RESUMEN
Despite increased pressure to capture patient-reported outcome measures for at least 1 year following total joint arthroplasty (TJA), follow-up rates during the first year after TJA are typically lower than desired and may result in biased findings if data are not missing at random. We conducted a retrospective review of medical records of primary total knee arthroplasty patients treated by a single surgeon at an urban academic private hospital. Main measures were demographics (sex, age, race, and insurance), body mass index, travel distance to clinic, and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Multivariable regression analyses were performed to identify patient characteristics associated with attendance at follow-up visits and predictors of attendance at 6-month follow-up. Among the 205 study patients, follow-up visit attendance declined from a high of 95.7% at day 14 to lows of 69.2% at 6 months and 64.4% at 1 year. Attendance at the previously scheduled follow-up visit was a statistically significant predictor of attendance at 3-month (P=.0015), 6-month (P=.0002), and 1-year (P<.0001) follow-up visits, and travel distance was significantly associated with attending the 1-year follow-up visit (P=.042). Patients with the most favorable KOOS Symptom, Pain, and Function in daily living subscale scores at 3-month follow-up were significantly less likely to attend the 6-month follow-up visit than patients with the least favorable KOOS scores. Prospective studies are needed to identify the full range of factors that may contribute to high rates of loss to follow-up after TJA, which should be of concern to researchers, clinicians, and hospitals. [Orthopedics. 2023;46(2):93-97.].
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Rodilla , Humanos , Estudios de Seguimiento , Osteoartritis de la Rodilla/cirugía , Estudios Retrospectivos , Medición de Resultados Informados por el Paciente , Resultado del TratamientoRESUMEN
As more commercial insurance companies adopt a bundled reimbursement model, similar to the Comprehensive Care for Joint Replacement (CJR) algorithm for Medicare beneficiaries, accurate risk adjustment of patient-reported outcomes (PROs) is critical to ensure success. With this movement toward bundled reimbursement, it is unknown if a formula adjusting for similar risks in the Medicare population could be applied to PROs in commercially insured and Medicare Advantage populations undergoing total knee arthroplasty (TKA). This study was performed to compare PROs after TKA in these insurance groups after adjusting for proposed risks. Demographics and clinical data were abstracted from medical records of 302 patients who underwent TKA performed by a single surgeon at a university-based orthopaedic practice during 2013 to 2017. Differences in PROs between commercially insured, Medicare Advantage, and Medicare patients during the 6 months following surgery were evaluated while controlling for demographics, clinical data, and baseline PRO scores. Medicare and Medicare Advantage patients were older (p < 0.001) and had more comorbidities (p = 0.001) than commercial patients. During the first 3 months following TKA, patients in all three groups experienced similar rates of recovery. At 6 months after surgery, outcomes began to diverge by insurance group. Medicare patients reported significantly less ability to perform activities of daily living (78.6 vs. 63.2; p = 0.001), worse physical function (39.6 vs. 44.9; p = 0.003), and more pain interference (57.9 vs. 52.4; p = 0.018) at day 180 than commercially insured patients. There were no statistically significant differences between Medicare Advantage patients and either commercially insured or Medicare patients. Therefore, commercial insurance companies that intend to apply a risk-adjusted equation similar to the CJR algorithm to commercial populations should be cautioned since the postoperative outcomes in this investigation differed after adjusting for the same risk factors that have been proposed for inclusion in the CJR algorithm. Nonetheless, further studies should be performed to ensure that companies participating in bundled reimbursement models have a positive influence on comprehensive health care for patients and providers. This is a level III, retrospective prognostic study.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Medición de Resultados Informados por el Paciente , Anciano , Femenino , Humanos , Seguro de Salud , Masculino , Medicare , Medicare Part C , Persona de Mediana Edad , Sector Privado , Estudios Retrospectivos , Estados UnidosRESUMEN
Although it is common practice to assess alignment prior to total knee arthroplasty, preoperative knee alignment and its effect on patient-reported outcomes (PROs) postoperatively has not been well studied. The purpose of this retrospective study was to determine if there are differences in PROs between patients with valgus deformities and patients with varus deformities. Further, this study assessed the baseline differences between these 2 groups preoperatively. Patients were placed into either the valgus or the varus group. Data collected included age, sex, race, height, weight, body mass index, knee alignment, Kellgren-Lawrence grade, and 2 PRO measures. Patient-reported outcomes were assessed preoperatively and at 5 scheduled follow-up visits during the first year postoperatively. The authors found that a higher percentage of female patients had a valgus deformity (84.9%). The varus group tended to have a higher body mass index. Radiographs revealed differences in tibia and femur deformities. The overall deformity was less in patients with a valgus deformity than in patients with a varus deformity (mean, 6.6° [SD, 4.4°] vs 8.6° [SD, 4.8°], P=.010). Preoperative Knee injury and Osteoarthritis Outcome Score symptoms were significantly worse in the valgus group (P=.033). After adjusting for the significant baseline differences, all patients reported improved PROs during the postoperative period (P<.0001). Preoperatively, patients with valgus deformities and patients with varus deformities do not appear to be mere opposites of one another. The groups differed by sex, Knee injury and Osteoarthritis Outcome Score symptoms, and tibia, fibula, and overall deformity. Postoperatively, there were no significant differences in PROs during and up to 1 year. [Orthopedics. 2018; 41(6):e783-e788.].
