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Background: In correlation with a growing body of evidence regarding nonoperative management for Achilles tendon rupture (ATR), studies from Europe and Canada have displayed a decreasing incidence in surgical management, which has not been noted in the United States. The primary objective of this study is to evaluate the US trend in ATR repair volume. Methods: The American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination Case List Database was used. All cases using Current Procedural Terminology codes for primary ATR repair were requested from the years 2006-2020. Total submitted Achilles repair volume, the number of candidates submitting an Achilles repair case, and the overall submitted case volume per examination year was analyzed. Poisson and linear regressions were used to determine statistically significant trends. Results: The total number of Achilles repair cases submitted for the ABOS Part II Oral Examination significantly increased from 2006 to 2011 and then decreased until 2020. Taking Achilles repair cases as a proportion of total orthopaedic cases submitted, the same trend was seen. The number of candidates submitting an Achilles repair case increased from 2006 to 2009 and then decreased until 2020. Foot and Ankle fellowship-trained candidates submitted an increasing number of ATR repair cases per candidate during the time period studied. Conclusion: This is the first study to demonstrate a decline in the volume of ATR repair in the United States. The decline in ATR repair volume seen in the ABOS Part II Case Lists does not match previously published US surgeon practice patterns but is not necessarily generalizable to beyond this period. Although the overall ATR repair volume in the ABOS Part II Case Lists is decreasing, we found Foot and Ankle fellowship-trained surgeons are operating on an increasing number of ATRs during their board collection period. Level of Evidence: Level III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Background: Cost and compliance are 2 factors that can significantly affect the outcomes of non-operative and operative treatment of trigger finger (TF) and both may be influenced by social factors. The purpose of this study was to investigate socioeconomic disparities in the surgical treatment for TF. Methods: Adult patients (≥18 years old) were identified using International Classification of Diseases 9 and 10 Clinical Modification diagnostic codes for TF and Current Procedural Terminology (CPT) procedural codes (CPT: 26055) in the New York Statewide Planning and Research Cooperative System database. Each diagnosis was linked to procedure data to determine which patients went on to have TF release. A multivariable logistic regression was performed to assess the likelihood of receiving surgery. The variables included in the analysis were age, sex, race, social deprivation index (SDI), Charlson Comorbidity Index, and primary insurance type. A P -value <.05 was considered significant. Results: Of the 31 411 TF patients analyzed, 8941 (28.5%) underwent surgery. Logistic regression analysis showed higher odds of receiving surgery in females (odds ratio [OR]: 1.108) and those with workers compensation (OR: 1.7). Hispanic (OR: 0.541), Asian (OR: 0.419), African American (OR: 0.455), and Other race (OR: 0.45) had decreased odds of surgery. Medicaid (OR: 0.773), Medicare (OR: 0.841), and self-pay (OR: 0.515) reimbursement methods had reduced odds of receiving surgery. Higher social deprivation was associated with decreased odds of surgery (OR: 0.988). Conclusions: There are disparities in demographic characteristics among those who receive TF release for trigger finger related to race, primary insurance, and social deprivation. [ABSTRACT FROM AUTHOR]

Objective: Considering the high rates of opioid usage following orthopedic surgeries, it is important to explore this in the setting of the current opioid epidemic. This study examined acute opioid poisonings in postoperative spine surgery patients in New York and the rates of poisonings among these patients in the context of New York's 2016 State legislation limiting opioid prescriptions.Methods: Claims for adult patients who received specific orthopedic spine procedures in the outpatient setting were identified from 2009 to 2018 in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Patients were followed to determine if they presented to the emergency department for acute opioid poisoning postoperatively. Multivariable logistic regression was performed to evaluate the effect of patient demographic factors on the likelihood of poisoning. The impact of the 2016 New York State Public Health Law Section 3331, 5. (b), (c) limiting opioid analgesic prescriptions was also evaluated by comparing