Short-Term (90 Days) Clinical Outcomes Following the Day of Surgery Conversion of Inpatient to Same-Day Hip and Knee Arthroplasty.

BACKGROUND: The incidence of total joint arthroplasty is increasing, with added emphasis on shifting care towards outpatient surgery. This has demonstrated improvements in costs and care; however, safety must be prioritized. Published assessment tools highlight candidates for outpatient surgery; however, they often do not define patients who have a worse prognosis. Limited healthcare resources occasionally force patients to convert to outpatient surgery or risk cancellation, creating a dilemma for both patients and surgeons. We evaluated the short-term (90-day) outcomes of patients converted from planned inpatient admission to same-day discharge on day of surgery outpatients and sought to identify any groups at risk, who may not be appropriate for this conversion. METHODS: We identified all patients undergoing planned inpatient total hip or knee arthroplasty at a tertiary academic medical center over a two-year period. We included patients discharged the day of surgery for analysis, excluding revision procedures and those performed for fracture care. A manual chart review identified demographic factors and primary outcome measures; including re-operation, re-admission, and emergency room visits within a 90-day post-operative period. RESULTS: We identified a total of 80 patients who converted from inpatient to outpatient surgery over a two-year interval. Over the first 90 days post-operatively four (5%) patients were readmitted: two (2.5%) for medical complications and two (2.5%) for re-operation. There were two (2.5%) re-operations; one (1.25%) for manipulation under anesthesia, and one (1.25%) for periprosthetic joint infection. There were five (6.3%) wound complications; however, only one (1.25%) required surgical intervention. A total of five (6.3%) patients returned to an emergency department, leading to a single (1.25%) hospital readmission. CONCLUSIONS: Hospital and healthcare resources are occasionally limited to the extent that patients must convert to outpatient surgery or risk cancellation. At our institution, the same-day conversion of planned inpatient hip and knee arthroplasty patients to outpatient surgery was safe and did not increase short-term clinical outcomes or complications.

Potential Role for Non-Salvage Procedures in the Treatment of Kienböck Disease Stage IV: A Systematic Review.

BACKGROUND: The purpose of this systematic review is to identify whether non-salvage procedures can provide satisfactory and acceptable outcomes in Lichtman stage IV disease. METHODS: The MEDLINE, Embase, and Cochrane databases were systematically searched for English publications between 1989 and 2019 that reported stage IV-specific primary treatment outcomes. Revisions and skeletally immature patients were excluded. Data extracted were patient demographics, pain scores, range of motion (ROM), grip strength, and patient-reported outcome measures (PROMs). The results were pooled into 3 categories: conservative management, non-salvage, and salvage procedures. RESULTS: Data from 24 studies (n = 114 patients) were extracted. Compared with conservative management and non-salvage treatment (joint-leveling radial osteotomies, lunate reconstruction), salvage procedures (intercarpal and radiocarpal arthrodesis, proximal row carpectomy, total wrist arthroplasty) showed significantly decreased ROM in flexion-extension arc of motion (89° vs 95° vs 73°, respectively, P = .0001) and no significant differences in grip strength as a percentage of the contralateral side (83% vs 86% vs 79%, respectively, P = .28). All reported treatments provided pain relief, ability to return to previous occupations, and variable PROMs. CONCLUSIONS: In young, active, and labor-intensive patients, motion-preserving, non-salvage options may be worth trialing as they do not preclude future salvage options.

Active Retrieval Improves Procedural Learning in Orthopedic Surgery.

OBJECTIVE: Tests are shown to enhance learning: this is known as the "testing effect". The benefit of testing is theorized to be through "active retrieval", which is the effortful process of recalling stored knowledge. This differs from "passive studying", such as reading, which is a low effort process relying on recognition. The testing effect is commonly studied in random word list scenarios and is thought to disappear as complexity of material increases. Little is known about the testing effect in complex situations such as procedural learning. Therefore, we investigated if testing improves procedural learning of fracture fixation as compared to "passive studying". DESIGN, SETTING, AND PARTICIPANTS: Fifty participants watched an instructional video of an open reduction internal fixation of a Sawbones™ femur. Participants then performed the procedure under guided supervision (pretest). After randomization, they either read the steps (passive studying group), or wrote down the steps from memory (active retrieval group) for a period of 15 minutes. After a washout period, all participants performed the procedure without guidance (posttest) and then once more, 1 week after the initial testing (retention test). The participants were assessed using the Objective Structured Assessment of Technical Skill. Each performance was video recorded for data analysis purposes. RESULTS: Participants in the passive studying group had significantly higher Objective Structured Assessment of Technical Skill scores during immediate assessment compared to the active retrieval group (p = 0.001), especially with respect to remembering the correct order of the steps (p = 0.002). The percentage of information forgotten was significantly less in the active retrieval group (p = 0.02) at the retention test. CONCLUSION: We demonstrated that, compared to passive studying, testing with active retrieval through writing resulted in better retention of fracture fixation knowledge (i.e., less forgetting). These findings can easily be applied and incorporated in existing curricula. Future studies are needed to determine the effects of different kinds of active retrieval methods such as verbal retrieval (e.g., dictating) in surgical practice.

Publication Productivity Among Academic Orthopaedic Surgeons in Canada.

Objective The Hirsch Index (h-index) and m-index are often utilized to assess academic productivity and have been widely found to have a positive association with academic promotion and grant selection. The aim of this study was to assess the relationship between these indices and academic ranks among Canadian orthopaedic surgery faculty members. Methods Five hundred and sixty-seven Canadian orthopaedic surgery faculty members associated with residency training programs were included in the study. H-indices of individual faculty members were obtained through Elsevier's Scopus database. Faculty members' year of residency graduation was recorded from their respective licensing body database and was utilized as a surrogate for the start of their academic career to determine career duration and calculate the m-index. Faculty members were divided based on their academic rank (assistant, associate and full professors) and subspecialty. Results Increased h-index, m-index and long career duration were associated with increased academic rank, while gender did not demonstrate an association. Overall, males had a significantly higher h-index compared to females, but no significant difference was observed when comparing the m-index between genders. The m-index varied between subspecialties among senior faculty, but not among junior-ranked faculty. Conclusion Bibliometric academic productivity using h-index and m-index is associated with academic ranking among Canadian orthopaedic surgeons at training institutions. Although these indices may provide insight into the academic merits of faculty members, caution must be taken about utilizing it indiscriminately and their limitations must be strongly considered.