Bone Marrow Aspirate Concentrate as a Reliable Adjunct in Tibiotalocalcanal Fusion: A Radiographic Modified RUST Score Analysis.

BACKGROUND: Tibiotalar and subtalar arthritis requiring tibiotalocalcaneal (TTC) fusion can be technically challenging and is dependent on reliable fusion for a good clinical outcome. Initial data regarding bone marrow aspirate concentrate (BMAC) has shown promise in use as an aide in both fracture and fusion healing. The purpose of this study is to determine the outcomes in TTC fusion when utilizing BMAC as an adjunct. METHODS: Twenty consecutive patients who underwent TTC fusion with BMAC adjunct between March 2013 and November 2017 were retrospectively screened for inclusion. Patients were included regardless of comorbidities or risk factors for non-union, and only excluded if they did not have a minimum of 12 months of clinical and/or radiographic chart data. Follow-up was obtained at regular intervals of 6 weeks, 3 months, 6 months and 1 year. Modified RUST scores were applied to grade bony union in a blinded fashion by two orthopedic trauma fellowship-trained surgeons and agreement was assessed via intraclass correlation coefficient (ICC). RESULTS: Twenty patients were screened and 12 met inclusion criteria for analysis. Majority were male (66.6%) at a mean age of 55.4 years and they were all treated via TTC fusion for a diagnosis of tibiotalar and subtalar arthritis. There were no postoperative complications and no reoperations in this cohort; no donor site morbidity was associated with BMAC. By the 3-month follow-up timepoint, all but one patient received a minimum modified RUST score of 10 indicating bony union (ICC 0.91); by the 6-month time point (ICC 0.94), all 12 patients were deemed united. CONCLUSION: BMAC as an adjunct in the setting of TTC fusion is a safe treatment option that can promote reliable, consistent bony fusion with minimal complications.

The Associations of Spine Surgeon Training, Office Wait Times, and Social Media Presence with Reviews on Physician Rating Websites.

This study evaluated the associations of demographics and social media (SM) usage on physician review websites for spine surgeons in New Jersey and Pennsylvania. Three physician rating websites were accessed to obtain training history, number of ratings/reviews, and overall rating (0-5). Surgeon web pages and publicly searchable SM accounts on Facebook (FB), Twitter (T), and/or Instagram (IG) were recorded. Of 246 spine surgeons included, 95.9% had a personal/institutional website while 12.2% were present on at least one SM platform. Physician age was inversely correlated with Healthgrades.com (HG), Vitals.com (V), and Google.com (G) ratings (p < 0.0001). Physicians with SM had higher ratings on HG (p = 0.006) and V (p = 0.006). Spine surgeons with SM received more ratings, comments, and higher scores than those without SM. All review sites agree that SM presence correlated with the number of ratings and comments across physician review websites, suggesting SM may influence patient feedback. (Journal of Surgical Orthopaedic Advances 31(4):256-262, 2022).

The impact of social media presence, age, and patient reported wait times on physician review websites for sports medicine surgeons.

BACKGROUND: When choosing physicians, patients often review options online via physician review websites, which may influence decisions on providers. PURPOSE: The purpose of this study is to investigate the impacts of social media usage, age, and patient reported wait times on online ratings for three popular review websites. STUDY DESIGN: Cross-sectional study. METHODS: The American Orthopaedic Society for Sports Medicine database was used to extract demographic information for all listed sports medicine surgeons in Florida. Overall ratings, number of ratings and comments, and patient reported wait-times were recorded from three leading review websites (Healthgrades.com, Vitals.com, Google.com). Professionally focused SM accounts were searched for each physician on Facebook.com, Twitter.com, Instagram, and LinkedIn.com. RESULTS: 102 orthopaedic sports medicine surgeons were included. At least one form of social media was used by 62.4% of our cohort. Those with social media had higher overall online physician ratings out of 5.00 across all review websites (Google:4.65vs4.44, p = 0.05; Healthgrades:4.41vs4.15, p = 0.03; Vitals:4.43vs4.14, p = 0.01). In bivariate analysis, older age was associated with lower ratings on Health Grades (Absolute difference (AD) -0.26, p < 0.0001), and social media was linked to higher ratings (Google: AD 0.21, p = 0.05; Healthgrades: AD 0.26, p = 0.03; Vitals: AD 0.29, p = 0.008). Longer wait times were associated with lower ratings in a dose-dependent manner in both bivariate and multivariable analysis. CONCLUSIONS: Social media use among sports medicine surgeons correlated with higher overall physician ratings. Potentially, younger surgeons increase social media use because of a heightened concern for online image, whereas older surgeons may have less value in using online platforms to capitalize on an online presence. Older age and increased patient reported wait times in office had a negative correlation with online reviews, which highlights that factors beyond the surgeon's skill sets can influence overall ratings.

