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Published 7/1/2007

Second Look

In case you mssed these news items the first time around, AAOS Now gives you a second chance to review them. Links to all items are available online at www.aaos.org/now.

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AAOS and specialty societies respond to NY T column
James H. Beaty, MD
(president, AAOS), Daniel J. Berry, MD (president, American Association of Hip and Knee Surgeons), Michael A. Kelly, MD (president, The Knee Society), and George H. Thompson, MD (president, Scoliosis Research Society), publicly responded to a column published in the New York Times (NYT), in which the columnist suggested that certain orthopaedic procedures such as knee replacement and lumbar fusion are considered “medically questionable care.” View their response at:

Read the original column at: www.nytimes.com/0706/business

Two studies support spine surgery treatments
Two studies published in the May 31 edition of the New England Journal of Medicine find some advantages in choosing surgery over non-invasive treatment for treating pain resulting from specific conditions. In a multicenter, prospective, randomized study conducted in the Netherlands, 283 patients with severe sciatica were randomized to either early surgery (141 patients) or conservative treatment (142 patients). There was no crossover from the early surgery to conservative treatment, although 16 patients assigned to early surgery recovered before the surgery was performed. Microdiskectomy was performed on the remaining 125 patients (89 percent) after a mean of 2.2 weeks. Among the group assigned to conservative treatment, 55 patients were treated surgically after a mean of 18.7 weeks. Although 1-year outcomes were similar for all patients, patients assigned to early surgery had faster relief of leg pain and a faster rate of perceived recovery. View an abstract of the study at

In the second report from the NIH-sponsored Spine Patient Outcomes Research Trial (SPORT), 607 patients with at least 12 weeks of symptoms and image-confirmed degenerative spondylolisthesis were enrolled in either a randomized cohort or an observational cohort. In the randomized cohort, 159 patients were assigned to surgery and 145 to nonsurgical treatment. Nearly two thirds (64 percent) of the patients randomized to surgery actually had surgery by 2 years; nearly half (49 percent) of those assigned to nonsurgical care had surgery by 2 years. Among the observational cohort, 97 percent of those who initially elected surgery underwent it within the first year. In addition, 25 percent of those who initially chose conservative treatment underwent surgery within 2 years. The intent-to-treat analysis of the randomized cohort showed no statistically significant effects for the primary outcomes, but the as-treated effects for the combined cohorts were statistically in favor of surgery for all primary and secondary outcomes for all time periods during the 2 years. View an abstract of the study at: http://content.nejm.org

Study: P4P didn’t improve hospital care
A study published in the June 6 edition of the Journal of the American Medical Association finds no significant difference in quality of care improvement between hospitals that received financial pay-for-performance (P4P) incentives and hospitals that participated in a purely voluntary initiative. Researchers analyzed the cases of 105,383 patients with acute non-ST-segment elevation myocardial infarction at 54 hospitals taking part in a national P4P incentive program and 446 control hospitals. They found a slightly higher rate of improvement for two (aspirin at discharge and smoking cessation counseling) of six targeted therapies at pay-for-performance vs. control hospitals. Yet there was no significant difference in a composite measure of the six rewarded therapies between the two hospital groups. View an abstract of the study at: