Surgery Rates
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2021 ◽  
Vol 21 (1) ◽  
AM Lewin ◽  
M Fearnside ◽  
R Kuru ◽  
BP Jonker ◽  
JM Naylor ◽  

Abstract Background Internationally, elective spinal surgery rates in workers’ compensation populations are high, as are reoperation rates, while return-to-work rates following spinal surgery are low. Little information is available from Australia. The aim of this study was to describe the rates, costs, return to work and reoperation following elective spinal surgery in the workers’ compensation population in New South Wales (NSW), Australia. Methods This retrospective cohort study used administrative data from the State Insurance Regulatory Authority, the government organisation responsible for regulating and administering workers’ compensation insurance in NSW. These data cover all workers’ compensation-insured workers in New South Wales (over 3 million workers/year). We identified a cohort of insured workers who underwent elective spinal surgery (fusion or decompression) between January 1, 2010 and December 31, 2018. People who underwent surgery for spinal fracture or dislocation, or who had sustained a traumatic brain injury were excluded. The main outcome measures were annual spinal surgery rates, cost of the surgical episode, cumulative costs (surgical, hospital, medical and physical therapy) to 2 years post-surgery, and reoperation and return-to-work rates 2 years post-surgery. Results There were 9343 eligible claims (39.1 % fusion; 59.9 % decompression); claimants were predominantly male (75 %) with a mean age of 43 (range 18 to 75) years. Spinal surgery rates ranged from 15 to 29 surgeries per 100,000 workers per year, fell from 2011-12 to 2014-15 and rose thereafter. The average cost in Australian dollars for a surgical episode was $46,000 for a spinal fusion and $20,000 for a decompression. Two years post-fusion, only 19 % of people had returned to work at full capacity; 39 % after decompression. Nineteen percent of patients underwent additional spinal surgery within 2 years of the index surgery, to a maximum of 5 additional surgeries. Conclusion Rates of workers’ compensation-funded spinal surgery did not rise significantly during the study period, but reoperation rates are high and return-to-work rates are low in this population at 2 years post- surgery. In the context of the poor evidence base supporting lumbar fusion surgery, the high cost, increasing rates, and the increased likelihood of poor outcomes in the workers’ compensation population, we question the value of this procedure in this setting.

2021 ◽  
Vol 11 (1) ◽  
Felix M. Bläsius ◽  
Markus Laubach ◽  
Hagen Andruszkow ◽  
Cavan Lübke ◽  
Philipp Lichte ◽  

AbstractPreinjury anticoagulation therapy (AT) is associated with a higher risk for major bleeding. We aimed to evaluated the influence of preinjury anticoagulant medication on the clinical course after moderate and severe trauma. Patients in the TraumaRegister DGU ≥ 55 years who received AT were matched with patients not receiving AT. Pairs were grouped according to the drug used: Antiplatelet drugs (APD), vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC). The primary end points were early (< 24 h) and total in-hospital mortality. Secondary endpoints included emergency surgical procedure rates and surgery rates. The APD group matched 1759 pairs, the VKA group 677 pairs, and the DOAC group 437 pairs. Surgery rates were statistically significant higher in the AT groups compared to controls (APD group: 51.8% vs. 47.8%, p = 0.015; VKA group: 52.4% vs. 44.8%, p = 0.005; DOAC group: 52.6% vs. 41.0%, p = 0.001). Patients on VKA had higher total in-hospital mortality (23.9% vs. 19.5%, p = 0.026), whereas APD patients showed a significantly higher early mortality compared to controls (5.3% vs. 3.5%, p = 0.011). Standard operating procedures should be developed to avoid lethal under-triage. Further studies should focus on detailed information about complications, secondary surgical procedures and preventable risk factors in relation to mortality.

2021 ◽  
Maria Holsen ◽  
Veronica Hovind ◽  
Haji Kedir Bedane ◽  
Knut Ivar Osvoll ◽  
Jan-Erik Gjertsen ◽  

Abstract BackgroundStandardised surgery rates for common orthopedic procedures vary across geographical areas in Norway. The aim in this study is to explore whether area-level factors related to demand and supply in publicly funded healthcare are associated with geographical variation in surgery rates for six common orthopedic procedures. MethodsCross-sectional population based study of the 19 hospital referral areas in Norway. Adult admissions for arthroscopy for degenerative knee disease, arthroplasty for osteoarthritis of the knee and hip, surgical treatment for hip fracture, and decompression with or without fusion for lumbar disc herniation and lumbar spinal stenosis over 5 years (2012-2016) were included. Extremal quotients, coefficients of variation and systematic components of variance were used to estimate variation in age and sex standardised surgery rates. Linear regression analyses were conducted to explore the association between standardised surgery rates and proportion of population in urban areas, unemployment, proportion of persons living in low-income households, proportion of persons with a high level of education, and mortality. ResultsArthroscopy for degenerative knee disease showed the highest level of variation and the number of arthroscopies decreased during the period. There was considerable variation in procedures for lumbar disc herniation and lumbar spinal stenosis, moderate to low variation for arthroplasty for osteoarthritis of the knee and hip, and least variation in surgical treatment for hip fracture. Association between surgery rates and socioeconomic and supply factors were weak for arthroscopy for degenerative knee disease and decompression for lumbar disc herniation and spinal stenosis. Standardised surgery rates for arthroplasty for osteoarthritis of the knee and hip, and surgical treatment for hip fracture were not associated with the supply and demand factors included in this study.ConclusionsVariation in surgery rates were particularly high for arthroscopy for degenerative knee disease, and these rates decreased considerably during the five-year period. Factors reflecting socioeconomic circumstances, health and supply have a weak association to orthopedic surgery rates at an area-level. Whether this reflects the equity of universal health care services, or if area-level factors are not detailed enough to detect an existing association is being explored in two ongoing Norwegian studies.

