What is the burden of osteomyelitis in Germany? An analysis of inpatient data from 2008 through 2018

Background The epidemiology of osteomyelitis in Germany is unknown, which makes it difficult to estimate future demands. Therefore, we aimed to analyse how the numbers of cases have developed over the last decade as a function of osteomyelitis subtype, age group, gender, and anatomical localization. Methods Osteomyelitis rates were quantified based on annual ICD-10 diagnosis codes from German medical institutions between 2008 through 2018, provided by the Federal Statistical Office of Germany (Destatis). Results Overall osteomyelitis prevalence increased by 10.44% from 15.5 to 16.7 cases per 100,000 inhabitants between 2008 through 2018. Out of 11,340 cases in 2018, 47.6% were diagnosed as chronic, 33.2% as acute and 19.2% as unspecified osteomyelitis. Men were often affected than women with 63.4% of all cases compared to 36.6%. The largest proportion of patients comprised the age group 60–69 years (22.1%), followed by 70–79 years (21.7%). A trend towards more osteomyelitis diagnoses in older patients was observed. Lower extremities were most frequently infected with 73.8% of all cases in 2018 (+ 10.8% change). Conclusions Osteomyelitis remains a serious problem for orthopedic and trauma surgery. Prevention methods and interdisciplinary approaches are strongly required.

Litigations in orthopedics and trauma surgery: reasons, dynamics, and profiles

Background In recent literature, the increasing number of medical litigations, both in terms of the number of cases being filed and the substantive costs associated with lawsuits, has been described. This study aims to provide an overview of the profile of litigation for orthopedic and trauma surgery to describe the differences and the development of the number of cases over time. Patients and Materials A retrospective review of all litigations between 2000 and 2017 was conducted using the institutional legal database. The causes of litigation were documented and classified into seven major categories. In addition to plaintiff characteristics, the litigation outcomes and the differences between emergency and elective surgery were analyzed. Results A total of 230 cases were evaluated. The mean age of the plaintiffs was 44.6 ± 20.1 years, and 56.8% were female. The main reasons for litigation were claimed inappropriate management (46.1%), misdiagnosis (22.6), and poor nursing care (8.3%). Significantly more litigations were filed against surgeons of the orthopedic subspecialty compared with trauma surgeons (78%; p ≤ 0.0001). There were significantly fewer litigations per 1000 cases filed overall in 2009–2017 (65% less; p = 0.003) than in 2000–2008. Conclusion Our results could not confirm the often-stated trend of having more litigations against orthopedic and trauma surgeons. Although the absolute numbers increased, the number of litigations per 1000 patients treated declined. Patients who underwent elective surgery were more likely to file complaints than emergency patients.

Effects of the COVID-19 Pandemic on the Management of Spinal Disorders – Results of a National Survey

Introduction Far-reaching political steps to contain the COVID-19 pandemic have been undertaken in recent weeks. These also impact on surgical specialties not directly involved in the management of patients infected with the coronavirus. The Spine Section, the interdisciplinary professional political arm of the German Spine Society (DWG), the Professional Association for Orthopedic and Trauma Surgery (BVOU), and the Federal Association of German Neurosurgeons (BDNC) conducted a survey on the collateral effects of the pandemic on spine surgery in Germany. Method This cross-sectional study included outpatient, day-patient and inpatient facilities caring for patients with spinal disorders during the COVID-19 pandemic. The survey was designed to analyse the impact of the COVID-19 pandemic on the management of inpatients and outpatients with spinal disorders and to assess the economic ramifications in the various settings. Results All members of the Spine Section (n = 134) were invited to participate in the questionnaire consented by BVOU and BDNC. The questions were answered anonymously, and the personal data entered did not permit any de-anonymisation. All in all, 68% (n = 91) of the respondents completed the survey in full. Based on the type of employment (practice 30%, practice/staff: 45% and staff: 25%) and range of activities (conservative: 5%, conservative/operative: 75%, operative: 20%) the survey by the Spine Section can be regarded as representative. 95% of the practices/outpatient clinics reported a decline in their number of patients. In addition, the number of operations performed fell by 36% (SD 17%). The percentage of elective procedures declined from approximately 78% to 6%. As a result, more than half of the physicians anticipated moderate (20 – 40%) economic challenges and 25% major (> 50%) financial problems. Conclusion In order to cushion collateral damage in the wake of future pandemic management, any implications in the interdisciplinary management of patients with spinal disorders should be based on these results.

