Industry Payments to Foot and Ankle-Trained Orthopedic Surgeons: An Analysis of the Open Payments Database From 2014 to 2019.

Introduction The authors examined if the transparency in industry payments to foot and ankle-trained orthopedic surgeons resulted in the following changes to the (1) median general payments to surgeons, (2) trend in median payments to surgeons across all subcategory payments, and (3) trend in median payments to surgeons in 11 regions of the United States. Methods A retrospective review of the Centers for Medicare and Medicaid Services (CMS) and Open Payments Database (OPD) was performed to identify all industry payments made by drug and medical device companies to orthopedic surgeons (N = 3,835) between January 1, 2014, and December 31, 2019. Descriptive statistics were calculated, and trend analyses in annual payments, number of payments to surgeons per year, payment subtypes, and regional distributions were analyzed. Results A total of 53,280 payments totaling $53,454,850.56 were made to orthopedic foot and ankle surgeons between 2014 and 2019. Mean and median payments were $1,003.28 and $60.19, respectively. Statistically significant differences in mean payment amounts were observed by year (p = 0.001) with a highly statistically significant, strong increase in the number of payments made over the six-year period (r = 0.97, p < 0.001). The greatest increases in median individual payments were observed for gifts (277.1%; r = 0.18, p = 0.05), education (250.6%; r = 0.17, p < 0.001), and royalties and licensing (72.1%; r = 0.05, p = 0.04). Statistically significant increasing trends in median payments over time were observed for the Northeast (p < 0.001) and South regions (p < 0.001). Discussion The results of this study demonstrate the increase in payments made across the six-year time period. The study demonstrates that there is a shift in the type of payments from speaker fees, entertainment, and lodging to education, gifts, honoraria, royalties, and consulting. Conclusion Since the OPD release, no significant decrease was identified in the financial relationship between foot and ankle surgeons and the industry; rather, an increase was observed. This increase in education, royalties, and consulting shows that more foot and ankle surgeons are getting involved in the industry, contrary to expectations. The partnership between industry and physicians can help to improve innovation and bring new ideas to the future of orthopedics.

Management of Grade 1 Open Distal Radius Fractures: A Survey of Practicing Surgeons.

Introduction Standard of care management for open fractures historically mandates emergent systemic antibiotic administration, followed by urgent irrigation and debridement in the operating room, regardless of injury severity. However, significant controversy exists regarding the specific implementation and importance of these commonly accepted guidelines. We aimed to define differences in the management of grade 1 open distal radius fractures. Methods An anonymous online survey was distributed to attending surgeon members of either the Orthopaedic Trauma Association (OTA) between January 2019 and April 2019 or the New York Society for Surgery of the Hand (NYSSH) in January 2019. Results A total of 68 attending surgeons responded to the survey. A total of 24 OTA members and 40 NYSSH members replied and were included in the study. Several factors influenced management in addition to the level of contamination. Of the surgeons, 68% stated that litigation was not a major factor of concern. When compared to surgeons who trained in trauma fellowships, more surgeons who trained in hand/upper extremity fellowships considered closed reduction alone as reasonable definitive treatment (when excluding antibiotic administration and debridement considerations, p = 0.024) and oral antibiotics as a supplement to IV antibiotics (p < 0.001). Of the surgeons, 90% would nonoperatively treat a patient who presented with a grade 1 open distal radius fracture greater than 72 hours after injury with stable and acceptable alignment on X-rays. Conclusion Some surgeons are willing to deviate from standard-of-care management protocols.

Industry Payments to Orthopedic Surgeons Among All Subspecialties: An Analysis of the Open Payments Database From 2014 to 2019.

