Comparison of cervical disk implants and cervical disk fusion treatments in human cadaveric models.

Articulating cervical disk implants have been proposed as an alternative to disk fusion in the treatment of cervical disk disease. To examine the mechanical effect of articulating cervical disk implants (ACDI) versus simulated cervical disk fusion, a mechanical test device was constructed and cadaveric tests were carried out. While results show little effect on the pressures above and below the treatment level, the percent hysteretic behavior of the specimens trended to be higher for the ACDI, indicating that these implants retain more of the natural energy absorption capability of the cervical spine.

Health care information processing: how accurate are the data?

Managed health care providers, governmental agencies, lawmakers, and the general public are now relying on informational databases to influence health care decisions. This information is also used to derive efficiency profiles for both the individual physician and the institution. However, database reporting procedures are not standardized or monitored. Further, the ICD-9-CM coding system lacks specificity. Consequently, the accuracy of the information in a typical informational database is questionable. As a result, credentialing of physicians and institutions may be based on erroneous information from inaccurate databases. The objective of our study was to document the accuracy of a local informational database. We did a retrospective review of 40 randomly selected charts with surgical procedure codes (ICD-9-CM) for decompression or diskectomy. We compared the diagnosis, procedures, comorbid events, and complications as originally recorded by the surgeon with results of our chart review. We also compared the procedure codes as originally recorded by a hospital recorder with results of our chart review. Results indicated that the information actually reported to the hospital database was lacking or inaccurate in 70% of cases. Discrepancies were not the fault of hospital coders; the coding accuracy rate was 95%. Discrepancies were largely the result of two problems. First, the primary procedure code (ie, the first code on the list recorded by the hospital medical records personnel) did not always match the actual primary procedure (ie, the most complex procedure) done by the surgeon. Second, the ICD-9-CM code was not specific enough to accurately describe the actual surgery done. We conclude that critical discrepancies were recorded into the informational database.

Gunshot fractures: a medical, social, and economic analysis.

One hundred ten fractures due to gunshots were reviewed to examine the medical, social, and financial implants of such injuries. The population was predominantly male (91%), unemployed (56%), and uninsured (79%). Sixty-eight percent were documented substance abusers, and 65% of the injuries appeared to be related to illicit drug activities. There were 94 long bone fractures and 16 intraarticular fractures. Early operative treatment was employed in 64 patients (58%) with formal internal fixation in 31. There was no difference between type of treatment, associated injury variables, and outcome, and no increase in complications with acute operative management employing internal fixation. Medical charges averaged $13,108 per patient, a 1200% increase over injuries treated at this institution in 1972 and a rise far in excess of the medical care inflation rate (334%) during the same period.

Effect of postoperative reinfusion systems on hemoglobin levels in primary total hip and total knee arthroplasties. A prospective randomized study.

A prospective randomized study was undertaken to quantify the effect of reinfusion of postoperative shed blood drainage on the hemoglobin levels in patients undergoing elective primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). One hundred eleven patients were enrolled between December 1990 and August 1991. There were 42 THAs and 69 TKAs. The study group consisted of 57 patients (35 TKAs and 22 THAs) who received a CBC ConstaVac (Stryker Surgical, Kalamazoo, MI) reinfusion system. The control group consisted of 54 patients (34 TKAs and 20 THAs) who received a ConstaVac collection unit. Postoperative drainage volumes were recorded for both groups. In addition, the volume of reinfused blood was recorded for the study group. Postoperative hemoglobins were recorded on postoperative days 1, 3, and 6, the latter reflecting the discharge hemoglobin level. All patients were encouraged to predeposit two units of autologous blood for both THAs and TKAs. This study showed no statistically significant difference in the postoperative hemoglobin levels between the study and control groups at anytime. Additionally, there was no statistically significant difference between hemoglobin levels and drainage volumes in both the THA and TKA study groups, compared to their respective control groups. The results of this study suggest that reinfusion units are not necessary in THAs and TKAs as a matter of routine use.