Are periprosthetic hip fractures more severe than native hip fractures? A systematic review of outcomes and resource utilization.

BACKGROUND: There is a paucity of data comparing periprosthetic hip fracture (PPHFx) outcomes and resource utilization to native fractures. Many surgeons consider periprosthetic hip fractures to be more severe injuries than native fractures. The aim of this systematic review is to characterize the outcomes of PPHFx and assess their severity relative to native hip fractures (NHFx). METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analysis systematic review was conducted using Medline, Biosis, and Cinahl. Primary outcomes were time to surgery, length of stay (LOS), cost of management, disposition, complication rates, readmission rates, and mortality. RESULTS: 14 articles (13,489 patients) from 2010 to 2018 were included in the study. Study quality was generally low. Patient follow-up ranged from 1 month to 3.2 years. LOS ranged from 5.2 to 38 days. US cost of management was best estimated at $53,669 ± 19,817. Discharge to skilled nursing facilities ranged from 64.5 to 74.5%. Time to surgery ranged from 1.9 to 5.7 days. Readmission rates ranged from 12 to 32%. Per Clavien-Dindo classification, 33.9% suffered minor complications; 14.3% suffered major complications. 1 month and 1 year mortality ranged from 2.9% to 10% and 9.7% to 45%, respectively. CONCLUSION: Time to surgery and LOS were longer for PPHFx relative to NHFx. Complications' rates were higher for PPHFx compared to NHFx. There is no evidence for differences in LOS, cost, discharge, readmission rates, or mortality between PPHFx and NHFx. These results may serve as a baseline in future evaluation of PPHFx management.

Patient Preferences and Perceptions of Provider Diversity in Orthopaedic Surgery.

BACKGROUND: Orthopaedic surgery in the U.S. historically has been among the least demographically diverse specialties in medicine. Currently, limited data exist on how patients perceive diversity within the field and what patients look for when choosing an orthopaedic surgeon. The purpose of this study was to identify specific patient preferences for surgeon demographics and understand patient perceptions of racial and gender diversity in orthopaedic surgery. METHODS: Nonconsecutive patients from orthopaedic clinics affiliated with a U.S. academic health system voluntarily completed a 39-item questionnaire that surveyed basic demographic information, perception of diversity, racial and gender preferences during surgeon selection, and perception of health-care inequalities. Bivariate analyses were used to test the association between patient-surgeon demographic variables and ratings of diversity. Multiple regression models were used to identify independent predictors of overall perceived diversity ratings. RESULTS: A total of 349 patients (80.6% White, 17.9% Black, and 1.5% other) were analyzed. Black patients were more likely to experience difficulty relating to their surgeon than White patients (11.48% versus 2.29%; odds ratio [OR], 5.62; 95% confidence interval [CI], 1.55 to 21.1; p = 0.004). Moreover, Black patients were more likely to perceive racial bias from their surgeon than White patients (5.17% versus 0.37%; OR, 14.44; 95% CI, 1.14 to 766.29; p = 0.02). While the level of racial diversity perceived by White patients (2.57 of 10) was significantly higher than that perceived by Black patients (2.10 of 10) (p = 0.001), the absolute difference between these 2 figures was small, suggesting that both groups perceived racial diversity in orthopaedics to be low. White and Black patients differed in their importance ranking of a surgeon's race (p < 0.0001): Black patients ranked a surgeon's race with higher importance (mean, 3.49 of 10) when selecting a surgeon compared with White patients (1.45 of 10). Both male and female patients gave relatively low importance rankings for a surgeon's gender (mean, 1.58 of 10 and 2.15 of 10, respectively, p = 0.02). CONCLUSIONS: Patients in this study did not perceive orthopaedic surgery as a diverse field (overall diversity rating, <3 of 10). There were significant racial and gender differences in patients' preferences for specific physician characteristics when choosing an orthopaedic surgeon, which may help explain some instances of perceived racial bias and difficulty relating to their orthopaedic surgeon.

Validation of a Novel Surgical Data Capturing System After Hip Arthroscopy.

INTRODUCTION: The purpose of this study is to compare the utility and validity of the OrthoMiDaS (Orthopaedic Minimal Data Set) Episode of Care (OME) database with the current benchmark for recording procedural details, the operative note (OpNote), with regard to disease severity and risk factors for hip arthroscopy cases. METHODS: A convenience sample of the first 100 hip arthroscopy cases for labral tears done at our institution between February and August 2015 were selected for this study. Surgeons recorded procedural details within OME after each case. An individual blinded to the OME data performed a chart review of the OpNote and/or implant log and recorded the information in a separate REDCap database. RESULTS: OME demonstrated higher completion rates than the OpNote for important procedural details such as previous left and right hip surgery (P < 0.001), anchor type (P = 0.008), and labrum tear clockface variables (P < 0.001 for both). In addition, OME exhibited "near-perfect" agreement with the OpNote for several important procedural details such as surgical limb (Kappa = 1.000), suture configuration (Kappa = 0.982), repair type (Kappa = 0.947), tear clockface: from (Kappa = 0.949), and tear clockface: to (Kappa = 0.885). On average, surgeons took 117 seconds to complete data entry within OME. CONCLUSION: The findings of this study validate the ability of OME to accurately and consistently capture important procedural details pertaining to arthroscopic hip surgery. Through the use of OME, high-quality standardized information can be captured and used to advance the field of hip arthroscopy by determining the clinically useful predictors of patient-reported outcome measures.