Social Media Presence Correlated with Improved Online Review Scores for Spine Surgeons.

BACKGROUND: In the next decade, health care reimbursement will be more aligned to patient clinical outcomes. These outcomes are influenced by the patient's perceived opinion of his or her care. An evaluation into the role of surgeon demographics, social media (SM) accessibility, and office wait times was conducted to identify correlations with these among 3 online review platforms. METHODS: A total of 206 (148 orthopedic, 58 neurosurgery trained) spine surgeons were included. Spine surgeon ratings and demographics data from 3 physician rating websites (Healthgrades.com [HG], Vitals.com, Google.com [G]) were collected in November 2019. Using the first 10 search results from G we then identified if the surgeons had publicly accessible Facebook, Twitter, or Instagram (IG) accounts. RESULTS: The mean age of the cohort was 54.3 years (±9.40 years), and 28.2% had one form of publicly accessible SM. Having any SM was significantly correlated with higher scores on HG and G. An IG account was associated with significantly higher scores on all 3 platforms, and having a Facebook account correlated with significantly higher scores on HG in multivariate analysis. An office wait time between 16 and 30 minutes and >30 minutes was associated with worse scores on all 3 platforms (all P < 0.05). An academic practice was associated with higher scores on all 3 platforms (P < 0.05). CONCLUSIONS: A shorter office wait time and an academic setting practice are associated with higher patient satisfaction scores on all 3 physician review websites. Accessible SM accounts are also associated with higher ratings on physician review websites, particularly IG.

PROMIS Versus Legacy Patient-Reported Outcome Measures in Patients Undergoing Surgical Treatment for Symptomatic Acetabular Dysplasia.

BACKGROUND: No previous study has investigated how the Patient-Reported Outcomes Measurement Information System (PROMIS) performs compared with legacy patient-reported outcome measures in patients with symptomatic acetabular dysplasia treated with periacetabular osteotomy (PAO). PURPOSE: To (1) measure the strength of correlation between the PROMIS and legacy outcome measures and (2) assess floor and ceiling effects of the PROMIS and legacy outcome measures in patients treated with PAO for symptomatic acetabular dysplasia. STUDY DESIGN: Cohort study (Diagnosis); Level of evidence, 2. METHODS: This study included 220 patients who underwent PAO for the treatment of symptomatic acetabular dysplasia. Outcome measures included the Hip disability and Osteoarthritis Outcome Score (HOOS) pain, HOOS activities of daily living (ADL), modified Harris Hip Score (mHHS), PROMIS pain, and PROMIS physical function subsets, with scores collected preoperatively and/or postoperatively at a minimum 12-month follow-up. The change in mean scores from preoperatively to postoperatively was calculated only in a subgroup of 57 patients with scores at both time points. Distributions of the PROMIS and legacy scores were compared to evaluate floor and ceiling effects, and Pearson correlation coefficients were calculated to evaluate agreement. RESULTS: The mean age at the time of surgery was 27.7 years, and 83.6% were female. The mean follow-up time was 1.5 years. Preoperatively, neither the PROMIS nor the legacy measures showed significant floor or ceiling effects. Postoperatively, all legacy measures showed significant ceiling effects, with 15% of patients with a maximum HOOS pain score of 100, 29% with a HOOS ADL score of 100, and 21% with an mHHS score of 100. The PROMIS and legacy instruments showed good agreement preoperatively and postoperatively. The PROMIS pain had a moderate to strong negative correlation with the HOOS pain (r = -0.66; P < .0001) and mHHS (r = -0.60; P < .0001) preoperatively and the HOOS pain (r = -0.64; P < .0001) and mHHS (r = -0.64; P < .0001) postoperatively. The PROMIS physical function had a moderate positive correlation with the HOOS ADL (r = 0.51; P < .0001) and mHHS (r = 0.49; P < .0001) preoperatively and a stronger correlation postoperatively with the HOOS ADL (r = 0.56; P < .0001) and mHHS (r = 0.56; P < .0001). CONCLUSION: We found good agreement between PROMIS and legacy scores preoperatively and postoperatively. PROMIS scores were largely normally distributed, demonstrating an expanded ability to capture variability in patients with improved outcomes after treatment.

