Sameer K. Singh

Factors Associated with Financial Relationships between Spine Surgeons and Industry

Study Design. A retrospective review of Centers for Medicare and Medicaid Services Database. Objective. Utilizing Open Payments data, we aimed to determine the prevalence of industry payments to orthopedic and neurospine surgeons, report the magnitude of those relationships, and help outline the surgeon demographic factors associated with industry relationships. Summary of Background Data. Previous Open Payments data revealed that orthopedic surgeons receive the highest value of industry payments. No study has investigated the financial relationship between spine surgeons and industry using the most recent release of Open Payments data. Methods. A database of 5898 spine surgeons in the United States was derived from the Open Payments website. Demographic data were collected, including the type of residency training, years of experience, practice setting, type of medical degree, place of training, gender, and region of practice. Multivariate generalized linear mixed models were utilized to determine the relationship between demographics and industry payments. Results. A total of 5898 spine surgeons met inclusion criteria. About 91.6% of surgeons reported at least one financial relationship with industry. The median total value of payments was

Do Demographic Factors of Spine Surgeons Affect the Rate at Which Spinal Fusion Is Performed on Patients

994.07. Surgeons receiving over

Effects of Conflicts of Interest on Practice Patterns and Complication Rates in Spine Surgery

1,000,000 from industry during the reporting period represented 6.6% of the database and accounted for 83.5% of the total value exchanged. Orthopedic training (P < 0.001), academic practice setting (P < 0.0001), male gender (P < 0.0001), and West or South region of practice (P < 0.0001) were associated with industry payments. Linear regression analysis revealed a strong inverse relationship between years of experience and number of payments from industry (r = -0.967, P < 0.0001). Conclusion. Financial relationships between spine surgeons and industry are highly prevalent. Surgeon demographics have a significant association with industry-surgeon financial relationships. Our reported value of payments did not include ownership or research payments and thus likely underestimates the magnitude of these financial relationships. Level of Evidence: 3

Risk Factors for Reoperation and Performance-Based Outcomes After Operative Fixation of Foot Fractures in the Professional Athlete: A Cross-Sport Analysis

Study Design. Retrospective study. Objective. The purpose of this study was to evaluate associations between spine surgeon demographics and the rate at which elective spine fusion is performed. Summary of Background Data. Rapidly increasing rates of elective spinal fusion in the United States have given rise to important questions about what factors may drive spine surgeon decision making. Methods. Publicly available spine surgeon practice pattern data from Centers for Medicare and Medicaid Services were reviewed retrospectively. Fusion rate was defined as the number of fusion procedures performed on Medicare beneficiaries by a surgeon per total number of unique Medicare beneficiaries seen. Inclusion criteria were neurological or orthopedic spine surgeons who performed 11 or more separate spine fusion procedures on Medicare patients between 2011 and 2013 as defined by this database. Demographic information was collected from public record. The increased probability of a surgeon performing spine fusion was assessed using a relative risk (RR) and corresponding 95% confidence interval (CI). Results. A total of 3979 spine surgeons who practice in the United States and performed spine fusion on 171,676 Medicare patients from 2011 to 2013 met the inclusion criteria. The average rate of spine fusion for surgeons in this database was 7.5%. Surgeons with higher fusion rates practiced in an academic versus private setting (RR = 1.44, 95% CI [1.35–1.53]; P < 0.0001), were more likely neurological versus orthopedic surgeons (RR = 1.10, 95% CI [1.05–1.15]; P < 0.0001), and practiced in the West versus Midwest, South, and Northeast region of the United States (RR = 1.20, 95% CI [1.14–1.27]; P < 0.0001). Number of years in practice was significantly associated negatively with fusion rate (P < 0.0001). Conclusion. Significant variation in the rate of spine fusion based on practice type, training, region, and experience suggests poor consensus on indications for this procedure. Knowledge of these relationships may help identify underlying reasons for variations in surgical care and improve surgical outcomes. Level of Evidence: 3

Performance-Based Outcomes Following Lisfranc Injury Among Professional American Football and Rugby Athletes.