rates of poisoning prelegislation and postlegislation enactment.Results: A total of 107,456 spine patients were identified and 321 (0.3%) presented postoperatively to the emergency department with acute opioid poisoning. Increased age [odds ratio (OR)=0.954, P <0.0001] had a decreased likelihood of poisoning. Other race (OR=1.322, P =0.0167), Medicaid (OR=2.079, P <0.0001), Medicare (OR=2.9, P <0.0001), comorbidities (OR=3.271, P <0.0001), and undergoing multiple spine procedures during a single operative setting (OR=1.993, P <0.0001) had an increased likelihood of poisoning. There was also a significant reduction in rates of postoperative acute opioid poisoning in patients receiving procedures postlegislation with reduced overall likelihood (OR=0.28, P <0.0001).Conclusion: There is a higher than national average rate of acute opioid poisonings following spine procedures and increased risk among those with certain socioeconomic factors. Rates of poisonings decreased following a 2016 legislation limiting opioid prescriptions. It is important to define factors that may increase the risk of postoperative opioid poisoning to promote appropriate management of postsurgical pain. [ABSTRACT FROM AUTHOR]

Socioeconomic status, race, and insurance status are known factors affecting adult orthopaedic surgery care, but little is known about the influence of socioeconomic factors on pediatric orthopaedic care. The purpose of this study was to determine if demographic and socioeconomic related factors were associated with surgical management of pediatric supracondylar humerus fractures (SCHFs) in the inpatient versus outpatient setting. Pediatric patients (<13 years) who underwent surgery for SCHFs were identified in the New York Statewide Planning and Research Cooperative System database from 2009–2017. Inpatient and outpatient claims were identified by International Classification of Diseases-9-Clinical Modification (CM) and ICD-10-CM SCHF diagnosis codes. Claims were then filtered by ICD-9-CM, ICD-10-Procedural Classification System, or Current Procedural Terminology codes to isolate SCHF patients who underwent surgical intervention. Multivariable logistic regression analysis was performed to determine the effect of patient factors on the likelihood of having inpatient management versus outpatient management. A total of 7079 patients were included in the analysis with 4595 (64.9%) receiving inpatient treatment and 2484 (35.1%) receiving outpatient treatment. The logistic regression showed Hispanic (OR: 2.386, p < 0.0001), Asian (OR: 2.159, p < 0.0001) and African American (OR: 2.095, p < 0.0001) patients to have increased odds of inpatient treatment relative to White patients. Injury diagnosis on a weekend had increased odds of inpatient management (OR: 1.863, p = 0.0002). Higher social deprivation was also associated with increased odds of inpatient treatment (OR: 1.004, p < 0.0001). There are disparities among race and socioeconomic status in the surgical setting of SCHF management. Physicians and facilities should be aware of these disparities to optimize patient experience and to allow for equal access to care. [ABSTRACT FROM AUTHOR]

To characterize the volume dependence of both facilities and surgeons on postoperative complications after lumbar fusion and characterize the role of socioeconomic status. Adults who underwent lumbar fusion from 2011 to 2015 were identified using International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes for lumbar disc degeneration or spondylolisthesis and procedure codes for lumbar fusion in the New York Statewide Planning and Research Cooperative System database. Complications were compared across surgeon and facility volumes using multivariable Cox proportional hazards regression, controlling for patient demographic and clinical factors. Surgeon and facility volumes were compared between the lowest and highest 20%. Of the 26,211 patients identified with a lumbar fusion, 16,377 patients were treated at a high-volume or low-volume facility or by a high-volume or low-volume surgeon. Low-volume facilities had higher 3-month and 12-month rates of readmission, pneumonia, and cellulitis; lower 1-month, 3-month, and 12-month rates of deep vein thrombosis; and lower 1-month rates of wound complications. Low-volume surgeons had higher 1-month, 3-month, and 12-month rates of readmission, acute renal failure, surgical site infection, and wound complications; high 1-month and 3-month rates of urinary tract infection and pulmonary embolism; and a lower 12-month rate of revision. Patients who were treated by low-volume surgeons and had complications were more concentrated to ZIP codes with high social deprivation. Both high-volume facilities and high-volume surgeons show lower rates of complications and readmission. There are significant socioeconomic disparities regarding which patients can access high-volume surgeons. [ABSTRACT FROM AUTHOR]