How wait-times, social media, and surgeon demographics influence online reviews on leading review websites for joint replacement surgeons.

OBJECTIVE: With the growth and popularity of the internet, physician review websites are being utilized more frequently by patients to learn about and ultimately select their provider. These sites allow patients to comment on the care they received in a public forum for others to see. With outcome and "quality" measures being used to dictate reimbursement formulas; online patient reviews may affect a physician's compensation in the near future. Therefore, it is of paramount importance for physicians to understand how best to portray themselves on social media and other internet sites. METHODS: In this retrospective study, we identified 145 arthroplasty surgeons via the AAHKS database. Then, surgeon data was collected from Healthgrades (HG) and Vitals (V). We identified if the surgeon had social media (SM) accounts by using google search. The number of ratings and comments, overall rating, reported wait-times and physician SM presence were analyzed with univariate, bivariate and multivariate analyses. RESULTS: 64% of surgeons had a SM presence, and younger surgeons with SM had lower distribution of wait-times. A SM presence correlated with significantly higher frequency of total ratings and comments. Both review sites showed that younger physicians with a SM presence had increased frequency of ratings and comments and a quicker office wait-times. SM presence did not impact the overall scores on either website. CONCLUSION: Having SM presence is correlated with increased number of ratings and comments on physician review sites, possibly revealing an increased likelihood of these physicians encouraging their patients to engage with them via the internet. SM presence did not correlate with higher review scores, displaying that there are many complex factors that go into a physician score outside of SM and internet appearance. Future studies should explore patient comments on these sites to understand additional factors that may optimize a patient's experience.

Is There a Correlation Between Preoperative or Postoperative Vitamin D Levels with Pseudarthrosis, Hardware Failure, and Revisions After Lumbar Spine Fusion?

BACKGROUND: Vitamin D deficiency is a well-known cause of postoperative complications in patients undergoing orthopedic surgery. Orthopedic complications seen in vitamin D deficiency include nonunion, pseudarthrosis, and hardware failure. We seek to investigate the relationship between vitamin D deficiency and outcomes after lumbar spinal fusions. METHODS: A retrospective patient chart review was conducted at a single center for all patients who underwent lumbar spinal fusions from January 2015 to September 2017 with preoperative or postoperative vitamin D laboratory values. We recorded demographics, social history, medications, pre-existing medical conditions, bone density (dual-energy x-ray absorptiometry) T-scores, procedural details, 1-year postoperative Visual Analog Score (VAS), documented pseudarthrosis, revisions, and hardware failure. A total of 150 patients were initially included in the cohort for analysis. RESULTS: Overall, preoperative and postoperative vitamin D levels were not significantly associated with a vast majority of the patient characteristics studied, including comorbidities, medications, or surgical diagnoses (P > 0.05). Age at surgery was significantly associated with vitamin D levels; older patients had higher serum levels of vitamin D both preoperatively (P = 0.03) and postoperatively (P = 0.01). Those with a higher average body mass index had lower vitamin D in both groups (P = 0.02). Vitamin D levels were not significantly associated with rates of postoperative pseudarthrosis, revision, or hardware complications (P > 0.05). VAS pain score at 1 year and smoking status preoperatively or postoperatively were not associated with vitamin D levels (P > 0.05). CONCLUSIONS: Both preoperative and postoperative vitamin D levels were not significantly associated with an increased or decreased risk of pseudarthrosis, revision surgery, hardware failure, or 1-year VAS pain score after lumbar spine fusion surgery.

The Pattern of Acetabular Cartilage Wear Is Hip Morphology-dependent and Patient Demographic-dependent.

