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Clinical News
 

By Quanjun "Trey" Cui, MD
VOS Newsletter Editor

Orthopaedists Generate More Revenue for Hospitals than Other Specialties

Survey data released by Merritt Hawkins finds that orthopaedic surgeons, on average, generate more revenue for hospitals than any other specialty. The research team sent the survey to 5,500 hospital chief financial officers in the United States, and found that orthopaedic surgeons generated an average of $2,683,510 per year for their affiliated hospitals, compared to an average of $1,566,165 for primary care providers and an average $1,424,917 for all other specialty physicians combined.

Read the abstract:
http://www.healthleadersmedia.com/content/FIN-292354/Primary-Care-Docs-Average-More-Hospital-Revenue-Than-Specialists

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NSAID May Offer Greater Improvement
Than Steroid for External Shoulder Impingement Syndrome

A study published in the May issue of the Journal of Shoulder and Elbow Surgery finds that an injection of ketorolac (NSAID) may result in greater improvements in UCLA shoulder rating scale compared to an injection of triamcinolone (steroid), for patients diagnosed with external shoulder impingement syndrome. The authors conducted a double blind, randomized, controlled clinical trial of 32 patients who received either 40 mg triamcinolone or 60 mg ketorolac. At 4-week follow-up, both treatment arms resulted in increased range of motion and decreased pain. However, active abduction decreased in patients in the triamcinolone group while it increased in the ketorolac group. The mean improvement in the UCLA shoulder rating scale at four weeks was 2.13 for the triamcinolone group and 7.15 for the ketorolac group.

Read the abstract:
http://www.jshoulderelbow.org/article/S1058-2746(12)00372-2/abstract

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Obesity and Complications During TJA

A literature review published in the May issue of the Journal of Arthroplasty attempts to define and identify areas of concern for obese patients undergoing total joint arthroplasty (TJA). "Obesity risk assessment is compounded by the fact that obesity is rarely an isolated diagnosis," the authors write, "and tends to cluster with other co-morbidities that may independently lead to increased risk such as diabetes mellitus, coronary artery disease, hyperlipidemia, hypertension, and sleep apnea." Among the authors’ findings: 1. Despite improvements in patient-related outcome measures, all obese patients undergoing total joint arthroplasty are at increased risk for perioperative complications. 2. Patients with a body mass index greater than or equal to 40 who undergo total knee arthroplasty are at risk for the majority of perioperative complications. 3. Published data on perioperative complications among obese patients undergoing total hip arthroplasty appear to be less clear.

Read the abstract:
http://www.arthroplastyjournal.org/article/S0883-5403(13)00174-5/abstract

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Want Better Sex?
Consider Getting a New Hip or Knee

The New York Times reported a study presented at 2013 AAOS Annual Meeting. While researchers have long known that hip and knee replacement leads to less pain and improved mobility, new research shows that the surgery offers an unexpected bonus in the bedroom. Among 147 patients who had joint replacement surgery in New York, most said arthritis had interfered with their sex lives. After surgery, 81 percent of those patients who had said their sex lives had suffered as a result of a bad joint reported that the frequency of sexual activity had increased. Many reported an increase in libido and stamina and an improvement in their ability to climax.

Read more:
http://well.blogs.nytimes.com/2013/04/08/surprise-path-to-better-sex-hip-surgery/?smid=tw-share

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Patient Satisfaction May Not Be A Good Indicator Of Surgical Quality

The study, led by researchers at the Johns Hopkins University medical and public health schools, looked at patient satisfaction and surgical quality measures at 31 urban hospitals in 10 states. The researchers found little relationship between a hospital’s patient satisfaction scores and most quality ratings. “At present, little evidence supports its ability to predict the quality of surgical care,” Heather Lyu, Dr. Martin Makary and the other researchers wrote in JAMA Surgery.

Read more:
http://capsules.kaiserhealthnews.org/index.php/2013/04/patient-satisfaction-may-not-be-a-good-indicator-of-surgical-quality-study-finds/

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CMS to Add THA and TKA to
30-Day Re-admission Measures

The U.S. Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would update FY 2014 Medicare payment policies and rates for inpatient stays at general acute care and long-term care hospitals. Included in the rule is an expansion of conditions and procedures calculated for 30-day readmission penalties, which would be updated to include patients admitted for elective total hip or total knee arthroplasty (THA/TKA). In addition, the rule lays out framework for a new patient safety program to be launched in FY 2015, aimed at reducing the frequency of hospital-acquired conditions and proposes to clarify admission and medical review criteria for hospital inpatient services.

Read more:
http://www.kaiserhealthnews.org/Stories/2012/December/21/medicare-hospitals-value-based-purchasing.aspx