scholarly journals Medical Malpractice Trends in Foot and Ankle Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0004
Author(s):  
Rishin J. Kadakia ◽  
Keith Orland ◽  
Akhil Sharma ◽  
Jie Chen ◽  
Craig C. Akoh ◽  
...  
Keyword(s):  
Medical Malpractice ◽  
Orthopaedic Surgery ◽  
Nonoperative Treatment ◽  
Anatomical Location ◽  
Foot And Ankle ◽  
Common Complication ◽  
Adult Females ◽  
Forefoot Surgery ◽  
Ankle Surgery ◽  
Malpractice Claims

Category: Other Introduction/Purpose: Medical malpractice lawsuits can place significant economic and psychologic burden on a provider. Orthopaedic surgery is one of the most common subspecialties involved in malpractice claims. There is currently no study examining malpractice lawsuits within foot and ankle surgery. Accordingly, the purpose of this work is to examine trends in malpractice claims in foot and ankle surgery. Methods: The Westlaw legal database was queried for lawsuits pertaining to foot and ankle surgery from 2008 to 2018. Only cases involving medical malpractice were included for analysis. All available details pertaining to the cases were collected. This included plaintiff demographic and geographic data. Details regarding the cases were also collected such as anatomical location, pathology, complications, and case outcomes. Results: Forty nine malpractice lawsuits pertaining to foot and ankle were identified. Most plaintiffs in these cases were adult females, and the majority of cases occurred in the northeast (53.1%). The most common anatomical region involved in claims involved the forefoot (29%). The majority of these claims involved surgery (65%). Infection was the most common complication seen in claims (22%). The jury ruled in favor of the defendant surgeon in most cases (73%). Conclusion: This is the first study to examine trends in medical malpractice within foot and ankle surgery. Infection was the most frequent complication seen in claims and forefoot surgery was the most common anatomic location. A large portion of claims resulted after nonoperative treatment. A better understanding of the trends within malpractice claims is crucial to developing strategies for prevention.

Excess Opioid Disposal Following Orthopaedic Surgery: A Randomized Clinical Trial

2020 ◽  
pp. 193864002098092
Author(s):  
Cornelia Keyser ◽  
Abhiram Bhashyam ◽  
Abdurrahman Abdurrob ◽  
Jeremy T. Smith ◽  
Eric Bluman ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Orthopaedic Surgery ◽  
Control Group ◽  
Foot And Ankle ◽  
Opioid Medication ◽  
Ankle Surgery ◽  
Randomized Control ◽  
Level I ◽  
To Receive ◽  
Experimental Group

Background Previous research indicates low disposal rates of excess postoperative narcotics, leaving them available for diversion or abuse. This study examined the effect of introducing a portable disposal device on excess opiate opioid disposal rates after lower extremity orthopaedic surgery. Methods This was a single site randomized control trial within an outpatient orthopaedic clinic. All patients 18 years or older, undergoing outpatient foot and ankle surgery between December 1, 2017 and August 1, 2018 were eligible. Patients were prospectively enrolled and randomized to receive standard opioid disposal instructions or a drug deactivation device at 2-week postoperative appointments. Participants completed an anonymous survey at 6-week postoperative appointments. Results Of the 75 patients surveyed, 68% (n = 26) of the experimental group and 56% (n = 21) of the control group had unused opioid medication. Of these, 84.6% of patients who were given Deterra Drug Deactivation System deactivation pouches safely disposed of excess medication, compared with 38% of controls (P = .003). When asked if they would use a disposal device for excess medication in the future, 97.4% (n = 37) of the experimental and 83.8% (n = 31) of the control group reported that they would. Conclusions Providing a portable disposal device with postoperative narcotic prescriptions may increase safe disposal rates of excess opioid medication following lower extremity orthopaedic surgery. Levels of Evidence Level I

scholarly journals Subsequent Injury is Common after Foot and Ankle Surgery in Patients Receiving Workers’ Compensation

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0017
Author(s):  
Gabrielle Bui ◽  
Phinit Phisitkul ◽  
Natalie Glass ◽  
Chris Cychosz ◽  
Sean Boarini
Keyword(s):  
Retrospective Chart Review ◽  
Anatomical Location ◽  
Workers Compensation ◽  
Foot And Ankle ◽  
Chi Square ◽  
Legal Representation ◽  
Increased Risk ◽  
Ankle Surgery ◽  
Poor Outcomes ◽  
Subsequent Injury