BACKGROUND: Acetabular cartilage damage has been described in patients with femoroacetabular impingement (FAI). However, most reports of articular cartilage damage in hip FAI have been focused on the acetabular cartilage and derived from single-center, retrospective studies of relatively small patient cohorts. Identifying patterns of articular cartilage wear is important in patient selection, treatment prognosis, and determining whether patterns of intraarticular cartilage wear are secondary to abnormal hip morphology. Using a multicenter, observational cohort, we sought to determine whether there was a specific pattern of cartilage wear across acetabular and femoral articular cartilage among patients with symptomatic FAI. QUESTIONS/PURPOSES: (1) Is there is a specific pattern of cartilage wear in the acetabulum and femoral head, assessed during hip arthroscopy, in cam FAI, pincer, and mixed-type hip pathologies? (2) Are there specific patterns of cartilage wear associated with duration of symptoms, age, and/or body mass index (BMI)? METHODS: A multicenter observational cohort and a hip preservation database from a senior author were used to identify 802 patients who underwent hip arthroscopy for the treatment of symptomatic FAI. The diagnosis of cam, pincer, or mixed-type FAI was determined by each treating surgeon at each institution using the minimum basic criteria of pain in the affected hip for a period of > 3 months, hip ROM, and radiographic findings. Acetabular and femoral head cartilage lesions were classified arthroscopically by location and severity for each group (cam, pincer, or mixed FAI). Cartilage wear was classified using the Beck classification and defined as cartilage lesions greater than Grade 1 (normal macroscopically sound cartilage). The assessment of cartilage wear was performed arthroscopically by experienced hip preservation surgeons who are a part of ANCHOR, a multicenter group that uses a longitudinally maintained database to investigate issues related to hip preservation surgery. Clinical characteristics, radiographic findings, and acetabular and femoral head damage by location and severity of wear were reported based on patient diagnoses of cam (n = 472), mixed (n = 290), and pincer (n = 40) FAI hip pathologies. Wald chi-square tests were used to test for differences in the presence of wear in each cartilage quadrant across hip pathologies, duration of symptoms, age, and BMI. One-way analysis of variance tests were used to test for differences in average grade of wear in each cartilage quadrant across hip pathologies, duration of symptoms, age, and BMI. A bivariate logistic regression model was used to identify factors independently associated with the presence of cartilage wear in the acetabulum and femoral head. Acetabular cartilage wear was present in 743 of 802 patients (93%) in the cohort. Femoral head cartilage wear was observed in only 130 (16%). RESULTS: We found significant associations between acetabular patterns of wear and FAI hip pathologies; specifically, we observed more frequent and severe debonding of acetabular cartilage in patients with symptomatic cam (93%, 1.7 ± 1.1 grade) and mixed (97%, 1.7 ± 1.2 grade) FAI compared with Pincer (75%, 1.5 ± 0.9 grade) FAI hip pathologies (p < 0.001). Superolateral peripheral cartilage lesions occurred more frequently and with greater severity in patients with cam (90% [416 of 472] prevalence, 3.1 ± 1.1 grade) and mixed (91% [260 of 290] prevalence, 3.1 ± 1.1 grade) FAI than in pincer (60% [24 of 40] prevalence, 2.2 ± 1.1 grade) FAI hip pathologies (p < 0.0001). Conversely, patients with pincer FAI most commonly demonstrated cartilage lesions with an even distribution at the anterior and superolateral acetabular rim: 64% (25 of 40) (mean grade 2.1 ± 1.0) and 60% (24 of 40) mean grade 2.2 ± 1.1, respectively. Age was associated with increased presence of wear in both the acetabulum (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.2-1.7; p = 0.005) and femoral head (OR, 1.08; 95% CI, 1.6-1.1; p < 0.001). BMI was associated with a greater presence of wear only in the femoral head (OR, 1.1; 95% CI, 1.2-1.1; p = 0.002). Specifically, compared with patients with a BMI < 30 kg/m, patients with a BMI ≥ 30 kg/m presented with more frequent and more severe lesions in the posterior peripheral acetabular rim (42% [47 of 117] versus 26% [171 of 677], p = 0.0006; grade 1.9 ± 1.3 versus grade 1.4 ± 0.9, p < 0.001), the anterolateral femoral head (22% [20 of 117] versus 9% [60 of 67], p = 0.006), and the anteromedial femoral head (15% [16 of 117] versus 6% [39 of 677], p = 0.002; grade 1.3 ± 0.8 versus grade 1.1 ± 0.6, p = 0.04). In general, we found that older patients (≥ 50 years old) presented with more frequent and more severe lesions in both the acetabulum and femoral head. We found no association between hip pathology and cartilage wear patterns in the examined femoral heads. CONCLUSIONS: Hip morphology affects the pattern of acetabular cartilage wear. More frequent and severe cartilage lesions were observed in patients with symptomatic FAI cam and mixed-type hip pathologies. Surgical attempts to restore normal anatomy to avoid FAI should be performed to potentially improve long-term joint homeostasis. Increasing age is an independent risk for cartilage wear in both the acetabulum and femoral head. Additionally, increased BMI is an independent risk factor for cartilage wear in the femoral head. In the future, prospective studies should provide further insight into the pathomechanics of early degenerative changes associated with hip FAI deformities. LEVEL OF EVIDENCE: Level III, prognostic study.