Introduction Since the passage of the Physician Payments Sunshine Act in 2010, the Centers for Medicare and Medicaid Services (CMS) started the National Physician Payment Transparency Program and Open Payments Database (OPD), which allowed for public access to financial disclosures between physicians and industry. Although orthopedic surgeons receive the highest average payments when compared to other specialties, there has been limited data evaluating these payments among the different orthopedic subspecialties. The purpose of this study was to analyze all industry payments made across all subspecialties among orthopedic surgeons. Methods A retrospective review of the CMS OPD was performed to identify all industry payments made by drug and medical device companies to orthopedic surgeons (N = 28,475) between January 1, 2014, and December 31, 2019. Descriptive statistics were calculated for the number, individual value, and total value of industry payments, stratified by payment type and orthopedic subspecialty. Results A total of 1,048,573 payments (approximately $1.6 billion) were made to orthopedic surgeons between 2014 and 2019. The average orthopedic surgeon received 6.14 payments per year (SD = 29.39), with a mean individual payment amount of $1,542.32. Royalties or licensing comprised the greatest proportion of open payments, followed by consulting fees. Adult reconstruction (M = $225,131.10) and spine (M = $197,404.74) received significantly greater total payments when compared to all other subspecialties (all p-values ≤ 0.001). Differences in total payments made to trauma (M = $73,789.65), sports medicine (M = $60,988.09), foot and ankle (M = $45,007.45), pediatric orthopaedics (M = $35,898.54), general orthopaedics (M = $28,405.81), and hand (M = $14,027.76) were all found to be statistically equivalent (all p--values > 0.20). Discussion Increased collaboration between physicians and industry has resulted in the rapid advancement of innovation that can have sizeable financial implications among orthopedic surgeons. There exists significant heterogeneity in open payments made to orthopedic surgeons when stratified by subspecialty. Adult reconstructive and spine surgeons were the most compensated whereas hand and general orthopaedic surgeons received the least.

Immediate Weight-bearing Through Walker or Crutches After Surgical Fixation of Clavicle Fractures in Patients With Lower Extremity Fractures: A Retrospective Cohort Study.

OBJECTIVES: To assess the safety of immediate upper extremity weight-bearing as tolerated (WBAT) rehabilitation protocol after clavicle fracture open reduction internal fixation (ORIF). DESIGN: Retrospective cohort study. SETTING: Three Level 1 trauma centers. PATIENTS SELECTION CRITERIA: Patients older than 18 years who had ORIF of mid-shaft clavicle fractures and lower extremity fractures who were allowed immediate WBAT on their affected upper extremity through use of a walker or crutches were included. All clavicles were fixed with either precontoured clavicular plates or locking compression plates. Included patients were those who had clinical/radiographic follow-up until fracture union, nonunion, or construct failure. OUTCOME MEASURES AND COMPARISONS: WBAT patients were matched in a one-to-one fashion to a cohort with isolated clavicle fractures who were treated non-weight-bearing (NWB) postoperatively on their affected upper extremity. Matching was done based on age, sex, and temporality of fixation. After matching, treatment and control groups were compared to determine differences in possible confounding variables that could influence the primary outcome, including patient demographics, fracture classification, cortices of fixation, and construct type. All patients were assessed to verify conformity with weight-bearing recommendation. Primary outcome was early hardware failure (HWF) with or without revision surgery. Secondary outcomes included postoperative infections and union of fracture. RESULTS: Thirty-nine patients were included in the WBAT cohort; there were no significant differences with the matched NWB cohort based on patient demographics. Both the WBAT and the NWB cohorts had 2.5% chance of acute HWF that required surgical intervention ( P = 1.0). Additionally, there was no difference in overall HWF ( P = 0.49). All patients despite weight-bearing status including those who required revision ORIF for acute HWF had union of their fracture ( P = 1.0). CONCLUSIONS: Our data would support that immediate weight-bearing after clavicle fracture fixation in patients with concomitant lower extremity trauma does not lead to an increase in HWF or impact ultimate union. This challenges the dogma of prolonged postoperative weight-bearing restrictions and allow for earlier rehabilitation. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cannabidiol as a treatment for arthritis and joint pain: an exploratory cross-sectional study.

