Cost and Clinical Outcome of Adolescent Idiopathic Scoliosis Surgeries-Experience From a Nonprofit Community Hospital.

BACKGROUND: Recognition of the variables that drive the cost of adolescent idiopathic scoliosis (AIS) surgeries will help physicians and hospitals to initiate cost-effective measures. The purpose of this study is to analyze the hospital costs and clinical outcome for AIS surgeries. METHODS: A total of 6417 individual hospital costs and charges for 42 consecutive AIS surgeries were reviewed. The patients' demographic, surgical, and radiographic data were recorded. The costs were categorized. The relationships between total costs, categorized costs, and the independent variables were analyzed. Perioperative and postoperative complications were reviewed. Back pain, leg pain, and Oswestry Disability Index scores were obtained. RESULTS: The patients' mean age was 15 years, and 37 patients were female. Their mean main curve measured 55°. A total of 39 patients had posterior-only procedures, and 3 patients had anterior/posterior procedures. The average number of levels fused was 8. The mean hospital charge was $126,284 (range, $76,171-$215,516). The mean hospital cost was $44,126 (range, $23,205-$74,302). The average hospital stay was 5 days, with an average cost per day of $8825. The largest contributors to the overall hospital cost were spinal implants (31%), and surgery department labor cost (23%). Other categoric cost contributors included medical/surgical bed (19%), central supply/operating room supplies (9%), intensive care unit (6%), bone graft (3%), and others. No complications or revision surgeries occurred in these patients. For patients who had back and/or leg pain preoperatively, their back pain visual analog scale scores improved 1.8 points (4.5 versus 2.7 points, P < .05) and their leg pain visual analog scale scores improved 1.5 points (2.1 versus 0.6 points, P < .05). Their Oswestry Disability Index scores improved 6.1 points (17.3 versus 11.2 points, P > 0.05). CONCLUSIONS: The hospital cost for AIS surgeries is significant, with spinal implants and surgery department labor being the largest contributors. These are also areas for potential cost-effective measures.

Stand-alone Anterior Lumbar Interbody, Transforaminal Lumbar Interbody, and Anterior/Posterior Fusion: Analysis of Fusion Outcomes and Costs.

Fusion outcomes and costs of stand-alone anterior lumbar interbody fusion (ALIF), transforaminal lumbar interbody fusion (TLIF) in association with posterior fusion, and anterior/posterior (A/P) fusion were compared using clinical, radiographic, and billing data. Adult patients with symptomatic 1- or 2-level degenerative disk disease in isolation or in association with a grade 1 or 2 degenerative or lytic spondylolisthesis and canal and/or foraminal stenosis who underwent elective stand-alone ALIF, TLIF, or A/P fusion were compared. The analysis focused primarily on fusion rates and costs and secondarily on radiographic and clinical parameters. One hundred six patients at least 2 years beyond surgery (ALIF, 53; TLIF, 17; A/P fusion, 36) were reviewed. Demographics were similar except for age, with the ALIF group being younger (mean, 37.8 years) than the other groups (TLIF, 53.1 years; A/P fusion, 48.2 years). There were no differences between the groups in fusion rates or outcomes as assessed by the Numeric Rating Scale. Compared with the other 2 groups, the ALIF group had a significantly shorter operative time, less blood loss, and a shorter stay (P<.0001). Evaluation of radiographic parameters revealed significant differences regarding disk angle (P<.001), disk height (P<.0001), and pelvic tilt (P=.001) favoring ALIF and A/P fusion over TLIF. Stand-alone ALIF should be considered in the management of patients with 1- or 2-level lumbar degenerative disk disease for which the pathology can be addressed adequately via this approach. [Orthopedics. 2018; 41(5):e655-e662.].

Short-term results of percutaneous treatment of acetabular fractures: functional outcomes, radiographic assessment and complications.

PURPOSE: Our purpose was to assess functional outcomes, radiographic characteristics and complications in patients who underwent fixation of acetabular fracture using percutaneous means only. METHODS: This was a retrospective cohort study of adult patients with an acetabular fracture admitted to a level 1 trauma centre and treated with closed reduction and percutaneous fixation. Nineteen patients were identified, and mechanism of injury, radiologic classification of fracture, complications and functional outcomes were analysed. Outcome measurements included Patient Reported Outcomes Measurement Information System (PROMIS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, which are validated patient questionnaires assessing functional outcome. They are scored as a point range on a per-question basis, with a combined range possibility of 0-96 for WOMAC and 5-75 for PROMIS. RESULTS: Nineteen patients over a two year period were reviewed. Fracture displacement improved following surgery from a mean 7.3 mm (range 0-33 mm) to 2.6 mm (range 0-12 mm). Complications included one post-operative death from non-ST-segment elevation myocardial infarction, sciatic nerve injury, malpositioned screw and deep infection. There were no vascular injuries, pulmonary emboli or deep venous thromboses. Of the 19 patients eligible for the study, seven completed both PROMIS mobility and WOMAC osteoarthritis questionnaires at a mean follow-up of 572 days (1.57 years), with a range of 435-862 days. The average WOMAC score was 7.4 (range 0-30) and mean PROMIS score 66.4 (range 50-75). CONCLUSIONS: Functional outcomes in this study are comparable with other published studies and support percutaneous management of acetabular fractures as an effective alternative to open reduction and internal fixation.

Percutaneous fixation of anterior and posterior column acetabular fractures.

Although open reduction and internal fixation (ORIF) has been the standard of care for acetabular fractures, recent advancements in minimally invasive techniques have allowed percutaneous fixation to gain popularity. Percutaneous technique has been described in the literature as an adjuvant to ORIF. However, isolated percutaneous fixation has the advantage of limiting soft tissue disruption, length of surgery, and blood loss when compared with ORIF. The technique also allows for earlier return to activity and better pain control when compared with nonsurgical management. This article reviews both indications and limitations, while highlighting the technique for percutaneous fixation of both anterior and posterior column acetabular fractures.

Orthopedic trauma surgery in the morbidly obese patient.

PURPOSE: The treatment of morbidly obese patients in orthopedic trauma differs in many ways compared to injured patients with normal body mass indices. This paper highlights key differences and ways to overcome obstacles. METHODS: We present specific tips, as well as considerations for initial planning, positioning for surgery, intra-operative strategies, and a discussion on both anesthesia and imaging. RESULTS: Several treatment strategies have been shown to have better results in morbidly obese patients. Pre-operative planning is necessary for minimizing risk to the patient. CONCLUSION: The prevalence of morbid obesity has increased in the USA in the past quarter century. Treatment for orthopedic injuries in morbidly obese patients requires a multidisciplinary approach that addresses not only their orthopedic injuries, but also medical co-morbidities. A team of medicine doctors, anesthesiologists, X-ray technicians, physical and occupational therapists, respiratory therapists, and social workers is needed in addition to the orthopedic surgeon. Modifications in both pre-operative planning and intra-operative strategies may be necessary in order to accommodate the patient. This paper presents numerous technical tips that can aid in providing stable fixation for fractures, as well as addressing peri-operative issues specific to the morbidly obese.