Background: Ankle arthroplasty has emerged as a viable alternative to ankle arthrodesis due in large part to recent advancements in both surgical technique and implant design. This study seeks to document trends of arthroplasty and arthrodesis for ankle osteoarthritis in New York State from 2009-2018 in order to determine if patient demographics play a role in procedure selection and to ascertain the utilization of each procedure and rates of complications. Methods: Patients 40 years and older from 2009-2018 were identified using International Classification of Diseases, Ninth and Tenth Revisions (ICD-9 and ICD-10), Clinical Modification (CM) diagnosis and procedure codes for ankle osteoarthritis, ankle arthrodesis, and ankle arthroplasty in the New York statewide planning and research cooperative system database. A trend analysis for both inpatient and outpatient procedures was performed to evaluate the changing trends in utilization of ankle arthrodesis and ankle arthroplasty over time. A multivariable logistic regression was used to assess the odds of receiving ankle arthrodesis relative to ankle arthroplasty. Complications were compared between inpatient ankle arthrodesis and arthroplasty using multivariable Cox proportional hazards regression. Results: A total of 3735 cases were included. Ankle arthrodesis increased by 25%, whereas arthroplasty increased by 757%. African American race, federal insurance, workers compensation, presence of comorbidities, and higher social deprivation were associated with increased odds of having an ankle arthrodesis vs an ankle arthroplasty. Compared with ankle arthroplasty, ankle arthrodesis was associated with increased rates of readmission, surgical site infection, acute renal failure, cellulitis, urinary tract infection, and deep vein thrombosis. Conclusion: Ankle arthroplasty volume has grown substantially without a decrease in ankle arthrodesis volume, suggesting that ankle arthroplasty may be selectively used for a different population of patients than ankle arthrodesis patients. Despite the increased growth of ankle arthroplasty, certain patient demographics including patients from minority populations, federal insurance, and from areas of high social deprivation have higher odds of receiving arthrodesis. Level of Evidence: Level III, retrospective cohort. [ABSTRACT FROM AUTHOR]

Background: There are limited epidemiologic data examining the incidence of pediatric anterior cruciate ligament reconstruction (ACLR) over the past decade. Purpose: To examine statewide population trends in the incidence of ACLR in a pediatric population. Study Design: Descriptive epidemiology study. Methods: Inpatient and outpatient claims for pediatric patients who underwent ACLR between 2009 and 2017 were identified in the New York Statewide Planning and Research Cooperative System database via International Classification of Diseases (ICD), Revision 9, Clinical Modification; ICD, Revision 10, Clinical Modification and Procedural Classification System; or Current Procedural Terminology codes. New York population data for each year between 2009 and 2017 were used from the New York State Department of Health to calculate the rates of ACLR per 100,000 people aged 3 to 19 years and determine the 95% confidence limits. The rates were then stratified by age, sex, and insurance. Two-year rates of revision and contralateral ACLR were also analyzed by sex. Results: Between 2009 and 2017, 20,170 pediatric ACLRs were identified. The rates of pediatric ACLR increased steadily from 49.3 per 100,000 in 2009 (95% CI, 47.2-51.4) to a peak of 61.0 (95% CI, 58.6-63.4) in 2014 and decreased to 51.8 (95% CI, 49.6-54.1) by 2017. The age group 15 to 17 years had the highest rates of ACLR of all age groups, peaking at 198.5 (95% CI, 188.3-208.7) per 100,000. Analysis by sex showed that ACLR rates between males and females were not different. Males had a 2-year ipsilateral revision rate of 4.3%, while females had a rate of 3.3% (P =.0001). Females had a contralateral ACLR rate of 4.0%, while males had a rate of 2.6% (P =.0002). Conclusion: Pediatric ACLR rates continued to rise until 2014, but there was a demonstrable decrease in rates after 2014. This decline in pediatric ACLR may point to the efficacy of injury prevention programs or changes in practice management. The high revision rate in males and high contralateral surgery rate in females can help guide patient counseling for return to play and complication risk. Clinical Relevance: This study showed that ACLR in pediatric patients may be decreasing in recent years. There were differences in revision and contralateral ACLR by sex. