Hospital Resource Utilization Associated With Endoprosthetic Reconstruction Versus Primary Arthroplasty.

Endoprosthetic reconstructions of the hip and knee are currently reimbursed as primary hip and knee arthroplasty according to Current Procedural Terminology (CPT) coding guidelines. The purpose of this study was to compare hospital resources consumed by patients undergoing endoprosthetic reconstruction with those consumed by patients undergoing primary arthroplasty. The authors' hypothesis was that the former group carries more comorbidities, experiences longer length of stay (LOS), and has greater resource consumption. A retrospective review was performed of 61 patients undergoing endoprosthetic reconstruction and 745 patients undergoing primary hip or knee arthroplasty between 2015 and 2018 at a single institution. Demographic, clinical, and financial data were compared. The Charlson Comorbidity Index (CCI) was used to measure patients' health status and identify comorbidities associated with prolonged LOS through linear regression analysis. Patients who underwent endoprosthetic reconstruction had a greater than 3.5 times average LOS compared with primary arthroplasty patients: 10.81 days vs 2.94 days (P<.01). They demonstrated a higher mean CCI, higher rates of malignancy and pulmonary disease, and a wider age range. Their mean cost of care totaled $73,730.29, compared with $24,940.84 imposed by primary arthroplasty patients (P<.01). Significant predictors of LOS were malignancy status (metastatic or localized) and age younger than 50 years, with increased LOS being associated with increased cost. Patients undergoing endoprosthetic reconstruction of the hip and knee represent a fundamentally different patient population than primary arthroplasty patients based on comorbidities, variability in health status, and surgical indications. They have higher comorbidity scores and longer hospitalizations and consume more financial resources than primary arthroplasty patients. [Orthopedics. 2021;44(1):e73-e79.].

The Efficacy of Medical Marijuana in the Treatment of Cancer-Related Pain.

Background: The opioid epidemic has spurred investigations for nonopioid options, yet limited research persists on medical marijuana's (MMJ) efficacy in managing cancer-related symptoms. Objective: We sought to characterize MMJ's role on symptomatic relief and opioid consumption in the oncologic population. Design: Retrospective chart review of MMJ-certified oncology patients was performed. Divided patients into MMJ use [MMJ(+)] versus no use [MMJ(-)], and Edmonton Symptom Assessment System (ESAS)-reported pain cohorts: "mild-moderate" versus "severe." Measurements: Medical records were reviewed for ESAS, to measure physical and emotional symptoms, and opiate consumption, converted into morphine milligram equivalents (MME). Minimal clinically important differences were determined. Wilcoxon signed-rank tests determined statistical significance between MMJ-certification and most recent palliative care visit. Results: Identified 232 patients [95/232 MMJ(-); 137/232 MMJ(+)]. Pain, physical and total ESAS significantly improved for total MMJ(-) and MMJ(+); however, only MMJ(+) significantly improved emotional ESAS. MMJ(-) opioid consumption increased by 23% (97.5-120 mg/day MME, p = 0.004), while it remained constant (45-45 mg/day MME, p = 0.522) in MMJ(+). Physical and total ESAS improved in mild-moderate-MMJ(-) and MMJ(+). Pain and emotional symptoms worsened in MMJ(-); while MMJ(+)'s pain remained unchanged and emotional symptoms improved. MMJ(-) opioid consumption increased by 29% (90-126 mg/day MME, p = 0.012); while MMJ(+)'s decreased by 33% (45-30 mg/day MME, p = 0.935). Pain, physical, emotional, and total ESAS scores improved in severe-MMJ(-) and MMJ(+); opioid consumption reduced by 22% in MMJ(-) (135-106 mg/day MME, p = 0.124) and 33% in MMJ(+) (90-60 mg/day MME, p = 0.421). Conclusions: MMJ(+) improved oncology patients' ESAS scores despite opioid dose reductions and should be considered a viable adjuvant therapy for palliative management.

The Changing Nature of the Oncology Section of the Orthopaedic In-Training Examination.

INTRODUCTION: The Orthopaedic In-Training Examination (OITE) assesses orthopaedic resident knowledge over 275 multiple-choice questions.Since the first publication examining the contents of the pathology section was published over ten years ago, the pathology content has been renamed (oncology) and revamped. As the overall extent of these alterations is currently unknown, the efficacy of current orthopaedic oncology educational practices for optimal OITE performance should be questioned. To determine how the oncology (pathology) material has changed, we compared the following characteristics from previous examinations (2002 to 2006) to current examinations (2012 to 2016): (1) What are the average number of oncology questions being asked? (2) What are the specific imaging modalities presented for examinee interpretation? (3) Which pathologic diagnoses are commonly examined? (4) What is the pattern of taxonomic question classifications? METHODS: The 2012 to 2016 OITE study guides were reviewed, and each oncology question was categorized into one of the following: benign or malignant, imaging modality grouping, common pathologic diagnosis, question type, and taxonomic classification. The aforementioned information was extrapolated from the previous pathology publication published in 2010 to create the previous examination cohort (2002 to 2006). The current examination characteristics were then compared with those of the previous examinations. RESULTS: The current number of oncology OITE questions significantly decreased from previous years (27.2 versus 21.2; P = 0.015). Current examinations displayed a significant increase in testing the interpretation of diagnostic imaging modalities compared with previous examinations (78.3% versus 55.8%; P < 0.001). The current examinations examined a wide spectrum of pathologic diagnoses, including previously untested pathologies. The number of taxonomy 1 questions on current examinations significantly decreased (36.8% versus 24.5%; P = 0.032), whereas the number of taxonomy 3 questions significantly increased from previous examinations (48.1% versus 32.4%; P = 0.032). DISCUSSION: This study demonstrated that the nature of the orthopaedic oncology (pathology) section has changed over the past 10 years. Although the overall number of pathology-related questions decreased, the difficulty level of these questions increased, demanding a higher level of knowledge and critical thinking. A formal orthopaedic oncology rotation may be the best method to educate and improve OITE oncology performance. LEVEL OF EVIDENCE: Prognostic study, level III.

Novel policing techniques decrease gun-violence and the cost to the healthcare system.

The objective was to investigate the effects of novel policing techniques on hospital-observed incidence, healthcare utilization, mortality and costs associated with gun violence, from the perspective of a level-1 trauma center. An eight-year retrospective review evaluating the clinical and financial effects of gunshot wound (GSW) encounters between January 1st, 2010 and December 31st, 2017. Individuals who presented to the emergency department (Level-1 trauma center in Camden, NJ) between January 1, 2010 and December 31, 2017 with GSW (995 encounters) were included; however, patients with incomplete financial or medical record data were excluded (55 encounters). Patients were subdivided into two cohorts: before and after changes in policing tactics (May 1st, 2013). 940 total firearm-related encounters were included in the study. Following the policing changes, the hospital-observed quarterly incidence of GSW encounters decreased by 22% post-policing changes, 44.3 to 34.6 (p = 0.038). Average quarterly days spent in-house for GSW treatment decreased 220.7 to 151.3 (31%) days. Hospital observed mortality increased from 13.5% of presentations to 17.3% of presentations (p = 0.106). Total cost savings associated with the policing change was roughly $254,000 per quarter (p = 0.023). In areas susceptible to high rates of gun violence, similar novel policing tactics could significantly decrease hospital-observed incidence, costs and healthcare utilization demanded by firearm-related injury.