Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Mar 2016
What Are the 30-day Readmission Rates Across Orthopaedic Subspecialties?
The Centers for Medicare & Medicaid Services (CMS) now include hip and knee replacements in the Hospital Readmission Reduction Program. The 30-day readmission rate is an important quality metric; however, the incidence has not yet been defined across the numerous orthopaedic subspecialties. Elucidating the readmission rate for each subspecialty may indicate that certain services are being disincentivized by the CMS reimbursement program. Furthermore, the "planned" and "unplanned" definitions of readmission have not been well examined to determine their clinical relevance and representation of safe patient care. Therefore, reducing the 30-day readmission rate has become a top priority in orthopaedic quality assurance. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Mar 2016
Do Surgical Margins Affect Local Recurrence and Survival in Extremity, Nonmetastatic, High-grade Osteosarcoma?
Long-term survival for all patients with osteosarcoma using current aggressive adjuvant chemotherapy and surgical resection is between 60% and 70%. In patients who present with nonmetastatic, high-grade extremity osteosarcoma of bone, limb salvage surgery is favored, when appropriate, over amputation to preserve the limb, because limb salvage may lead to a superior quality of life compared with amputation. However, concern remains that in the attempt to preserve the limb, close or microscopically positive surgical margins may have an adverse effect on event-free survival. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Mar 2016
What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?
Perioperative cerebrovascular accidents (CVAs) are one of the leading causes of patient morbidity, mortality, and medical costs. However, little is known regarding the rates of these events and risk factors for CVA after elective orthopaedic surgery. ⋯ Level III, prognostic study.
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Clin. Orthop. Relat. Res. · Mar 2016
Sacral Insufficiency Fractures are Common After High-dose Radiation for Sacral Chordomas Treated With or Without Surgery.
Surgery with high-dose radiation and high-dose radiation alone for sacral chordomas have shown promising local control rates. However, we have noted frequent sacral insufficiency fractures and perceived this rate to be higher than previously reported. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Mar 2016
What Are the Risk Factors and Management Options for Infection After Reconstruction With Massive Bone Allografts?
Massive bone allografts have been used for limb salvage of bone tumor resections as an alternative to endoprosthesis, although they have different outcomes and risks. The use of massive bone allografts has been thought to be associated with a high risk for infection, and there is no general consensus on the management of this complication and final outcome. Because infection is such a devastating complication of limb salvage, at times leading to loss of a limb, recognizing the risk factors for infection and the results of treatment is important. ⋯ Level III, therapeutic study.