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: The two most common surgical procedures for end stage ankle arthritis patients who fail conservative management are arthrodesis and arthroplasty. The appropriateness of total ankle arthroplasty versus arthrodesis remains controversial. The long-term outcomes of current generation prostheses are not yet available and there is continued debate regarding the cost-benefit and risk-benefit analysis of each procedure. This study seeks to document rates of arthroplasty and arthrodesis for ankle osteoarthritis in New York in order to ascertain utilization of each procedure over time and stratification by patient demographics. Methods: Patients from 2009-2018 were identified using International Classification of Disease (ICD)-9 and 10 Clinical Modification (CM) codes for ankle osteoarthritis and Current Procedural Terminology or ICD-9 CM and ICD-10 Procedural Classification System procedural codes for ankle arthrodesis or ankle arthroplasty in the New York Statewide Planning and Research Cooperative System (SPARCS) database. SPARCS is an all-payer database collecting outpatient (emergency department, ambulatory surgery, and hospital-based clinic visits) and all inpatient claims in New York. A trend analysis was performed to determine if there was a shift towards either ankle arthrodesis or ankle arthroplasty over time. A multivariable logistic regression was performed to assess the impact of patient demographic factors on the likelihood of receiving arthrodesis versus arthroplasty. The variables included in the analysis were age, sex, race, ethnicity, Social Deprivation Index (linked by ZIP code), Charlson Comorbidity Index, and primary insurance type. Results: 3,735 cases were included in the trend analysis in years 2009-2018. In 2009, 220 (84%) procedures were ankle arthrodesis and 42 (16%) were ankle arthroplasty. By 2018, 274 (43.2%) were ankle arthrodesis and 360 (56.8%) were ankle arthroplasty (p<.0001). Ankle arthrodesis increased 25% over the study period while ankle arthroplasty increased 757%. The multivariable logistic regression showed older age (OR: 0.95, p<.0001) and females (OR: 0.71, p=.0003) had decreased odds of arthrodesis. African American race (OR: 1.63, p=.0459), federal insurance (OR: 1.72, p<.0001), worker's compensation (OR: 1.75, p=.0072), being from an area with higher social deprivation (OR: 1.01, p=.0004) or having >=1 Charlson comorbidities (OR: 1.4, p=.0007) was associated with increased odds of arthrodesis compared to arthroplasty. Conclusion: The present study demonstrates a substantial rise in ankle arthroplasty volume without a matching decrease in ankle arthrodesis volume over ten years. Patients who are wary of the motion limitation of arthrodesis and would previously have gravitated towards nonoperative management may now be finding a commonly performed, motion sparing alternative in arthroplasty. Ankle arthrodesis volume slightly increased, suggestive of nonequivalent patient populations undergoing these two procedures. There are apparent socioeconomic disparities in the utilization of these procedures, likely stemming from numerous nuanced factors but nevertheless also likely reflective of disparities in foot and ankle healthcare access. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Osteochondral lesions of the talus (OLT) are common injuries that are often found in patients with chronic disabling pain after ankle sprains. While OLT is becoming increasingly prevalent in the younger active population, there is disagreement and a lack of strong evidence about the impact of age on outcomes. The purpose of this study is to perform an Age- Based multivariate analysis to evaluate the clinical outcomes of Autologous Osteochondral Transplantation (AOT) for the treatment of OLT. The goals of this study are to examine trends in patient characteristics and clinical outcomes that occur with age as a statistical variable when performing AOT for the treatment of OLT. Methods: All study protocols were approved by the Institutional Review Board at the senior author's institution. A retrospective cohort study using chart review for AOT procedures on approximately 80 patients from 2006 to 2019 performed by a single surgeon. Clinical outcomes of patients were evaluated via FAOS scores for Symptoms, Pain, Activities of Daily Living, Sports and Quality of Life. A multivariable linear regression was used to assess the independent factors predictive of the first post-operative FAOS after AOT. The independent variables included in the model were pre-operative FAOS, age, defect size, whether the lesion was a shoulder lesion, cystic lesion, or a result of a traumatic injury, and whether the patient had a prior microfracture surgery. A p-value <.05 was considered significant and 95% confidence limits (95% CL) for regression coefficient estimates (est.) were calculated. Results: 78 patients were included in the analysis with an average age of 35.5 +- 13.6. The average follow-up was 54.4 months +- 18.9 months, average pre-operative FAOS was 54.3 +- 19.4 and the average post-operative FAOS was 83.4 +- 13.6. The average defect size was 109.3 mm2 (std. dev. = 62.4 mm). 