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The Centers for Medicare and Medicaid Services (CMS) now requires hospitals to publish charges for commonly performed procedures. This study aimed to evaluate compliance with the price transparency mandate and to determine if there is a correlation between hospital charges and episode-of-care claims costs and outcomes after total hip arthroplasty (THA) and total knee arthroplasty (TKA).We identified a consecutive series of 2476 Medicare patients who underwent primary THA or TKA from 2018 to 2019 at one of 18 hospitals. Each hospital website was explored to assess compliance with the new price transparency requirements. Demographics, comorbidities, complications, and readmissions were recorded. Ninety-day episode-of-care claims costs were calculated using CMS claims data. Multivariate regression was performed to determine whether hospital charges had any association with complications, readmissions, or episode-of-care costs.There was no correlation between published hospital charges and inpatient costs (r = 0.087), postacute care costs (r = 0.126), or episode-of-care costs (r = 0.131). When controlling for demographics and comorbidities, there was no association between published charges and complications (P = .433) or readmissions (P = .141). All hospitals posted some shoppable services information online, but only 7 (39%) were fully compliant by publishing all price data. Of the 11 hospitals (61%) publishing hospital THA and TKA charges, the mean charge was $48,325 (range, $12,625-$79,531).Published charges for TKA and THA had no correlation with episode-of-care claims costs and were not associated with clinical outcomes. Despite efforts by CMS to increase price transparency, few hospitals were fully compliant, and a wide range in published charges was found.

Surgical specialty hospitals provide patients, surgeons, and staff with a streamlined approach to elective surgery but may not be equipped to handle all complications arising postoperatively. The purpose of this study is to evaluate the immediate postoperative and 90-day outcomes of patients who were transferred from a high-volume specialty hospital following primary total hip arthroplasty (THA) or total knee arthroplasty (TKA).All patients who were admitted to one orthopedic specialty hospital for primary THA or TKA between January 2015 and December 2019, and subsequently transferred to a tertiary care hospital, were identified and propensity matched to nontransferred patients. Emergency department visits, complications, readmissions, mortality, and revisions within 90 days of surgery were identified for each group.There were 26 TKAs (0.78%) and 20 THAs (0.48%) transferred, representing 0.62% of all primary THAs and TKAs performed over the study duration. Arrhythmia and chest pain were the most common reasons for transfer. Ninety-day readmissions were significantly higher in the transfer group (15.2% vs 4.3%, P = .020) with an odds ratio for readmission after transfer of 3.9 (95% confidence interval 1.3-12.4). Overall complications and orthopedic complications did not differ significantly, although transferred patients had a higher rate of medical complications (13.0% vs 2.2%, P = .008) with an odds ratio of 6.7 (95% confidence interval 1.6-28.2).Transfer from a specialty hospital is rarely required following primary TKA and THA. Although not at increased risk for orthopedic complications, these transferred patients are at increased risk for readmissions and medical complications within the first 90 days of their care, necessitating increased vigilance.

Our objective was to describe a measurement to assess sagittal tibial tuberosity (TT)-trochlear groove (TG) distance and to compare this between asymptomatic (control) patients and patients with symptomatic patellar instability.We compared static CT images of 22 fully extended knees of patients with symptomatic patellar instability with images of 22 asymptomatic knees. TT-TG distance was measured to quantify lateralization of the TT, and anteroposterior TT-TG distance was used to quantify the sagittal distance between these two points. Lateral trochlear inclination, sulcus angle, and trochlear depth were measured. Groups were compared using paired t tests (alpha = 0.05). Correlations of anteroposterior TT-TG distance with lateral trochlear inclination, sulcus angle, and trochlear depth were assessed using linear and multivariate regression.Mean TT-TG distances were 19.9 ± 4.4 mm (symptomatic) and 16.8 ± 5.5 mm (control) (mean ± std deviation) (P = 0.002). Mean anteroposterior TT-TG distances were 8.3 ± 7.8 mm (symptomatic) and -0.5 ± 4.6 mm (control) (P 0.0001). The symptomatic group had greater measurements of trochlear dysplasia, with lower lateral trochlear inclination, greater sulcus angle, and lower trochlear depth (all P 0.0001). Anteroposterior TT-TG distance and trochlear depth were strongly negatively correlated (r = 0.62, RIn asymptomatic patients, the anteroposterior TT-TG distance was -0.5 mm, indicating that the TG and TT were nearly in the same coronal plane. In patients with symptomatic patellar instability, the TG was almost nine millimeters anterior, and this distance correlated with measurements of trochlear dysplasia.III, case control study.

Alternative payment models, such as bundled payments, have grown in popularity to align incentives among providers to provide quality care at a reduced cost. Early data demonstrated success at reducing post-acute care resources and episode-of-care costs in total knee arthroplasty (TKA), but concerns regarding target price methodology and lack of appropriate risk-adjustment may limit the future of these bundled payment programs. This review will address specific drivers of episode-of-care costs in TKA. Modifiable medical comorbidities such as uncontrolled diabetes and malnutrition can be optimized prior to elective TKA. Minimizing in-hospital medical complications and unplanned ICU admissions can help drive down inpatient TKA costs. Finally, reducing rates of home health and discharge to skilled nursing facilities has the highest impact of episode-of-care cost reduction following TKA.

BACKGROUND CONTEXT The Oswestry Disability Index (ODI) and Neck Disability Index (NDI) were not intended for spine trauma patients but are routinely used for such purposes. To date the Patient-Reported Outcome Measurement Information System (PROMIS) has not been studied in the spine trauma population. A patient reported outcome (PRO) instrument that is efficient and applicable to spine trauma patients would be ideal. PURPOSE To identify correlation between legacy outcome questionnaires (ODI, NDI) with PROMIS physical function (PF), pain interference (PI) and depression. STUDY DESIGN/SETTING Retrospective cross-sectional analysis, Level I trauma center. PATIENT SAMPLE Sixty-three spine trauma patients with 384 office encounters where PROs were completed. OUTCOME MEASURES Correlation between PROMIS and ODI/NDI METHODS Sixty-three spine trauma patients treated by one surgeon at a level 1 trauma center between 1/1/15 and 12/31/17 were enrolled. Patient-reported outcome from 384 encounters was used for analysis. Fifty-seven patients underwent surgical intervention and 6 patients had a halo vest applied. The ODI was administered for thoracic/lumbar/sacral trauma while the NDI was administered for cervical trauma. Normality of distributions were assessed with Shapiro-Wilk test. PROMIS scores were not normally distributed in our cohort, therefore the nonparametric Spearman rho correlation was performed between ODI and NDI with PROMIS PF, PI and depression scores. Coefficients of determination were reported for bivariate regression models RESULTS PROMIS PF was moderately (ρ=−0.6254, R2=0.266) and poorly (ρ=−0.259, R2=0.501) correlated with the ODI and NDI, respectively. PROMIS PI was highly (ρ=0.7345, R2=0.537) and moderately (ρ=0.6912, R2=0.556) correlated with ODI and NDI, respectively. PROMIS Depression was moderately (ρ=0.528, R2=0.182) and highly (ρ=0.7234, R2=0.378) correlated with OWI and NDI, respectively. CONCLUSIONS PROMIS PI is most highly correlated with ODI/NDI in spine trauma patients. While PROMIS PF shows moderate correlation with the ODI, a negligible correlation was found with the NDI. PROMIS tools allow for more effective data collection across multiple domains and, moving forward, may be better poised to monitor changes in function, pain and depression in spine trauma patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.