Academic and Demographic Characteristics of Orthopedic Adult Reconstruction Division Chiefs.

INTRODUCTION: Division chiefs play crucial leadership, administrative, and instructive roles within orthopedic subspecialties. The purpose of this study is to investigate the demographic and academic characteristics of division chiefs of adult reconstruction at fellowship institutions in the United States. METHODS: Adult reconstruction fellowship programs were identified using the American Association of Hip and Knee Surgeons database. Characteristic information about sex, race, academic rank, additional degrees, fellowship institution, and year of completion were collected. Hirsch indices (h-indices) of the division chiefs were collected from the Scopus database. RESULTS: Of the 120 adult reconstruction fellowship programs identified, 39 had a designated division chief of adult reconstruction. All of the division chiefs were male (n=39). Race breakdown was as follows: 74.4% were White (n=29), 12.8% were Asian (n=5), 7.7% were of mixed ethnicity (n=3), 2.6% were Latinx (n=1), and 2.6% were African American (n=1). The majority (53.8%; n=21) of division chiefs also held the academic rank of professor. The mean time since completion of fellowship was 21.7 ± 8.2 years and the mean h-index of the division chiefs was 24.9 ± 16.2. The fellowship programs that trained the most division chiefs were Massachusetts General Hospital (n=9) and the Hospital for Special Surgery (n=6). DISCUSSION: Division chiefs of adult reconstruction are integral leaders within their orthopedic subspecialty. An analysis of demographic and educational characteristics revealed a lack of diversity among adult reconstruction division chiefs in the United States. Deliberate efforts to increase the diversity of adult reconstruction leadership must be made to address these disparities.

The Most Impactful Articles on Cauda Equina Syndrome.

Cauda equina syndrome (CES) is an uncommon condition that can lead to permanent neurological deficits if not diagnosed and addressed promptly. Varying prognoses, including retropulsed fracture fragments, disc herniations, and epidural abscesses, can result in CES. Our objective was to identify the top 50 most impactful articles on CES and analyze the characteristics of these publications. In August of 2021, we used the Web of Science Core Collection bibliographic database to query the phrase "cauda equina syndrome." Articles between 1900 and 2021 were included in the search, and these articles were ranked based on the number of citations. The following variables were recorded: title, first author, journal, year of publication, number of citations, country of origin, the institution of publication, and topic of the paper. A total of 2096 articles matched the search criteria. The top 50 most impactful articles ranged from 43 to 439 in their number of citations. All articles on the list were published in English, with the year of publication ranging from 1938 to 2014. The United States accounted for the greatest number of articles published at 27. The medical journal Spine accounted for the greatest number of publications at nine. And the 2000s was the decade with the most cited articles. It is generally acknowledged that the clinical signals for CES are diverse with no predictive value on patient outcomes. Similar uncertainty exists in the etiology of the condition, though CES induced by spinal anesthesia is a factor of particular interest. Additionally, it is generally recognized that delayed diagnosis of the condition often results in permanent neurological deficits. Identification of the most impactful articles on CES is critical in drawing attention to this significant condition.

No decay in outcomes at a mean 8 years following surgical treatment for aseptic fracture nonunion.

PURPOSE: The purpose of this study is to compare medium to long term patient reported outcomes to one-year data for patients treated surgically for an aseptic fracture nonunion. METHODS: 305 patients surgically treated for a fracture-nonunion were prospectively followed. Data collected included pain scores measured by the Visual Analog Scale (VAS), clinical outcomes assessed by the Short Musculoskeletal Functional Assessment (SMFA), and range of motion. 75% of patients in this study had lower extremity fracture nonunions and 25% had upper extremity fracture nonunions. Femur fracture nonunions were the most common. Data at latest follow-up was compared to one-year follow-up using the independent t-test. RESULTS: Sixty-two patients were available for follow-up data at an average of eight years. There were no differences in patient reported outcomes between one and eight years according to the standardized total SMFA (p = 0.982), functional index SMFA (p = 0.186), bothersome index SMFA (p = 0.396), activity index SMFA (p = 0.788), emotional index SMFA (p = 0.923), or mobility index SMFA (p = 0.649). There was also no difference in reported pain (p = 0.534). Range of motion data was collected for patients who followed up in clinic for an average of eight years after their surgical treatment. 58% of these patients reported a slight increase in range of motion at an average of eight years. CONCLUSION: Patient functional outcomes, range of motion, and reported pain all normalize after one year following surgical treatment for fracture nonunion and do not change significantly at an average of eight years. Surgeons can feel confident in counseling patients that their results will last and they do not need to follow up beyond one year, barring pain or other complications. LEVEL OF EVIDENCE: Level IV.