56 patients had a shoulder lesion, 24 had a prior microfracture surgery, 42 had a cystic lesion, and 27 had a prior traumatic injury. The multivariable linear regression showed that the pre-operative FAOS was associated with a higher post-operative FAOS (est., 95% CL: 0.16, 0.012 - 0.307; p=0.034). Defect size (est., 95% CL: -0.05, -0.097 - -0.003; p=0.0358), having a shoulder lesion (est., 95% CL: -9.068, -15.448 - -2.688; p=0.006), or having a prior microfracture surgery (est., 95% CL: -7.07, -13.118 - -1.021; p=0.0226) were associated with a lower post-operative FAOS. Conclusion: The main finding of this study is patient age was not an independent risk factor for inferior clinical outcomes after AOT for OLT. Additionally, having a cystic lesion, or having a lesion because of a traumatic injury were not significantly associated with post-operative FAOS. Having a shoulder lesion had the largest marginal effect on post-operative FAOS. These findings provide important information for providers when counseling and selecting patients for AOT procedure for treatment of OLT. [ABSTRACT FROM AUTHOR]

The annual high volume of carpal tunnel releases (CTRs) has a large financial impact on the health care system. Validating the cost drivers related to CTR in a large, diverse patient population may aid in developing cost reduction strategies to benefit health care systems. Adult patients with carpal tunnel syndrome who underwent CTR were identified in the New York Statewide Planning and Research Cooperative System database from 2016 to 2017. The Statewide Planning and Research Cooperative System is a comprehensive all-payer database that collects all inpatient and outpatient preadjudicated claims in New York. A multivariable mixed model regression with random effects was performed for the facility to assess the variables that contributed significantly to the total charge. The variables included were patient age, sex, anesthesia method, whether the surgery took place in an ambulatory surgery center or a hospital outpatient department, operation time in minutes, primary insurance type, race, ethnicity, Charlson Comorbidity Index, and categories for billed procedure codes. During the period of 2016 to 2017, 8,717 claims were included, with a mean charge per claim of $4,865. General anesthesia was associated with higher charges than local anesthesia. A procedure at a hospital outpatient department was associated with an approximately 48.2% increase in the total charge compared with that at an ambulatory surgery center. A 1-minute increase in the operation time was associated with a 0.3% increase in the total charge. Claims with antiemetics, antihistamines, benzodiazepines, intravenous fluids, narcotic agents, or preoperative antibiotics were associated with higher total charges than claims that did not bill for these. Compared with endoscopic procedures, open procedures had a 44.3% decrease in the total charges. This comprehensive multivariable model has validated that general anesthesia, hospital-based surgery, the use of antibiotics and opioids, longer operative times, and endoscopic CTR significantly increased the cost of surgery. Economic and decision analyses II. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to characterize the influence of social deprivation on the rate of complications, readmissions, and revisions following primary total shoulder arthroplasty (TSA), using the Social Deprivation Index (SDI). The SDI is a composite measurement, in percentages, of seven demographic characteristics: living in poverty, with < 12 years of education, single-parent households, living in rented or overcrowded housing, households without a car, and unemployed adults aged < 65 years., Methods: Patients aged ≥ 40 years, who underwent primary TSA between 2011 and 2017, were identified using International Classification of Diseases (ICD)-9 Clinical Modification and ICD-10 procedure codes for TSA in the New York Statewide Planning and Research Cooperative System database. Readmission, reoperation, and other complications were analyzed using multivariable Cox proportional hazards regression controlling for SDI, age, ethnicity, insurance status, and Charlson Comorbidity Index., Results: A total of 17,698 patients with a mean age of 69 years (SD 9.6), of whom 57.7% were female, underwent TSA during this time and 4,020 (22.7%) had at least one complication. A total of 8,113 patients (45.8%) had