INTRODUCTION: An estimated 54 million Americans currently suffer from debilitating arthritis. Patients who have exhausted conservative measures can be subject to chronic pain and resort to symptomatic management with anti-inflammatories, acetaminophen, and opioids. Cannabidiol (CBD) is a non-psychoactive cannabinoid that has shown promise in preclinical studies to reduce inflammation and pain associated with arthritis. The purpose of this study was to explore patient perceived effects of cannabidiol on symptoms of arthritis. METHODS: A novel anonymous questionnaire was created to evaluate perceived efficacy of cannabidiol for the treatment of arthritis. A self-selected convenience sample (N=428) was recruited through online methods including social media accounts and newsletters (The Arthritis Foundation and Savvy Cooperative) between May 5, 2020, and November 5, 2020. Statistical analysis was performed to determine differences between types of arthritis and improvements in quality-of-life symptoms. Furthermore, a regression analysis was performed to identify variables associated with decreasing or discontinuing other medications. RESULTS: CBD use was associated with improvements in pain (83%), physical function (66%), and sleep quality (66%). Subgroup analysis by diagnosis type (osteoarthritis, rheumatoid, or other autoimmune arthritis) found improvements among groups for physical function (P=0.013), favoring the osteoarthritis group. The overall cohort reported a 44% reduction in pain after CBD use (P<0.001). The osteoarthritis group had a greater percentage reduction (P=0.020) and point reduction (P<0.001) in pain compared to rheumatoid arthritis and other autoimmune arthritis. The majority of respondents reported a reduction or cessation of other medications after CBD use (N=259, 60.5%): reductions in anti-inflammatories (N=129, 31.1%), acetaminophen (N=78, 18.2%), opioids (N=36, 8.6%) and discontinuation of anti-inflammatories (N=76, 17.8%), acetaminophen (N=76, 17.8%), and opioids (N=81, 18.9%). CONCLUSION: Clinicians and patients should be aware of the various alternative therapeutic options available to treat their symptoms of arthritis, especially in light of the increased accessibility to cannabidiol products. The present study found associations between CBD use and improvements in patient's arthritis symptoms and reductions in other medications. Future research should focus on exploring the benefits of CBD use in this patient population with clinical trials.

The Association of Immediate-Use Steam Sterilization with the Incidence of Orthopaedic Surgical Site Infections: A Propensity Score-Matched Cohort Study.

BACKGROUND: Immediate-use steam sterilization (IUSS), formerly termed "flash" sterilization, has been historically used to sterilize surgical instruments in emergency situations. Strict guidelines deter its use, as IUSS has been theorized to increase the risk of surgical site infections (SSIs), leading to increased health-care costs and poor patient outcomes. We sought to examine the association between the use of IUSS and the rate of orthopaedic SSIs. METHODS: The cases of 70,600 patients who underwent orthopaedic surgery-total knee or hip arthroplasty, laminectomy, or spinal fusion-from January 2014 to December 2020, were retrospectively reviewed for IUSS use. Of this group, 3,526 patients had had IUSS used during surgery. A propensity score-matched (PSM) analysis was conducted to account for known predictors of SSIs and included a total of 7,052 patients. The risk difference (RD), relative risk (RR), odds ratio (OR), and McNemar test compared the SSI risk for patients whose procedure had included the use of IUSS and those whose procedure had not included IUSS. RESULTS: After propensity score matching, 111 (1.57%) of the 7,052 matched patients developed an SSI. Of the 111 patients, 61 (54.95%) were in the IUSS group and 50 (45.05%) were in the non-IUSS group. The estimated probability for developing an SSI was 1.42% for the patients in the non-IUSS group versus 1.73% for the patients in the IUSS group (RR = 0.82 [95% confidence interval (CI)]: 0.57 to 1.19], RD = -0.3% [95% CI: -0.9% to 0.27%]).There was no evidence that the proportion of SSI was greater in the IUSS group (McNemar test, p > 0.29). CONCLUSIONS: SSI rates were not significantly different between IUSS and non-IUSS patients undergoing orthopaedic surgery. Future prospective studies are warranted to further explore the utility of IUSS during orthopaedic procedures. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Predictors of Staphylococcus Aureus Nasal Colonization in Joint Arthroplasty Patients.