Study Design. Retrospective cohort study. Objective. We sought to determine whether financial relationships with industry had any impact on operative and/or complication rates of spine surgeons performing fusion surgeries. Summary of Background Data. Recent actions from Congress and the Institute of Medicine have highlighted the importance of conflicts of interest among physicians. Orthopedic surgeons and neurosurgeons have been identified as receiving the highest amount of industry payments among all specialties. No study has yet investigated the potential effects of disclosed industry payments with quality and choices of patient care. Methods. A comprehensive database of spine surgeons in the United States with compiled data of industry payments, operative fusion rates, and complication rates was created. Practice pattern data were derived from a publicly available Medicare-based database generated from selected CPT codes from 2011 to 2012. Complication rate data from 2009 to 2013 were extracted from the ProPublica-Surgeon-Scorecard database, which utilizes postoperative inhospital mortality and 30-day-readmission for designated conditions as complications of surgery. Data regarding industry payments from 2013 to 2014 were derived from the Open Payments website. Surgeons performing <10 fusions, those without complication data, and those whose identity could not be verified through public records were excluded. Pearson correlation coefficients and multivariate regression analyses were used to determine the relationship between industry payments, operative fusion rate, and/or complication rate. Results. A total of 2110 surgeons met the inclusion criteria for our database. The average operative fusion rate was 8.8% (SD 4.8%), whereas the average complication rate for lumbar and cervical fusion was 4.1% and 1.9%, respectively. Pearson correlation analysis revealed a statistically significant but negligible relationship between disclosed payments/transactions and both operative fusion and complication rates. Conclusion. Our findings do not support a strong correlation between the payments a surgeon receives from industry and their decisions to perform spine fusion or associated complication rates. Large variability in the rate of fusions performed suggests a poor consensus for indications for spine fusion surgery. Level of Evidence: 3

Clinical Trials in Obstructive Sleep Apnea: Recognizing Trends and Future Opportunities: Clinical Trials in Obstructive Sleep Apnea

Background: Professional athletes are predisposed to fractures of the foot due to large stresses placed on the lower extremity. These players are concerned with efficiently returning to play at a high level. Return-to-play rates after operative treatment have been previously reported, yet performance outcomes after such treatment are generally unknown in this population. Hypothesis: Overall, professional athletes sustaining a foot fracture would return to play at high rates with little impact on postoperative performance or league participation. However, National Football League (NFL) athletes would have a significantly greater decline in performance due to the high-impact nature of the sport. Study Design: Case series. Level of Evidence: Level 4. Methods: Athletes in the National Basketball League (NBA), NFL, Major League Baseball (MLB), and National Hockey League (NHL) undergoing operative fixation of a foot fracture were identified through a well-established protocol confirmed by multiple sources of the public record. Return-to-play rate and time to return were collected for each sport. League participation and game performance data were collected before and after surgery. Statistical analysis was performed, with significance accepted as P ≤ 0.05. Results: A total of 77 players undergoing 84 procedures met the inclusion criteria. Overall, 98.7% (76/77) of players were able to return to play, with a median time to return across all sports of 137 days. Players returned to preoperative performance levels within 1 season of surgery. Six players (7.8%) sustained refracture requiring reoperation, all of whom were in the NBA. Percentage of games started during the season after primary operative treatment was a predictive factor for reinjury (99% vs 40%, P = 0.001). Conclusion: Athletes returned to play at a high rate after foot fracture fixation, with excellent postoperative performance levels, regardless of sport and fracture location. NBA athletes sustaining fifth metatarsal and navicular fractures are at greater risk of reinjury compared with other athletes. Returning to high levels of athletic participation soon after surgery may predispose athletes to refracture and subsequent reoperation. Clinical Relevance: Players, coaches, and team physicians should be aware of the impact of foot fractures on career performance and longevity to best guide therapy.

A cross-sport comparison of performance-based outcomes of professional athletes following primary microfracture of the knee