at least one comorbidity, and the median SDI in those who developed complications 12 months postoperatively was significantly greater than in those without a complication (33 vs 38; p < 0.001). Patients from areas with higher deprivation had increased one-, three-, and 12-month rates of readmission, dislocation, humeral fracture, urinary tract infection, deep vein thrombosis, and wound complications, as well as a higher three-month rate of pulmonary embolism (all p < 0.05)., Conclusion: Beyond medical complications, we found that patients with increased social deprivation had higher rates of humeral fracture and dislocation following primary TSA. The large sample size of this study, and the outcomes that were measured, add to the literature greatly in comparison with other large database studies involving TSA. These findings allow orthopaedic surgeons practising in under-served or low-volume areas to identify patients who may be at greater risk of developing complications., Competing Interests: S. S. Shah is a paid consultant for Exactech, unrelated to this study; a board/committee member of the American Academy of Orthopaedic Surgeons, the American Orthopaedic Society for Sports Medicine, and the Arthroscopy Association of North America; and an editorial/governing board member of Arthroscopy. A. I. Cruz Jr. is a board/committee member of the Pediatric Orthopaedic Society of North America and Pediatric Research in Sports Medicine (PRiSM)., (© 2024 The British Editorial Society of Bone & Joint Surgery.)

Objectives: The aim of this study was to characterize the case volume dependence of both facilities and surgeons on morbidity and mortality after femoral shaft fracture (FSF) fixation., Methods: Adults who had an open or closed FSF between 2011 and 2015 were identified in the New York Statewide Planning and Research Cooperative System database. Claims were identified by International Classification of Disease-9, Clinical Modification diagnostic codes for a closed or open FSF and International Classification of Disease-9, Clinical Modification procedure codes for FSF fixation. Readmission, in-hospital mortality, and other adverse events were compared across surgeon and facility volumes using multivariable Cox proportional hazards regression, controlling for patient demographic and clinical factors. Surgeon and facility volumes were compared between the lowest and highest 20% to represent low-volume and high-volume surgeons/facilities., Results: Of 4,613 FSF patients identified, 2,824 patients were treated at a high or low-volume facility or by a high or low-volume surgeon. Most of the examined complications including readmission and in-hospital mortality showed no statistically significant differences. Low-volume facilities had a higher 1-month rate of pneumonia. Low-volume surgeons had a lower 3-month rate of pulmonary embolism., Conclusion: There is minimal difference in outcomes in relation to facility or surgeon case volume for FSF fixation. As a staple of orthopaedic trauma care, FSF fixation is a procedure that may not require specialized orthopaedic traumatologists at high-volume facilities., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Introduction: This study seeks to evaluate (1) the relationship between hospital and surgeon volumes of shoulder arthroplasty and complication rates and (2) patient demographics/socioeconomic factors that may affect access to high-volume shoulder arthroplasty care., Methods: Adults older than 40 years who underwent shoulder arthroplasty between 2011 and 2015 were identified in the New York Statewide Planning and Research Cooperative System database using International Classification of Disease 9/10 and Current Procedural Terminology codes. Medical/surgical complications were compared across surgeon and facility volumes. The effects of demographic factors were analyzed to determine the relationship between such factors and surgeon/facility volume in shoulder arthroplasty., Results: Seven thousand seven hundred eighty-five patients were included. Older, Hispanic/African American, socially deprived, nonprivately insured patients were more likely to be treated by low-volume facilities. Low-volume facilities had higher rates of readmission, urinary tract infection, renal failure, pneumonia, and cellulitis than high-volume facilities. Low-volume surgeons had patients with longer hospital lengths of stay., Discussion: Important differences in patient socioeconomic factors exist in access to high-volume surgical care in shoulder arthroplasty, with older, minority, and underinsured patients markedly more likely to receive care by low-volume surgeons and facilities. This may highlight an area of potential focus to improve access to high-volume care., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)