Early identification and treatment of Staphylococcus aureus (S. aureus) nasal colonization can reduce the risk of prosthetic joint infection. The purpose of this study was to evaluate patient-specific predictors for S. aureus nasal colonization in total joint arthroplasty patients to aid in preoperative screening protocols. A total of 2,147 arthroplasty patients who were preoperatively screened for S. aureus nasal colonization were retrospectively reviewed. Factors analyzed consisted of procedure type, primary diagnosis, gender, ethnicity, body mass index, the presence of chronic obstructive pulmonary disease, obstructive sleep apnea, hypertension, diabetes mellitus, use of immunosuppression medication, smoking history, and chronic kidney disease. Univariate and multivariate analyses were performed with significance p < 0.05 and 95% confidence intervals. Overall, 3.7% (79) of our cohort tested positive for methicillin-resistant Staphylococcus aureus (MRSA), and 23.2% (493) tested positive for methicillin-sensitive Staphylococcus aureus (MSSA). Independent predictors for MRSA colonization were of Hispanic ethnicity (p = 0.001, odds ratio [OR] 13.98, confidence interval [CI] 2.97-65.76), immunosuppression medication use (p = 0.006, OR 2.82, CI 1.35-5.87), and revision total hip arthroplasty (THA) procedure (p < 0.001, OR 7.51, CI 2.58-21.89). Independent predictors for MSSA colonization were body mass index (BMI) >35 (p = 0.002, OR 1.57, CI 1.19-2.1). Variables were found to be protective against MSSA colonization including female gender (p = 0.012, OR 0.76, CI 0.61-0.94), age 60 to 69 (p = 0.025, OR 0.75, CI 0.58-0.96), and age 70 to 79 (p = 0.002, OR 0.63, CI 0.47-0.84). Age, Hispanic ethnicity, gender, revision THA, use of immunosuppression medication, and elevated BMI were independent risk factors for S. aureus nasal colonization.

Patient Satisfaction After Lower Extremity Total Joint Arthroplasty: An Analysis of Medical Comorbidities and Patient Demographics.

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey has received increased attention to determine which demographics may influence patient satisfaction after Total Hip and Knee Arthroplasty. The purpose of this study was to evaluate the various effects that patient-specific factors, medical comorbidities, and demographics had on patient satisfaction. Two thousand and ninety-two patients underwent lower extremity total joint arthroplasty at our institution between 2014 and 2018. Nine hundred twenty-three of these patients responded to their HCAHPS survey (44%). Most patients (609, 66%) underwent primary total knee arthroplasty followed by 244 (26.4%) total hip arthroplasties, 35 (3.8%) revision total knee arthroplasties, 28 (3.0%) bilateral total knee arthroplasties, and 7 (0.8%) revision total hip arthroplasties. Increasing age and length of stay were associated with a decrease in patient satisfaction whereas patients who were married reported higher satisfaction. Patients discharged to a rehabilitation facility had a 12% decrease in top-box response rate compared to those discharged home. Contrary to our hypothesis, specific procedure type and the presence of comorbidities failed to predict patient satisfaction. The results of this study shed light on the intricate relationship between patient satisfaction and patient-specific factors. Furthermore, health care workers can counsel patients on expected satisfaction when considering total hip and knee arthroplasty.

The Influence of the Sunshine Act on Industry Payments to United States Orthopaedic Sports Medicine Surgeons.

