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Conversion hip arthroplasty is defined as a patient who has had prior open or arthroscopic hip surgery with or without retained hardware that is removed and replaced with arthroplasty components. Currently, it is classified under the same diagnosis related group (DRG) as primary total hip arthroplasty (THA), however, it frequently requires a higher cost of care.A retrospective study of 228 conversion THA procedures in an orthopaedic specialty hospital were performed. Propensity score matching was used to compare the study group to a cohort of 510 primary THA patients by age, body mass index (BMI), sex and American Society of Anesthisiology (ASA) score. These matched groups were compared based on total costs, implants used, operative times, llengths of stay (LOS), readmissions, and complications.Conversion THA incurred 25% greater mean total costs compared to primary THA (p.05), longer lengths of surgery (154 vs 122 minutes), and hospital LOS (2.1 vs 1.56 days). A subgroup analysis showed a 57% increased cost for cephalomedullary nail conversion, 34% increased cost for sliding hip screw, 33% for acetabular ORIF conversion, and 10% increased costs in closed reduction and percutaneous pinning conversions (all p.05). There were 5 intraoperative complications in the conversion group versus none in the primary THA group (P.01), with no statistically significant difference in readmissions.Conversion THA is significantly more costly than primary THA and has longer surgical times, and greater LOS. Specifically, conversion THA with retained implants had the greatest impact on cost.

BACKGROUND CONTEXT Sagittal balance in adult spinal deformity is topic of ongoing exploration. Junctional kyphosis and junctional failure are challenging problems whose contributing factors are not entirely understood. A high native pelvic incidence has been shown to be a risk factor for adjacent segment disease. Recent developments in sagittal plane measures include the T1 pelvic angle which was proven to correlate with health-related quality of life scores. PURPOSE To evaluate whether a high preoperative pelvic incidence, postoperative pelvic incidence-lumbar lordosis mismatch, or postoperative T1-pelvic angle is predictive of proximal junctional kyphosis or failure and subsequent revision or persistent pain at long-term follow-up. STUDY DESIGN/SETTING A multicenter, multisurgeon retrospective cohort study. PATIENT SAMPLE All patients who underwent a posterior thoracolumbar fusion with pelvic fixation, with or without interbody fusion, with or without three-column osteotomy between 2010-2019. OUTCOME MEASURES Outcome measures included radiographic evaluation of PJK or PJF, sagittal alignment, adjacent segment disease, revision rate, and back pain needing opiates, pain management, or documentation of surgical revision counseling at or before long-term follow-up. METHODS Patients were separated into cohorts of preoperative pelvic incidence less than or equal to 55° and greater than 55°. -term follow-up ranged from 1 to 8 years post index surgery. Pelvic incidence, lumbar lordosis, T1-pelvic angle, and proximal junctional angle were recorded at preoperative, short term postoperative (less than 3 months) and Long-term postoperative (over 1 year) follow-up. At Long-term follow-up the revision rate and patient symptoms were recorded as well as radiographic parameters. Multivariate statistical analysis is being conducted. RESULTS Preliminary data indicates that 60% of patients with a high native pelvic incidence had evidence of PJK or PJF at or prior to Long-term follow-up. No patients with a low pelvic incidence had junctional kyphosis at Long-term follow-up. Of patients with a T1-pelvic angle over 20°, 55% had evidence of PJK or PJF. The overall rate of revision surgery, continued pain or deformity was 87% in patients with a T1-pelvic angle over 20°. No patients with a T1-pelvic angle less than 20° had PJK or PJF and one patient in this cohort developed symptomatic adjacent segment disease. CONCLUSIONS A native pelvic incidence over 55° may be predictive of Long-term junctional kyphosis and symptomatic adjacent segment disease. A postoperative T1-pelvic angle greater than 20° degrees is associated with continued back pain and revision surgery following thoracolumbar fusions at up to 8 years post surgery. Interestingly, despite correction of PI-LL mismatch within 9° at the short term follow-up, the T1 pelvic angle tended to return to within 10° of the initial preoperative measure in the majority of cases at Long-term follow-up suggesting that the pursuit of sagittal plane correction to meet defined spinopelvic parameters may not account for physiologic kyphosis with increasing age. Data collection is ongoing to meet power analysis and statistical significance criteria. