The American Association of Latino Orthopaedic Surgeons: Our History, Achievements, and Future Goals.

ABSTRACT: The mission of the American Association of Latino Orthopaedic Surgeons (AALOS) is to provide collegiality, advancement, education, and social justice for Latino orthopaedic surgeons and the minority populations they represent. We strive to enhance diversity within the field of orthopaedic surgery by increasing the visibility of AALOS, highlighting its core focus, and emphasizing its mission. The purposes of this article are to discuss the need for this organization and highlight its history and future goals. As AALOS recently celebrated its 15-year anniversary, we are excited to continue advancing the field of orthopaedic surgery and improving our patients' care.

Total joint replacement surgeon choice: A qualitative analysis in a medicare population.

INTRODUCTION: Previous research has shown that patients from historically marginalized groups in the United States tend to have poorer outcomes after joint replacement surgery and that they are less likely to receive joint replacement surgery at high-volume hospitals. However, little is known regarding how this group of patients chooses their joint replacement surgeon. The purpose of this study was to understand the factors influencing the choice of joint replacement surgeon amongst a diverse group of patients. METHODS: Semi-structured interviews were conducted with Medicare patients who underwent a hip or knee replacement within the last 24 months (N = 38) at an academic and community hospital. Interviews were audio recorded, transcribed and verified for accuracy. Transcripts were reviewed using iterative content analysis to extract key themes related to how respondents chose their joint replacement surgeon. RESULTS AND DISCUSSION: MD referral/recommendation appears to be the strongest factor influencing joint replacement surgeon choice. Other key considerations are hospital reputation and surgeon attributes-including operative experience, communication skills, and participation in shared decision-making. Gender/ethnicity of a surgeon, industry payments to surgeons, number of publications and cost did not play a large role in surgeon choice. CONCLUSION AND CLINICAL RELEVANCE: The process of choosing a joint replacement surgeon is a complex decision-making process with several factors at play. Despite growing availability of information regarding surgeons, patients largely relied on referrals for choosing their joint replacement surgeon regardless of ethnicity. Referring physicians need to ensure that patients are able to access hospital and surgeon outcomes, operative volume, and industry-payment information to learn more about their orthopedic surgeons in order to make an informed choice.

The Role of Gender, Academic Affiliation, and Subspecialty in Relation to Industry Payments to Orthopaedic Surgeons.

BACKGROUND: The Physician-Payments-Sunshine-Act (PPSA) was introduced in 2010 to provide transparency regarding physician-industry payments by making these payments publicly available. Given potential ethical implications, it is important to understand how these payments are being distributed, particularly as the women orthopaedic workforce increases. The purpose of this study was thus to determine the role of gender and academic affiliation in relation to industry payments within the orthopaedic subspecialties. METHODS: The PPSA website was used to abstract industry payments to Orthopaedic surgeons. The internet was then queried to identify each surgeon's professional listing and gender. Mann-Whitney U, Chi-square tests, and multivariable regression were used to explore the relationships. Significance was set at a value of P < 0.05. RESULTS: In total, 22,352 orthopaedic surgeons were included in the study. Payments were compared between 21,053 men and 1299 women, 2756 academic and 19,596 community surgeons, and across orthopaedic subspecialties. Women surgeons received smaller research and non-research payments than men (both, P < 0.001). There was a larger percentage of women in academics than men (15.9% vs 12.1%, P < 0.001). Subspecialties with a higher percentage of women (Foot & Ankle, Hand, and Pediatrics) were also the subspecialties with the lowest mean industry payments (all P < 0.001). Academic surgeons on average, received larger research and non-research industry payments, than community surgeons (both, P < 0.001). Multivariable linear regression demonstrated that male gender (P = 0.006, P = 0.029), adult reconstruction (both, P < 0.001) and spine (P = 0.008, P < 0.001) subspecialties, and academic rank (both, P < 0.001) were independent predictors of larger industry research and non-research payments. CONCLUSIONS: A large proportion of the US orthopaedic surgeon workforce received industry payments in 2014. Academic surgeons received larger payments than community surgeons. Despite having a larger percentage of surgeons in academia, women surgeons received lower payments than their male counterparts. Women also had a larger representation in the subspecialties with the lowest payments.

Academic Influence and Its Relationship to Industry Payments in Orthopaedic Surgery.

BACKGROUND: The Hirsch index (h-index) quantifies research publication productivity for an individual, and has widely been considered a valuable measure of academic influence. In 2010, the Physician Payments Sunshine Act (PPSA) was introduced as a way to increase transparency regarding U.S. physician-industry relationships. The purpose of this study was to investigate the relationship between industry payments and academic influence as measured by the h-index and number of publications among orthopaedic surgeons. We also examined the relationship of the h-index to National Institutes of Health (NIH) funding. METHODS: The h-indices of faculty members at academic orthopaedic surgery residency programs were obtained using the Scopus database. The PPSA web site was used to abstract their 2014 industry payments. NIH funding data were obtained from the NIH web site. Mann-Whitney U testing and Spearman correlations were used to explore the relationships. RESULTS: Of 3,501 surgeons, 78.3% received nonresearch payments, 9.2% received research payments, and 0.9% received NIH support. Nonresearch payments ranged from $6 to $4,538,501, whereas research payments ranged from $16 to $517,007. Surgeons receiving NIH or industry research funding had a significantly higher mean h-index and number of publications than those not receiving such funding. Surgeons receiving nonresearch industry payments had a slightly higher mean h-index and number of publications than those not receiving these kinds of payments. Both the h-index and the number of publications had weak positive correlations with industry nonresearch payment amount, industry research payment amount, and total number of industry payments. CONCLUSIONS: There are large differences in industry payment size and distribution among academic surgeons. The small percentage of academic surgeons who receive industry research support or NIH funding tend to have higher h-indices. For the overall population of orthopaedic surgery faculty, the h-index correlates poorly with the dollar amount and the total number of industry research payments. Regarding nonresearch industry payments, the h-index also appears to correlate poorly with the number and the dollar amount of payments. These results are encouraging because they suggest that industry bias may play a smaller role in the orthopaedic literature than previously thought.

