Adam E.M. Eltorai

Effect of Sarcopenia on Postoperative Morbidity and Mortality After Thoracolumbar Spine Surgery.

Sarcopenia is the loss of muscle mass associated with aging and advanced disease. This study retrospectively examined patients older than 55 years (N=46) who underwent thoracolumbar spine surgery between 2003 and 2015. Each patients comorbidity burden was determined using the Charlson Comorbidity Index, and the Mirza Surgical Invasiveness Index was used to measure procedural complexity. Sarcopenia was diagnosed by measuring the total cross-sectional area of the psoas muscle at the L4 vertebrae using perioperative computed tomography scans. Of the 46 patients assessed, 16 were in the lowest third for L4 total psoas area (sarcopenic). Average follow-up time was 5.2 years (range, 6 days to 12.7 years). The cohort of patients with sarcopenia was significantly older than the cohort without sarcopenia (mean age, 76.4 vs 69.9 years; P=.01) but did not have a significantly different mean Charlson Comorbidity Index (3.3 vs 2.0; P=.32) or mean Mirza Surgical Invasiveness Index (7.1 vs 7.0; P=.49). Patients with sarcopenia had a hospital length of stay 1.7-fold longer than those without sarcopenia (8.1 vs 4.7 days; P=.02) and a 3-fold increase in postoperative in-hospital complications (1.2 vs 0.4; P=.02), and they were more likely to require discharge to a rehabilitation or nursing facility (81.2% vs 43.3%; P=.006). Patients with sarcopenia had a significantly lower cumulative survival (log rank=0.007). All 4 deaths occurred among patients with sarcopenia. Patients with sarcopenia have a significantly increased risk of in-hospital complications, longer length of stay, increased rates of discharge to rehabilitation facilities, and increased mortality following thoracolumbar spinal surgery, making sarcopenia a useful perioperative risk stratification tool. [Orthopedics. 2016; 39(6):e1159-e1164.].

Readability of Patient Education Materials on the American Association for Surgery of Trauma Website

Background: Because the quality of information on the Internet is of dubious worth, many patients seek out reliable expert sources. As per the American Medical Association (AMA) and the National Institutes of Health (NIH) recommendations, readability of patient education materials should not exceed a sixth-grade reading level. The average reading skill of U.S. adults is at the eighth-grade level. Objectives: This study evaluates whether a recognized source of expert content, the American Association for Surgery of Trauma (AAST) website’s patient education materials, recommended readability guidelines for medical information. Materials and Methods: Using the well-validated Flesch-Kincaid formula to analyze grade level readability, we evaluated the readability of all 16 of the publicly-accessible entries within the patient education section of the AAST website. Results: Mean ± SD grade level readability was 10.9 ± 1.8 for all the articles. All but one of the articles had a readability score above the sixth-grade level. Readability of the articles exceeded the maximum recommended level by an average of 4.9 grade levels (95% confidence interval, 4.0-5.8; P < 0.0001). Readability of the articles exceeded the eighth-grade level by an average of 2.9 grade levels (95% confidence interval, 2.0-3.8; P < 0.0001). Only one of the articles had a readability score below the eighth-grade level. Conclusions: The AAST’s online patient education materials may be of limited utility to many patients, as the readability of the information exceeds the average reading skill level of adults in the U.S. Lack of patient comprehension represents a discrepancy that is not in accordance with the goals of the AAST’s objectives for its patient education efforts.

Readability of Patient Education Materials on the American Orthopaedic Society for Sports Medicine Website

Abstract Background: The recommended readability of patient education materials by the American Medical Association (AMA) and National Institutes of Health (NIH) should be no greater than a sixth-grade reading level. However, online resources may be too complex for some patients to understand, and poor health literacy predicts inferior health–related quality of life outcomes. Aim: This study evaluated whether the American Orthopaedic Society for Sports Medicine (AOSSM) websites patient education materials meet recommended readability guidelines for medical information. We hypothesized that the readability of these online materials would have a Flesch-Kincaid formula grade above the sixth grade. Methods: All 65 patient education entries of the AOSSM website were analyzed for grade level readability using the Flesch-Kincaid formula, a widely used and validated tool to evaluate the text reading level. Results: The average (standard deviation) readability of all 65 articles was grade level 10.03 (1.44); 64 articles had a readability score above the sixth-grade level, which is the maximum level recommended by the AMA and NIH. Mean readability of the articles exceeded this level by 4.03 grade levels (95% CI, 3.7–4.4; P < 0.0001). We found post-hoc that only 7 articles had a readability score ≤ an eighth-grade level, the average reading level of US adults. Mean readability of the articles exceeded this level by 2.03 grade levels (95% CI, 1.7–2.4; P < 0.0001). Conclusion: The readability of online AOSSM patient education materials exceeds the readability level recommended by the AMA and NIH, and is above the average reading level of the majority of US adults. This online information may be of limited utility to most patients due to a lack of comprehension. Our study provides a clear example of the need to improve the readability of specific education material in order to maximize the efficacy of multimedia sources.