Smartphone and medical app usage among orthopedic and trauma surgery patients in Germany - a paper-based survey of the acceptance and prospective app requirements (Preprint)

BACKGROUND Smartphones have become an essential part of everyday life and it is undeniable that apps offer enormous opportunities for dealing with future challenges in public health. Nevertheless, the exact patient requirements for medical apps in the field of orthopedic and trauma surgery are currently unknown. OBJECTIVE The aim of this study was to define target groups, evaluate patient requirements, potentials and pitfalls regarding medical apps specific for orthopedic and trauma surgery. METHODS A prospective multicenter study was conducted between August 2018 and December 2019 at a German trauma center and 3 trauma surgery/orthopedic practices. A paper-based survey consisting of 15 questions evaluated information regarding smartphone and medical app usage behavior. In addition, suggested app functions were rated using Likert scales. Descriptive statistics and binary log-binomial regression was performed. RESULTS A total of 1,055 questionnaires were included in the statistical analysis. A total of 89.57 % owned a smartphone. Ownership probability decreased with every decade of life and increased with a higher level of education. Medical information was obtained via mobile web access by 62.65% of participants; this correlated similarly to ownership in regard to age and educational level. Only 11.18% reported previous medical app usage; 3.50% received an app recommendation from a physician. More than half (56.30%) were unwilling to pay for a medical app. The highest rated app functions were information about medication, behavioral guidelines and medical record archival. An improved treatment experience through suggested app features was reported by 71.18%. CONCLUSIONS Mobile devices are a widely used source of information for medical content, but only a minority reports previous medical app usage. The main target group for medical apps in orthopedic and trauma surgery tends to be younger, what harbours the danger of excluding fringe groups especially the elderly. Education seems to be one of the most important pull factors to use smartphones or a mobile web connection to obtain health information. Medical apps, primarily focusing on an optimized patient education and flow of information, therefore seem to have the potential to support patients in health issues, at least in their subjective perception. For future target group-oriented app developments, further evidences on clinical application, feasibility, and acceptance of app usage are necessary, in order to avoid patient endangerment and limit socio-economic costs.

Open access redefined: Survey data and literature review on the impact of Sci-Hub in orthopedic research (Preprint)

BACKGROUND Since Alexandra Elbanyan founded Sci-Hub in 2011, the website has been used by a growing number of researchers worldwide. Sci-Hub is a so-called shadow library or guerilla open access format bypassing publishers’ paywalls, giving everyone free access to scientific papers. Until today, there are no publications about orthopedic and trauma surgeon usage Sci-Hub or other “pirate-sides” and how it may influence their work. OBJECTIVE The goal of this study was to objectify Sci-Hub’s use and potential impact to research the field of orthopedic and trauma surgery. METHODS Orthopedic and trauma surgeons of four university hospitals in Germany and Europe were consulted using a standardized questionnaire containing multiple items about the use and evaluation of Sci-Hub. In addition, the Medline and Cochrane databases were screened for all studies related to Sci-Hub. Two reviewers independently reviewed all articles and the references of these articles. RESULTS 69% of all orthopedics knew Sci-Hub and 66,7% used it on a regular basis. 77% of younger participants (<45 years old) knew the webpage, while only 25% older participants (>45 years old) knew the webpage. 90% found the quality of their citation and research was enhanced since using Sci-Hub. On a scale of 1 to 10, user friendliness was rated with a mean rating of 7.58 (95%; CI: 7.262 – 7.891). Ethical or legal concerns among users seem mixed. On a scale of 1 (no concerns) to 5 (many concerns), the mean score was 2.39 (95%; CI: 2.154 – 2.615). 89% of doctors using Sci-Hub would recommend it to other colleagues. CONCLUSIONS The quality and number of articles in Sci-Hub is outstanding, and the rate of young researchers using the website is high. The most important shift in literature research for decades is a phenomenon mostly used by young researchers and is not the subject of current research itself. Sci-Hub has already and will further change how orthopedic research works.

Scientific Backgrounds for the Timing of Acute Care Surgery

The correct timing of urgent surgery in the field of orthopedic and trauma surgery is under constant discussion. The authors of this review like to present a scientific based recommendation for the timing of acute care surgery using the TACS-classification for the description of urgency. The timing and priority of the indicated procedure is deduced only from the expected mortality and disability caused by a potential delay. A proposal for a nomenclature is given to be integrated in the clinical practice and to be completed.