Tsun Yee Law

Trends in total elbow arthroplasty in the Medicare population: a nationwide study of records from 2005 to 2012

BACKGROUNDnUtilization of total elbow arthroplasty (TEA) has reportedly increased in recent years. Since the introduction of disease-modifying antirheumatic drugs, there has been a reported decline in its use among rheumatoid patients; yet, the shift in indications for TEA remains unclear. This study evaluated trends in TEA utilization from 2005 to 2012 by analyzing the most common indications within the population of Medicare patients.nnnMETHODSnWe performed a retrospective review of a comprehensive Medicare patient population database using the PearlDiver supercomputer (Warsaw, IN, USA) for TEA utilization in rheumatoid arthritis (RA), osteoarthritis (OA), distal humerus fracture (DHF), post-traumatic arthritis (PTA), and distal humerus nonunion (DHNU). Total reported incidence of office visits and TEA utilization for each indication was reviewed.nnnRESULTSnUtilization of TEA remained unchanged (Pu2009=u2009.9530) despite a growing Medicare population (Pu2009=u2009.0201). There was a significant decline in annual TEA utilization for RA (Pu2009=u2009.002) and DHNU (Pu2009=u2009.003). No significant change was found in TEA use for DHF, OA, and PTA. A significant increase was noted in total visits coded for OA, RA, and DHNU (Pu2009<u2009.001). A significant, strong negative correlation was found for office visit coding and TEA use in RA (ru2009=u2009-0.850; Pu2009=u2009.008) and DHNU (ru2009=u2009-0.902; Pu2009=u2009.002).nnnCONCLUSIONnFrom 2005 to 2012, utilization rates of TEA in the Medicare population remained constant. Despite increases in office visits, TEA use for RA and DHNU has declined, likely secondary to improved medical management with disease-modifying antirheumatic drugs and the surgeons comfort with improved fracture fixation options.

Trends in surgical management of proximal humeral fractures in the Medicare population: A nationwide study of records from 2009 to 2012

BACKGROUNDnSurgical management of proximal humeral fractures has reportedly increased in recent years. Much of this growth relates to a growing elderly population, together with the introduction of modern implants, such as locking plates and, recently, introduction of reverse shoulder arthroplasty (RSA). This study evaluated trends in surgical management of proximal humeral fractures from 2009 to 2012 by analyzing the use of hemiarthroplasty (HA), RSA, and osteosynthesis (open reduction with internal fixation [ORIF]) within the Medicare patient population.nnnMETHODSnWe retrospectively reviewed a comprehensive Medicare patient population database within the PearlDiver supercomputer (Warsaw, IN, USA) for proximal humeral fractures treated with HA, RSA, or ORIF. Total use, annual utilization rates, age, and gender were investigated.nnnRESULTSnWithin the study period, 32,150 proximal humeral fractures were treated operatively, with no significant change in annual volume (Pxa0=xa0.119). The percentage of fractures treated surgically decreased significantly from 16.2% to 13.9% (Pxa0<xa0.001). The utilization rate decreased significantly for HA from 52% to 39% (Pxa0<xa0.001), increased significantly for RSA from 11% to 28% (Pxa0<xa0.001), and did not change significantly for ORIF (Pxa0=xa0.164). The utilization rate of RSA nearly tripled for patients older than 65 years (11% to 29%) and doubled for patients younger than 65 (6% to 12%).nnnCONCLUSIONnFrom 2009 to 2012, utilization rates of ORIF remained fairly constant. HA remains the most commonly used surgical treatment for proximal humeral fractures in the Medicare population, but its use has declined significantly. This decline has been offset by a corresponding increase in RSA.

