BackgroundOperative fixation of ankle fractures is common. However, as reimbursement plans evolve with the potential for bundled payments, it is critical that orthopedic surgeons better understand factors influencing the postoperative length of stay (LOS) in patients undergoing these procedures to negotiate appropriate reimbursement. We sought to identify factors influencing the postoperative LOS in patients with operatively treated ankle fractures.Materials and methodsSix hundred twenty-two patients with ankle fractures between January 1st, 2004 and December 31st, 2010 were identified retrospectively. Charts were reviewed for gender, length of operative procedure, method of fixation, American Society of Anesthesiologists (ASA) physical status score, medical comorbidities, and postoperative LOS. Both univariate and multivariate models were developed to determine predictors of patient LOS. Financial data for an average 24-h inpatient stay were obtained from financial services.ResultsSix hundred twenty-two patients were included. In a linear regression analysis, a statistically significant relationship was demonstrated between ASA status and LOS (P < 0.001). Multiple regression analysis further characterized the relationship between ASA and LOS: a 1-U increase in ASA classification conferred a 3.42-day increase in LOS on average (P < 0.001). Based on an average per-day inpatient cost of $4,503, each unit increase in ASA status led to a $15,490 increase in cost.ConclusionsOur study demonstrates that ASA status is a powerful predictor of LOS in patients undergoing operative fixation of ankle fractures. More complete understanding of these factors will lead to better risk adjustment models for measuring outcomes, determining fair reimbursement, and potential improvements to the efficiency of patient care.Level of EvidenceLevel III retrospective comparative study regressing length of stay with many variables, including ASA physical status.Electronic supplementary materialThe online version of this article (doi:10.1007/s10195-013-0280-9) contains supplementary material, which is available to authorized users.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Osteochondral lesions of the talus present a challenge to the foot and ankle surgeon with regards to treatment. Although most bone marrow stimulation (BMS) procedures have relatively good outcomes, those patients who do not improve or present with large lesions (>1.5 cm2) are candidates for a range of more involved procedures. All of these treatments focus on improving pain and function by restoring cartilage at the lesion site. Treatment options are generally classified as either BMS or restorative. Histologic studies have found that BMS leads to infill by fibrocartilage that has physical properties inferior to that of native hyaline cartilage. The goal of restorative treatments is to create hyaline or hyaline-like cartilage. This category includes a variety of techniques each with their own advantages and disadvantages. This paper focuses specifically on one of these techniques, particulate juvenile articular cartilage transfer. A brief overview of BMS and restorative treatment options is provided. A detailed description of the surgical technique for particulate juvenile articular cartilage transfer and a review of published clinical results are discussed. Level of Evidence: Level V—expert opinion. See Instructions for Authors for a complete description of levels of evidence.
The material presented herein focuses on the exploration of the production of gadolinium aluminum gallium garnet and lutetium oxyorthosilicate doped with cerium (GAGG:Ce and LSO:Ce, respectively) through mechanochemical means. Multiple parameters are explored including mass of starting material, ball size, rotational speed of the mill, number of balls employed, and material used for the milling container. Theoretical calculations were conducted using a pre-established equation and showed that, when all other parameters were held constant, in scenarios where (1) a smaller mass of sample, (2) faster revolutions per minute, (3) greater numbers of balls, or (4) a greater density of the material used for the vials and balls were employed, there should be higher energies imparted to the system. Actual results executed appeared to exhibit somewhat congruent results, but showed limitations due to experimental (non-idealized) conditions.
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