Reducing Radiation and Lowering Costs With a Standardized Care Pathway for Nonoperative Thoracolumbar Fractures

Hanson, Gregory J.; Lyons, Kady; Fournier, Debra; Lollis, S. Scott; Martin, Emily B.; Rhynhart, Kurt K.; Handel, Wanda J.; McGuire, Kevin J.; Abdu, William A.; Pearson, Adam M.

doi:10.1177/2192568219831687

Cited by 5 publications

(8 citation statements)

References 22 publications

(44 reference statements)

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“…After each position change, check whether the pipeline is unobstructed, and check whether the circuit is smooth and whether the electrode is pasted to avoid the pressure. When adjusting the head, support the lower jaw and the forehead, avoid supporting the face from both sides, and prevent the face from being stretched too tight when it is lifted, which increases the chance of damage (Gumussuyu et al, 2019;Hanson et al, 2019). In addition, for female patients, their breasts should be placed inside the prone frame to reduce breast compression, and male patients should avoid penile compression.…”

Section: Discussionmentioning

confidence: 99%

Effect of postural nursing intervention on preventing pressure injury after thoracolumbar incision and internal fixation in southern China

et al. 2022

Food Sci. Technol

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The purpose of this study was to investigate the effect of postural nursing intervention on patients with moderate pressure ulcers through posterior thoracolumbar incision and internal fixation. A total of 100 patients were divided into a control group and an experimental group. The satisfaction rate of nursing care, incidence of complications, hospital stay, incidence of pressure ulcers, and VAS score of pain before and after operation were recorded in the 2 groups. Compared with the control group, the patients in the experimental group has higher satisfaction rate, shorter hospitalization time, and lower incidence of pressure ulcers and complications (all P <0.05). The VAS score of the control group (2.83 ± 0.56) was higher than that in the experimental group ((1.28 ± 0.57) all P <0.05). Postoperative thoracolumbar vertebral incision and internal fixation surgery for patients with postural nursing intervention can not only improve the satisfaction rate of nursing, reduce the occurrence of complications, shorten the length of hospitalization, but also reduce the incidence of intraoperative pressure ulcers.

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Section: Discussionmentioning

confidence: 99%

Effect of postural nursing intervention on preventing pressure injury after thoracolumbar incision and internal fixation in southern China

et al. 2022

Food Sci. Technol

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“…However, as estimated by World Health Organization (in 2010, in international dollars [int$]) the cost per inpatient bed day may range from 234.7 to 757.5 int$ in European countries to 646.5 to 1093.5 int$ in USA and Canada 19 . A previous study on a sample from an USA hospital found costs associated with orthosis that ranged from about $7000 to 13000, including hospitalization until the orthosis was fitted 20 …”

Section: Discussionmentioning

confidence: 99%

“…19 A previous study on a sample from an USA hospital found costs associated with orthosis that ranged from about $7000 to 13000, including hospitalization until the orthosis was fitted. 20 Apart from the costs associated with hospitalization, the cost of the device itself was also significantly higher in inpatients compared with outpatients. This may be associated with the fact that inpatients receive custom-made orthosis, significantly more expensive than prefabricated ones.…”

Section: Orthosis Costsmentioning

confidence: 99%

Use and Cost of Orthosis in Conservative Treatment of Acute Thoracolumbar Fractures