PURPOSE: The purpose of the present study is to investigate trends in overall payments to orthopaedic sports medicine surgeons reported by the Open Payments Database (OPD) over the 6 full years of available data (2014-2019). METHODS: A retrospective review of industry payments to United States sports medicine trained orthopaedic surgeons from 2014 to 2019 was performed using the Centers for Medicare and Medicaid Services OPD. Total payments and subtype payments were analyzed for yearly trends. Regional analysis was also performed. The primary outcome was the overall trend in total median payments (defined as the median total payments per surgeon per year), which was assessed via the Jonckheere-Terpstra test. Descriptive statistics include medians with interquartile ranges. P values < .05 were considered statistically significant. RESULTS: From 2014 to 2019, there were a total of 1,941,772 payments to 12,816 sports medicine orthopaedic surgeons. The median payments to surgeons demonstrated a significant upward trend (P < .001). The total number of payments (r = 0.002; P = .99) did not significantly correlate with changing year. The top 5 compensated surgeons received 45.8% of all industry contributions with a median total payment of $9,210,974.06 (interquartile range: 25,029,951.46). The majority of industry contributions in the top 5 earners were attributed to royalties and licenses (98.7%). Across the study period, 89.4% of the total orthopaedic sports medicine surgeons received a yearly total payment less than $10,000, which made up 8.3% of the total industry payment sum. Those receiving a yearly total payment greater than $500,000 accounted for 0.3% of surgeons but received 53.4% of the sum payments. We found a yearly increasing trend in payments in all regions including the Midwest, South, Northeast, and West (P < .001, P < .001, P < .001, and P = .006). CONCLUSION: Despite the transparency of reporting mandated by the Sunshine Act, orthopaedic sports medicine surgeons have continued to maintain industry relationships with a notable disparity in distribution. CLINICAL SIGNIFICANCE: Our analysis suggests continued relationships among sports medicine surgeons and industry. Future research is needed to determine how this impacts medical practice in the United States.

The Effect of Operating Room Size on Orthopaedic Surgical Site Infection Rates.

OBJECTIVE: With many preventable causes of surgical site infections (SSIs) identified, the effect of operating room (OR) size on SSI rates has not been assessed. This study investigated the effect of OR size on incidence of SSIs for orthopaedic procedures. BACKGROUND: SSIs remain a common complication within the perioperative realm. Responsible for increasing length of hospitalization and costs, SSIs result in a decreased quality of life for patients. METHODS: A retrospective review of 11,163 patients who underwent orthopaedic surgery-including total knee and hip arthroplasties, laminectomies, and spinal fusions-between January 2018 and January 2020 were reviewed. Total net square footage (NSF) of all ORs was recorded, and incidence of SSIs was calculated. Cases were categorized based on the size of the OR (small: 250 to 399 NSF; medium: 400 to 549 NSF; and large: 550 to 699 NSF). Chi-square analysis compared infection rates between the different OR sizes, and a binary logistic regression model identified other predictors of infection. RESULTS: Overall, 137 patients (1.2%) developed an SSI. Of these infections, 16 (11.7%) occurred in small ORs, 83 (60.6%) in medium ORs, and 38 (27.7%) in large ORs. The incidence of SSIs was 0.7% in small ORs, 1.3% in medium ORs, and 1.8% in large ORs. Factors found to significantly impact SSI's included medium-sized ORs, younger patients, procedure type (fusions and emergencies/traumas), longer procedures, and higher American Society of Anesthesiologists scores (>3). CONCLUSION: Our study shows that OR size in addition to various other perioperative parameters plays a role in the rate of SSIs for orthopaedic procedures. LEVEL OF EVIDENCE: Retrospective Cohort Study; Level III Evidence.

Return-to-Driving Recommendations After Lower-Extremity Orthopaedic Procedures.

