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Study: BMI Associated with Higher Complication Rate in THA, TKA

Terry Stanton

A study of 13,250 patients undergoing total hip or knee arthroplasty (THA/TKA) showed that patients with higher body mass index (BMI) had a higher overall complication rate, compared to patients of normal weight (P = 0.0006).

The study, presented yesterday at the Annual Meeting by Hasham M. Alvi, MD, of Northwestern University, also found a correlation between elevated BMI and the surgical complication rate, including superficial wound infection and deep infection, return to operating room, and total length of hospital stay.

Risk Prediction Tools for Hip and Knee Arthroplasty

The current healthcare environment in America is driven by the

concepts of quality, cost containment, and value. In this environment,

primary hip and knee arthroplasty procedures have been targeted for

cost containment through quality improvement initiatives intended to

reduce the incidence of costly complications and readmissions.

Accordingly, risk prediction tools have been developed in an attempt

to quantify the patient-specific assessment of risk. Risk prediction

tools may be useful for the informed consent process, for enhancing

risk mitigation efforts, and for risk-adjusting data used for

reimbursement and the public reporting of outcomes. The evaluation

of risk prediction tools involves statistical measures such as

discrimination and calibration to assess accuracy and utility.

Furthermore, prediction tools are tuned to the source dataset from

which they are derived, require validation with external datasets, and

should be recalibrated over time. However, a high-quality, externally

validated risk prediction tool for adverse outcomes after primary total

joint arthroplasty remains an elusive goal.

Business, Policy, and Practice Management in Orthopaedics Lecture Series

Welcome to the Business, Policy, and Practice Management in Orthopaedics Lecture Series homepage! This collection of lectures represents years of preparation and collaboration by surgeons, attorneys, a practice administrator, a business school professor and residents who believe in the importance of developing residents-in-training into surgeons-in-practice who are interested in and equipped to take on leadership roles wherever they practice. This curriculum is designed as a “curriculum-in-a-box” solution for programs that currently do not have a series in place or are looking to augment an existing one. Each topic is composed of a Content Chapter and PowerPoint presentation. How these materials are used is left to the discretion of the program, but we recommend distributing the Content Chapters ahead of the lecture to give residents the necessary background for each topic and prepare them for meaningful discussion. Each PowerPoint is designed to be given by a local champion or mentor with experience in or understanding of the topic, whether that person is in-house legal counsel, a hospital administrator, or a “fresh” attending who just negotiated his or her first contract. We encourage speakers to modify the talks as they see fit, but we ask that the authors are always given their due credit and that any ideas for improvement are shared with us for future revisions. The topics are listed below along with our contributing authors, but we also encourage you to read our vision and mission statements, as they represent the foundation of this series. It is our hope, that by understanding the language and perspective of practice management, residents will be more interested in and better prepared to be active participants in the management of our profession and more effective advocates for our patients. Sincerely, Kevin Bozic, MD, MBA Alexe Page, MD James M. Saucedo, MD, MBA Mission: Facilitate fulfillment of the AGCME requirement for Systems-based Practice for orthopaedic training programs. Enhance orthopaedic resident education by introducing basic business principles early in training Prepare residents for a more active role in their future practices by exposing them to practice management concepts throughout their residency experience. Foster resident interest in advocacy and health care policy while integrating a systems-based perspective into education curricula. Vision: Build a foundation for future collaboration between hospitals, health care systems, and young surgeons. Expand and improve access to quality musculoskeletal care for orthopaedic patients through active surgeon involvement in health policy and advocacy. Introduction - Overview of the Health Care System By John Cherf, MD, MBA, MPH and Paul Switaj, MD Presentation Essential Legal Knowledge for the Orthopaedic Surgeon By B. Sonny Bal, MD, JD, MBA and Lawrence Brenner, JD Presentation Coding and Billing: A Global Perspective By William Beach, MD and Julie B. Samora, MD, PhD, MPH Presentation Employment and Compensation By Bonnie S. Mason, MD, Kim Boike, Esq. and Hasham M. Alvi, MD Presentation The Art of Negotiation By James M. Saucedo, MD, MBA, Mary O’Brien, MBA, CMPE and Lal Puri, MD, MBA Presentation Organizational Design and Behavior By John P. Andrawis, MD and Thomas J. Grogan, MD Presentation Enterprise Finance By Shyam Vekaria, MD and Bonnie S. Mason, MD Presentation Hospital Systems By Daniel K. Moon, MD, MBA, MS and Craig A. Butler, MD, MBA, CPE Presentation Total Quality Management and Performance Improvement By Kevin J. McGuire, MD, MS, Steven J. Spear, DBA, MS and Prem Ramkumar, BA Presentation Leadership By David B. Bumpass, MD and Ken Yamaguchi, MD Presentation Health Care Policy and Reform: A Primer By Eric C. Makhni, MD, MBA and Kevin J. Bozic, MD, MBA Presentation

The Business of Orthopaedics for Residents

New lecture series focuses on preparing residents to become practice leaders

James Saucedo, MD, MBA; Kevin J. Bozic, MD, MBA; and Alexandra E. Page, MD

When did you learn about the art of negotiation? Organizational design and behavior? Leadership techniques? Probably not as a resident. When did you need to learn about negotiating, hospital systems, and leadership? Probably as a resident—if only you had the time.

Salvage Treatment of Hip Fractures After Failure of Surgical Fixation: A Systematic Review

Surgical fixation is generally the treatment used for the repair of uncomplicated fractures of the hip. However, complications following the fixation of such fractures, such as nonunion, hardware failure, osteonecrosis, posttraumatic osteoarthritis, and infection may require salvage treatment with total hip arthroplasty. This systematic review article addresses the challenges of conversion to total hip arthroplasty after prior fixation of a hip fracture, and provides recommendations for minimizing complications related to such conversion.