Autograft, Allograft, and Bone Graft Substitutes: Clinical Evidence and Indications for Use in the Setting of Orthopaedic Trauma Surgery.

Bone grafts are the second most common tissue transplanted in the United States, and they are an essential treatment tool in the field of acute and reconstructive traumatic orthopaedic surgery. Available in cancellous, cortical, or bone marrow aspirate form, autogenous bone graft is regarded as the gold standard in the treatment of posttraumatic conditions such as fracture, delayed union, and nonunion. However, drawbacks including donor-site morbidity and limited quantity of graft available for harvest make autograft a less-than-ideal option for certain patient populations. Advancements in allograft and bone graft substitutes in the past decade have created viable alternatives that circumvent some of the weak points of autografts. Allograft is a favorable alternative for its convenience, abundance, and lack of procurement-related patient morbidity. Options include structural, particulate, and demineralized bone matrix form. Commonly used bone graft substitutes include calcium phosphate and calcium sulfate synthetics-these grafts provide their own benefits in structural support and availability. In addition, different growth factors including bone morphogenic proteins can augment the healing process of bony defects treated with grafts. Autograft, allograft, and bone graft substitutes all possess their own varying degrees of osteogenic, osteoconductive, and osteoinductive properties that make them better suited for different procedures. It is the purpose of this review to characterize these properties and present clinical evidence supporting their indications for use in the hopes of better elucidating treatment options for patients requiring bone grafting in an orthopaedic trauma setting.

How do physician demographics, training, social media usage, online presence, and wait times influence online physician review scores for spine surgeons?

OBJECTIVEThe purpose of this study was to assess the impact of certain demographics, social media usage, and physician review website variables for spine surgeons across Healthgrades.com (Healthgrades), Vitals.com (Vitals), and Google.com (Google).METHODSThrough a directory of registered North American Spine Society (NASS) physicians, we identified spine surgeons practicing in Texas (107 neurosurgery trained, 192 orthopedic trained). Three physician rating websites (Healthgrades, Vitals, Google) were accessed to obtain surgeon demographics, training history, practice setting, number of ratings/reviews, and overall score (January 2, 2018-January 16, 2018). Using only the first 10 search results from Google.com, we then identified whether the surgeon had a website presence or an accessible social media account on Facebook, Twitter, and/or Instagram.RESULTSPhysicians with either a personal or institutional website had a higher overall rating on Healthgrades compared to those who did not have a website (p < 0.01). Nearly all spine surgeons had a personal or institutional website (90.3%), and at least 1 accessible social media account was recorded for 43.5% of the spine surgeons in our study cohort (39.5% Facebook, 10.4% Twitter, 2.7% Instagram). Social media presence was not significantly associated with overall ratings across all 3 sites, but it did significantly correlate with more comments on Healthgrades. In multivariable analysis, increasing surgeon age was significantly associated with a lower overall rating across all 3 review sites (p < 0.05). Neurosurgeons had higher overall ratings on Vitals (p = 0.04). Longer wait times were significantly associated with a lower overall rating on Healthgrades (p < 0.0001). Overall ratings from all 3 websites correlated significantly with each other, indicating agreement between physician ratings across different platforms.CONCLUSIONSLonger wait times, increasing physician age, and the absence of a website are indicative of lower online review scores for spine surgeons. Neurosurgery training correlated with a higher overall review score on Vitals. Having an accessible social media account does not appear to influence scores, but it is correlated with increased patient feedback on Healthgrades. Identification of ways to optimize patients' perception of care are important in the future of performance-based medicine.

