Study lead Bradford S. Waddell, MD, hip and knee surgeon at HSS commented on the findings, stating, "Everybody is hurting after knee and hip surgery, but if you have easy access to the ER you’re just going to pop on in." Dr. Waddell explained, "We noticed a trend that patients were being discharged sooner and with the introduction of the electronic medical records, we felt that there was an increase in communications to the physician, either by phone or by email. This led us to investigate who was calling versus showing up to the clinic. With that, we expanded to see if those who traveled further had more complications as a result of being further from the ER." Additionally, Dr. Waddell cited "When we looked at the data, we were surprised to see that patients who lived closer to the hospital/ER, presented to the ER more often for reasons not requiring readmission (such as pain and swelling). This has led us to change how we educate patients, so they call us or show up in the clinic, as opposed to the very expensive ER."

Furthermore, when asked about particular language that might be helpful in counseling patients, Dr. Waddell advised, "Basically, explaining that while one day you will be extremely happy you had a joint replacement, the healing process can be quite rigorous and painful. We have opened lines of communication so that the patients are more likely to call us before appearing to the ER."

Read the full article at ryortho.com.

Previous studies have shown that high blood sugar, or hyperglycemia, during the perioperative period of orthopedic joint replacement surgery is a risk factor for infection. The new study, by Bradford S. Waddell, MD, a hip and knee surgeon at HSS, took a narrower look at the question. It included patients with a diagnosis of diabetes whose blood sugar was being controlled using the hormone insulin and compared them to diabetics who did not require insulin. Patients requiring insulin can be considered to have more severe diabetes and have a greater chance of experiencing elevated blood glucose in the perioperative period, Dr. Waddell said. 

For the new study, Dr. Waddell and his colleagues reviewed the medical charts of 773 men and women who had undergone total hip or knee replacement between 2011 and 2016. Of those, 437 had been diagnosed with insulin-dependent diabetes, while 336 had not been diagnosed with the condition. 

Patients with insulin-dependent diabetes were more than five times as likely as those without the condition to develop hyperglycemia, or high blood sugar, after surgery (odds ratio, 5.2; P<0.0001), the researchers found. Patients with higher blood glucose over the previous three months--as measured by hemoglobin A1c—were more likely to experience post-operative hyperglycemia regardless of which group they were in. An A1c above 6.59 for people with insulin-dependent diabetes, and 6.6 for those without the condition, was associated with an elevated risk for post-operative hyperglycemia (P<0.0001). 

Despite the increased risk for elevations in blood sugar after surgery, however, the incidence of post-operative joint infections did not differ between the two groups of patients. However, Dr. Waddell noted that a limitation of the study was that it was underpowered to detect the risk of infection.  

The bottom line for clinicians, Dr. Waddell said, is “if your patient comes in with diabetes and is dependent on insulin, you need to be more cognizant of controlling their blood sugar in the perioperative period because they’re at higher risk.”

The HSS researchers presented their findings at AAOS 2019, the annual meeting of the American Academy of Orthopaedic Surgeons.

"Intuition would say that they came to the ER because it’s available," said Bradford S. Waddell, MD, a hip and knee surgeon at HSS, who led the study. "Everybody is hurting after knee and hip surgery, but if you have easy access to the ER you’re just going to pop on in."

The impetus for the research was a relatively recent change in the demographics of surgery. A growing number of patients who require specialty procedures, such as knee and hip replacements, are referred by their local physicians to centers of excellence far from where they live. The result is that they may travel hundreds of miles for an operation but be unable to conveniently seek follow-up care at the same institution. Dr. Waddell and colleagues set out to evaluate how these patients were following up and communicating with the surgeon after their procedure. 

As Dr. Waddell and his colleagues found by reviewing medical records that included addresses, these patients are far less likely to show up at the hospital where they underwent their joint procedures than those who live in the general area. Instead, they turned to the telephone, calling in with questions and, if necessary, scheduling appointments to come see their surgeons—which is ideal, he said. "They should be calling us and coming to the clinic. We should try to avoid them showing up to the ER, which can be very expensive," Dr. Waddell said.  

The findings point to a need for better communication with patients who undergo orthopedic surgeries, Dr. Waddell said. Surgeons should emphasize that pain and swelling after these operations are normal and rarely require urgent care. "They should be calling us and coming to the clinic rather than using the ER," he said. 

