Surprise! No Surgery Required for Epidural Abscesses…All you need is Aspirin!? Really?…Traumatologists Tests Generics and Report Huge Savings….and More…
Surprise! No Surgery Required for Epidural Abscesses
Christopher Bono, M.D. is chief of orthopaedic spine at Brigham and Women’s Hospital. In collaboration with one of his partners, Mitchel Harris, M.D., the principal investigator of the study and one of their outstanding residents, Sang Kim, M.D., Dr. Bono has found a way to spare patients unnecessary surgery. He tells OTW, “We see a lot of patients with epidural abscesses in our hospital; in addition, there has been some recent literature suggesting that nonoperative treatment might be a good option for these patients, instead of ‘surgery for all.’ Interestingly, physicians on the medical service feel uncomfortable if we do not operate on these patients. The fact is, however, that many patients can be successfully treated with antibiotics alone.”
“Our research, which we will soon submit for publication, was a very large retrospective study; in this first phase we looked at patients treated nonoperatively, and specifically examined which characteristics led to failure and which led to success. We found that diabetes, age greater than 65 years, MRSA infection, and neurological compromise were associated with failure of nonoperative treatment. Conversely, if someone did not fulfill these criteria then they had a high chance of succeeding with nonoperative care. It was really surprising how strong of a cohort of patients we found that could be treated nonoperatively. Honestly, if you ask 8 out of 10 spine surgeons about what to do in these situations, they would say, ‘Operate!’ We will continue to develop this instrument, have it published, and analyze it to see how well it works prospectively.”
All You Need Is Aspirin!? Really?
Javad Parvizi, M.D., director of research for The Rothman Institute in Philadelphia, tells OTW of his revolutionary new work. “My colleagues and I have just completed a study showing that aspirin is as good as any other medication at preventing blood clots in joint replacement. We looked at 26, 000 patients in this single center study; the fact that aspirin can prevent DVT [deep vein thrombosis] or pulmonary embolism is a huge revelation. This means that going forward we can avoid giving toxic drugs to our patients. Those at the highest risk will still need something more than aspirin, of course.”
“My colleagues and I undertook this study because we were seeing a lot of patients coming in with bleeding after taking drugs that were aimed at preventing them from developing problems in the first place. It was surprising to see that the majority of patients were returning to us due to bleeding issues and hematomas as opposed to venous thromboembolism. We will be presenting our results at the American Academy of Orthopaedic Surgeons meeting in 2013; this is very exciting indeed, and it will be practice-changing.”
Rick Epstein New President, CEO at Sonoma
Sonoma Orthopedic Products, Inc. has announced that Rick Epstein will lead the company as President and Chief Executive Officer, thus succeeding Glen Coleman. Epstein was also named to the Board of Directors.
Prior to joining Sonoma Orthopedic Products, Epstein was CEO at Ellman International, a privately held medical device company. He has also served as Vice President and General Manager at V. Mueller (Cardinal Health) and has held senior executive positions at Cardinal Health, Intuitive Surgical and Baxter Healthcare. Epstein earned an MBA from University of Chicago, an MS in Mechanical Engineering from Stanford University and a BS in Engineering from the University of Illinois.
Traumatologists Test Generics and Report Large Savings
Peter Althausen, M.D. is lead author on a new study that may lead the way in cost savings for the U.S. healthcare system. Dr. Althausen, a traumatologist with the Reno Orthopaedic Clinic tells OTW, “This year the Orthopaedic Trauma Association announced that its new focus is on safety, quality, and cost containment. This is critical because over the past ten years payments to doctors and hospitals have decreased while payment to implant companies have increased. My trauma colleagues and I are extremely concerned that our system can’t pay for the patients we are taking care of. In some markets, six out of nine emergency rooms have closed in the last ten years because they can’t pay for indigent care.”
“We worked with colleagues from the University of Nevada School of Medicine and did two studies where we utilized generic screws from The Orthopaedic Implant Company (OIC). What we are extremely interested in is helping to decrease the cost of medical care. In a system where implant companies and reps are paid regardless of whether or not the providers and facilities get paid, something is wrong.”
“In the first study we had 45 femoral neck fracture patients treated with generic 7.3 mm cannulated screws made by OIC that were compared to 50 patients treated with screws made by traditional companies. We examined things like time in the OR, blood loss, complication rate, and length of stay. Everything was the same except for cost…the hospital saw a 67% cost reduction by using OIC’s generic screws! This resulted in an annual savings of $34, 653 for the hospital…and that’s just for ONE operation.”
“In the other study we compared 35 patients treated with generic cannulated screws from OIC with 44 patients treated with conventional screws for posterior pelvic ring injuries. In the generic group, surgeons implanted 45 screws and 40 washers. In the conventional group surgeons implanted 59 screws and 50 washers. A blind reviewer found there was no increase in operative time, estimated blood loss, complication rate, screw cutout, screw deformation or screw loosening. For the hospital this meant a 73% cost reduction, which translates to an annual savings of $14, 472.”
“The average drill bit we use costs around ten dollars to make—the big manufacturers sell it for $96—it’s just crazy. Note that these generic implants were biomechanically tested by an independent lab before we used them. The average doctor doesn’t know that all of the big companies make their screws, plates, and rods in the same manufacturing facilities…the one selling for $1, 000 was made on the same machine that the one selling for $200. Final thought: the market for cannulated screws is $393 million. Just imagine how much can be saved by using generics.”
Stem Cells for Extreme Foot and Ankle Problems
Chris Coetzee, M.D. is a foot and ankle specialist at Twin Cities Orthopedics in Minneapolis. He tells OTW, “My colleagues and I were seeing a number of complex nonunions and there were just not many options if someone has already had multiple surgeries. I had a patient who was scheduled for an amputation; this person was obviously interested in another option. I had just heard about using stem cells in these situations and we went forward and we were able to save this person the trauma of an amputation.”
“This study evolved from that experience, and is the first prospective randomized study to compare autologous bone graft to stem cells for fusions (the study only involves subtalar fusions). We are two-thirds of the way through the study, but at this point we can say that the stem cells are at least equal to the autologous bone graft. Each patient will be followed for three or four years afterwards, and will undergo periodic CT scans to evaluate their progress.”
Lawrence Crossett, M.D. To Be Honored
The University of Pittsburgh has announced that Dr. Lawrence Crossett, chief of the Adult Reconstruction Division within the Department of Orthopaedic Surgery at the University of Pittsburgh Medical Center, is the medical honoree for the 2012 Bone Bash. Dr. Crossett is also Assistant Professor of Orthopaedic Surgery at the University of Pittsburgh School of Medicine. He specializes in joint replacement surgery of the hip and knee as well as complex revision/reconstruction of those joints. Dr. Crossett has been consistently named as one of America’s Top Doctors and one of Pittsburgh’s Top Doctors. This event will take place at the Clear Story Studio in Pittsburgh on October 19, 2012.