Category: Ankle Introduction/Purpose: Workers’ compensation (WC) has been associated with poor outcomes following a variety of injuries and surgeries. Previous studies have investigated surgical outcomes via satisfaction surveys, but rates of subsequent injury following surgery have not been specifically studied. The purpose of this study was to investigate the rates, locations and risk factors for subsequent injuries in WC patients and non-WC patients who underwent the same surgeries. Methods: With IRB approval, we identified the records of patients with a foot or ankle surgery performed by a single surgeon from 2009-2015. We included only surgeries with one of the most common current procedural terminology (CPT) codes from the WC population. A retrospective chart review was performed on all WC and non-WC patients with at least one of these CPT codes. A subsequent injury was defined as a new injury at a different anatomical location that occurred from 2 months to 2 years after the index surgery. Chi-square and two-tailed t-tests were used to compare WC and non-WC patient populations, and to determine factors associated with subsequent injuries. Results: Overall, the WC population had higher rates of subsequent injury than the non-WC population 23.21% versus 7.27%, p=.0011. Within the WC patient population, patients with subsequent injuries were older than patients without subsequent injuries 48.78±7.30 versus 41.58±12.40, p=.0137. In a blinded review of the charts and Iowa Courts Online, legal representation was found to be more common in WC patients with subsequent injuries than WC patients without subsequent injuries (76.92% versus 37.21%, p=.0240). In the non-WC population, there were more males in the group without subsequent injuries than in the group with subsequent injuries 42.48% versus 8.33%, p=.0287. There were no significant differences in locations of subsequent injury. Hip, knee and contralateral foot and ankle were common areas of subsequent injury in both groups. Conclusion: Overall, WC patients had higher rates of subsequent injury than non-WC patients. Within the WC group, legal representation further raised the risk of subsequent injury. Gender may mediate variable reporting of subsequent injuries in non-WC populations. While the reason for this increased risk of subsequent injury is not known, the differences are enough that they should be considered when counseling WC patients considering these surgeries. Additionally, if further study supported these findings, knowledge of the areas at risk for subsequent injury might lead to preventative strategies that could decrease the risk of subsequent injury.

scholarly journals The Perceived Effectiveness of a Short-term Orthopaedic Foot and Ankle Mission Trip to Kenya

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0023
Author(s):  
Eric C. Gokcen ◽  
Joshua C. Luginbuhl ◽  
Joshua C. Luginbuhl
Keyword(s):  
Orthopaedic Surgery ◽  
Ankle Instability ◽  
Foot And Ankle ◽  
Perceived Effectiveness ◽  
Educational Impact ◽  
Short Term ◽  
Surgical Mission ◽  
Ankle Surgery ◽  
Orthopaedic Residency ◽  
The Impact

Category: Other Introduction/Purpose: Short-term surgical mission trips have become increasingly common, with many benefits seen by the hosts and the visitors when trips are done properly. However, few visitors ever attempt to measure the impact of their visit other than to list the surgeries that were performed. This study was performed to determine the perceived educational impact on orthopaedic attendings and residents of a Kenyan internationally accredited orthopaedic residency program and to determine the hosts’ opinions on the effectiveness of orthopaedic short-term trips. Methods: A survey was developed and distributed to four host attending surgeons and 9 host residents at the beginning of an orthopaedic mission trip. The visitors included four attending orthopaedic foot and ankle surgeons from various US sites, and two orthopaedic surgery residents from one US program. Using a scale from 1-10, with 1 meaning definitely No, and 10 meaning definitely Yes, hosts were asked if they felt there was a need for more foot and ankle training in Kenya. A post-trip survey was distributed to the host attendings and residents to determine perceived competency in five topics of foot and ankle pathology. Results: When hosts were asked if they felt there was a need for more foot and ankle training in Kenya, attendings responded an average 8.3, and residents 9.4. When asked if a short-term trip would improve foot and ankle care for the community, attendings responded 7.8, and residents 7.9. A post-trip survey was completed by one attending and 3 residents to determine their perceived competency in five topics of foot and ankle pathology. Overall, they averaged an increase of +2.0 on the scale in their competency for all topics. The highest increase was with ankle instability and hallux valgus at +3.0, and the lowest increase was with Achilles pathology at +0.75. Conclusion: The survey supported the hypothesis that short-term orthopaedic foot and ankle surgery trips to this program are helpful according to the hosts. Furthermore, understanding the competencies of the hosts can help the visitors develop more impactful teaching by focusing on the topics of need. Further studies such as this should be routinely performed with medical trips to help determine their effectiveness.

scholarly journals Subsequent Pain or Injury After Foot and Ankle Surgery in Patients Receiving Workers’ Compensation

