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Large Joints Feature

Source: Wikimedia Commons and Julia Midgley

Under-Reporting Adverse Events; OREF and NIH Connection; Brad Bruns Wins “Healthcare Hero” Award

Elizabeth Hofheinz, M.P.H., M.Ed. • Tue, September 5th, 2017

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Why Adverse Events Are Under-Reported

Seeking to bring uniformity to the multiple ways of defining adverse events (AEs), Canadian researchers set out to test a certain system that would uses a common definition of AEs and a common capture and reporting system. Their work, “Factors Associated with Adverse Events in Inpatient Elective Spine, Knee, and Hip Orthopaedic Surgery,” appears in the August 16, 2017 edition of the Journal of Bone Joint Surgery.

Yoga Raja Rampersaud, M.D., a spine surgeon with the University of Toronto and Toronto Western Hospital and co-author on the study, told OTW, “In-hospital adverse events (AEs) following surgical procedures can have negative consequences for patients and are associated with increased costs to the system. Our previous work in spinal surgery has demonstrated that in-hospital AEs consume one dollar (direct cost) for every six spent on hospital care. Given the very high, and increasing, volume of surgical procedures for degenerative musculoskeletal conditions in North America, AEs in this population can have considerable individual and societal implications. Identifying factors associated with AEs in this population is the necessary first step towards developing strategies to mitigate the risk of AEs.”

“How AEs are captured, documented and reported is highly variable in practice and in the literature. There is often gross variation in what is defined as an AE within and across institutions, specialties, and procedures. The consequence is that findings with respect to identifying important correlates of adverse events are inconsistent, and thus often uninformative to developing appropriate mitigation strategies. A unique feature of our study was the use of Orthopaedic Surgical Adverse Events Severity (OrthoSAVES) system which uses a common definition of AEs and a common capture and reporting system for all orthopaedic surgical procedures to capture minor (often overlooked) to severe adverse events at the point of care.”

“We reported a higher adverse event rate than has typically been reported, particularly as more minor adverse events were included and adverse events were captured at point-of-care. This has implications for system practices and costs. Common risk factors across surgical procedures were identified. We also report that while the risk for an adverse event was higher in spine than hip and knee surgery, this greater risk was fully explained by differences in procedure times (i.e., longer in spine).”

“The incidence of AEs in elective surgery for degenerative conditions of the hip, knee and spine is relatively similar and substantial (25-29%). These higher reported rates are very much dependent on method of AE capture. Reliance on administrative data alone is not advised. A common case definition and approach to capturing the occurrence of adverse events is critical to help identify adverse event risk factors at a system, institutional and programmatic level. This enables the ability to leverage large data generation and apples-to-apples comparison within and across orthopaedic sub-specialties. Also, an increased focus on mitigation of typically ‘minor’ but highly frequent AEs that are common across the most frequent in-patient elective orthopaedic procedures may prove to be most cost-effective.”

“The use of a common case definition and approach to capturing the occurrence of adverse events is critically important to enable more accurate patient counseling regarding the risks of AEs within and across common elective orthopaedic procedures. Increasing age, male sex, revision surgery, length of stay, and increasing operative duration are common independent risk factors for an in-hospital adverse event associated with elective hip, knee and spine procedures.”

OREF Funding Sets Up NIH Funding

To what extent is the Orthopaedic Research and Education Foundation (OREF) a well-functioning launch pad for later funding from the National Institutes of Health (NIH)? A pretty reliable one, says new research. “The Relationship Between OREF Grants and Future NIH Funding Success,” is featured in the August 16, 2017 edition of the Journal of Bone and Joint Surgery.

Nicholas M. Bernthal, M.D., orthopedic surgeon with the David Geffen School of Medicine at the University of Los Angeles (UCLA) in California, told OTW, “The OREF is our field's top funder of early stage investigators. Part of its mission is to support investigators as they build their research skill set and program to be able to apply for federal funding. We really wanted to know if this process is working. Is this vehicle for identifying and supporting promising candidates translating into high level, federally funded musculoskeletal research? Honestly, for a young orthopedic surgeon-scientist, I wanted to know if this path I had been encouraged to take—get preliminary data, apply for OREF grants, get more data, apply for federal funding—was realistic.”

