Published 6/1/2010

Second Look—Advocacy

If you missed these Headline News Now items the first time around, AAOS Now gives you a second chance to review them. Headline News Now—the AAOS thrice-weekly, online update of news of interest to orthopaedic surgeons—brings you the latest on clinical, socioeconomic, and political issues, as well as important announcements from AAOS.

Variances in arthroplasty procedure rates
According to a report released by the nonprofit Dartmouth Atlas Project, rates for patients undergoing hip, knee, and shoulder replacement under Medicare vary widely by race and geographic location. For example, in 2005–2006, Bryan, Texas, had the lowest rate of hip replacements in the United States, at 1.8 per 1,000 Medicare beneficiaries, while the rate in Boulder, Colo., was 6.7 per 1,000. Similarly, in 2005–2006, black Medicare enrollees underwent knee replacement at a rate of 5.6 per 1,000, compared to a rate of 9.1 per 1,000 for all other beneficiaries. Additionally, the report finds that usage rates among Medicare beneficiaries are on the rise for all three procedures.

Physicians take aim at political office
According to USA Today, 47 physicians—41 Republicans and 6 Democrats—are running this year for positions in the U.S. Congress. Currently a total of 16 physicians serve in Congress, including two orthopaedic surgeons. The large number of physician candidates may be in response to debate surrounding recently approved healthcare reform legislation.

ATV deaths falling, but injuries remain high
Data released by the U.S. Government Accountability Office find that the likelihood of fatality associated with four-wheeled all-terrain vehicle (ATV) use dropped from 1.4 deaths per 10,000 ATVs in 1999 to 1.1 deaths per 10,000 ATVs in 2005. However, an estimated 134,900 people were treated in emergency departments for ATV-related injuries in 2008, compared with about 81,800 in 1999, a 65 percent increase. About one-fifth of the deaths and about one-third of the injuries in 2008 involved children. Crashes involving children frequently occur when they are driving adult-sized ATVs.

FDA issues Class 1 Recall of certain Aisys and Avance Anesthesia Systems.
GE Healthcare, LLC, and the FDA have issued a Class I Recall of specific lots of Aisys and Avance Anesthesia Systems. The control board wiring harnesses have a defect that can cause the machine to unexpectedly shut down, terminating ventilation, anesthetic delivery, and potentially patient monitoring. Any adverse events experienced with the use of this product or quality problems may be reported to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program by phone at 1-800-FDA-1088. Class 1 Recalls are the most serious type of recall and involve situations in which there is a reasonable probability that use of these products will cause serious adverse health consequences or death.

Fewer adverse events equal fewer liability suits
A study released by the nonprofit RAND Corporation finds that reducing the number of preventable injuries in hospitals strongly correlates with a drop in the number of medical liability lawsuits. An analysis of approximately 365,000 adverse safety events and approximately 27,000 medical liability claims in California from 2001 to 2005, broken down by county, found that reducing the number of adverse safety events per year by 10 correlated to 3.7 fewer medical liability claims during that same time-frame.

FDA: “New” heparin is less potent
FDA testing has determined that Heparin Sodium, USP (heparin) made under the new United States Pharmacopeia (USP) Monograph (“new heparin”) has approximately 10 percent less blood-thinning (anticoagulant) activity compared to heparin prepared using the previous (“old”) USP Monograph. The FDA recommends that healthcare professionals exercise clinical judgment in determining the dose of heparin for a patient and consider the clinical circumstances in which the potency decrease may require dosage adjustments and more frequent monitoring. The FDA warns healthcare professionals that heparin products made using both the old and the new USP standards may be available simultaneously for some time and recommends against using the products interchangeably. Pharmacies and hospitals should consider separating the supplies of “old” and “new” heparin and exhausting the “old” supplies before transitioning to the “new” product.

Barcoding helps reduce medication errors
A study published in the New England Journal of Medicine (May 6) finds that use of barcoding can substantially reduce error rates for order transcription and medication administration in a hospital setting. Of 1,271 errors in medication administration that were not timing-related at a single academic medical center, 776 occurred in units that did not use the barcode and 495 in units that did use the barcode—a 41.4 percent relative reduction in errors (p < 0.001). Additionally, the rate of non–timing-related potential adverse drug events fell from 3.1 percent before barcoding to 1.6 percent after barcoding—a 50.8 percent relative reduction (p < 0.001). The rate of timing errors in medication administration also fell, but the rate of potential adverse drug events associated with timing errors did not change significantly.

Multispecialty groups more cost-effective than smaller practices
Large, multispecialty medical groups often provide higher quality care at lower cost than physicians working in small group practices, according to data from a study published in Health Affairs (May). A comparison of cost and quality of care delivered to 741,448 fee-for-service Medicare beneficiaries in 22 healthcare markets found that, after adjusting for patient factors, large multispecialty group practices improved the quality of care by 5 percent to 15 percent, with an average annual savings of $272 per patient.

Colleague infusion pumps recalled
Stating that the company “has failed to adequately correct, within a reasonable timeframe, the deficiencies in the Colleague infusion pumps still in use,” the FDA has ordered Baxter Healthcare to recall and destroy all of its Colleague Volumetric Infusion Pumps currently in use in the United States. In addition, the agency has ordered the company to provide refunds to customers or replace pumps at no cost. In the past 5 years, the FDA has received more than 56,000 reports of adverse events associated with the use of infusion pumps, including serious injuries and more than 500 deaths.

McNeil recalls several OTC drugs
FDA states that McNeil Consumer Healthcare has notified healthcare professionals of a voluntary recall of certain over-the-counter (OTC) children’s and infants’ liquid products manufactured in the United States, including Tylenol, Motrin, Zyrtec, and Benadryl products. Some of the products included in the recall may contain a higher concentration of active ingredient than is specified; others may contain inactive ingredients that may not meet internal testing requirements; and others may contain tiny particles. Although the potential for serious medical events is remote, consumers who have purchased these products should discontinue their use.

Haiti update: Dengue fever
The U.S. Centers for Disease Control and Prevention (CDC) has issued an alert regarding reports of dengue fever among relief workers returning from Haiti, where the disease is endemic. According to the alert, healthcare providers in the United States should consider dengue fever in the differential diagnosis of febrile illness in any person who has recently been to Haiti. Most dengue fever cases are self-limited and can be treated with bed rest, acetaminophen, and oral fluids, but dengue hemorrhagic fever may develop in some patients. The CDC Dengue Branch provides free diagnostic testing for physicians and confirmatory dengue testing for health department and private laboratories.