Professional National Football League (NFL) and rugby athletes have high rates of Lisfranc injuries. Although favorable return-to-play rates have been previously reported, a thorough assessment of postinjury performance is lacking. Professional NFL and rugby athletes who sustained a Lisfranc injury were identified using a well-established protocol confirmed by multiple sources of the public record. Return-to-play rate and time to return were determined for each athlete. League participation and game performance were collected 1 season prior to injury and up to 3 seasons after injury. Statistical analysis was performed, with P≤.05 being significant. A total of 47 athletes (NFL=35, rugby=12) with Lisfranc injuries were identified, having 23 ligamentous injuries and 24 fractures. Thirty-five (75%) were treated operatively. Among NFL players, 29 (83%) returned to play, taking 10.0±2.9 months to do so. Overall, NFL players started fewer games 2 and 3 seasons following surgery (P=.002 and .035, respectively) and showed a significant decline in performance 1 season after return compared with preinjury levels (21%; P=.05). Offensive players had a significantly greater decline in statistical performance compared with defensive counterparts (P=.02). Although professional NFL athletes return to play at a high rate (83%) following Lisfranc injury, their league participation and performance is significantly decreased on return. Ligamentous and bony injuries have similar prognoses; however, offensive players show greater declines in performance compared with defensive players. To best guide therapy, players, coaches, and team physicians should be aware of the impact of Lisfranc injuries on career performance and longevity. [Orthopedics. 2018; 41(4):e479-e482.].

Risk Factors for Reoperation and Performance-based Outcomes following Surgical Fixation of Foot Fractures in the Professional Athlete: A Cross-Sport Analysis

Examine US and international clinical trials in obstructive sleep apnea (OSA) to characterize researchers involved, interventions being studied, and opportunities for future investigation.

Performance-based Outcomes among American Professional Athletes Following Microfracture of the Knee: A Cross-sport Analysis:

BACKGROUND The purpose of this study was to compare performance-based outcomes among professional athletes in four major North American sports following microfracture to treat symptomatic chondral defects of the knee. METHODS Major League Baseball (MLB), National Basketball Association (NBA), National Football League (NFL), and National Hockey League (NHL) athletes who underwent primary unilateral microfracture of the knee were identified through a previously reported protocol based on public sources. Successful return-to-play was defined as returning for at least one professional regular season game after surgery. Regular season player statistics and sport-specific performance scores were compiled for each player. Each player served as his own control, with the season prior to surgery defined as baseline. Comparisons across sports were enabled by adjusting for expected season and career length differences between sports and by calculating percent changes in performance. RESULTS One hundred thirty one professional athletes who underwent microfracture were included. One hundred three athletes (78.6%) successfully returned to play. The ratio of games started-to-games played before surgery was found to be a significant positive independent predictor of returning (p = 0.002). Compared with their preoperative season, basketball and baseball players demonstrated significantly decreased performance one season after surgery (-14.8%, p = 0.029 and -12.9%, p = 0.002, respectively) that was recoverable to baseline by postoperative seasons 2-3 for baseball players but not for basketball players (-9.7%, p = 0.024). CONCLUSION Knee microfracture surgery is associated with a high rate of return to the professional level. However, the impact of this procedure on postoperative performance varied significantly depending on sport.

Factors Associated With Financial Relationships Between Spine Surgeons and Industry: An Analysis of the Open Payments Database

Objectives: Professional athletes are predisposed to fractures of the foot due to large stresses placed on the lower extremity; these players are concerned with efficiently returning to play at a high level. Return to play rates following operative treatment have been previously reported, yet performance outcomes following such treatment are generally unknown in this population. The purpose of this study was to assess and compare performance-based outcomes following foot fracture fixation among professional athletes of the 4 major North American sports. Methods: Athletes in the National Basketball League (NBA), National Football League (NFL), (Major League Baseball) MLB, and National Hockey League (NHL) undergoing operative fixation of a foot fracture were identified through a well-established protocol confirmed by multiple sources of the public record. Return-to-play rate and time to return were collected for each sport. League participation and game performance were collected before and after surgery. Statistical analysis was performed with significance accepted as P ≤ .05. Results: A total of 77 players undergoing 84 procedures met the inclusion criteria. Overall, 98.7% of players were able to return to play with an average time to return across all sports of 172 ± 22 days. Players returned to preoperative performance levels within one season of surgery. Six players (7.8%) sustained re-fracture requiring reoperation, all of whom were in the NBA. Percentage of games started during the season after primary surgical treatment was a predictive factor for re-injury (99% vs 40%, p = .001). Conclusion: Athletes returned to play following foot fracture fixation at a high rate with excellent postoperative performance levels, regardless of sport and fracture location. NBA athletes sustaining fifth metatarsal and navicular fractures are at a higher risk of re-injury compared to other athletes. Returning to high levels of athletic participation soon after surgery may predispose athletes to re-fracture and subsequent reoperation.