Open Versus Percutaneous Fixation of Trigger Finger: Meta-Analysis of Clinical Outcomes.

PURPOSE: With variable and conflicting results to date, it remains unclear whether the percutaneous or open surgical A1 pulley release technique is superior regarding safety and efficacy. The goal of this meta-analysis was to compare the two techniques. METHODS: PubMed, Cochrane, and Google Scholar (pages 1-20) were searched through August 2023. Eight randomized controlled trials met the inclusion criteria and were included in this meta-analysis. RESULTS: Of the eight included studies and 548 total patients, there were 278 subjects in the percutaneous release group and 270 subjects in the open release group. There was no significant difference between the two surgical techniques in postoperative rates of revision, complications, or pain. CONCLUSIONS: This meta-analysis found no significant difference between open and percutaneous techniques regarding the need for revision procedures, complications, or postoperative pain. Therefore, both open and percutaneous releases are appropriate. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.

How much are patients willing to pay for spine surgery? An evaluation of attitudes toward out-of-pocket expenses and cost-reducing measures.

BACKGROUND CONTEXT: With rising healthcare expenditures in the United States, patients and providers are searching to maintain quality while reducing costs. PURPOSE: The aim of this study was to investigate patient willingness to pay for anterior cervical discectomy and fusion (ACDF), degenerative lumbar spinal fusions (LF), and adult spine deformity (ASD) surgery. STUDY DESIGN/SETTING: A survey was developed and distributed to anonymous respondents through Amazon Mechanical Turk (MTurk). METHODS: The survey introduced 3 procedures: ACDF, LF, and ASD surgery. Respondents were asked sequentially if they would pay at each increasing price option. Respondents were then presented with various cost-saving methods and asked to select the options that made them most uncomfortable, even if those would save them out-of-pocket costs. RESULTS: In total, 979 of 1,172 total responses (84%) were retained for analysis. The average age was 36.2 years and 44% of participants reported a household income of $50,000 to 100,000. A total of 63% used Medicare and 13% used Medicaid. A total of 40% stated they had high levels of financial stress. A total of 30.1% of participants were willing to undergo an ACDF, 30.3% were willing to undergo a LF, and 29.6% were willing to undergo ASD surgery for the cost of $3,000 (p=.98). Regression demonstrated that for ACDF surgery, a $100 increase in price resulted in a 2.1% decrease in willingness to pay. This is comparable to degenerative LF surgery (1.8% decrease), and ASD surgery (2%). When asked which cost-saving measures participants were least comfortable with for ACDF surgery, 60% stated "Use of the older generation implants/devices" (LF: 51%, ASD: 60%,), 61% stated "Having the surgery performed at a community hospital instead of at a major academic center" (LF: 49%, ASD: 56%), and 55% stated "Administration of anesthesia by a nurse anesthetist" (LF: 48.01%, ASD: 55%). Conversely, 36% of ACDF patients were uncomfortable with a "Video/telephone postoperative visit" to cut costs (LF: 51%, ASD: 39%). CONCLUSIONS: Patients are unwilling to contribute larger copays for adult spinal deformity correction than for ACDF and degenerative lumbar spine surgery, despite significantly higher procedural costs and case complexity/invasiveness. Patients were most uncomfortable forfeiting newer generation implants, receiving the operation at a community rather than an academic center, and receiving care by physician extenders. Conversely, patients were more willing to convert postoperative visits to telehealth and forgo neuromonitoring, indicating a potentially poor understanding of which cost-saving measures may be implemented without increasing the risk of complications.

Young Age and Concomitant or Prior Bony Realignment Procedures are Associated with Decreased Risk of Failure of Osteochondral Allograft Transplantation in the Knee: A Nationwide Database Study.

OBJECTIVE: Osteochondral allograft (OCA) transplantation is a restorative surgical option for large, full-thickness chondral or osteochondral defects in the knee. Variability in outcomes reporting has led to a broad range of graft survival rates. Using rate of salvage surgery following OCA as a failure metric, the purpose of this study was to analyze the incidence and risk factors for failure in a nationwide cohort. DESIGN: The M151Ortho PearlDiver database was queried for patients aged 20 to 59 who underwent primary OCA between 2010 and 2020. Patients with prior cartilage procedures or arthroplasty were excluded. Kaplan-Meier survival analysis was performed to characterize cumulative rate of salvage surgery, defined as any patient subsequently undergoing revision OCA, autologous chondrocyte implantation (ACI), osteochondral autograft transfer system (OATS), unicompartmental knee arthroplasty (UKA), or total knee arthroplasty (TKA). Multivariable logistic regression was used to determine the effect of several variables on odds of salvage surgery. RESULTS: Around 6,391 patients met inclusion criteria. Cumulative 5-year salvage rate was 1.71%, with 68.8% in the first 2 years. Age 20 to 29 and concomitant or prior bony realignment procedures were associated with significantly decreased rate of salvage surgery (age-adjusted odds ratio [aOR] = 0.49, 95% confidence interval [CI], 0.24-0.99, P = 0.046; realignment-aOR = 0.24, 95% CI, 0.04-0.75, P = 0.046). CONCLUSIONS: In the largest OCA cohort studied to date, less than 2% of patients required salvage surgery. Young age and bony realignment were protective. These findings suggest that OCA in the knee is a durable cartilage-restoration procedure, especially in young patients with corrected alignment.

Outcomes and Complications After Primary Arthroscopic Suprapectoral Versus Open Subpectoral Biceps Tenodesis for Superior Labral Anterior-Posterior Tears or Biceps Abnormalities: A Systematic Review and Meta-analysis.

