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NYU Langone Orthopedic Surgeons Present Latest Clinical Findings & Research at AAOS 2015

Experts from the Department of Orthopedic Surgery at NYU Langone Medical Center will present their latest clinical findings and research discoveries at the American Academy of Orthopaedic Surgeons (AAOS), March 24-28 in Las Vegas, Nevada.

Topics presented on will include quality outcomes on fracture surgeries and joint arthroplasties, and cost analyses on implementing bundled payment strategies at hospitals.

"Our emphasis on bench to bedside care and implementing quality and patient safety initiatives throughout our medical center and the NYU Langone Hospital for Joint Diseases has led to advances in clinical care in orthopedics, and we are thrilled with the opportunity to share these findings with our peers at the AAOS meeting," said Joseph 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.

NYU Langone’s Department of Orthopedic Surgery performed more than 16,000 surgical procedures in 2014, published 175 articles in academic journals, and received $2 million in research funding.

At this year’s meeting, NYU Langone orthopedic surgeons will present 26 papers, 8 posters, 23 scientific exhibits, 14 videos, and four symposia. Some research from this year’s conference includes:

Paper 860: Cost Analysis of Total Joint Arthroplasty Readmissions in a Bundled Payment Care Initiative

Authors: AJ Clair, Perry Evangelista, Richard Iorio, James Slover, Claudette Lajam, Joseph Bosco.

A new study from researchers at NYU Langone’s Hospital for Joint Diseases identifies common causes of hospital readmissions following total hip and knee arthroplasty procedures. By finding these common causes, researchers believe quality can be increased and hospital costs decreased.

The patients were part of the Bundled Payment for Care Initiative from the Centers for Medicare and Medicaid Services (CMS), a government pilot program where hospitals are paid for quality of procedures rather than quantity. One way to measure quality is by examining hospital readmission rates.

Researchers studied 721 patients admitted to NYU Langone’s Hospital for Joint Diseases between January and December 2013 for a total hip arthroplasty (THA) or total knee arthroplasty (TKA). Of those cases, 80 patients, or 11 percent, had to be re-admitted within 90 days.

THA and TKA readmissions due to surgical complications accounted for 54 percent and 44 percent of the indications for readmissions, respectively. Surgical complications included infection (11), wound complications (8), bleeding (7), periprosthetic fracture (5), dislocations (4), and post-surgical pain (4). The average cost of readmission for surgical complications was $36,038 for THA and $61,049 for TKA.

Medical complications included gastrointestinal disease (11), pulmonary disease (8), genitourinary/renal complications (6), hematologic (6), cardiovascular (3), endocrine disorders (2), syncope (2), rheumatologic (1), lumbago (1), and an open ankle wound (1). The average cost of medical complications was $22,775 for THA and $10,283 for TKA patients, respectively.

"While some complications are unavoidable, we are proud of our low readmission rates at the Hospital for Joint Diseases, and by identifying the causes for readmission, we hope to reduce our rates even further," said study co-author Joseph Bosco, MD, associate professor and Vice Chair for Clinical Affairs in the Department of Orthopedic Surgery at NYU Langone. "As bundled payment programs are implemented more widely nationwide, other U.S. hospitals will follow our example and implement strategies to boost quality and reduce medical costs."

Poster P208, Selected for AAOS "Poster Tour": The Impact of Diabetes on Hospital Length of Stay, Cost, and Inpatient Mortality Following ORIF of Ankle Fractures: An Argument for Increased Hospital Reimbursement

Authors: Deirdre Regan, Arthur Manoli, Sanjit Konda, Kenneth A. Egol.

New research from NYU Langone orthopedic surgeons finds patients with diabetes who fracture their ankle incur significantly more inpatient health care costs compared to patients who do not have diabetes.

The research, led by Kenneth A. Egol, MD, a professor and vice chair of education in the Department of Orthopedic Surgery at NYU Langone, showed patients with diabetes who undergo ankle fracture surgery have significantly longer lengths of stay and total hospital charges compared to non-diabetics, with worse trends seen among patients with complicated disease.

NYU Langone researchers looked at nearly 59,000 individuals who underwent open reduction and internal fixation (ORIF) surgery to fix an ankle fracture, as recorded by the New York Statewide Planning and Research Cooperative System (SPARCS) database.

About 7,500 patients had diabetes, nearly 1,100 of whom had complicated disease that caused renal or neurologic manifestations.

The researchers found that patients with diabetes were more likely to incur significantly greater hospital charges (mean: $26,491 diabetes versus $20,428 nondiabetes) and have significantly longer lengths of stay (5.8 days diabetes compared with 3.9 days nondiabetes) compared to patients without diabetes.

A similar trend was seen when patients with complicated diabetes were compared to patients with diabetes alone. Such data may be used to convince payers to increase hospital reimbursements for diabetics undergoing ankle fracture surgeries.

"With increasing U.S. diabetes rates, more orthopedic surgeons are faced with treating the unique needs of patients in this population," said Dr. Egol. "Better understanding of the complications and care considerations among diabetics could allow health care professionals better manage and treat this growing group of patients and keep down medical costs."

Poster P359: Higher Volume Is Associated With Fewer Early Reoperation Events after Adolescent Idiopathic Scoliosis Surgery

Authors: Justin Paul, Baron Lonner, Thomas Errico.

Adolescent patients who need scoliosis surgery may benefit most from going to a hospital that performs a high volume of the procedures, according to new research from NYU Langone spine surgeons.

Researchers looked at a New York State database of hospital discharges and identified 3,928 surgeries for adolescent idiopathic scoliosis, and found reoperation rates were significantly lower among surgeons who perform a high volume of the procedures.

Specifically, 14.1 percent of patients who saw a surgeon that performed a low volume of the procedures (less than 6 per year) needed a new operation, compared to 5.1 percent of patients who saw a surgeon that performed more than 43 surgeries per year.

Previously, higher surgical volumes had been associated with reduced perioperative complications, but studies had not shown whether that resulted in fewer reoperations.

"Families and patients making the informed decision of undergoing scoliosis surgery are faced with many choices, including when to have the surgery and which hospital to entrust with their care," said Thomas J. Errico, MD, professor of orthopedic surgery and neurosurgery, and Chief of the Spine Division at NYU Langone. "Our findings emphasize that seeing an experienced spine surgeon, like those at our NYU Langone Hospital for Joint Diseases, may reduce an adolescent patient’s need for a revision surgery and reduce overall complications."

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