What are the academic and demographic characteristics of orthopaedic spine surgery division chiefs?

Background: To our knowledge no analysis of academic orthopedics division chiefs (DC) exists in the current orthopedic literature. Serving as a Division Chief may be a career milestone or an opportunity to lead and transition to additional leadership roles. Our objective is to answer the following questions (1) Are there academic characteristics common to Spine divisions chiefs? (2) Are there demographic characteristics common to Spine division chiefs? (3) Do most Spine division chiefs train at certain fellowships? Methods: Allopathic residency program websites were used to locate DC and Division Co-Chiefs (DCC). Academic characteristics evaluated included: H-index, academic rank, number of degrees, additional leadership titles, the availability of fellowship training and service as past/current society president and participation in travelling fellowships. Demographic characteristics including gender and race were collected. Years since completions of fellowship and which fellowship program the DC/DCC trained at were collected. Results: 102 DC/DCC were identified and had an average H-index of 22.1. The majority (48%) had an academic rank of Professor, 29% Associate Professor, 16% Assistant Professor and 8% rank could not be identified. 45% had additional leadership positions within their department and 18% had additional graduate degrees. Two institutions had designations of co-chiefs. The majority (57%) offered spine fellowships at their institution. The majority of DC were males (99%) and White (72.5%). On average the DC/DCC were 19.5 years past their fellowship completion. 19% participated in at least one travelling fellowship and 14% served as a president of a Spine or Orthopaedic Society. Conclusions: Spine surgery division chiefs are 99% male, with a rank of Professor and trained at select fellowship programs. Nearly half of spine surgery division chiefs held concurrent administrative roles in the department and 14% have served as President of a spine or Orthopaedic society. There is room to Improve on the gender and ethnic/racial diveristy of spine surgery division chief leadership.

Usage of a Value-based Triaging Methodology for Assessing Improvements in Value for Hip Fracture Inpatient Episodes of Care From 2014 to 2019: A Pilot Study.

INTRODUCTION: The purpose of this study was to demonstrate a novel technology used to measure improvements in quality and value of care for treatment of hip fracture patients. METHODS: A novel value-based triaging methodology uses a risk prediction (risk M) and inpatient cost prediction (risk C) algorithm and has been demonstrated to accurately predict high-risk:high-cost episodes of care. Two hundred twenty-nine hip fracture patients from 2014 to 2016 were used to establish baseline length of stay (LOS) and total inpatient cost for each (16) risk:cost quadrants. Two hundred sixty-five patients between 2017 and 2019 with hip fractures were input into the algorithm, and historical LOS and cost for each patient were calculated. Historical values were compared with actual values to determine whether the value of the inpatient episode of care differed from the 2014 to 16 cohort. RESULTS: When evaluated without risk or cost stratification, the mean actual LOS and cost of the baseline cohort compared with the 2017 to 2019 cohort were 8.0 vs 7.5 days (P = 0.43) and $25,446 vs $29,849 (P = 0.15), respectively. This analysis demonstrates that there was only a small change in value of care provided to patients based on LOS/cost over the studied period; however, risk:cost analysis using the novel methodology demonstrated that for select risk:cost quadrants, value of care measured by LOS/cost improved, whereas for others it decreased and for others there was no change. CONCLUSION: Risk-cost-adjusted analysis of inpatient episodes of care rendered by a value-based triaging methodology provides a robust method of assessing improvements and/or decreases in value-based care when compared with a historical cohort. This methodology provides the tools to both track hospital interventions designed to improve quality and decrease cost as well as determine whether these interventions are effective in improving value.