Current concepts on the use of corticosteroid injections for knee osteoarthritis

Abstract Intraarticular corticosteroid injections are commonly used by the primary care providers and orthopedic surgeons to treat knee pain associated with osteoarthritis (OA). There is a spectrum of options for treating knee OA, ranging from ice therapy to partial or total knee replacement surgery. In mid-range treatment spectrum are different kinds of injections, with the most widely used being corticosteroid and hyaluronic acid. In addition, there are different types of corticosteroids used and also commonly mixed with different local anesthetics. The purpose of this paper is address current concepts on the use of corticosteroid steroid therapy for the treatment of knee OA.

Effect of Hypoglycemia on the Incidence of Revision in Total Knee Arthroplasty

BACKGROUNDnIt is well established that diabetic patients undergoing total knee arthroplasty (TKA) are more susceptible to infection, problematic wound healing, and overall higher complication rates. However, a paucity in current literature exists. The purpose of this study was to determine the effect of hypoglycemia on TKA revision (rTKA) incidence by analyzing a national private payer database for procedures performed between 2007 and 2015 Q1 Q2.nnnMETHODSnA retrospective review of a national private payer database within the PearlDiver Supercomputer application for patients undergoing TKA with blood glucose levels from 20 to 219 mg/mL, in 10-mg/mL increments, was conducted. Patients who underwent TKA were identified by Current Procedural Terminology (CPT) and International Classification of Disease (ICD) codes. Glucose ranges were identified by filtering for Logical Observation Identifiers Names and Codes within the PearlDiver database. Patients with diagnosed diabetes mellitus type I or II were excluded by using ICD-9 codes 250.00-250.03, 250.10-250.13, and 250.20-250.21. rTKA causes including mechanical loosening, failure/break, periprosthetic fracture, osteolysis, infection, pain, arthrofibrosis, instability, and trauma were identified with CPT and ICD-9 codes. Statistical analysis was primarily descriptive.nnnRESULTSnOur query returned 264,824 TKAs, of which 12,852 (4.9%) were revised. Most TKAs were performed with a glucose of 70-99 mg/mL (26.1%), followed by 100-109 mg/mL (18.5%). Patients with TKAs performed with glucose 20-29 mg/mL had the highest rate of revision (17.2%; P < .001). Infection was the most common cause of revision among all glucose ranges (P < .001).nnnCONCLUSIONnInfection remains one of the most common causes of rTKA irrespective of glucose level. Our results suggest that hypoglycemia may increase revision rates among TKA patients. Tight glycemic control before and during surgery may be warranted.

Economic benefit of carpal tunnel release in the medicare patient population

OBJECTIVE The epidemiology of carpal tunnel syndrome (CTS) has been extensively researched. However, data describing the economic burden of CTS is limited. The purpose of this study was to quantify the disease burden of CTS and determine the economic benefit of its surgical management. METHODS The authors utilized the PearlDiver database to identify the number of individuals with CTS in the Medicare patient population, and then utilized CPT codes to identify which individuals underwent surgical management. These data were used to calculate the total number of disability-adjusted life years (DALYs) associated with CTS. A human capital approach was employed and gross national income per capita was used to calculate the economic burden. RESULTS From 2005 to 2012 there were 1,500,603 individuals identified in the Medicare patient population with the diagnosis of CTS. Without conservative or surgical management, this results in 804,113 DALYs without age weighting and discounting, and 450,235 DALYs with age weighting and a discount rate of 3%. This amounts to between

Effect of Obesity on Total Knee Arthroplasty Costs and Revision Rate

21.8 and

Racial Disparities in Revision Total Knee Arthroplasty: Analysis of 125,901 Patients in National US Private Payer Database

39 billion in total economic burden, or

Incidence of Drug Abuse in Revision Total Knee Arthroplasty Population

2.7-

Impact of Perioperative HbA1c on Reimbursements in Diabetes Mellitus Patients Undergoing Total Hip Arthroplasty: A Nationwide Analysis

4.8 billion per year. Surgical management of CTS has resulted in the aversion of 173,000-309,000 DALYs. This has yielded between

E-mail reminders improve completion rates of patient-reported outcome measures

780 million and