The HSS researchers presented their findings at AAOS 2019, the annual meeting of the American Academy of Orthopaedic Surgeons. 

Alexander S. McLawhorn, MD, MBA, hip and knee surgeon at HSS, published a study in Orthopedics that compared overall patient satisfaction ratings for orthopedic surgeons from provider-based surveys with those found online. His team found that provider-initiated surveys had a higher number of patient ratings and higher satisfaction rates than those found online (such as on Healthgrades, Vitals, etc.).

"Surveys tend to capture the processes and outcomes of the entire care team and care environment, and they can be contingent on patient variables, such as comorbidities and patient behavior," Dr. McLawhorn says. "However, these outcomes are often not adequately risk-adjusted when they are reported."

Bradford S. Waddell, MD, hip and knee surgeon at HSS, who was also involved in the study, explains that government ratings provide a more comprehensive data set than crowdsourced ones. 

"Health care provider ratings are an anonymous survey given to all patients after care with the physician and are required by the government," Dr. Waddell says. "This automatically includes a larger and more robust representation of the physician's patients. This will give a more accurate representation of the care provided by the physician."

"As with everything, there is the possibility of bias in the health care provider reporting, and this should be properly guarded against by the care system to provide the most accurate results," he adds.

Dr. McLawhorn notes that further studies are needed to understand the parameters around crowdsourced care. "Patient-reported outcomes measures, or PROMs, like the Knee injury and Osteoarthritis Outcome Score are other potential candidate measures of quality, but we do not yet know how best to analyze these outcome scores so that they can be interpreted reliably as quality measures," he says. "Certainly, to use them as quality measures at this time would be premature and ahead of the science as well as our understanding of the links between PROMs and quality of care."

Read the full article at Healio.com/Rheumatology.

Read the full article at healio.com [registration required].

Founded in 1991, the mission of AAHKS is to advance hip and knee patient care through education and advocacy.

"About two years ago, my colleague Dr. Jeff Lange and I sought to connect recently graduated hip and knee fellows for research and collaboration," said Dr. Waddell. "We began with 10 to 12 surgeons, creating this new informal group and then brought the idea to AAHKS, where it has now grown into a larger group and committee."

The mission of YAG is to connect young arthroplasty surgeons (with under 5 years of practice) in order to promote collaboration and young surgeon activity within AAHKS, with a particular focus on research, leadership and advocacy.

At the inaugural YAG meeting at AAHKS’ Annual meeting in 2017, over 100 surgeons were in attendance.

Dr. Waddell has been a member of AAHKS since 2014 and began his term as chair on June 1, 2018. Previously, as a Health Policy Fellow for AAHKS, he was charged with finding new ways to bring younger surgeons into the organization. "Bringing our informal group to AAHKS was the perfect way to fulfill this duty," says Dr. Waddell, who also practices in CT at HSS Stamford.

The YAG Committee’s co-founder, Jeffrey Lange, MD, orthopedic surgeon at Brigham and Women’s Hospital, serves as vice-chair, with 5 liaisons to different AAHKS committees comprising the rest of the committee.

"This group recruits young arthroplasty surgeons and works to encourage and empower them to take advantage of the full benefits of the organization whether it is in research, advocacy or leadership," added Dr. Waddell. "I’m happy to say we’ve had 250 surgeons sign up for the group to date!"

Dr. Waddell joined HSS in October 2017; however he was no stranger to the organization as he completed his fellowship at HSS. He specializes in reconstruction of the hip and knee, specifically primary and revision hip and knee replacement. Devoted to getting his patients back to an active lifestyle, Dr. Waddell currently researches patient safety, new technologies and value-based care.

According to the article, the committee aims to connect arthroplasty surgeons with less than five years of practice to promote collaboration.

Read the full article at beckersspine.com.
 

In warmer temperatures, Dr. Waddell noted that people want to exercise outside, but could injure themselves by rushing into an activity. 

"Those [injuries] typically can be prevented by working your way slowly into whatever activity you're trying to get back to," Dr. Waddell said. 

To prevent injuries, Edelstein recommended performing any exercise that strengthens the core, such as planks, crunches or squats. 

"It's a combination of stretching, strengthening, getting those base muscles and mobility back," Edelstein added. 

If a patient is injured, Dr. Waddell explained that "one of the big things we push at HSS is that we want to avoid surgery if at all possible. The treatment is going to be similar for many of these injuries which involve rest. Physical therapy is so important to strengthen the muscles."

