole, survival after solid organ transplant in Italy ranks among the best for both donations and transplantation. The quality of transplants carried out is above European standards. Nevertheless, the growing health needs of patients require improvement in both the procurement process and in the use of available organs.     

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.     

An analysis of readmission trends by urgency and race/ethnicity in the MBSAQIP registry, 2015–2018

BackgroundLarge-scale analyses stratifying bariatric surgery readmissions by urgency are lacking.ObjectivesIdentify predictors of urgent/nonurgent readmission among “ideal” bariatric candidates, using a national registry.SettingMetabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) national database.MethodsWe extracted an “ideal” patient cohort from the 2015–2018 Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) registry, characterized by only typical weight-related comorbidities (hypertension [HTN], obstructive sleep apnea [OSA], gastroesophageal reflux disease [GERD], and diabetes (insulin-dependent diabetes mellitus [IDDM] and non–insulin-dependent diabetes mellitus [NIDDM]) undergoing primary bariatric surgery with an uneventful postoperative course. Readmissions were classified as “urgent” (UR; e.g., leak, obstruction, bleeding) or “nonurgent” (NUR; e.g., dehydration, nonspecific abdominal pain). χ² or t test analyses were used for bivariate significance testing. Multivariate logistic regression models were constructed to assess independent predictors of readmission.ResultsThe cohort (N = 292,547) comprised 38.5% of all MBSAQIP patients (mean age [standard deviation] = 43.2 [11.7]; body mass index [BMI] = 44.9 [6.6]; 81% female; 62% White, 17% Black, 14% Hispanic). Total readmission rates were 2.75% (n = 8046) and decreased from 2015–2018 (3.00%–2.63%; P < .001). Independent predictors of readmissions included Roux-en-Y gastric bypass (RYGB) (odds ratio [OR] = 1.97, p < .001), Black (OR = 1.46, P < .001) and Hispanic race (OR = 1.14, P < .001), GERD (OR = 1.27, P < .001), HTN (OR = 1.08, P = .003), and IDDM (OR = 1.39, P < .001). NUR and UR readmission rates were 1.27% (n = 3702) and 1.06% (n = 3090), respectively. NURs decreased over time (1.42%–1.16%, P < .001), with no change in Urs (1.01%–1.06%, P = .51); this trend persisted in multivariate analysis (2017: NUR OR = .85, P < .001; 2018: NUR OR = .82, p < .001). Independent predictors of both URs and NURs included Black (NUR OR = 1.71, p < .001; UR OR = 1.27, p < .001) and Hispanic (NUR OR = 1.15, P < .001; UR OR = 1.19, P < .001) race, RYGB (NUR OR = 1.84, P < .001; UR OR = 2.34, P < .001), and GERD (NUR OR = 1.39, p < .001; UR OR = 1.17, P < .001). Female sex (NUR OR = 1.64, P < .001), age (NUR OR = .98, P < .001), HTN (NUR OR = 1.22, P < .001), and IDDM (NUR OR = 1.41, P < .001) predicted NURs, while higher BMI (UR OR = 1.01, P < .001), and OSA (UR OR = 1.10, P = .02) predicted URs.ConclusionReadmission rates for “ideal” bariatric patients improved over time, driven by reductions in non-urgent etiologies. Racial disparities persist for both urgent and non-urgent causes of readmission.     

High adiponectin levels fail to protect against the risk of hypertension and,in women,against coronary disease: involvement in autoimmunity?