2019 ◽  
Vol 41 (1) ◽  
pp. 17-24
Author(s):  
Gabrielle Bui ◽  
Yubo Gao ◽  
Natalie Glass ◽  
Christopher Cychosz ◽  
John Lawrence Marsh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Retrospective Chart Review ◽  
Anatomical Location ◽  
Workers Compensation ◽  
Foot And Ankle ◽  
Chi Square ◽  
Level Of Evidence ◽  
Legal Representation ◽  
Ankle Surgery

Background: Workers’ compensation (WC) has been associated with poor outcomes following a variety of injuries and surgeries, but rates of subsequent pain or injury (SPI) following surgery have not been studied. The purpose of this study was to investigate the rates, locations, and risk factors of SPI in WC patients and non-WC patients who underwent the same surgeries. Methods: With institutional review board approval, records from foot or ankle surgery performed by author P.P. from 2009 to 2015 were obtained. A retrospective chart review was performed on all WC and non-WC patients with at least 1 Current Procedural Terminology code of interest. SPI was defined as a new injury at a different anatomical location occurring 2 months to 2 years after the index surgery. Chi-square and 2-tailed t tests were used to compare risk factors and rates of SPI in both groups. Results: The WC population had higher rates of SPI than the non-WC population. Specifically, 13 of 56 WC patients (23.2%) vs 12 of 165 non-WC patients (7.3%) reported SPI ( P = .001). The hip, knee, and contralateral foot and ankle were common areas of SPI in both groups. Legal representation and increased age were risk factors for SPI in the WC population. Specifically, 10 of 13 WC patients with SPI had legal representation vs 16 of 43 WC patients without SPI ( P = .02). Female sex was a risk factor for SPI in the non-WC population. Conclusions: WC patients had higher rates of subsequent pain or injury than non-WC patients. Legal representation was a risk factor for SPI in the WC population. Level of Evidence: Level III, comparative series.

scholarly journals Surgical Trends in the Treatment of Acute Achilles Ruptures

2017 ◽  
Vol 2 (2) ◽  
pp. 2473011416S0001
Author(s):  
Bryant Ho ◽  
Sandeep Soin ◽  
Ashlee MacDonald ◽  
Judith Baumhauer ◽  
John Ketz
Keyword(s):  
Achilles Tendon ◽  
Orthopaedic Surgery ◽  
Fellowship Training ◽  
Nonoperative Treatment ◽  
Geographic Region ◽  
Foot And Ankle ◽  
Functional Rehabilitation ◽  
Orthopaedic Surgeons ◽  
Tendon Ruptures ◽  
Level I

Category: Sports Introduction/Purpose: Historically, nonoperative treatment of acute Achilles tendon ruptures was felt to have significant re-rupture rates. With improved functional rehabilitation, recent studies have shown decreased rates of tendon re-rupture. Recent randomized control trials circa 2010 have shown no difference in re-ruptures between early functional rehabilitation and surgical repair. The goal of this study was to evaluate trends in surgical treatment of Achilles ruptures, based on data obtained from the American Board of Orthopaedic Surgery (ABOS), in response to evolving level I evidence. Methods: All operative cases submitted by part II applicants from 2003 to 2015 for primary board certification by the American Board of Orthopaedic Surgery (ABOS) were retrospectively reviewed. Isolated primary Achilles tendon repairs for acute ruptures were identified by ICD-9 and CPT code. Surgeon information including fellowship training and geographic region, and patient information including age, sex, and complications were collected. Results: Out of 1,118,457 cases, there were 4792 Achilles repairs (0.43%) with 510 complications (10.6%). The rate of Achilles repairs increased from 2006 to 2010, when rates peaked at 0.57% of all collected cases (Figure 1). Since 2010, there has been a decrease in rates back to pre-2006 values. The changing rates appear to be largely driven by non-fellowship trained orthopaedic surgeons. The rates of sports and foot and ankle fellowship trained surgeons had mild increases in 2006 and decreases in 2010, but overall have slightly increased. The rate for patients greater than 65 have decreased from 2002 to 2004. Since then, there have been yearly variations, with minimal overall change. Examination of regional differences demonstrate the greatest change in the Northeast. All regions had increased rates in 2006 and decreased rates in 2010, with the exception of the Northwest and South regions, who showed little overall change. Conclusion: Surgical trends for Achilles ruptures corresponded closely to high impact level 1 publications in the literature in 2005 and 2010, suggesting evidence-based responsiveness in newly trained orthopaedic surgeons. These trends are less pronounced in the Northwest and South regions and for sports and foot and ankle specialists.

scholarly journals A Prospective Evaluation of Opioid Consumption Following Orthopaedic Foot and Ankle Surgery

