ICD-10 Coding of Cervical Radiculopathy Underestimates Concurrent Myelopathy.

Study Design: Retrospective cohort study.

Objectives: To evaluate the accuracy of ICD-10 codes in identifying isolated degenerative cervical radiculopathy versus concurrent myelopathy in surgical patients across an 11-hospital health care system (2016-2023).

Summary Of Background Data: ICD-10 codes are commonly used for patient stratification in database studies, yet their accuracy in differentiating cervical radiculopathy from concurrent myelopathy remains poorly characterized.

Surgeon Preferences, Surgical Location, and Timing of Repair Drive Achilles Tendon Rupture Repair Cost.

Background: Midsubstance Achilles tendon repair is a common procedure, yet the factors influencing its cost have been underexamined and often imprecisely understood. Using time-driven activity-based costing (TDABC), we examined variation in total cost, compared patient-, surgeon-, and surgery-specific characteristics between high- and non-high-cost repairs, and assessed factors associated with total cost to identify specific cost drivers that might reduce expenses without compromising clinical outcomes.

Methods: Patients undergoing midsubstance Achilles tendon rupture repair between January 3, 2022 and December 28, 2023 at 2 academic medical centers and their affiliated community hospitals and ambulatory surgical centers were identified.

How Does CMS' Merit-based Incentive Payment System Penalize or Reward Orthopaedic Surgeons Caring for Socially At-risk Patients?

Background: The largest value-based payment system in the United States is the Merit-based Incentive Payment System (MIPS), implemented by the Centers for Medicare & Medicaid Services (CMS). MIPS was designed to adjust physician reimbursement based on performance across several categories. However, concerns arose that MIPS may inadvertently penalize physicians caring for patients of high social risk.

Risk Stratification in Orthopaedic Surgery: An Important Adjustment for Value-Based Health Care and Quality Measurement.

➢ Risk stratification in orthopaedic surgery is complex and depends on the outcome of interest and multiple interdependent factors. Effective risk stratification has uses for limiting and predicting adverse events in patients undergoing discretionary surgery, avoiding the penalization of surgeons for operating on candidates whose health is situated in more difficult circumstances, and ensuring that inordinate attention is not placed on discrete musculoskeletal pathophysiology when there are other pressing health priorities.➢ For individual patient decision-making, no comprehensive risk-stratification tool currently exists, in part due to the heterogeneity of orthopaedic procedures performed and the diverse patient population treated.

Presenteeism and Absenteeism Before and After Carpal Tunnel Release or Open Reduction and Internal Fixation for Distal Radius Fracture.

Purpose: The use of a person's hands is crucial to their ability to succeed at work. Hand pathologies can impact work success by increasing absenteeism (ie, not being able to go to work) and presenteeism (ie, being able to work but in a reduced capacity). In this study, we quantified employed patients' presenteeism and absenteeism following carpal tunnel release or surgical fixation of a distal radius fracture (DRF).

A comparison of orthopaedic surgery training across five English-speaking countries.

Introduction: There is undocumented and unjustified variability in orthopaedic surgery training between countries. This study compares and contrasts the main features of orthopaedic training in Australia, New Zealand, the United Kingdom, United States, and Canada.

Methods: Comparisons included: competition for, and selection into, training; training pathway structures; training requirements, and; training length.

Price Transparency in United States' Health Care: A Narrative Policy Review of the Current State and Way Forward.

Health care price transparency is gaining momentum as a tangible policy intervention that can unleash market principles to increase competition, help begin to decrease U.S. health care expenditures, and provide Americans with access to affordable, high-quality health care.

Assessing the variation and drivers of cost in 1-level lumbar fusion: a time-driven activity-based costing analysis.

Background Context: As value-based health care arrangements gain traction in spine care, understanding the true cost of care becomes critical. Historically, inaccurate cost proxies have been used, including negotiated reimbursement rates or list prices. However, time-driven activity-based costing (TDABC) allows for a more accurate cost assessment, including a better understanding of the primary drivers of cost in 1-level lumbar fusion.

