Study: Patients Want MORE Surgery
According to a new study, it’s not the doctors that are pushing for surgeries. It’s the patients! Chad Mather, M.D., an attending orthopedic surgeon at Duke University, and a former AAOS [American Academy of Orthopaedic Surgeons] Washington Health Policy Fellow, tells OTW, “We are working on an exciting new area of study in the field of personalized and customized medicine. This is an effort that grew out of my policy work in traditional economic analysis which commonly compares two interventions. I observed that in simulations of these models that while we could determine if strategy A or B was better for a population of patients, some patients had better outcomes with A and some with B. Therefore, the best strategy was not to pick between treatment A or B, but rather to get treatment A and B to the right patients. Our current work utilizes a common marketing research tool, conjoint analysis which involves a personalized assessment of risks and tradeoffs to measure patient preferences. Our pilot work focuses on the treatment decision for a first time anterior shoulder dislocation and over 50% of respondents chose surgery with cost sharing at $1, 000 cost share and 42% at $2, 000. A full 90% of patients chose surgery if they had only one more recurrence.”
“At the same time, epidemiological data suggests only 37% of patients ever have surgery after a first time anterior shoulder dislocation. These findings suggest that according to patient preferences, we are actually underutilizing not overutilizing surgical treatment. We are still in the early stages of this project and more testing is required to confirm these early results. However, if these trends continue and occur in other orthopaedic conditions, this data could refute the influence of supplier induced demand causing over-utilization of orthopaedic surgery. Orthopaedic surgeons continue to argue that current utilization is appropriate, but we might be wrong after all—in fact, some orthopaedic surgeries might be actually be underutilized!”
ACL Injuries NOT on the Rise
In contrast to what many think, ACL injuries in the NFL are not increasing, says Matthew Matava, M.D., President of the NFL Physicians Society. Dr. Matava, an orthopedic surgeon with the Washington University School of Medicine and Team Physician for the St. Louis Rams, tells OTW, “While the general impression is that ACL injuries in the NFL are increasing, in fact they have remained consistent. In 2011 (preseason and regular season) we saw 55 such injuries; in 2012 it was 63, and in 2013 it was 57.”
“Players are being very up front, saying, ‘We can’t hit each other in the head, so we have to hit lower in order to make a tackle.’ So naturally, it would seem that we would see an increase in knee injuries. I think the ACL tears have remained relatively constant because the new concussion rules haven’t caused players to hit as low as perhaps they fear. However, any rule change has to be examined after being in affect several years in order to truly assess its effect on the game. Each and every player will tell a doctor, ‘I would rather be hit in the head than in the knees. I’ll take my chances with a concussion…that wouldn’t be career-ending.’ I tell them, ‘I can reconstruct your knee, but I can’t reconstruct your brain.’”
“And you would think that we would see more injuries in Thursday night games as compared to Sunday and Monday night games, but that has not been the case. While I do not have any theories as to why injuries remained the same, it could be that the three days between games is enough to recuperate from the prior week’s injuries. It is important to note that even if the numbers increase that all of this data represent a snapshot in time and should be analyzed after several years of data collection in order to truly assess any negative effects on injury rates.”
“Unfortunately, football is a collision sport and will always be associated with the risk for injury. The NFL and NFL Physician Society have committed significant resources and effort to reduce this risk. In addition, the collection of injury data is done in a scientifically rigorous fashion by an independent organization with significant experience and expertise in biomedical data collection.”
ZERO Pain After Knee Replacement Thanks to “Godsend” Drug
Want happy patients? Do something that frees them of their pain. John Barrington, M.D., an orthopedic surgeon at Texas Center for Joint Replacement in Plano, Texas, tells OTW, “Pain relief after joint replacement is strongly correlated with patient satisfaction. Unfortunately, in the past we haven’t done very well in this regard; about 20% of patients have chronic pain after knee replacement. And we know that short term, severe pain can leads to chronic pain. The goal is to create a painless experience, something that is hard to achieve because often what we use—local numbing or an epidural—doesn’t work long enough…then we are left with narcotics. More recently surgeons have used things like regional blocks with femoral nerve catheters, but those can increase the risk of falls, which can leads to reoperation.”
So what is the answer? “Liposomal bupivacaine, ” says Dr. Barrington. “It is a Godsend in that it provides 72 hours of pain relief. In our study, up to 65% of patients experienced zero pain while in the hospital. The average pain score for those treated with Liposomal Bupivacaine was 1.6 on a scale of 0 to 10 (measured on the Visual Analog Scale). There were also secondary positive effect such as a decrease in length of stay, an increase in patient satisfaction as measured by the Press Ganey satisfaction scores, and lower costs. We decreased the overall cost to the hospital by $1, 250 per patient. We increased the pharmacy cost by $280, but we saved $1, 500 in other medications. Overall, this meant a $1.24 million saved in this study (1, 000 patients treated with liposomal bupivacaine versus 1, 000 patients without this drug). I was pleasantly surprised as I thought that this would be cost neutral.”
“One of the most exciting things is that this opens up the world of joint replacement to same day procedures. I am pleased to say that I am often asked to speak on behalf of surgeons and hospital groups. Surgeons often come watch the procedure, and frequently ask me to facilitate conversations about this between their hospital administrators and ours.”
“This study gives hospitals a more thorough understanding of pain control. If we can have a win for the patient and a win for the doctors…and a win for the hospital, then why not use this medication?”
OrthoWorx Forms University/Industry Advisory Board
OrthoWorx, Inc. has announced that it has formed a University/Industry Advisory Board to better connect the technology and talent needs of Indiana’s orthopedic medical device industry with the assets and capabilities represented by Indiana’s higher education institutions.
“We believe this is the right time and the right group of partners to address critical economic and educational challenges facing the State of Indiana, ” said Sheryl Conley, President and CEO of OrthoWorx, in the March 20 news release. “Indiana is known for its great universities and, in fact, it produces more graduates than the state is currently able to employ. The orthopedic device industry has many needs that can be met by resources within our state, but a great number of its relationships with academia have evolved over time with out-of-state institutions—we intend to address that missed connection for the benefit of students, employers and the State’s economy overall.”
Colleges and universities that are currently committed to joining OrthoWorx as part of the University/Industry Advisory Board include: Indiana University; University of Notre Dame; Ivy Tech Community College; Manchester University; and Trine University. Discussions regarding membership are still underway with Ball State University, IPFW (Indiana University-Purdue University Fort Wayne) and Purdue University. Grace College, a founding member and frequent collaborator of OrthoWorx, also will be a member of this new Advisory Board.
Conley added, “Many companies would like a stronger recruiting presence at Indiana schools and many Indiana schools desire to create more experiential learning experiences for students, as well as to place more graduates in our industry. What has been lacking is an appreciation on both sides of the strengths and capabilities of each other. We think that should change and we are grateful to those universities who have committed their time and resources to joining us in this important collaboration.”
