RESUMO
Performance on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey can affect up to 33% of a physician's reimbursement from the Centers for Medicare & Medicaid Services. At this pseudo-private orthopedic practice, the authors characterized how physicians often achieve drastically different scores between HCAHPS and an Internal Patient Satisfaction Questionnaire (IPSQ). Eighteen physicians were ranked separately according to percentage of top-box scores on HCAHPS and IPSQ. There was an inverse relationship between physician rank for the 2 surveys according to Spearman correlation coefficient (ρ = -0.36, P = .15). Qualitative subanalysis indicated that although "physician interaction" was the most common reason for negative comments on HCAHPS, "ancillary staff" and "workflow" concerns were common on IPSQ. The outpatient setting remains a critical component in achieving high-quality orthopedic care. Consequently, HCAHPS alone may not be a sufficient indicator of patient satisfaction for orthopedic and other subspecialty practices.
Assuntos
Ortopedia , Satisfação do Paciente , Idoso , Humanos , Medicare , Estudos Retrospectivos , Inquéritos e Questionários , Estados UnidosRESUMO
Achieving an osseous fusion across the lumbosacral spine is still challenging in spine surgery. For the long multisegmental fusion surgery, it is crucial to build a robust and substantial foundation, which sometimes necessitates the distal spinal fixation to the pelvis. The pelvic fixation technique involves advancing the screw through the alar, thereby providing more purchase across the sacroiliac joint and into the ilium. The S2 alar iliac screws can obtain immediate stability and proper biomechanical strength of constructs. Here we demonstrated our experience of how to place the S2 alar iliac screw accurately as well as some pitfalls and pearls of this technique.
Assuntos
Parafusos Ósseos , Articulação Sacroilíaca , Fusão Vertebral , HumanosRESUMO
In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 17 focused on the use of antibiotics in spine surgery, for which this article provides the recommendations, voting results, and rationales.
Assuntos
Antibacterianos/uso terapêutico , Guias de Prática Clínica como Assunto , Fusão Vertebral , Infecção da Ferida Cirúrgica/prevenção & controle , HumanosRESUMO
In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 11 focused on risk factors and prevention questions in spine surgery, for which this article provides the recommendations, voting results, and rationales.
Assuntos
Procedimentos Ortopédicos/efeitos adversos , Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção da Ferida Cirúrgica/terapia , Algoritmos , Antirreumáticos , Consenso , Diarreia/prevenção & controle , Humanos , Staphylococcus aureus Resistente à Meticilina , Ortopedia , Período Perioperatório , Philadelphia , Propionibacterium acnes , Músculos Psoas/patologia , Medição de Risco , Fatores de Risco , Revisões Sistemáticas como Assunto , Tuberculose da Coluna Vertebral/complicações , Tuberculose da Coluna Vertebral/tratamento farmacológicoRESUMO
The instrumentation of C2 is technically challenging given the anatomic complexity of the upper cervical spine. Although the placement of C2 pedicle screws may be safer than transarticular screw placement, the inconsistent location of the transverse foramen and vertebral artery precludes placement of such screws in up to 26% of patients. In cases where vertebral artery anatomy prevents the safe placement of a pedicle screw, a pars screw is an excellent alternative. However, pars screws must stop short of the vertebral foramen, limiting the typical length of these screws to only 14-18 mm. The associated purchase and rigidity are compromised compared with the pedicle screw. A modified C2 fixation technique was developed by our group which we have named the C2 "parsicle" screw reflecting the hybrid nature of the screw incorporating aspects of pars and pedicle screw fixation.
Assuntos
Articulação Atlantoaxial/cirurgia , Vértebra Cervical Áxis/cirurgia , Vértebras Cervicais/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Parafusos Pediculares , Artéria Vertebral , Desenho de Equipamento , Fixação Interna de Fraturas/métodos , Humanos , Período Intraoperatório , Instabilidade Articular/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Fusão Vertebral/métodosRESUMO
In July of 2018, the Second International Consensus Meeting on Musculoskeletal Infection convened in Philadelphia, PA to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 7 focused on wound care, for which this article provides the recommendations, voting results, and rationales.
Assuntos
Antibacterianos/uso terapêutico , Procedimentos Ortopédicos/efeitos adversos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/prevenção & controle , Consenso , Humanos , Ortopedia , Philadelphia , Falha de Prótese , Sociedades Médicas , Coluna Vertebral/cirurgia , CicatrizaçãoRESUMO
In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 8 questions focused on general principles in spine surgery, for which this article provides the recommendations, voting results, and rationales.
Assuntos
Procedimentos Ortopédicos/efeitos adversos , Ortopedia/métodos , Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Antibacterianos/uso terapêutico , Consenso , Conferências de Consenso como Assunto , Humanos , Ortopedia/normas , Osteomielite/microbiologia , Philadelphia , Período Pós-Operatório , Propionibacterium acnes , Sociedades Médicas , Infecção da Ferida Cirúrgica/tratamento farmacológicoRESUMO
In July 2018, the Second International Consensus Meeting on Musculoskeletal Infection convened in Philadelphia, PA to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 15 focused on the use of imaging, tissue sampling, and biomarkers in spine surgery, for which this article provides the recommendations, voting results, and rationales.
Assuntos
Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/diagnóstico por imagem , Infecção da Ferida Cirúrgica/prevenção & controle , Antibacterianos/uso terapêutico , Biomarcadores/metabolismo , Biópsia , Sedimentação Sanguínea , Proteína C-Reativa/metabolismo , Consenso , Conferências de Consenso como Assunto , Humanos , Imageamento por Ressonância Magnética , Ortopedia/normas , Philadelphia , Tomografia por Emissão de Pósitrons , Falha de Prótese , Fatores de Risco , Sociedades Médicas , Infecção da Ferida Cirúrgica/sangue , Tomografia Computadorizada por Raios X , CicatrizaçãoRESUMO
In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 9 focused on implants questions in spine surgery, for which this article provides the recommendations, voting results, and rationales.