Linhares

Sousa‐Pinto

Silva

et al. 2020

Spine

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Survey study. Objective. Assess practices and opinions of spine specialists from Europe and North America on orthosis use in adult patients with acute thoracolumbar (TL) fractures. Evaluate cost of the devices.Summary of Background Data. Although orthosis are traditionally used in conservative treatment of TL fractures, recent systematic reviews showed no benefit in patient's outcomes. Methods. A search for contact authors with publications on spine fractures from all European and North American countries was performed. An online questionnaire was sent on demographic data, practice setting, mean number of fractures treated, use of orthosis upon choice for conservative treatment, and average orthosis cost. Data was analyzed based in world regions, economic rank of the country, and health expenditure. Results. We received 130 answers, from 28 European and five North American countries. Most responders had more than 9 years of practice and worked at a public hospital. 6.2% did not prescribe a brace in any patient with acute TL fractures conservatively treated and 11.5% brace all patients. In a scale from 1 to 5, 21 considered that there is no/low benefit (1) and 14 that bracing is essential (5), with a mean of 3.18. Europeans use orthosis less commonly than North Americans (P < 0.05). Orthosis mean cost was $611.4 AE 716.0, significantly higher in North America compared with Europe and in high income, when compared with upper middle income countries (both P < 0.05). Although hospital costs were not evaluated, orthosis is costlier when it involves admission of the patient (P < 0.05). An increase in orthosis cost associated with higher gross domestic product (GDP) per capita and higher health expenditure was found. Conclusion. More than 90% of spine specialists still use orthosis in conservative treatment of adult patients with acute TL fractures. Orthosis cost vary significantly between continents, and it is influenced by the country's economy.

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“…[14][15][16][17] While the costs of TLSOs vary, even the most expensive (custom-made) braces typically cost less than $5,000, with lifetime costs of bracing treatment estimated to be less than $65,000, or roughly a third of the cost of surgery. [18][19][20] Avoiding spinal fusion by early AIS identification and appropriate treatment with a TLSO brace is advantageous to both the patient and healthcare systems.…”

Section: Key Conceptsmentioning

confidence: 99%

Factors Associated with Presentation of Severe Adolescent Idiopathic Scoliosis

Erkkila¹,

Reynolds²,

Weissman³

et al. 2023

Journal of the Pediatric Orthopaedic Society of North America

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Background: Adolescent idiopathic scoliosis (AIS) is a common referral to pediatric orthopaedic surgeons. Timely treatment with appropriate bracing decreases the risk of curve progression and need for surgical intervention. Despite pediatrician screening, patients still present to orthopaedic surgeons with curve magnitudes too significant for appropriate nonoperative bracing. Methods: This retrospective cross-sectional study included patients aged 10 to 18 years diagnosed with AIS between 2011-2021 at a major metropolitan tertiary care center. Patients were excluded if initial radiographs were obtained more than 1 week after clinical diagnosis. Scoliosis severity was classified based on initial radiographs. Sociodemographic factors were recorded, including patient addresses, which were cross-referenced with the diversitydatakids.org Child Opportunity Index (COI) database, which analyzes the quality of resources in a geographic area. Results: Gender, health insurance provider, race/ethnicity, and COI were all found to have a statistically significant relationship with CA and age at initial presentation. The odds of presenting with severe (versus mild and moderate) scoliosis was 2.3 times higher for patients who identified as black/African American compared to those who identified as white. Additionally, the odds of initially presenting with severe scoliosis were almost 40% higher in females compared to males. Furthermore, each stepwise increase in COI was associated with a 17%-19% decrease in odds of presenting with severe scoliosis, depending on standardization. Conclusions: There are sociodemographic disparities in the identification and initiation of treatment for AIS. Specifically, the odds of presenting with severe scoliosis are increased in patients who identify as black/African American or female and/or come from areas with lower access to resources (as defined by COI). Appropriate and timely referral to a pediatric orthopaedic surgeon for AIS treatment thus requires 1) educating primary care providers, pediatricians, and scoliosis screeners on how to appropriately identify scoliosis and the risks associated with late identification/referral and 2) public health initiatives to address access to care for patients at risk for late scoliosis identification.

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Reducing Radiation and Lowering Costs With a Standardized Care Pathway for Nonoperative Thoracolumbar Fractures

Cited by 5 publications

References 22 publications

Effect of postural nursing intervention on preventing pressure injury after thoracolumbar incision and internal fixation in southern China

Effect of postural nursing intervention on preventing pressure injury after thoracolumbar incision and internal fixation in southern China

Use and Cost of Orthosis in Conservative Treatment of Acute Thoracolumbar Fractures

Factors Associated with Presentation of Severe Adolescent Idiopathic Scoliosis

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