BACKGROUND: Biceps tenodesis is a surgical treatment for both superior labral anterior-posterior (SLAP) tears and long head of the biceps tendon (LHBT) abnormalities. Biceps tenodesis can be performed either above or below the pectoralis major tendon with arthroscopic or open techniques. PURPOSE: To analyze the outcomes and complications comparing primary arthroscopic suprapectoral versus open subpectoral biceps tenodesis for either SLAP tears or LHBT disorders. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A search strategy based on the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) protocol was used to include 18 articles (471 patients) from a total of 974 articles identified. Overall exclusion criteria included the following: non-English language, non-full text, biceps tenodesis with concomitant rotator cuff repair, review articles, meta-analyses, and case reports. Data were extracted and analyzed according to procedure type and tenodesis location: arthroscopic suprapectoral biceps tenodesis (295 patients) versus open subpectoral bicepts tenodesis (176 patients). RESULTS: For arthroscopic suprapectoral biceps tenodesis, the weighted mean American Shoulder and Elbow Surgeons (ASES) score was 90.0 (97 patients) and the weighted mean Constant score was 88.7 (108 patients); for open subpectoral biceps tenodesis, the mean ASES score was 91.1 (199 patients) and mean Constant score was 84.7 (65 patients). Among the 176 patients who underwent arthroscopic biceps tenodesis, there was an overall complication rate of 9.1%. Among the 295 patients who underwent open biceps tenodesis, there was an overall complication rate of 13.5%. Both residual pain (5.7% vs 4.7%, respectively) and Popeye deformity (1.7% vs 1.0%, respectively) rates were similar between the groups. Open subpectoral biceps tenodesis had higher reoperation (3.0% vs 0.0%, respectively), wound complication (1.0% vs 0.0%, respectively), and nerve injury (0.7% vs 0.0%, respectively) rates postoperatively. A meta-analysis of 3 studies demonstrated that both methods had similar ASES scores (P = .36) as well as all-cause complication rates (odds ratio, 0.76 [95% CI, 0.13-4.48]; P = .26). CONCLUSION: Patients undergoing arthroscopic suprapectoral biceps tenodesis for either SLAP tears or LHBT abnormalities had similar outcome scores and complication rates compared with those undergoing open subpectoral biceps tenodesis. Additionally, both residual pain and Popeye deformity rates were similar between the 2 groups.

Epidemiology and Perioperative Complications in Patients With Sickle Cell Disease After Orthopaedic Surgery: 26 Years' Experience at a Major Academic Center.

INTRODUCTION: Surgical management of patients with sickle cell disease (SCD) poses a unique challenge to orthopaedic surgeons due to increased operative and perioperative risk. Studies evaluating perioperative complications among patients with SCD undergoing orthopaedic surgery have been limited. We sought to review the clinical characteristics and perioperative complications in our patients with SCD who required orthopaedic surgery. METHODS: Our institution has one of the largest sickle cell centers in the Northeastern United States. We performed a retrospective chart review of all patients referred to the Orthopaedic Surgery Department between 1990 and 2016 and analyzed the demographics, comorbidities, surgical intervention, and perioperative complications. RESULTS: In total, 96 orthopaedic surgeries were surveyed across 26 years performed at our institution. The majority of the patients with SCD were African American (90.3%) and women (60.4%). The most common surgical intervention was for hip osteonecrosis. Only 11.5% of the patients (11 of 96) experienced a perioperative complication, with the vasoocclusive event being the most common (7 patients; 64%). DISCUSSION: These data suggest that orthopaedic surgery for a patient with SCD is safe but does require careful multidisciplinary consultation including hematology and anesthesia to medically optimize the patient before surgical intervention.

Process Improvements Positively Impact the Use of Intravesical Mitomycin C after Transurethral Resection of Nonmuscle Invasive Bladder Cancer in a Large, Urban Urology Practice.

INTRODUCTION: We assessed the rate of intravesical mitomycin C therapy in patients with nonmuscle invasive bladder cancer who underwent transurethral resection of the bladder, as well as the impact of procedural changes governing its use. METHODS: A retrospective review of our bladder cancer database identified patients who underwent transurethral resection of the bladder with mitomycin C therapy during January 2008 to July 2014. Since our mitomycin C protocols were revised during 2013, patients were stratified based on date of service. Patient demographics and data describing mitomycin C use were tabulated. RESULTS: During January 2008 to May 2013, 276 of 737 (37.5%) ideal patients received mitomycin C (not accounting for patients in whom mitomycin C was contraindicated). Conversely 461 of 737 patients (62.5%) did not receive mitomycin C. Shortages of mitomycin C were responsible for nonuse in 18.4% of cases while no specified reason for nonuse was given in 59%. When cases in which mitomycin C use was contraindicated were taken into account, mitomycin C was used in 51.6% overall. After the implementation of new mitomycin C operating procedures, mitomycin C use increased significantly to 76.0% (p <0.001) (accounting for appropriate nonuse). During this period mitomycin C shortages were not responsible for any case in which mitomycin C was not used. CONCLUSIONS: During 2008 to 2013 mitomycin C was not used in a significant proportion of patients who underwent transurethral resection of the bladder. The implementation of a revised protocol governing mitomycin C use significantly and positively impacted mitomycin C use. Importantly, pharmacy shortages no longer contribute to the nonuse of mitomycin C in patients with bladder cancer. These data highlight the impact of continual improvement initiatives on standard clinical practice.