Following lower-extremity orthopaedic surgery, recommendations for safe return to driving include at least 6 to 12 weeks for a right ankle fracture, 2 days to 2 weeks for a right ankle arthroscopy, 6 to 9 weeks for a total ankle arthroplasty, 6 to 7 weeks for a right Achilles tendon rupture repair, 1 to 4 weeks for a right total knee arthroplasty, 2 weeks for a left total knee arthroplasty, 3 to 6 weeks for a right anterior cruciate ligament repair, and 1 to 4 weeks for a total hip arthroplasty. Important individual factors such as extent of injury, laterality of injury, current driving habits, type of vehicle transmission (manual or automatic), and medical comorbidities must be taken into consideration. State laws vary widely and often use vague language to describe the legal responsibilities that orthopaedic surgeons have when providing return-to-driving recommendations.

Risk factors for complications and in-hospital mortality: An analysis of 19,834 open pelvic ring fractures.

BACKGROUND: Open pelvic fractures are rare injuries, associated with high patient morbidity and mortality. Few studies have investigated the impact of patient demographics, comorbidities, and injury related factors on complication and mortality rates. The purpose of this study was to: (1) identify the overall incidence of complications and mortality after open pelvic fractures, (2) compare patient factors between those who did and did not develop complications, (3) identify perioperative independent risk factors for complications and mortality. METHODS: A query was performed for patients with open pelvic fractures between 2007 and 2017 using the American College of Surgeons National Trauma Data Bank. Patient and injury specific variables were collected and complications were identified using International Classification of Disease Ninth and Tenth edition Codes. Patient demographic and perioperative data was compared using Fisher's exact test and chi-square test for categorical variables, and Welch's t-test for continuous variables. Using pooled data from multiple imputations, logistic regressions were used to calculate odds ratios and confidence intervals of independent risk factors for complications. RESULTS: A total of 19,834 open pelvic fracture cases were identified, with 9622 patients (48.5%) developing at least one complication. Patients who developed complications were older (35.0 vs 38.1 years), and had higher Injury Severity Scores (17.7 vs 26.5), lower Glasgow Coma Scores (14.2 vs 11.7), and a larger proportion presenting with hypotension (21% vs 6.9%). After pooled regression involving 19 factors, these were the strongest independent predictors of inpatient complication and mortality. CONCLUSION: We report a mortality rate of 14%, with an inclusive complication rate of 48.5%. Evaluating risk factors for morbidity and mortality for this devastating orthopaedic injury provides knowledge of an inherently sparse population. LEVEL OF EVIDENCE: Level II, Retrospective study.

Radiation Exposure in Orthopaedics.

¼ The damaging effects to human tissue caused by radiation exposure have been documented since the first reports regarding use of radiographs in the late nineteenth century. ¼ Orthopaedic surgeons and residents often are undereducated about the risks associated with radiation exposure and the recommended safety precautions to help mitigate these potential risks. ¼ Orthopaedic surgeons need to adopt the ALARA (as low as reasonably achievable) principle: whenever possible, all available precautions should be taken to keep all members of the operating room safe from radiation exposure while emphasizing the best appropriate care for patients. ¼ An emphasis on radiation safety and protection should be universally incorporated into graduate medical education.

Association of Disposable Perioperative Jackets With Surgical Site Infections in a Large Multicenter Health Care Organization.