Postoperative Patient Portal Messaging Is Associated With Return to the Emergency Department After Lumbar Spine Surgery.

Study Design: Retrospective study.

Objective: To explore the association between patients undergoing lumbar spine surgery who message their care team via an electronic patient portal (EPP) postoperatively and emergency department (ED) visits within 90 days of surgery.

Summary Of Background Data: Secure patient messaging through electronic patient portals has grown over recent years.

When Do Patients Achieve PROMIS Milestones After Rotator Cuff Repair?

Background: Given the variability of the questions asked, the Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) computer adaptive test (CAT) Version 2.0 item bank aids in the evaluation of rotator cuff repair (RCR) rehabilitation by determining when recovery milestones are possible based on the quality of patient responses at certain time points.

Purpose: To assess the time point at which patients with RCR were able to achieve specific functional milestones, determined as positive responses to the 5 most frequently asked items on the PROMIS UE CAT Version 2.

Patient-Reported Outcomes Measurement Information System Physical Function and Global Physical Health Subscale Strongly Correlate and Perform Similarly to the Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form.

Background: Arthroplasty surgeons use a variety of patient-reported outcome measures (PROMs) to assess functional well-being, including the Knee Injury and Osteoarthritis Outcome Score (KOOS) Physical Function short form (KOOS-PS), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a (PROMIS PF SF 10a), and PROMIS Global-10 Physical Health subscale. However, there is a paucity of literature assessing their concurrent validity and performance.

Methods: Between June 2016 and December 2020, patient visits at an arthroplasty clinic for knee concerns were identified.

PROMIS Global Physical Health Subscale Strongly Correlates and Performs Similarly to the QuickDASH in Hand and Upper Extremity Patients.

Background: The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) is a validated, static hand and upper extremity patient-reported outcome measure (PROM) commonly used. However, with the growth of PROM implementation across orthopedic and plastic surgery clinics, it is beneficial to determine whether a more general PROM can be used to capture the same insights. This would ease implementation broadly.

Are Commonly Used Geographically Based Social Determinant of Health Indices in Orthopaedic Surgery Research Correlated With Each Other and With PROMIS Global-10 Physical and Mental Health Scores?

Background: Geographically based social determinants of health (SDoH) measures are useful in research and policy aimed at addressing health disparities. In the United States, the Area Deprivation Index (ADI), Neighborhood Stress Score (NSS), and Social Vulnerability Index (SVI) are frequently used, but often without a clear reason as to why one is chosen over another. There is limited evidence about how strongly correlated these geographically based SDoH measures are with one another.

Evaluating and Comparing the Correlation and Performance of PROMIS and FAAM ADL in a Foot and Ankle Patient Population.

BackgroundThere is a paucity of literature assessing 2 of the commonly used static Patient-Reported Outcomes Measurement Information System (PROMIS) forms (PROMIS Global-10 and PROMIS Physical Function Short Form 10a [PF SF 10a]) and the Foot and Ankle Ability Measure Activities of Daily Living (FAAM ADL).MethodsThe PROMIS Global-10, PROMIS PF SF 10a, and FAAM ADL were compared among new foot and ankle patients. Spearman rho (ρ) correlations were calculated, and ceiling and floor effects were determined.

Characteristics, comorbidities, and complications in multiple sclerosis (MS) and non-MS patients undergoing lumbar fusion for deformity.

Background: We compared the characteristics, comorbidities, and complications in spinal deformity patients with and without multiple sclerosis (MS) undergoing primary lumbar spine fusion.

Methods: We used the Nationwide Inpatient Sample (NIS) from 2003 to 2014, International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes to create experimental MS (842 patients) and non-MS control (165,726 patients) cohorts undergoing primary lumbar spine fusion. Characteristics, comorbidities, and complications in spinal deformity patients with and without MS were evaluated using univariate and bivariate analysis.