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Genu Valgum/complicaciones , Genu Varum/complicaciones , Medición de Resultados Informados por el Paciente , Anciano , Índice de Masa Corporal , Femenino , Fémur/anomalías , Fémur/diagnóstico por imagen , Peroné/anomalías , Peroné/diagnóstico por imagen , Genu Valgum/diagnóstico por imagen , Genu Varum/diagnóstico por imagen , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Retrospectivos , Factores Sexuales , Tibia/anomalías , Tibia/diagnóstico por imagenRESUMEN
Over the past ten years, medical students have increased their research activity to be competitive for orthopaedic residency positions throughout the country. This increase may favor students at institutions with a strong history of research production and well-established research departments with supporting staff. To compete with these institutions, a Musculoskeletal Research Committee was developed at a southern academic institution to provide a mutually beneficial link between orthopaedic research faculty and medical students. This manuscript describes the formation of this committee and the resultant involvement of young medical students in departmental research over a one year period. Composed of students and faculty, the committee developed a Research Guide for Medical Students, Research Database and Student List, Medical Students' Webpage, and Routing Form, and holds quarterly meetings for those students active in orthopaedic research. With this platform, the committee aimed to increase young student involvement in research and provide a stratified level of study participation among upper-level students for continued mentorship. In one calendar year, the total number of first and second-year students participating in department research increased 460% (5 to 28). Also, the total number of research projects with student involvement from these two classes increased 780% (5 to 44). The introduction of a research committee is an effective method of stimulating student interest in departmental research. Early participation results are promising, and this method may be applicable to other departments and institutions hoping to increase research productivity. ABBREVIATIONS: IRB: Institutional Review Board.
Asunto(s)
Comités Consultivos/organización & administración , Investigación Biomédica/organización & administración , Docentes Médicos/organización & administración , Ortopedia/educación , Estudiantes de Medicina , Humanos , Mentores , Medios de Comunicación SocialesRESUMEN
Retrospective studies using large databases serve a major purpose in providing evidence in the current literature. However, the quality of medical coding is highly variable. This retrospective cohort study aimed to evaluate the documentation regarding the diagnosis of heterotopic ossification (HO) and the implications it may have for conducting retrospective research using electronic medical records (EMRs). A retrospective chart review using the EMR was performed to identify all patients with a diagnosis of HO within 7 university-affiliated hospital facilities. A limited data set request was conducted for all patients with HO-specific International Classification of Diseases, Ninth Revision (ICD-9) codes and additional nonspecific musculoskeletal codes to capture patients with HO who were improperly coded. A total of 522 patients were identified-26 patients with specific HO codes and 496 patients with nonspecific codes. Imaging and clinical notes were inspected for evidence and location of HO, and histories were reviewed for traumatic injury mechanism. Two-thirds of the patients with HO were discovered by reviewing miscellaneous musculoskeletal ICD-9 codes. Thirty-eight percent of the patients with an HO-specific ICD-9 code had no evidence of HO in their EMR. Thirty-three patients had a clinical history of a traumatic injury preceding HO formation, but only 16 of the 33 had documented ICD-9 codes for the injury. The utility of databases in retrospective research is dependent on the integrity of the coding. This study questions the use of retrospective reviews for patients with uncommon diagnoses and shows how painstaking verification may be necessary to ensure that research conclusions are based on accurate data. [Orthopedics. 2017; 40(4):237-241.].