Effect of orthopedic surgery delay and counseling on postoperative complications and mortality rate in patients aged over 55 years in a teaching hospital

Ghadami, Ladan; Shishvan, Seyed Amir Mahlisha Kazemi; Shirdel, Abbas; Dorost, Abolfazl; Homauni, Abbas; Rohollahi, Nayereh Sadat; Jafarieh, Arash

doi:10.4103/jehp.jehp_372_19

Cited by 3 publications

(1 citation statement)

References 10 publications

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“… 19 However, U.S. patients also had a significantly shorter average pre-operative delay which has been shown to decrease the mortality risk in elderly patients undergoing orthopedic surgery. 20 When treating acetabulum fractures, the timing for definitive surgical stabilization has been controversial. In the past, stabilization surgery has been staged for acetabular fractures; however, recent studies have described early definitive fixation is a safe and viable treatment option even for hemodynamically unstable and polytrauma patients.…”

Section: Discussionmentioning

confidence: 99%

Physician Workforce in Kansas: Where are the Orthopedic Surgeons?

Hughes,

Reese,

Templeton

2024

kjm

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Introduction. Rural patients have greater need but less access to orthopedic surgical care than their urban counterparts. Previous studies have investigated rural surgical care, but this is the first to assess the Kansas orthopedic surgery workforce to identify changes over time and rurality and inform thinking about future workforce composition. Methods. The authors analyzed 2009 and 2019 AMA MasterFile and Area Health Resource File (AHRF) data. Using frequencies, percentages, and calculations of orthopedic surgeons per capita, we assessed workforce changes by rurality (Rural Urban Continuum Codes). Results. The dataset included 307 orthopedic surgeons; 197 were in both 2009 and 2019. Of these, 165 were in active practice in 2009 and 244 in 2019, an increase of 79 (47.9%). Kansas had smaller proportions of surgeons in rural (non-metro) versus urban (metro) counties in both years. Orthopedic surgeons per capita grew throughout the state, but the increase was smaller in rural counties. There were 11 women orthopedic surgeons in both years, 3.6% of the total 307. Among the 197 surgeons in both years, four (2.0%) were women. No women orthopedic surgeons were in non-metro counties either year. Conclusions. Although the Kansas orthopedic surgery workforce grew from 2009 to 2019, rural Kansas remains a surgery desert based on orthopedic surgeons per capita. Further studies could determine whether this trend is similar to that in other rural states and how to attract orthopedic surgeons to rural practice.

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Section: Discussionmentioning

confidence: 99%

Physician Workforce in Kansas: Where are the Orthopedic Surgeons?

Hughes,

Reese,

Templeton

2024

kjm

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Racial and Social Determinants of Health Disparities in Spine Surgery Affect Preoperative Morbidity and Postoperative Patient Reported Outcomes

Mohanty

Harowitz

Lad

et al. 2022

Spine

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Study Design. Retrospective observational study. Objective. To elucidate racial and socioeconomic factors driving preoperative disparities in spine surgery patients. Summary of Background Data. There are racial and socioeconomic disparities in preoperative health among spine surgery patients, which may influence outcomes for minority and low socioeconomic status (SES) populations.Methods. Presenting, postoperative day 90 (POD90), and 12month (12M) outcome scores (PROMIS global physical and mental [GPH, GMH] and visual analog scale pain [VAS]) were collected for patients undergoing deformity arthrodesis or cervical, thoracic, or lumbar laminotomy or decompression/ fusion; these procedures were the most common in our cohort. Social determinants of health for a patient's neighborhood (county, zip code, or census tract) were extracted from public databases. Multivariable linear regression with stepwise selection was used to quantify the association between a patient's preoperative GPH score and sociodemographic variables.Results. Black patients presented with 1 to 3 point higher VAS pain scores (7-8 vs. 5-6) and lower (worse) GPH scores (6.5-10 vs. 11-12) than White patients (P < 0.05 for all comparisons); similarly, lower SES patients presented with 1.5 points greater pain (P < 0.0001) and 3.5 points lower GPH (P < 0.0001) than high SES patients. Patients with lowest-quartile presenting GPH scores reported 36.8% and 37.5% lower (worse) POD-90 GMH and GPH scores than the highest quartile, respectively (GMH: 12 vs. 19, P < 0.0001; GPH: 15 vs. 24, P < 0.0001); this trend extended to 12 months (GMH: 19.5 vs. 29.5, P < 0.0001; GPH: 22 vs. 30, P < 0.0001). Reduced access to primary care (B ¼ À1.616, P < 0.0001) and low SES (B ¼ -1.504, P ¼ 0.001), proxied by median household value, were independent predictors of worse presenting GPH scores. Conclusion. Racial and socioeconomic disparities in patients' preoperative physical and mental health at presentation for spine surgery are associated adversely with postoperative outcomes. Renewed focus on structural factors influencing preoperative presentation, including timeliness of care, is essential. Key words: access to surgical care, area deprivation index, outcomes in spine surgery, patient reported outcomes in spine surgery, racial disparities, racial disparities in patient reported outcomes, social determinants of health, socioeconomic disparities in spine surgery, timeliness of surgical care.

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The Effect of COVID-19 on Orthopedic Practices and Surgeons in Louisiana

Kale¹,

Patel²,

Leddy³

et al. 2020

Orthopedics

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This study was performed to analyze the effect that coronavirus 2019 (COVID-19) has had on orthopedic surgeons' practices, their patients, and orthopedic surgeons themselves through a survey distributed to members of the Louisiana Orthopaedic Association (LOA). An anonymous 22-question online survey was created and distributed to 323 LOA members. Of the 323 recipients of the survey, 99 (30.7%) responded. As a part of a multiple response set, in which respondents could choose more than one answer, the majority reported delayed care for routine orthopedic injuries (81 of 97, 83.5%). Almost every surgeon (n=95, 96.0%) reported stopping or delaying elective surgery because of COVID-19 and an increase in pain/disability/deformity in patients due to delay in elective procedures (73 of 97, 75.3%) and delay in seeking care (66 of 97, 68.0%). The majority reported an increased use of telehealth visits (68 of 97, 70.1%), a decrease in patient volume (88 of 97, 90.7%), and a reduction in income (79 of 98, 80.6%) during the past 6 months. A majority of surgeons (58 of 98, 59.2%) reported that they had applied for government assistance or took out loans. Via a multiple response set, respondents indicated that as a result of the pandemic, telehealth will become more widespread (64 of 98, 65.3%) and hospitals will exert a stronger influence over health care (64 of 98, 65.3%). The COVID-19 pandemic has had lasting effects on orthopedic surgeons in Louisiana and their practices, with a substantial decrease in the number of patients treated (90.5%), surgical volume, and revenue (80.6%). Orthopedic surgeons affected by the pandemic could use these data to further understand future challenges with patient care and changing orthopedic practice dynamics during this unique time. [ Orthopedics . 2020;43(6):351–355.]

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Effect of orthopedic surgery delay and counseling on postoperative complications and mortality rate in patients aged over 55 years in a teaching hospital

Cited by 3 publications

References 10 publications

Physician Workforce in Kansas: Where are the Orthopedic Surgeons?

Physician Workforce in Kansas: Where are the Orthopedic Surgeons?

Racial and Social Determinants of Health Disparities in Spine Surgery Affect Preoperative Morbidity and Postoperative Patient Reported Outcomes

The Effect of COVID-19 on Orthopedic Practices and Surgeons in Louisiana

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