2021 ◽  
Giovanni E Ferreira ◽  
Joshua Zadro ◽  
Chang Liu ◽  
Ian Harris ◽  
Chris Maher

Abstract Background: Second opinions have the goal of clarifying uncertainties around diagnosis or management, particularly when healthcare decisions are complex, unpleasant, and carry considerable risks. Second opinions might be particularly useful for people recommended surgery for their back pain as surgery has at best a limited role in the management of back pain. No studies have attempted to summarise the available evidence for second opinion services designed for people with back pain that have been recommended to have surgery.Methods: We conducted a scoping review. Two independent researchers screened PubMed, EMBASE and Cochrane CENTRAL from their inception to May 6th, 2021. Studies of any design were eligible provided that they described a second opinion intervention for people with spinal pain (low back or neck pain with or without radicular pain) either considering surgery or to whom surgery had been recommended. We assessed the methodological quality of studies with the Downs & Black scale. Outcomes were: i) characteristics of second opinion services for people considering or who have been recommended spinal surgery, ii) agreement between first and second opinions in terms of diagnoses, need for surgery and type of surgery, iii) their effectiveness in reducing surgery rates and improving patient –reported outcomes; and iv) the costs and healthcare use associated with these services. Outcomes were presented descriptively. Results: We included 12 studies (11 had poor methodological quality; one had fair). Studies described patient, doctor, and insurance-initiated second opinion services. Diagnostic agreement between first and second opinions varied from 53% to 96% across studies. Agreement for need for surgery between first and second opinions ranged from 0% to 83%. There is some very-low quality evidence that second opinion services may reduce surgery rates in the short-term, but it is unclear whether these reductions are sustained in the long-term or if patients only delay surgery. Second opinion services may reduce costs and some healthcare use (e.g. imaging), but might increase others (e.g. injections, prescription drugs). Conclusions: There is a need for high-quality studies to determine the value of second opinion services for reducing spinal surgery.

2021 ◽  
Vol 21 (1) ◽  
Brian Chen ◽  
Cole Chapman ◽  
Sarah Bauer Floyd ◽  
John Mobley ◽  
John Brooks

Abstract Background How much does the medical malpractice system affect treatment decisions in orthopaedics? To further this inquiry, we sought to assess whether malpractice liability is associated with differences in surgery rates among elderly orthopaedic patients. Methods Medicare data were obtained for patients with a rotator cuff tear or proximal humerus fracture in 2011. Multivariate regressions were used to assess whether the probability of surgery is associated with various state-level rules that increase or decrease malpractice liability risks. Results Study results indicate that lower liability is associated with higher surgery rates. States with joint and several liability, caps on punitive damages, and punitive evidence rule had surgery rates that were respectively 5%-, 1%-, and 1%-point higher for rotator cuff tears, and 2%-, 2%- and 1%-point higher for proximal humerus fractures. Conversely, greater liability is associated with lower surgery rates, respectively 6%- and 9%-points lower for rotator cuff patients in states with comparative negligence and pure comparative negligence. Conclusions Medical malpractice liability is associated with orthopaedic treatment choices. Future research should investigate whether treatment differences result in health outcome changes to assess the costs and benefits of the medical liability system.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 8503-8503
Jonathan Spicer ◽  
Changli Wang ◽  
Fumihiro Tanaka ◽  
Gene Brian Saylors ◽  
Ke-Neng Chen ◽  

