Antonio Cusano

Insurance status affects postoperative morbidity and complication rate after shoulder arthroplasty

BACKGROUND Shoulder arthroplasty is an effective procedure for managing patients with shoulder pain secondary to end-stage arthritis. Insurance status has been shown to be a predictor of patient morbidity and mortality. The current study evaluated the effect of patient insurance status on perioperative outcomes after shoulder replacement surgery. METHODS Data between 2004 and 2011 were obtained from the Nationwide Inpatient Sample. Analysis included patients undergoing shoulder arthroplasty (partial, total, and reverse) procedures determined by International Classification of Disease, 9th Revision procedure codes. The primary outcome was medical and surgical complications occurring during the same hospitalization, with secondary analyses of mortality and hospital charges. Additional analyses using the coarsened exact matching algorithm were performed to assess the influence of insurance type in predicting outcomes. RESULTS A data inquiry identified 103,290 shoulder replacement patients (68,578 Medicare, 27,159 private insurance, 3544 Medicaid/uninsured, 4009 other). The overall complication rate was 17.2% (n = 17,810) and the mortality rate was 0.20% (n = 208). Medicare and Medicaid/uninsured patients had a significantly higher rate of medical, surgical, and overall complications compared with private insurance using the controlled match data. Multivariate regression analysis found that having private insurance was associated with fewer overall medical complications. CONCLUSION Private insurance payer status is associated with a lower risk of perioperative medical and surgical complications compared with an age- and sex-matched Medicare and Medicaid/uninsured payer status. Mortality was not statistically associated with payer status. Primary insurance payer status should be considered as an independent risk factor during preoperative risk stratification for shoulder arthroplasty procedures.

Distal biceps repair using the lacertus fibrosus as a local graft.

BACKGROUND We report a case series of 15 patients who underwent a new surgical technique that uses a transfer of the lacertus fibrosus to augment the repair of the distal biceps tendon. This technique seeks to minimize the need for and potential complications associated with autogenous or allograft tendon reconstruction in this clinical scenario. METHODS We reviewed the clinical outcomes of patients who both underwent a lacertus transfer for biceps tendon reconstruction during a 10-year period and had at least 6 months of follow-up. Their clinical outcomes, including success of tendon repair, functional performance, and associated surgical complications, were evaluated. RESULTS During a 10-year period, 244 patients underwent surgery for repair or reconstruction of the distal biceps tendon. During this time, 15 patients met the criteria for use of the lacertus transfer technique. When direct repair was not possible because of tendon retraction and attrition, although a tendon graft was considered, the intact lacertus fibrosus was used to augment the biceps repair. Of these 15 patients, 12 met study inclusion criteria. At latest follow-up, all 12 patients were successfully treated by the lacertus transfer without complication, had regained elbow flexion and forearm supination strength, and had no lacertus harvest complications. CONCLUSIONS When operative treatment is chosen for biceps tendon injuries and if the lacertus fibrosus is intact, transfer of the lacertus to augment repair of the distal biceps provides predictable outcomes without the potential complications associated with allograft or autograft tendon reconstruction.

Regional Variations of Medicare Physician Payments for Hand Surgery Procedures in the United States

Background: Medicare reimbursement is known to exhibit geographic variation for inpatient orthopedic procedures. This study determined whether US geographic variations also exist for commonly performed hand surgeries. Methods: Using the Medicare Provider Utilization and Payment Data (2012-2013) from Centers for Medicare & Medicaid Services, we analyzed regional physician charges/payments for common outpatient hand surgeries. Results: The most commonly performed procedures in the United States were open carpal tunnel release (n = 21 944), trigger finger release (n = 15 345), endoscopic carpal tunnel release (n = 7106), and basal joint arthroplasty/ligament reconstruction and tendon interposition (n = 2408). A range of average Medicare physician reimbursements existed based on geographic region for basal joint arthroplasty (

Posterior Interosseous Nerve Palsy Associated with Radial Neck Nonunion

669-

Latissimus Dorsi Tendon Transfer With Acromial Osteotomy for Massive Irreparable Rotator Cuff Tear

571), endoscopic carpal tunnel release (

Extensor Mechanism Reconstruction for Chronic Patellar Fracture

400-

Pectoralis Major Muscle Transfer With the Sternal Head and Hamstring Autograft for Scapular Winging

317), open carpal tunnel release (

All-Arthroscopic Coracoclavicular Ligament Reconstruction Surgical Technique Using a Semitendinosus Allograft and Tenodesis Screws

325-

Eden-Hybinette and Pectoralis Major Transfer for Recurrent Shoulder Instability Due to Failed Latarjet and Chronic Subscapularis Rupture

261), and trigger finger release (

Allograft tissue irradiation and failure rate after anterior cruciate ligament reconstruction: A systematic review

215-