Tissue Engineering and Cell-Based Therapies for Fractures and Bone Defects.

Bone fractures and segmental bone defects are a significant source of patient morbidity and place a staggering economic burden on the healthcare system. The annual cost of treating bone defects in the US has been estimated to be $5 billion, while enormous costs are spent on bone grafts for bone injuries, tumors, and other pathologies associated with defective fracture healing. Autologous bone grafts represent the gold standard for the treatment of bone defects. However, they are associated with variable clinical outcomes, postsurgical morbidity, especially at the donor site, and increased surgical costs. In an effort to circumvent these limitations, tissue engineering and cell-based therapies have been proposed as alternatives to induce and promote bone repair. This review focuses on the recent advances in bone tissue engineering (BTE), specifically looking at its role in treating delayed fracture healing (non-unions) and the resulting segmental bone defects. Herein we discuss: (1) the processes of endochondral and intramembranous bone formation; (2) the role of stem cells, looking specifically at mesenchymal (MSC), embryonic (ESC), and induced pluripotent (iPSC) stem cells as viable building blocks to engineer bone implants; (3) the biomaterials used to direct tissue growth, with a focus on ceramic, biodegradable polymers, and composite materials; (4) the growth factors and molecular signals used to induce differentiation of stem cells into the osteoblastic lineage, which ultimately leads to active bone formation; and (5) the mechanical stimulation protocols used to maintain the integrity of the bone repair and their role in successful cell engraftment. Finally, a couple clinical scenarios are presented (non-unions and avascular necrosis-AVN), to illustrate how novel cell-based therapy approaches can be used. A thorough understanding of tissue engineering and cell-based therapies may allow for better incorporation of these potential therapeutic approaches in bone defects allowing for proper bone repair and regeneration.

Analysis of Internet Review Site Comments for Spine Surgeons: How Office Staff, Physician Likeability, and Patient Outcome Are Associated With Online Evaluations.

STUDY DESIGN: Observational study. OBJECTIVE: To evaluate how online patient comments will affect website ratings for spine surgeons. SUMMARY OF BACKGROUND DATA: With the ever-growing utilization of physician review websites, healthcare consumers are assuming more control over whom they choose for care. We evaluated patient feedback and satisfaction scores of spine surgeons using comments from three leading physician rating websites: Healthgrades.com, Vitals.com, Google.com. This is the largest review of online comments and the largest review of spine surgeon comments. METHODS: From the North American Spine Society (NASS) membership directory, 210 spine surgeons practicing in Florida (133 orthopedic trained; 77 neurosurgery trained) with online comments available for review were identified, yielding 4701 patient comments. These were categorized according to subject: (1) surgeon competence, (2) surgeon likeability/character, (3) office staff, ease of scheduling, office environment. Type 1 and 2 comments were surgeon-dependent factors whereas type 3 comments were surgeon-independent factors. Patient comments also reported a score (1-5), 5 being the most favorable and 1 being the least favorable. RESULTS: There were 1214 (25.8%) comments from Healthgrades, 2839 (60.4%) from Vitals, and 648 (13.8%) from Google. 89.9% (4225) of comments pertained to surgeon outcomes and likeability (comment type 1 and 2), compared with 10.1% (476) surgeon-independent comments (comment type 3) (P < 0.0001). There was a significantly higher number of favorable ratings associated with surgeon-dependent comments (types 1 and 2) compared with surgeon-independent comments (type 3). Surgeon-independent comments were associated with significantly lower scores compared with comments regarding surgeon-dependent factors on all review sites. CONCLUSION: Spine surgeons are more likely to receive favorable reviews for factors pertaining to outcomes, likeability/character, and negative reviews based on ancillary staff interactions, billing, and office environment. Surgeons should continue to take an active role in modifying factors patients perceive as negative, even if not directly related to the physician. LEVEL OF EVIDENCE: 3.