AIM: To investigate whether serum adiponectin protects against cardiometabolic risk in a population sample with prevailing metabolic syndrome.METHODS: Middle-aged adults representative of a general population with baseline circulating adiponectin measurements (n = 1224) were analyzed prospectively at a mean of 3.8 years’ follow-up, using continuous values or sex-specific tertiles. Total adiponectin was assayed by an ELISA kit. Type-2 diabetes was identified by criteria of the American Diabetes Association. Hypertension was defined as a blood pressure ≥ 140 mmHg and/or ≥ 90 mmHg and/or use of antihypertensive medication. Outcomes were predicted using Cox proportional hazards regression analysis in models that were controlled for potential confounders.RESULTS: In models of multiple linear regression, sex hormone-binding globulin, fasting insulin (inverse) and, in men, age were significant independent covariates of serum adiponectin which further tended in women to be positively associated with serum creatinine. Cox regression analyses for incident coronary heart disease (CHD), adjusted for sex, age, non-HDL cholesterol, waist circumference and C-reactive protein, revealed significant inverse association with adiponectin tertiles in men but not women (HR = 0.66; 95%CI: 0.32-1.38 for highest tertile). Cox regression for type-2 diabetes in a similar model (wherein glucose replaced non-HDL cholesterol), adiponectin tertiles appeared to protect in each gender. HR for incident hypertension roughly displayed unity in each of the adiponectin tertiles (P-trend = 0.67).CONCLUSION: High adiponectin levels failed to protect against the development of hypertension and, in women, against CHD, presumably paralleling impairment in renal function as well. Involvement of adiponectin in autoimmune complex with loss of antioxidative-antiatherogenic properties may be underlying.     

True and anastomotic femoral artery aneurysms: is the risk of rupture and thrombosis related to the size of the aneurysms?

OBJECTIVE: the management of asymptomatic femoral aneurysms remains controversial. The purpose of this study was to investigate the relation between the diameter of true and anastomotic aneurysms and the risk of rupture. DESIGN: retrospective study. Material and methods: we reviewed the case records of 17 patients who underwent 17 arterial reconstructive procedures for true femoral aneurysms. In addition, the case records of 76 patients who underwent 90 arterial reconstructive procedures for femoral anastomotic aneurysms were identified and reviewed. RESULTS: the rupture rate for aneurysms less than 5 cm in diameter was 1.6% (one out of 64) compared with 16% (seven out of 43) for those larger than 5 cm. The thrombosis rate for aneurysms less than 5 cm in diameter was 17% compared with 5% for those larger than 5 cm. CONCLUSIONS: this study seems to show that the risk of rupture of femoral artery aneurysms is related to the diameter of the aneurysms. However, the rise in the risk of rupture with increasing size seems less dramatic than for abdominal aortic aneurysm (AAA).     

Obesity Surgery in England: An Examination of the Health Episode Statistics 1996–2005

Background The authors examined the uptake of obesity surgery across England. Methods Data were analyzed from the Hospital Episode Statistics covering all 9 goverment office regions with a total population of 49.1 million. The data analyzed covered 9 years 1996/97 – 2004/05. Results 1,465 records were identified with a primary diagnostic code for obesityand an operation code for obesity surgery. The surgery was performed mostly in women (male to female ratio of 1:5), who were predominantly mid-aged (average 40.4 years ± SD 9.00), the majority of whom reside in local authority districts ranked within the lowest two deprivation quintiles. The availability of obesity surgery varied considerably across the 9 different regions of England, although the number of operations increased nationally over time. Conclusions Access to this intervention is highly variable and does not appear to reflect estimated regional differences in morbid obesity. This specialist service may benefit from more effective national organization, to ensure appropriate capacity and eliminate inequalities in service delivery.     

Changes in the morbidity and costs of systemic lupus erythematosus in Poland in the years 2008–2012

Objectives

The goal of the article is to present the changes in morbidity and costs of systemic lupus erythematosus (SLE) in Poland in the 2008–2012 period, depending on the province of residence of the patients based on data reported to the public payer – the National Health Fund.

Material and methods

Based on the ICD-10 code and the patient''s personal identity number, the number of patients and medical costs (cost of hospitalization, pharmaceutical, medical procedures, dialysis and specialist consultations) were calculated by province (voivodeship) and urban or rural residence.

Results

Annually on average in the assessed period in Poland approximately 20 000 patients were diagnosed with SLE. The studied group was dominated by women (they were 5.2 times more numerous). The morbidity rate was 52.183 patients per 100 thousand inhabitants. Most patients were in the age range of 48–56 years. Average annual expenses for this group of patients over the examined period were USD 16,327 million. Two times more was expended on patients inhabiting cities, approximately 4 times more on women. Calculated per patient, the average cost of therapy was USD 810.63.

Conclusions

The population of SLE patients in Poland is highly stable. The results of analysis indicate 1.64 times more frequent occurrence in urban areas, which may be connected with availability of doctors. The SLE treatment costs in Poland are much lower than in other countries, which is related mainly to the fact that therapy with biological drugs is not financed.