Anterior and posterior cervical fusion in patients with high body mass index are not associated with greater complications.

BACKGROUND CONTEXT: Obesity has been associated with adverse surgical outcomes; however, limited information is available regarding the effect of obesity on cervical spinal fusion outcomes. PURPOSE: To determine the effect of obesity on complication rates after cervical fusions. STUDY DESIGN/SETTING: Retrospective cohort analysis of prospectively collected data on cervical fusion surgeries. PATIENT SAMPLE: Patients in the ACS-NSQIP database from 2005 to 2010 undergoing cervical anterior or posterior fusion. OUTCOME MEASURES: Primary outcome measures were 30-day postsurgical complications, including mortality, deep-vein thrombosis, pulmonary embolism, septic complications, system-specific complications, and having ≥1 complication overall. Secondary outcomes were time spent in the operating room, blood transfusions, length of stay, and reoperation within 30 days. METHODS: Patients undergoing anterior or posterior cervical fusions in the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program were selected using Current Procedural Terminology codes. Anterior cervical fusion patients were categorized into four groups on the basis of body mass index (BMI): nonobese (18.5-29.9 kg/m(2)), obese I (30-34.9 kg/m(2)), obese II (35-39.9 kg/m(2)), and obese III (≥40 kg/m(2)). Posterior cervical patients were categorized into two groups based on the basis of BMI: nonobese (18.5-29.9 kg/m(2)) and obese (≥30 kg/m(2)) due to the smaller sample size. Patients in the obese categories were compared with patients in the nonobese categories by the use of χ(2), Fisher's exact test, Student t test, and analysis of variance. Multivariate linear/logistic regression models were used to adjust for preoperative comorbidities. The authors report no sources of funding or conflicts of interest related to this study. RESULTS: Data were available for 3,671 and 400 patients who underwent anterior or posterior cervical fusion, respectively. Obese class III patients only showed a greater incidence of deep-vein thrombosis after anterior fusions on univariate analysis. Obese patients only showed longer mean surgical times and total operating room times after posterior fusions on univariate analysis. On multivariate analyses, these differences did not remain significant. There were also no differences in multivariate analyses for overall and system-specific complication rates, lengths of hospital stay, reoperation rates, and mortality among the obesity groups when compared with the nonobese groups with anterior or posterior cervical fusions. CONCLUSIONS: High BMI, regardless of obesity class, does not appear to be associated with increased complications after cervical fusion in the 30-day postoperative period.

Longitudinal urban-rural discrepancies in the US orthopaedic surgeon workforce.

BACKGROUND: It is unclear whether the supply of orthopaedic surgeons can meet the needs of a growing and aging population. This may be especially concerning in rural areas where there are known disparities in overall healthcare provision. QUESTIONS/PURPOSES: We therefore (1) determined urban-rural trends in the US physician and orthopaedic workforce (including the age of that workforce) from 1995 to 2010; (2) geographically mapped the physician and orthopaedic distribution; and (3) examined urban-rural changes in select nonorthopaedic musculoskeletal provider (chiropractor and podiatrist) workforces from 2000 to 2010. METHODS: County-level provider data from 1995 to 2010 were obtained from the Department of Health and Human Services. This was aggregated to Hospital Referral Regions and ranked by Rural-Urban Continuum Code. Hospital Referral Region-level data were mapped to identify geographic trends. Total physician and orthopaedic surgeon workforce data were averaged across the most urban and rural regions for the study period. RESULTS: There were urban-rural discrepancies in the physician and orthopaedic workforce from 1995 to 2010 with fewer orthopaedic surgeons in rural areas than urban areas (6.52 versus 8.73 per 100,000 in 2010; p=0.001). Furthermore, orthopaedic surgeons in rural areas were older than their urban counterparts, with a workforce age ratio (age>55: age<55 years) of 0.92 versus 0.65 in 2010 (p=0.024). From 2000 to 2010, the rural chiropractor and podiatrist workforces showed tremendous growth of 229.6% and 279.9%, respectively. CONCLUSIONS: There were significant urban-rural orthopaedic surgeon workforce discrepancies from 1995 to 2010. Concurrent growth in chiropractor and podiatrist numbers shows significant trends in the musculoskeletal provider workforce that warrant continuing observation and analysis. LEVEL OF EVIDENCE: Level IV, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.