8503 Background: CheckMate 816 (NCT02998528) is a randomized phase 3 study of neoadjuvant NIVO + chemo vs chemo in resectable NSCLC. The study met its first primary endpoint, demonstrating significantly improved pathological complete response (pCR) with neoadjuvant NIVO + chemo. Here we report key surgical outcomes from the study. Methods: Adults with stage IB (≥ 4 cm)–IIIA (per AJCC 7th ed) resectable NSCLC, ECOG PS ≤ 1, and no known EGFR/ ALK alterations were randomized to NIVO 360 mg + platinum-doublet chemo Q3W or chemo Q3W for 3 cycles (n = 179 each). Definitive surgery was to be performed within 6 weeks of treatment. Primary endpoints are pCR (defined as 0% viable tumor cells in lung and lymph nodes) and event-free survival; both are evaluated by blinded independent review. Feasibility of surgery and surgery-related adverse events (AEs) are exploratory endpoints. Results: Baseline characteristics were comparable between arms; 64% of patients (pts) were stage IIIA. Definitive surgery rates were 83% with NIVO + chemo (n = 149) vs 75% with chemo (n = 135). Reasons for cancelled surgery were disease progression (12 and 17 pts, respectively), AEs (2 pts/arm), or other scenarios (14 and 19 pts, respectively; including pt refusal, unresectability, poor lung function). Minimally invasive surgery rates were 30% and 22%, and conversion from minimally invasive to open surgery rates were 11% and 16% for NIVO + chemo and chemo, respectively. Lobectomy was performed in 77% vs 61% of pts, and pneumonectomy in 17% and 25% for NIVO + chemo vs chemo, respectively. AEs were responsible for delays of surgery in 6 pts in the NIVO + chemo arm and 9 pts in the chemo arm. An R0 resection was achieved in 83% vs 78% of pts and median residual viable tumor (RVT) cells in the primary tumor bed were 10% vs 74% for NIVO + chemo vs chemo. There was no increase in median (Q1, Q3) duration of surgery and length of hospitalization between NIVO + chemo vs chemo (184 [130, 252] vs 217 [150, 283] min; and 10.0 [7, 14] vs 10.0 [7, 14] days, respectively). Any-grade and grade 3–4 surgery-related AEs were reported in 41% vs 47% and 11% vs 15% of the NIVO + chemo vs chemo arms, respectively. Grade 5 surgery-related AEs were reported in 2 vs 0 pts in the NIVO + chemo vs chemo arms; 0 vs 3 pts died due to treatment-related AEs, respectively. Conclusions: In CheckMate 816, neoadjuvant NIVO + chemo did not impede the feasibility and timing of surgery, nor the extent or completeness of resection vs chemo alone; treatment was tolerable and did not increase surgical complications. NIVO + chemo led to increased depth of pathological response. The surgical outcome data from CheckMate 816 along with significant improvement in pCR support NIVO + chemo as a potential neoadjuvant option for patients with stage IB to IIIA resectable NSCLC. Clinical trial information: NCT02998528.

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S576-S577
D O Magro ◽  
P G Kotze ◽  
A B Quaresma ◽  
A O M C Damiao ◽  
D A Valverde ◽  

Abstract Background The impact of current medical options in Crohn’s disease (CD) on hospitalization and surgical rates may be conflicting, and there is lack of data in newly industrialized countries. This study aims to describe temporal trends of proportional hospitalization and CD-related abdominal surgery rates according to drug-dispensing in Brazil, using public healthcare datasets. Methods All CD patients from the unique public healthcare national system (DATASUS) were included from January 2012 to December 2020 and identified according to ICD codes, medication or CD-related procedures. Data extraction was performed with the platform “TT Disease Explorer” (Techtrials Healthcare Data Science), which collects publicly available data via electronic algorithms with automatic updates. Annual rates of all-cause hospitalization and CD-related abdominal surgical procedures were captured and stratified by type of drug dispended. Average Annual Percent Change (AAPC) and 95% confidence intervals (CI) were calculated using poisson (or negative binomial) regression. Results The absolute number of registries of overall drug-dispensing for CD was 178,209, being 32.03% for Azathioprine (AZA), 10.91% for infliximab (IFX) and 10.52% for Adalimumab (ADA). AZA dispensing increased from 28.60% to 30.83% (AAPC 1.15; CI 0.23–2.09; p=0.015), ADA increased from 5.98% to 12.03% (AAPC 8.79; CI 6.33–11.30; p&lt;0.001) and IFX increased from 7.09% to 12.03% (AAPC 7.52; CI 6.94–8.10; p&lt;0.001) (figure 1). A total of 39,161 hospitalizations (all-cause) were captured in the same period. Hospitalization rates with AZA varied from 37.09% to 36.35% (AAPC -0.42, CI -1.08-0.24; p=0.209); for ADA remained stable (13.16% to 13.12%, AAPC -0.03; CI -1.10-1.05; p=0.962) and for IFX increased from 17.93% to 22.49% (AAPC 3.21; CI 1.66–4.79, p&lt;0.001) (figure 2). Regarding CD-related abdominal surgical procedures (n=1181), rates were stable for AZA (AAPC 1.34; CI -8.41–12.12; p=0.797). Considering the use of anti-TNF agents, rates were stable with ADA, varying from 26,7% to 20,0% (AAPC -1.64; CI -13.84-12.29; p=0.807) and decreased from 33,3% to 4,5% for IFX (AAPC -17.05; CI -28.19- -4.17; p=0.011) (figure 3). Conclusion In this large national study, there was an increase in the number of dispensings of AZA, IFX and ADA for CD from 2012–2020 in the public healthcare system in Brazil, due in part to the increasing prevalence of CD. All-cause hospitalization rates remained stable for AZA and ADA, and increased in IFX patients. A reduction in CD-related abdominal surgical procedures was observed in patients who used IFX and were stable with AZA and ADA. These data can be used for future strategic planning in the national public healthcare system (SUS) in CD management in Brazil.

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