Antimicrobial technology in orthopedic and spinal implants

Infections can hinder orthopedic implant function and retention. Current implant-based antimicrobial strategies largely utilize coating-based approaches in order to reduce biofilm formation and bacterial adhesion. Several emerging antimicrobial technologies that integrate a multidisciplinary combination of drug delivery systems, material science, immunology, and polymer chemistry are in development and early clinical use. This review outlines orthopedic implant antimicrobial technology, its current applications and supporting evidence, and clinically promising future directions.

READABILITY OF TRAUMA-RELATED PATIENT EDUCATION MATERIALS FROM THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS

Context: According to the american medical association (AMA) and the national institutes of health (NIH), the recommended readability of patient education materials should be no greater than a sixth-grade reading level. The online patient education information produced by the american academy of orthopaedic surgeons (AAOS) may be too complicated for some patients to understand. This study evaluated whether the AAOS’s online trauma-related patient education materials meet recommended readability guidelines for medical information. Evidence Acquisition: Ninety-nine articles from the “Broken Bones and Injuries” section of the AAOS-produced patient education website, orthoinfo.org, were analyzed for grade level readability using the Flesch-Kincaid formula, a widely-used and validated tool to evaluate the text reading level. Results for each webpage were compared to the AMA/NIH recommended sixth-grade reading level and the average reading level of U.S. adults (eighth-grade). Results: The mean (SD) grade level readability for all patient education articles was 8.8 (1.1). All but three of the articles had a readability score above the sixth-grade level. The readability of the articles exceeded this level by an average of 2.8 grade levels (95% confidence interval, 2.6 - 3.0; P < 0.0001). Furthermore, the average readability of the articles exceeded the average reading skill level of U.S. adults (eighth grade) by nearly an entire grade level (95% confidence interval, 0.6-1.0; P < 0.0001). Conclusions: The majority of the trauma-related articles from the AAOS patient education website have readability levels that may make comprehension difficult for a substantial portion of the patient population.

Is the Readability of Spine-Related Patient Education Material Improving?: An Assessment of Subspecialty Websites.

Study Design. Analysis of spine-related patient education materials (PEMs) from subspecialty websites. Objective. The aim of this study was to assess the readability of spine-related PEMs and compare to readability data from 2008. Summary of Background Data. Many spine patients use the Internet for health information. Several agencies recommend that the readability of online PEMs should be no greater than a sixth-grade reading level, as health literacy predicts health-related quality of life outcomes. This study evaluated whether the North American Spine Society (NASS), American Association of Neurological Surgeons (AANS), and American Academy of Orthopaedic Surgeons (AAOS) online PEMs meet recommended readability guidelines for medical information. Methods. All publicly accessible spine-related entries within the patient education section of the NASS, AANS, and AAOS websites were analyzed for grade level readability using the Flesch-Kincaid formula. Readability scores were also compared with a similar 2008 analysis. Comparative statistics were performed. Results. A total of 125 entries from the subspecialty websites were analyzed. The average (SD) readability of the online articles was grade level 10.7 (2.3). Of the articles, 117 (93.6%) had a readability score above the sixth-grade level. The readability of the articles exceeded the maximum recommended level by an average of 4.7 grade levels (95% CI, 4.292–5.103; P < 0.001). Compared with 2008, the three societies published more spine-related patient education articles (61 vs. 125, P = 0.045) and the average readability level improved from 11.5 to 10.7 (P = 0.018). Of three examined societies, only one showed significant improvement over time. Conclusion. Our findings suggest that the spine-related PEMs on the NASS, AAOS, and AANS websites have readability levels that may make comprehension difficult for a substantial portion of the patient population. Although some progress has been made in the readability of PEMs over the past 7 years, additional improvement is necessary. Level of Evidence: 2