How social media, training, and demographics influence online reviews across three leading review websites for spine surgeons.

BACKGROUND CONTEXT: The future of health care is consumer driven with a focus on outcome metrics and patient feedback. Physician review websites have grown in popularity and are guiding patients to certain health-care providers, for better or worse. No prior study has specifically evaluated Internet reviews of spine surgeons, determined if social media (SM) correlates with patient reviews, or evaluated Google as a physician review website. PURPOSE: This study aimed to evaluate patient satisfaction scores for spine surgeons in Florida using leading physician ratings websites. STUDY DESIGN: A retrospective study was carried out. SAMPLE POPULATION: The sample comprised spine surgeons with a review on Healthgrades.com (HG), Vitals.com (V), or Google.com (G) online rating websites as of August 17, 2017. OUTCOME MEASURES: Number of ratings, number of comments, overall rating, patient-reported wait times, physician website presence, and physician SM presence were the outcome measures. METHODS: Using the directory of registered North American Spine Society physicians, we identified all spine surgeons practicing in Florida (137 orthopedic trained; 78 neurosurgery trained). Surgeon demographics and ratings data were collected from three physician rating websites (HG, V, G) from July 19, 2017 to August 17, 2017. Using only the first 10 search results from Google.com we then identified if the surgeon had accounts on Facebook (FB), Twitter (TW), or Instagram (IG). RESULTS: Nearly every surgeon in this cohort had either an institutional or personal website (98.1%), and 38.6% had at least one SM outlet of our three reviewed. Both personal and institutional website presence significantly correlated with higher G scores. Spine surgeons with a searchable account on FB, TW, or IG made up 35.4%, 10.2%, and 0.5% of the cohort, respectively. Surgeons with an SM presence had a significantly higher number of ratings and comments on HG, V, and G, but not overall scores. In multivariable analysis, only V showed a significant inverse correlation between overall score and age, private institution, and orthopedic surgery training. Wait times >30 minutes were significantly associated with worse overall scores across all three review sites. Overall ratings between HG, V, and G all had significantly positive correlations on Pearson correlation analysis. CONCLUSION: Social media presence correlates with patient communication in the form of number of ratings and comments, yet does not impact overall scores, suggesting social media may influence patient feedback. Longer wait times are indicative of lower scores across all three platforms. Overall ratings from all three websites correlate significantly with each other, indicating agreement between physician ratings across different platforms. Understanding the factors that optimize a patient's overall experience with a physician is an important and emerging outcome measure for the future of patient-centered health care.

Physician-Patient Communication is Associated With Hepatocellular Carcinoma Screening in Chronic Liver Disease Patients.

BACKGROUND: Patients with chronic liver disease are at high risk for developing liver cancer. Factors associated with screening awareness and doctor-patient communication regarding liver cancer were examined. STUDY: Four hundred sixty-seven patients with chronic liver disease at a tertiary-care clinic participated in a phone survey regarding awareness of cancer screening, doctor-patient communication, and health behaviors. Medical records were retrospectively reviewed for data on liver disease etiology and dates of liver imaging tests. RESULTS: Seventy-nine percent of patients reported awareness of liver cancer screening, and 50% reported talking to their doctor about liver cancer. Patients with higher education, abstinence from alcohol, and liver cirrhosis were more likely to be aware of liver cancer screening (P=0.06, 0.005, <0.0001). Whites, patients with higher education, and those with cirrhosis were more likely to talk to their doctor about liver cancer (P=0.006; P=0.09, <0.0001). Awareness of liver cancer screening (79%) was similar to that of colorectal cancer screening (85%), lower than breast cancer screening (91%), and higher than prostate cancer screening (66%). Patients who were aware of liver cancer screening and reported talking to their doctor about liver cancer were significantly more likely to receive consistent liver surveillance (odds ratio, 4.81; 95% confidence interval, 2.62-8.84 and odds ratio, 1.97; 95% confidence interval, 1.19-3.28, respectively). CONCLUSIONS: Our study demonstrates the importance of effective physician communication with chronic liver disease patients on the risks of developing liver cancer and the importance of regular screening, especially among nonwhites and patients with lower education.