Watch the full segment at wtnh.com. This also aired during the May 21, 2018 broadcast. 
 

"When I see you as a patient, I listen to your history, perform a detailed exam and review the x-rays or other imaging. All three are vital components in my decision to recommend for or against surgery," Dr. Waddell wrote.

Additionally, Dr. Waddell advises that patients should ask themselves if their pain is preventing them from performing their daily activities.

Read the full article at brookfield.dailyvoice.com

Investigators found a much higher number of reviews and more favorable physician ratings overall on the hospital websites. The research was presented today at the American Academy of Orthopaedic Surgeons Annual Meeting in New Orleans. The study was also published in the journal Orthopedics in August 2017.

Consumer-driven healthcare and an increasing emphasis on quality measures have encouraged patient engagement in the rating of doctors and the care they provide. Independent commercial physician rating websites such as Healthgrades.com have become a popular outlet for patients to express their satisfaction or dissatisfaction.

A number of hospitals and medical practices have also started to publicly report the results of their own patient satisfaction surveys, which are often administered by a third party such as Press Ganey.

"The purpose of our research was to compare overall patient satisfaction ratings for orthopedic surgeons derived from hospital surveys with those posted on commercial physician rating websites. We also sought to determine which physician characteristics resulted in higher ratings," explained Bradford Waddell, MD, an orthopedic surgeon at Hospital for Special Surgery.

The study included 12 hospitals or medical practices that were publicly reporting patient satisfaction data collected for their orthopedic surgeons as of August 2016. Investigators identified 415 orthopedic surgeons with online patient ratings at the following institutions: Duke University, Midwest Orthopedics at Rush, Vanderbilt University, Northwell Health, Cleveland Clinic, University of Utah, University of Arkansas, Stanford University, University of Pittsburgh, Wake Forest University, Southern California Orthopedic Institute and Piedmont Healthcare.

The hospital surveys were administered at the time of the office visit or sent to randomly selected patients by email or regular mail. Independent third parties experienced in the creation and evaluation of health care surveys were used by most hospitals to gather the information. Patient response rates ranged from 18 percent to 30 percent. Most institutions required a minimum of 30 ratings within the past 12 to 18 months for the physician’s ratings to be made public.

For each orthopedic surgeon, the type of institution (academic setting versus private practice), sex, years in practice, geographic location and subspecialty training were recorded. The number of individual survey questions ranged from 6 to 20, depending on the institution, and most included questions on communication, trust in provider decision-making, time spent with the patient and willingness to recommend the physician to others. At all of the hospitals, an overall physician rating was reported on a scale of 1 to 5, with 5 as the highest rating.

Most of the institutions had a stated policy of publishing all physician ratings, including negative reviews and comments, as long as no offensive, profane, or slanderous remarks were made and there was no violation of patient privacy or confidentiality.

Researchers compared the ratings reported for each doctor posted on the hospital websites with the physician’s ratings on four commercial websites: Healthgrades.com, Vitals.com, RateMDs.com and UCompareHealthCare.com.

"Compared to commercial ratings websites, we found that provider-initiated patient satisfaction surveys yielded a higher number of ratings for each doctor, higher average patient satisfaction scores and a lower percentage of negative comments," said Alexander McLawhorn, MD, an orthopedic surgeon at HSS. "We saw a small association between increased years in practice and the likelihood of a negative rating, while academic practice settings and those in the Northeast had a lower percentage of negative comments."

"While hospital surveys are distributed to patients who received care from a specific doctor, ratings on sites such as Healthgrades and Vitals are often anonymous, and you really don’t know who is posting a review," Dr. Waddell noted. "We believe hospital surveys filled out by patients provide data of a higher quality and are a better indication of patient satisfaction."

Feedback from patients can also provide valuable information to physicians, according to Dr. Waddell, who believes increasing the use and reporting of patient satisfaction surveys could benefit the orthopedic community. "In contrast to a limited number of random online reviews, healthcare provider surveys can gain insights from a much larger population of patients. The more information we have, the more we can improve patient care."

The article notes that some patients may qualify for a partial knee replacement.

HSS hip and knee surgeon Bradford S. Waddell, MD, noted that patients could opt for a partial knee replacement when only one area of the knee's cartilage is damaged. According to the article, Dr. Waddell determines if a patient is a candidate for a partial knee replacement based on the patient's needs, the medical exam and imaging.

Read the full article at rd.com