Computer-assisted Orthopaedic Surgery

Nowadays, operating rooms can be inefficient and overcrowded. Patient data and images are at times not well integrated and displayed in a timely fashion. This lack of coordination may cause further reductions in efficiency, jeopardize patient safety, and increase costs. Fortunately, technology has much to offer the surgical disciplines and the ongoing and recent operating room innovations have advanced preoperative planning and surgical procedures by providing visual, navigational, and mechanical computerized assistance. The field of computer‐assisted surgery (CAS) broadly refers to surgical interface between surgeons and machines. It is also part of the ongoing initiatives to move away from invasive to less invasive or even noninvasive procedures. CAS can be applied preoperatively, intraoperatively, and/or postoperatively to improve the outcome of orthopaedic surgical procedures as it has the potential for greater precision, control, and flexibility in carrying out surgical tasks, and enables much better visualization of the operating field than conventional methods have afforded. CAS is an active research discipline, which brings together orthopaedic practitioners with traditional technical disciplines such as engineering, computer science, and robotics. However, to achieve the best outcomes, teamwork, open communication, and willingness to adapt and adopt new skills and processes are critical. Because of the relatively short time period over which CAS has developed, long‐term follow‐up studies have not yet been possible. Consequently, this review aims to outline current CAS applications, limitations, and promising future developments that will continue to impact the operating room (OR) environment and the OR in the future, particularly within orthopedic and spine surgery.

The Risk of Expanding the Uninsured Population by Repealing the Affordable Care Act

Discussions surrounding repeal or repeal and replacement of the Affordable Care Act (ACA) have been a high priority for the Trump administration and the Republican majority of the US Congress, but specific replacement plans are less clear. Levitt1 outlined what the ACA replacement plan might look like based on proposed legislation from House Speaker Paul Ryan (R, Wisconsin) and Secretary of Health and Human Services Tom Price. Levitt observed that repeal of the entire ACA and the replacement plans that have been proposed recently by Republican congressional leaders “would likely result in more people uninsured, less comprehensive benefits, and fewer protections for people with preexisting conditions.”1

Patient‐Specific Orthopaedic Implants

Patient‐specific orthopaedic implants are emerging as a clinically promising treatment option for a growing number of conditions to better match an individuals anatomy. Patient‐specific implant (PSI) technology aims to reduce overall procedural costs, minimize surgical time, and maximize patient outcomes by achieving better biomechanical implant fit. With this commercially‐available technology, computed tomography or magnetic resonance images can be used in conjunction with specialized computer programs to create preoperative patient‐specific surgical plans and to develop custom cutting guides from 3‐D reconstructed images of patient anatomy. Surgeons can then place these temporary guides or “jigs” during the procedure, allowing them to better recreate the exact resections of the computer‐generated surgical plan. Over the past decade, patient‐specific implants have seen increased use in orthopaedics and they have been widely indicated in total knee arthroplasty, total hip arthroplasty, and corrective osteotomies. Patient‐specific implants have also been explored for use in total shoulder arthroplasty and spinal surgery. Despite their increasing popularity, significant support for PSI use in orthopaedics has been lacking in the literature and it is currently uncertain whether the theoretical biomechanical advantages of patient‐specific orthopaedic implants carry true advantages in surgical outcomes when compared to standard procedures. The purpose of this review was to assess the current status of patient‐specific orthopaedic implants, to explore their future direction, and to summarize any comparative published studies that measure definitive surgical characteristics of patient‐specific orthopaedic implant use such as patient outcomes, biomechanical implant alignment, surgical cost, patient blood loss, or patient recovery.

Federally mandating motorcycle helmets in the United States

BackgroundMotorcycle helmets reduce both motorcycle-related fatalities and head injuries. Motorcycle crashes are a major public health concern which place economic stress on the U.S. healthcare system.DiscussionAlthough statewide universal motorcycle helmet laws effectively increase helmet use, most state helmet laws do not require every motorcycle rider to wear a helmet. Herein, we propose and outline the solution of implementing federal motorcycle helmet law, while addressing potential counterarguments.ConclusionsThe decision to ride a motorcycle without a helmet has consequences that affect more than just the motorcyclist. In an effort to prevent unnecessary healthcare costs, injuries, and deaths, public health efforts to increase helmet use through education and legislation should be strongly considered. Helmet use on motorcycles fits squarely within the purview of the federal government public health and economic considerations.