“The most interesting aspect for me was the OREF's willingness to share its internal data. I cold called leadership, explained the project, and they sent all their data. This study could have resulted in conclusions that would have negatively impacted them and they didn't hesitate. They believe in their mission and in their positive impact. Turns out they were absolutely correct to.”

“We were really astonished at just how successful the OREF is at identifying and supporting researchers who will go on to federal funding. I think young orthopedic surgeon-scientists can really feel confident in this pathway and should be applying to OREF if they are interested in establishing an independent research program.”

“NIH funding is not outside the realm of possibility for orthopedic surgeons. With a well laid out research plan, the path from OREF funding to NIH funding is well travelled and high-level paradigm shifting research is feasible in orthopedics.”

Brad Bruns, M.D. Named Phoenix Business Journal’s 2017 Healthcare Hero

Brad Bruns, M.D. / Courtesy of OrthoArizona

Brad Bruns, M.D., an orthopedic surgeon with OrthoArizona, has been recognized by The Phoenix Business Journal as part of this year’s group of 2017 Healthcare Heroes. Dr. Bruns, who has donated much of his time and expertise to those most in need, was named a winner in the Healthcare Hero “Physician” category for his orthopedic expertise and for donating his time to help ensure that those less fortunate receive access to quality orthopedic care.

As OrthoArizona wrote in its August 23, 2017 news release, “The prestigious annual ranking recognizes 25 influential Phoenix healthcare professionals from throughout the Valley who have gone above and beyond to improve patients’ lives, while making significant contributions toward the field of healthcare.”

“Dr. Bruns is a board-certified orthopedic surgeon in practice since 1985 with a special interest in total joint replacement, trauma, and sports medicine. He has sat on the OrthoArizona Board of Directors for more than 20 years. A proud Arizona native, Dr. Bruns serves as the covering physician for numerous Valley sports teams. He volunteers his time locally and abroad, having worked with the Share the Dream organization, the Arizona Dominican Medical Friends organization, Community Charity Surgery Services, St. Vincent DePaul, and Healing the Children. Dr. Bruns has been awarded the prestigious PHOENIX Magazine "Top Docs" title for 10+ years.”

"I am humbled and honored to have been recognized by The Phoenix Business Journal for my medical work and volunteer efforts, both of which inspire and motivate me every day,” said Dr. Bruns. “In being acknowledged for my work, my hope is to spur others in the medical profession to volunteer their time and ‘pay it forward’ to help others less fortunate."

“We congratulate Dr. Bruns on this outstanding and well-deserved accolade,” said OrthoArizona CEO John Kinna. “While he’s certainly considered a hero by the patients he serves, it is gratifying to see our colleague be recognized publicly for his expertise, compassion, and efforts to bring quality orthopedic care to all.”

Asked what he might say to convince other doctors to pay it forward, Dr. Bruns commented to OTW, "I would definitely recommend to other doctors, to take any and all chances to donate their services to charity groups—whether here or outside the country! They should not question whether they can help with their expertise—their training in the U.S. is at the top of their fields, and decades ahead of that in the 2nd and 3rd world countries they may ask to help!”

“Also, just when they are questioning whether they really can make a difference—a tennis player that can't serve as fast as they want, a person with a tension headache from being on the internet most of the day, or someone overweight that hasn't taken responsibility for their health issues—after dealing daily with those problems, you may start to doubt your worth—you will find numerous of these patients that can truly enhance and extend their lives through simple medical interventions and recommendations that you take for granted! There are numerous opportunities—make yourself available and interested to volunteer—and be flexible and innovative enough to adapt and be creative (that's where reading those old throw away journals come in handy)! You may not have the most up to date equipment—but look to anything that has been used before, to help in diagnosis and treatment—it is a no-lose situation for that particular patient!"

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