NYU Langone orthopedic surgery experts are presenting their latest clinical findings and research discoveries at the annual American Academy of Orthopaedic Surgeons (AAOS) conference, August 31 to September 2, in San Diego.
Topics presented include when not to operate on spinal deformity in adults; patient satisfaction using telemedicine for arthroscopic surgery follow-up; and representation of women in academic orthopedic leadership.
“The diversity of our research interests, the quality of our clinical teams, and the expertise in knowing when or when not to operate are on full display this year,” says Joseph D. Zuckerman, MD, the Walter A.L. Thompson Professor of Orthopedic Surgery, chair of the Department of Orthopedic Surgery at NYU Langone, and former president of AAOS. “We also thank Dr. Joseph Bosco, vice chair for clinical affairs, for completing his AAOS presidency during an exceptionally challenging year for all of us.”
NYU Langone’s Department of Orthopedic Surgery is ranked No. 4 in the nation by U.S. News and World Report, performs more than 28,000 orthopedic procedures annually, and includes more than 200 orthopedic physician faculty experts. At this year’s meeting, NYU Langone orthopedic and sports medicine specialists are presenting 40 papers, 52 posters, 18 videos, and 26 symposia, courses, and special sessions. Some research from this year’s conference includes the following.
Paper 38: When Not to Operate on Spinal Deformity: Identifying Subsets of Patients with Simultaneous Clinical Deterioration, Major Complications, and Reoperation
In the previous two decades, due to an aging population, the prevalence of adult spinal deformity has increased dramatically and is now recognized as a significant public health issue affecting 68 percent of patients older than 65. During that time numerous advances in surgical instrumentation, operative techniques, and perioperative care led to increased acceptance of surgical intervention to treat adult spinal deformity. The occurrence of complications, though rare, has not been eliminated.
This multicenter study analyzed data collected from 2013 to 2018 from 13 high-volume spinal deformity centers across North America and Europe. Using a robust cohort of 633 patients with adult spinal deformity, researchers sought to determine the prevalence of surgeries resulting in the combined occurrence of poor functional and radiographic outcomes, together with the occurrence of major complications requiring intervention, to determine which baseline demographic, clinical, and radiographic factors might suggest it would be potentially inadvisable to undertake a deformity correction procedure.
“Spinal deformity procedures are often complex surgeries with multidimensional goals, and generally require high levels of surgical invasiveness to achieve these goals. Intrinsic to these surgeries are the associated high levels of risk,” says Peter G. Passias, MD, lead author of the study and member of the Department of Orthopedic Surgery’s Division of Spine Surgery. “With this study, we wanted to evaluate factors associated with unequivocal poor clinical outcomes following these complicated surgeries. While such dramatic negative outcomes following adult spinal deformity surgery are rare, we found the likelihood of operative failure was highest among patients with severe psychological distress, poor neurological function, and concomitant cervical malalignment in addition to their deformity.”
The findings confirmed the generally high success rate of corrective surgery for adult spinal deformity, while at the same time identifying a small population of outliers that respond less favorably to surgery.
Paper 354: Patient Satisfaction with Overall Care Is Equivalent Using Telemedicine Versus Traditional Office-Based Follow-Up After Arthroscopic Meniscus Surgery
A randomized controlled trial at NYU Langone Health studied the overall satisfaction patients had with the quality of a virtual video visit following arthroscopic meniscus surgery versus an in-office visit. Though this study began before the COVID-19 pandemic, its findings have become more relevant as telemedicine’s role in healthcare increased exponentially in 2020.
The study included 150 prospectively enrolled adult patients from August 1, 2019, to March 1, 2020, with 122 included in the final analysis. The patients had isolated arthroscopic meniscal repair or meniscectomy and were assigned follow-up care via a virtual video visit or in-person visit.
Study authors concluded that patient satisfaction with overall care was equivalent no matter the type of visit, and a telemedicine follow-up should be considered a reasonable alternative to the traditional in-office modality.
“As the healthcare industry evaluates pivoting to telemedicine where possible, this study demonstrates patient satisfaction will not be affected in some cases,” says Laith M. Jazrawi, MD, a co-author of the study and chief of the Division of Sports Medicine at NYU Langone.
“While the scope of this trial was limited, it provides valuable insight on the patient experience, which is always our top priority,” says Kirk A. Campbell, MD, study co-author and director of the orthopedic virtual health initiative within the Division of Sports Medicine at NYU Langone.
Paper 419: Female Representation Within Orthopedic Leadership: Where Are We Now?
Women have long been underrepresented in orthopedic surgery, but there has been a lack of quantitative data across orthopedic academic program leadership. Researchers probed 161 academic orthopedic residency programs listed on the Accreditation Council for Graduate Medical Education website in July 2020 to determine representation among women in leadership roles. The study found only 3 percent of chairs, 8 percent of vice chairs, 11 percent program directors, 27 percent assistant program directors, and 9 percent division chiefs were women.
“Orthopedic surgery is a specialty that has long been disproportionately practiced by men,” says Mara Karamitopoulos, MD, study co-author and associate director of NYU Grossman School of Medicine’s Orthopedic Surgery Residency. “There is hope for increased diversification through the promising recent increase in women in junior leadership positions.”
The study noted the field has increased from a single woman chair in 2016 to four in 2020, and that junior leadership positions are evenly represented when compared to the percentage of potential candidates who are women. Additional direct mentorship pipelines, such as the Ruth Jackson Orthopedic Society, Nth Dimensions, and The Perry Initiative, can continue to encourage more women to pursue leadership in orthopedic surgery, the study concluded.