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0010
Author(s):  
Sundeep Saini ◽  
Elizabeth McDonald ◽  
Kristen Nicholson ◽  
Ryan Rogero ◽  
Megan Chapter ◽  
...  
Keyword(s):  
Drug Prescription ◽  
Median Number ◽  
Opioid Consumption ◽  
Consumption Patterns ◽  
Utilization Rate ◽  
Foot And Ankle ◽  
Narcotic Drug ◽  
Opioid Prescription ◽  
Forefoot Surgery ◽  
Ankle Surgery

Category: Other Introduction/Purpose: The purpose of our study was to assess opioid consumption patterns following outpatient orthopaedic foot and ankle procedures in order to develop a pragmatic approach to narcotic drug prescription. Methods: Patients undergoing outpatient orthopaedic foot and ankle procedures who met inclusion criteria had the following prospective information collected: patient demographics, preoperative health history and Visual Analog Scale (VAS), anesthesia type, procedural details, and opioid prescription and consumption details. Utilization rates were compared using the Man-Whitney Test or the Kruskall-Wallis analysis of variance test with post-hoc Dunn’s multiple comparison test. Results: A total of 1,009 of 1,027 patients were included in this study (mean age: 49 years). Overall, patients consumed a median of 20 pills whereas the median number of pills prescribed was 40. This resulted in a utilization rate of 51% and nearly 21,196 pills left unused. Patients who received forefoot surgery used 6 pills less than those receiving hindfoot/ankle surgery (p=0.002). Patients between the ages of 60-79 consumed significantly less than those between 18-59 years old (p<0.012). Patients with preoperative VAS score =77 (p=0.002) or self-reported anxiety (p=0.070) a had an increase in opioid consumption compared to those who did not. Conclusion: Our study demonstrates that patients who undergo orthopaedic foot and ankle procedures are overprescribed narcotic medication by nearly twice the amount that is actually consumed. This leads to a significant surplus of narcotics available for potential diversion. We recommend that surgeons judiciously administer opioid prescriptions based on their patients’ consumption patterns and anatomic location of surgery.

scholarly journals Opioid Consumption and Time to Return to Work After Percutaneous Foot and Ankle Surgery

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0001
Author(s):  
Jimmy J. Chan ◽  
Javier Z. Guzman ◽  
Kevin K. Chen ◽  
Jesse C. Chan ◽  
Ettore Vulcano
Keyword(s):  
Soft Tissue ◽  
Return To Work ◽  
Opioid Consumption ◽  
Foot And Ankle ◽  
Foot Surgery ◽  
Average Return ◽  
Forefoot Surgery ◽  
Ankle Surgery ◽  
The Usa ◽  
Long Acting

Category: Hindfoot, Lesser Toes, Midfoot/Forefoot Introduction/Purpose: Orthopaedic surgeons are the 5th highest prescriber for narcotics in the USA. Foot and ankle procedures can be amongst some of the more painful procedures in orthopedics. A recent study demonstrated that patient underwent open foot and ankle surgeries averaged 27.2 tablets of narcotics with 37% of patients unwilling to stop at 3-month post-operative visit. Percutaneous techniques for foot and ankle procedures were recently approved in the U.S., which allow for significantly smaller incisions and minimal soft tissue disruption, which may potentially decrease post-operative pain and allow faster recovery. The purpose of this study is to assess the total opioid consumption and time for return to work following percutaneous foot and ankle surgery. Methods: In this prospective cohort study, 50 consecutive patients underwent percutaneous foot surgery (bony procedures with or without soft tissue work) by a single surgeon. All surgeries were outpatient procedures and performed under general anesthesia with a long-acting popliteal nerve block. All patients were prescribed 30 tablets of 5 mg oxycodone, 50 tablets of 500 mg acetaminophen, and 9 tablets of 600 mg ibuprofen post-operatively for pain control. All patients were given a log sheet to record number of pain medications taken during the first 14 post-operative days. The log sheet and leftover pills were collected and counted to confirm the amount of pain medication used at 2-week post-operative visit. Time return to work was also recorded in subsequent follow-up appointment. Results: All 50 patients returned their log sheet at 2-week post-operative visit. Mean age was 47.1 years. N=36 (72%) were forefoot surgeries, N=2 (4%) midfoot, N=9 (18%) hindfoot, and N=3 (6%) combined. Average oxycodone tablets taken during the first 14 days after surgery was 3.3 tablets. By the 14th day, no patient was taking any narcotic medication. The average return to work was 18.9 days post-operatively. Patients with forefoot surgery averaged 2.2 tablets of oxycodone with return to work at 10.4 days. Midfoot surgery patients averaged 3.5 tablets with return to work at 33 days. Hindfoot surgery patients averaged 5.3 tablets with return to work at 38.9 days. Combined foot surgery patients averaged 11 tablets with return to work at 54.3 days. Conclusion: This study demonstrated that percutaneous foot and ankle surgery has significant reduction and cessation in narcotic consumption post-operatively when compared to the reported values with open procedures in current literature.

