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Introduction: Effective pain management is vital in orthopaedic care, impacting postoperative recovery and patient well-being. This study aimed to discern national and regional pain prescription trends among orthopaedic surgeons through Medicare claims data, using geospatial analysis to ascertain opioid and nonopioid usage patterns across the United States., Methods: Physician-level Medicare prescription databases from 2016 to 2020 were filtered to orthopaedic surgeons, and medications were categorized into opioids, muscle relaxants, anticonvulsants, and NSAIDs. Patient demographics were extracted from a Medicare provider demographic data set, while county-level socioeconomic metrics were obtained primarily from the American Community Survey. Geospatial analysis was conducted using Geoda software, using Moran I statistic for cluster analysis of pain medication metrics. Statistical trends were analyzed using linear regression, Mann-Whitney U test, and multivariate logistic regression, focusing on prescribing rates and hotspot/coldspot identification., Results: Analysis encompassed 16,505 orthopaedic surgeons, documenting more than 396 million days of pain medication prescriptions: 57.42% NSAIDs, 28.57% opioids, 9.84% anticonvulsants, and 4.17% muscle relaxants. Annually, opioid prescriptions declined by 4.43% ( P < 0.01), while NSAIDs rose by 3.29% ( P < 0.01). Opioid prescriptions dropped by 210.73 days yearly per surgeon ( P < 0.005), whereas NSAIDs increased by 148.86 days ( P < 0.005). Opioid prescriptions were most prevalent in the West Coast and Northern Midwest regions, and NSAID prescriptions were most prevalent in the Northeast and South regions. Regression pinpointed spine as the highest and hand as the lowest predictor for pain prescriptions., Discussion: On average, orthopaedic surgeons markedly decreased both the percentage of patients receiving opioids and the duration of prescription. Simultaneously, the fraction of patients receiving NSAIDs dramatically increased, without change in the average duration of prescription. Opioid hotspots were located in the West Coast, Utah, Colorado, Arizona, Idaho, the Northern Midwest, Vermont, New Hampshire, and Maine. Future directions could include similar examinations using non-Medicare databases., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)

Background: The utilization of robotic knee arthroplasty (RKA) continues to increase across the United States. The aim of this geospatial analysis was to elucidate if RKA is distributed uniformly across the United States or if disparities exist in patient access., Methods: Publicly available provider-finding functions for 5 major manufacturers of RKA systems were used to obtain the practice locations of surgeons performing RKA along with their associated RKA system manufacturer. The average travel distance for each county to the nearest RKA surgeon was calculated and Moran's index clustering analysis was used to find hotspots and coldspots of RKA access. A logistic regression model was used to identify the predictive odds ratios between robotic hotspots and coldspots with county-level sociodemographic variables. Of the 34,216 currently practicing orthopedic surgeons in 2022, 2,571 have access to robotic assistance for knee arthroplasty., Results: Hotspots of increased travel time were predominantly in West South Central and West North Central census regions. Hotspots were significantly more rural and consisted of predominantly White populations, with lower median income and health insurance coverage., Conclusions: The results of the current study align with existing literature, demonstrating absolute geographic access disparities for rural and economically disadvantaged populations. Additionally, relative access disparities persist for minority populations and individuals with high comorbidity burdens residing in urban areas., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: There is limited literature available about educational satisfaction and fellowship selection among orthopaedic surgery residents. The purpose of this study was to identify factors that influence resident subspecialty career choice, fellowship selection, and satisfaction with orthopaedic training programs., Methods: A self-report survey was electronically administered to orthopaedic surgery residents at 44 academic centers in the United States and Canada. Basic demographic information and level of satisfaction with a number of factors (surgical independence, mentorship opportunities, etc.) were evaluated using a 5-point Likert scale ranging from "excellent" to "poor." Summary statistics and group differences for discrete variables were compared with use of a chi-square test., Results: Of the 283 respondents, 77% rated residency program satisfaction as "very good" or "excellent," and 93% said they would choose the same training program again. Decreased surgical independence (p < 0.01), poor faculty reputation (p < 0.01), reduced volume and variety of cases (p < 0.01), inadequate mentorship (p < 0.01), and reduced educational opportunities (p < 0.01) were associated with low satisfaction. Surgical variety and job opportunities were the top 2 factors contributing to subspecialty choice. Sports medicine and joints were the most popular career choices; case volume, surgical variety, and program reputation were the top factors contributing to fellowship program selection., Conclusions: In order to achieve resident satisfaction, orthopaedic training programs should strive to improve resident surgical independence, surgical case variety, mentorship programs, faculty reputation, and educational opportunities. Important factors for fellowship program selection include case volume, surgical variety, and overall program reputation.