Overlapping Surgery in Orthopaedics: A Review of Efficacy, Surgical Costs, Surgical Outcomes, and Patient Safety.

INTRODUCTION: Overlapping surgery (OS) refers to when an attending surgeon supervises two surgeries at the same time with noncritical portions of both surgeries occurring simultaneously. Limited literature reviewing OS exists in orthopaedics. Our goal is to provide insight into this practice across orthopaedic subspecialities to inform its future utilization. METHODS: A review of the literature was conducted after Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review guidelines. All articles (630 total) were independently reviewed by two authors with a third to resolve discrepancies. Inclusion criteria encompassed any journal publication that included data on a series of orthopaedic OS. Data points sought included the type of surgery, quantity of cases, case duration, overlap time, perioperative complications, and cost. RESULTS: Eleven articles met the inclusion criteria, encompassing a total of 34,494 overlapping surgeries. The studies varied regarding setting and subspecialties included. Six studies demonstrated increased surgical times for overlap cases. Two studies found that although OS increased cost per case, it improved the overall efficiency. Ten studies tracked short-term outcomes (<90 days) and reported no increase in complications with OS. Only one study examined long-term outcomes (1 year) and found a markedly increased risk for surgical complications with OS, with higher complication rates among nonelective compared with elective cases. DISCUSSION: Current literature suggests that OS may increase surgical time, but from the 11 articles reviewed, only one demonstrates an increase in perioperative complications across orthopaedic subspecialities. OS also seems to increase costs per case; however, this is offset by the ability to perform more cases in the same period, resulting in an overall increase in the net profit. These data are consistent with studies from other surgical specialties. CONCLUSION: Although OS seems to be both safe and effective, future investigations are needed to understand the impact it has on patients and healthcare systems.

Musculoskeletal Oncology Fellowship Websites: A Comprehensive Assessment and Cross-Sectional Content Analysis.

This manuscript evaluates the utility of Musculoskeletal Oncology (MSK Oncology) fellowship program websites and identifies areas for improvement. This study identified 20 MSK Oncology programs using two public databases, allocated 45 criteria domains into 6 categories, and evaluated each program independently. MSK Oncology programs had limited information (34%) on their websites, particularly under the "People" category. It is recommended that programs include more information about current fellows and their training background, faculty publications, and alumni descriptions. MSK Oncology program websites should contain necessary information for prospective applicants, particularly considering the increased virtual world during and after the COVID-19 pandemic. Websites should be more comprehensive for applicants in their process of choosing their preferred programs and submitting their rank order lists.

Pediatric Upper Cervical Spine Trauma: A 10-Year Retrospective Review at a Pediatric Trauma Center.

Background Traumatic upper cervical spine injuries (tUCSI) are generally caused by high-impact injuries to the C1-C2 vertebral level. The current literature is limited with regards to comparing epidemiological trends, treatment options, and overall outcomes for tUCSI within the pediatric cohort. The purpose of this study was to analyze pediatric tUCSI epidemiological data, potential variations in treatment and patient outcomes, and to evaluate any specific trends that may be clinically relevant. Methodology We conducted a retrospective cohort study on pediatric patients ages 1 day to 16 years old, admitted for tUCSI over the past 10 years (1/2011 to 1/2021) at a Midwest level 1 trauma center. Retrospective data was queried using ICD-9 and ICD-10 diagnosis codes for tUCSI. Children were stratified into three age groups: Group 1 - Infants and Toddlers (children under three years of age); Group 2 - Young Children (children between three and seven years of age); Group 3 - Juveniles and Adolescents (children between the ages of seven and 16). Numerical data and categorical variables were summarized and the normality of the distribution of data was evaluated using the Anderson-Darling normality test. Differences between the age groups were examined using either an unpaired, independent Two-Sample t-test or Unpaired Mann-Whitney U test. Pearson's chi-squared or Fisher's exact tests were used to compare categorical data between groups. Results Forty total patients were included in the final analysis, 23 female (57.5%) and 17 male (42.5%). The mean age was 11 ± 4 (range 2-16). Overall, the most common mechanism of injury was a motor vehicle collision (n=16, 40%), followed by sports injury (n=13, 32.5%), falls (n=6, 15%), and unknown mechanism (n=5, 12.5%). The most common mechanism of injury in young children was a fall (n=4, 57.5%, p<0.001). Adolescents and Juveniles significantly suffer from sports injuries compared to young children (n=13, 39.4%, p=0.043). Mechanisms of injuries presented with unique associated concomitant injuries. The most common associated sites of injuries were lower cervical spine (n=31, 77.5%), and skull injury (n=4, 10%). The vast majority of these cases were managed nonoperatively (pain medication and non-operative cervical orthosis) (n=36, 90%). Mortality and morbidity rates from tUCSI were rare in our cohort (n=1, 2.5%). Conclusion This study found that the majority of pediatric tUCSI patients can be managed nonoperatively, with dislocations and spinal instability being the most common indications for operative management. Commonly used non-operative external fixation methods include cervical collars and Minerva jackets. Our cohort showed very low mortality and morbidity rates, however, these preliminary results will require validation by future prospective multicenter studies.