scholarly journals 4-in-1 and 5-in-1 blocks in percutaneous forefoot surgery

2020 ◽  
Vol 14 (1) ◽  
pp. 79-83
Author(s):  
César Lima Oliveira ◽  
Lucio Carlos de Azevedo Torres Filho ◽  
Luiz Carlos Ribeiro Lara ◽  
Gabriel Lopes de Faria Cervone ◽  
Rafael Nogueira Figueiredo ◽  
...  
Keyword(s):  
Case Series ◽  
Anesthetic Technique ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Nerve Blocks ◽  
Forefoot Surgery ◽  
Ankle Surgery ◽  
Study Case ◽  
Therapeutic Study ◽  
Male Subjects

Objective: To analyze the effectiveness of peripheral nerve blocks in the ankle in percutaneous forefoot surgery and their potential complications. Methods: Retrospective study with a survey of the medical records of patients who underwent percutaneous orthopedic surgery onthe forefoot between 2009 and 2015, performed by the orthopedic foot  and ankle surgery group of our hospital, in which 4-in-1 and 5-in-1 anesthetic nerve blocks were used. We evaluated 239 cases, consisting of 222 female and 17 male subjects with a mean age of 61.2 years, seeking to observe the effectiveness and potential complications of the anesthetic technique. Results: Complications were observed in 3.34% of the 239 patients, with seven cases of neuritis and one case of tachycardia. Regarding the anesthetic technique, there were nine cases of block failure (3.76%), with four cases requiring supplementary local anesthetic, one case spinal anesthesia, and four cases general anesthesia. Conclusion: Having observed the low rate of complications and the almost complete success of 5-in-1 blocks in percutaneous forefoot surgery, we concluded that it is a safe and effective anesthetic technique. Level of Evidence IV, Therapeutic Study; Case Series.

Medical Malpractice Trends in Foot and Ankle Surgery

2021 ◽  
Author(s):  
Rishin J. Kadakia ◽  
Keith J. Orland ◽  
Akhil Sharma ◽  
Craig C. Akoh ◽  
Jie Chen ◽  
...  
Keyword(s):  
Medical Malpractice ◽  
Foot And Ankle ◽  
Ankle Surgery

scholarly journals Interprofessional Relationships between Orthopaedic and Podiatric Surgeons in the UK

2008 ◽  
Vol 90 (8) ◽  
pp. 663-670 ◽  
Author(s):  
A Isaac ◽  
SE Gwilym ◽  
IN Reilly ◽  
TE Kilmartin ◽  
WJ Ribbans
Keyword(s):  
Orthopaedic Surgery ◽  
Working Relationships ◽  
Foot And Ankle ◽  
Foot Surgery ◽  
Medical Practitioners ◽  
Orthopaedic Surgeons ◽  
Ankle Surgery ◽  
Training And Research ◽  
The Uk ◽  
Sizeable Number

INTRODUCTION The first comprehensive report on the interprofessional relationships between foot and ankle surgeons in the UK is presented. MATERIALS AND METHODS A questionnaire was sent to orthopaedic surgeons with membership of the British Foot and Ankle Surgery Society (BOFAS), orthopaedic surgeons not affiliated to the specialist BOFAS and podiatrists specialising in foot surgery. The questionnaire was returned by 77 (49%) of the BOFAS orthopaedic consultant surgeons, 66 (26%) of non-foot and ankle orthopaedic consultant surgeons and 99 (73%) of the podiatric surgeons. RESULTS While most respondents have experience of surgeons working in the other specialty in close geographical proximity, the majority do not believe that this has adversely affected their referral base. The experience of podiatrists of the outcomes of orthopaedic surgery has been more positive than orthopaedic surgeons of podiatric interventions. Podiatrists are more welcoming of future orthopaedic involvement in future foot and ankle services than in reverse. However, there are a sizeable number of surgeons in both professions who would like to see closer professional liaisons. The study has identified clear divisions between the professions but has highlighted areas where there is a desire from many clinicians to work more harmoniously together, such as in education, training and research. CONCLUSIONS While major concerns exist over issues such as surgery by non-registered medical practitioners and the suitable spectrum of surgery for each profession, many surgeons, in both professions, are willing to provide training for juniors in both specialties and there is a wish to have closer working relationships and common educational and research opportunities than exists at present.

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