Importance: To help prevent surgical site infections (SSIs), recommendations by a national organization led to implementation of a mandatory operating room policy in a large multicenter health care organization of required use of disposable perioperative jackets. Objective: To assess whether the use of perioperative disposable jackets is associated with the incidence of SSIs. Design, Setting, and Participants: Surgical site infection data for patients undergoing clean surgical procedures were retrospectively reviewed from 12 hospitals in a large multicenter health care organization during a 55-month period from January 1, 2014, to July 31, 2018. The incidence of SSI was analyzed for all National Healthcare Safety Network monitored and reported procedures. The patient population was split into 2 groups; the preintervention group consisted of 29 098 patients within the 26 months before the policy starting March 1, 2016, and the postintervention group consisted of 30 911 patients within 26 months after the policy. Main Outcome and Measures: Comparison of the incidence of SSIs before and after intervention periods underwent statistical analysis. The total number of disposable jackets purchased and total expenditures were also calculated. Exposures: Implementation of the mandated perioperative attire policy. Results: A total of 60 009 patients (mean [SD] age, 62.8 [13.9] years; 32 139 [53.6%] male) were included in the study. The overall SSI incidence for clean wounds was 0.87% before policy implementation and 0.83% after policy implementation, which was not found to be significant (odds ratio [OR], 0.96; 95% CI, 0.80-1.14; P = .61). After accounting for possible confounding variables, a multivariable analysis demonstrated no significant reduction in SSIs (OR, 0.85; 95% CI, 0.71-1.01; P = .07). During the postintervention study period (26 months), a total of 2 010 040 jackets were purchased, which amounted to a cost of $1 709 898.46. Conclusions and Relevance: The results of this study suggest that the use of perioperative disposable jackets is not associated with reductions in SSI for clean wounds in a large multicenter health care organization and presents a fiscal burden.

Impact of a Resident-Guided Rounding Initiative on the Hospital Consumer Assessment of Healthcare Providers and Systems Survey Scores in Orthopaedic Surgery Inpatients.

Patient-centered medicine is becoming the main focus of many healthcare systems, and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a tool used to track patient satisfaction. In this study, we evaluate the HCAHPS scores in orthopaedic surgery inpatients before and after implementation of a resident-guided rounding protocol. Analyses of the HCAHPS surveys for 154 orthopaedic surgical inpatients at one community hospital were compared 6 months before and after implementation of a resident-guided rounding initiative. Specific questions of the HCAHPS survey were analyzed using the top box, mean, and positive scores. Implementation of the rounding initiative resulted in an increase in the top box, mean, and positive scores for all questions evaluated; however, no significance was noted in the results, with the exception of the positive score for a staff cohesiveness question (P = 0.046). Physician and hospital recommendation questions showed a 5-point increase (91st to 96th percentile) compared with 42-point increase (21st to 63rd percentile) by publicly reported national data. Implementation of the rounding initiative resulted in increases in HCAHPS scores across multiple questions and domains; however, these were not significant. These results suggest that simple interventions can help increase the overall patient satisfaction and promote future investigations.

Additive effect of continuous adductor canal block and liposomal bupivacaine periarticular injection in total knee arthroplasty.

BACKGROUND: Novel methods of postoperative analgesia for total knee arthroplasty (TKA) have demonstrated improved functional outcomes and decreased narcotic consumption. These approaches include continuous adductor canal blocks (CACB) and periarticular injection (PAI). There is a lack of current understanding regarding the effect of these modalities on narcotic usage, functionality, and pain when both PAI and CACB are utilized compared to PAI alone. METHODS: TKAs were performed unilaterally by a single surgeon with a standardized protocol. Patients were divided into two groups: those receiving PAI alone (n = 54) and those receiving PAI and CACB (n = 37). Patient outcomes including, narcotics usage, pain scale, and distance walked, were recorded on postoperative day (POD) zero through three. RESULTS: When compared with PAI alone, it was identified that concurrent use of PAI and CACB results in a statistically significant decrease in narcotics usage on POD 0, 1, 3, and total narcotic usage while admitted. Patients in the PAI and CACB group walked significantly farther than patients in the PAI only group on POD 1, 2, and 3. On POD 0, patients in the PAI and CACB reported significantly less pain with activity when compared to the PAI only group. CONCLUSION: Here we identify an additive effect when utilizing both PAI and CACB for postoperative TKA analgesia. Our findings demonstrate significant decrease in patient total narcotic usage, pain scores, and an increase in walking distance when utilizing PAI and CACB compared with PAI alone. This analgesic technique may help reduce patients' narcotic use while also increasing functional outcomes.