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Work disability presents a major burden and stressor at the levels of the individual and society in general. Factors that inhibit or prevent return to work must continually be researched. PURPOSE A study was conducted to examine and define the rates of return to full-time employment for patients not involved in worker's compensation (WC) and to identify modifying factors thereof. STUDY DESIGN/SETTING A retrospective chart review with a prospective IRB approved telephone questionnaire designed to collect pre and postop work history was utilized. Multiple factors were examined that may affect the return to work (RTW) rate of a patient population working full time 3 months prior to surgery (including baseline data such as comorbidities, gender, surgical complexity, age, BMI, social history, ethnicity). PATIENT SAMPLE An IRB-approved retrospective chart review was performed on all surgical patients who underwent spinal surgery from December 2006 to January 2016 in two spinal surgeons’ practices. A total of 1,648 patients were identified with a minimum of 2-year follow-up. After reaching out to 1,088 sequential patients over a 2-year period, 394 called back. Of these, 325 consented to the questionnaire with 69 patients declining. OUTCOME MEASURES Factors examined to affect rate of return to work with 1 year were: procedure type, levels fused, ethnicity, gender, BMI, smoker status, alcohol consumption status, diabetes, heart disease, osteoporosis, anxiety, depression, DVT, previous spine surgery, IV antibiotics, intraoperative and postoperative complications, and infection. METHODS Subgroups within the patient sample showed no significant difference in male-female ratio. Prospective questionaire asked were: status before work, after work, when they returned full time and when RTW to the same job. Minimum phone follow-up was two years postoperatively. Baseline data (date of birth, gender, BMI, preoperative comorbidities, ethnicity, social history, surgery date, surgery type, levels fused, occupation) was obtained by chart review for these patients. The prospective data collecting pre- and postoperative work history along with the retrospective chart review data was analyzed looking for any trends in patients who were working full time 3 months preop and not returning to full time work within a year of surgical date. RESULTS No comorbidity or other correlative factors of RTW were detected. However, a significant difference of RTW rate was noticed between genders. Examining nonretired patients who reported full-time employment within 3 months of surgical intervention, 87 females and 94 males qualified. Only 60% of patients in the female group and 89% in the male group returned to full-time employment within one year. When subdivided by surgical complexity, in noncomplex cases, the rate of return to full-time employment was 59% for females, and 89% for males vs complex cases, where 64% of females and 90% for males returned to work full-time. Both analyses had a power of 99% with p-values less than .05. CONCLUSIONS Our data demonstrated that the return to work rate is significantly lower in female patients undergoing spine surgery, irrespective of the complexity of the surgery. This information may be helpful in pre- and postoperative management. This difference warrants discussion with patients preoperatively. Attitudes of employers towards employees after spinal surgery and the confidence of females after spinal surgery should be further investigated FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Background Contemporary interpretation of fetal heart rate patterns is based largely on the tenets of Drs Quilligan and Hon. This method differs from an older method that was championed by Dr Caldeyro-Barcia in recording speed and classification of decelerations. The latter uses a paper speed of 1 cm/min and classifies decelerations referent to uterine contractions as type I or II dips, compared with conventional classification as early, late, or variable with paper speed of 3 cm/min. We hypothesized that 3 cm/min speed may lead to over-analysis of fetal heart rate and that 1 cm/min may provide adequate information without compromising accuracy or efficiency. Objective The purpose of this study was to compare the Hon-Quilligan method of fetal heart rate interpretation with the Caldeyro-Barcia method among groups of obstetrics care providers with the use of an online interactive testing tool. Study Design We deidentified 40 fetal heart rate tracings from the terminal 30 minutes before delivery. A website was created to view these tracings with the use of the standard Hon-Quilligan method and adjusted the same tracings to the 1 cm/min monitoring speed for the Caldeyro-Barcia method. We invited 2–4 caregivers to participate: maternal-fetal medicine experts, practicing maternal-fetal medicine specialists, maternal-fetal medicine fellows, obstetrics nurses, and certified nurse midwives. After completing an introductory tutorial and quiz, they were asked to interpret the fetal heart rate tracings (the order was scrambled) to manage and predict maternal and neonatal outcomes using both methods. Their results were compared with those of our expert, Edward Quilligan, and were compared among groups. Analysis was performed with the use of 3 measures: percent classification, Kappa, and adjusted Gwet-Kappa ( P Results Overall, our results show from moderate to almost perfect agreement with the expert and both between and within examiners (Gwet-Kappa 0.4–0.8). The agreement at each stratum of practitioner was generally highest for ascertainment of baseline and for management; the least agreement was for assessment of variability. Conclusion We examined the agreement of fetal heart rate interpretation with a defined set of rules among a number of different obstetrics practitioners using 3 different statistical methods and found moderate-to-substantial agreement among the clinicians for matching the interpretation of the expert. This implies that the simpler Caldeyro-Barcia method may perform as well as the newer classification system