Parvizi J.,Thomas Jefferson University |
Gehrke T.,Helios Endo Klinik Hamburg |
Chen A.F.,Rothman Institute
Bone and Joint Journal | Year: 2013
Louis Pasteur once said that: "Fortune favours the prepared mind." As one of the great scientists who contributed to the fight against infection, he emphasised the importance of being prepared at all times to recognise infection and deal with it. Despite the many scientific discoveries and technological advances, such as the advent of antibiotics and the use of sterile techniques, infection continues to be a problem that haunts orthopaedic surgeons and inflicts suffering on patients. The medical community has implemented many practices with the intention of preventing infection and treating it effectively when it occurs. Although high-level evidence may support some of these practices, many are based on little to no scientific foundation. Thus, around the world, there is great variation in practices for the prevention and management of periprosthetic joint infection. This paper summaries the instigation, conduct and findings of a recent International Consensus Meeting on Surgical Site and Periprosthetic Joint Infection. © 2013 The British Editorial Society of Bone & Joint Surgery.
Miller A.G.,Thomas Jefferson University |
Margules A.,Thomas Jefferson University |
Raikin S.M.,Rothman Institute
Journal of Bone and Joint Surgery - Series A | Year: 2012
Background: The overall rate of complications after ankle fracture fixation varies between 5% and 40% depending on the population investigated, and wound complications have been reported to occur in 1.4% to 18.8% of patients. Large studies have focused on complications in terms of readmission, but few studies have examined risk factors for wound-related issues in the outpatient setting in a large number of patients. A review was performed to identify risk factors for wound complications tracked in the hospital and outpatient setting. Methods: Four hundred and seventy-eight patients underwent open reduction and internal fixation of an ankle fracture between 2003 and 2010 by a single surgeon at a single institution. Demographic characteristics, time to surgery, comorbidities, and postoperative care were tracked. Wound complications were defined as those requiring dressing care and oral antibiotics or requiring further surgical treatment. Results: Of the 478 patients who were followed, six (1.25%) had wounds requiring surgical debridement. Fourteen patients (2.9%) required further dressing care or a course of oral antibiotics. There were significant associations between wound complications and a history of diabetes (p < 0.001), peripheral neuropathy (p = 0.003), wound-compromising medications (p = 0.011), open fractures (p = 0.05), and postoperative noncompliance (p = 0.027). There was a significant difference in age between patients with and without wound complications (p = 0.045). We did not identify a relationship between time to surgery and complications. Conclusions: These results highlight the difficulty of treating medically complex and noncompliant patient populations. With careful preoperative monitoring of swelling, time to surgery does not affect wound outcome. The failure of the patient to adhere to postoperative instructions should be a concern to the treating surgeon. Level of Evidence: Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2012 by The Journal of Bone and Joint Surgery, Incorporated.
News Article | November 2, 2016
Hire Deepens Commitment to Nationwide Roll-Out of Programs Aimed at Reducing Costs and Improving Patient Outcomes CHARLOTTESVILLE, VA--(Marketwired - November 02, 2016) - Locus Health is pleased to announce that T. Clifford Deveny, MD has been appointed as President effective November 7, 2016. Dr. Deveny joins Locus Health after having served for the past five years as Senior Vice President for Physician Services and Clinical Integration for Catholic Health Initiatives (CHI), the nation's third-largest nonprofit health system operating in 19 states and comprised of 103 hospitals. "I am delighted to join Locus Health at this important point in the company's history," said Dr. Deveny. "Locus Health's remote patient care solutions combine to deliver a compelling solution for supporting providers in their implementation of scalable value-based care models. I look forward to helping the company expand its current programs as well as develop new offerings to support providers as the world of healthcare undergoes profound changes." Locus Health has developed a unique platform that includes a comprehensive suite of software and services to enable providers to deliver remote patient care for a wide range of pediatric and adult populations. The Locus Health platform currently supports episodic, bundled and chronic care management programs at The University of Virginia Health System and the Rothman Institute in Philadelphia. Data from UVA over the past three years has shown a greater than 40% reduction in readmissions for patients monitored by Locus Health. The Charlottesville-based company also offers consulting services to hospital C-suites in designing programs focused on lowering costs while simultaneously improving patient outcomes. "We are truly excited that Dr. Deveny has decided to become a senior member of the Locus Health team," said Kirby Farrell, Chief Executive Officer. "Dr. Deveny's extensive clinical and administrative background -- and particularly his insights and experience in helping to develop thoughtful and innovative patient care programs -- will be instrumental in leading Locus Health through our next stage of growth. "We are particularly excited about Dr Deveny's ability to help us focus our care coordination solutions to add value in today's fee for service world while positioning providers to succeed in the emerging world of value based care." Throughout his career, and of particular significance for Locus Health, Dr. Deveny has been a strong advocate for including clinicians in the development of programs, believing that clinician buy-in and engagement are essential to programmatic success and the patient experience throughout the continuum of care. While at CHI, Dr. Deveny played an integral role in developing initiatives to support its transition from a hospital company to a healthcare organization and meet the challenges of healthcare's shift to value-based care models. His accomplishments included establishing multi-state clinically integrated networks as well as developing and expanding national service lines for orthopedic and spine, cardiovascular, oncology and hospital medicine services. He also played a key role in developing and growing CHI's physician enterprise and management services organization and improving the operational and clinical performance of its ambulatory-based primary care services. About Locus Health Founded in 2009, Locus Health is a team of experts in healthcare, technology, and data analytics working to improve quality, clinical and financial outcomes for health systems and other institutional providers. Data-driven and clinically oriented, Locus Health develops comprehensive patient care solutions that improve care coordination efforts for a wide range of populations. Services include both professional consulting and remote care management powered by a proprietary, fully customizable software platform. Locus Health's services support a number of provider patient care initiatives, including bundled payment strategies for orthopedics and cardiology, and readmissions reduction, self-insured employee wellness and chronic care management programs. More information about Locus Health is available at www.locushealth.com.
News Article | February 15, 2017
February 15, 2017 - For patients undergoing total hip or knee replacement, smoking is associated with an increased risk of infectious (septic) complications requiring repeat surgery, reports a study in the February 15 issue of The Journal of Bone & Joint Surgery. The journal is published by Wolters Kluwer. "Our results found that current smokers had a significantly higher rate of septic reoperation compared with nonsmokers," commented senior author Dr. Matthew S. Austin of the Rothman Institute at Thomas Jefferson University, Philadelphia. "Furthermore, each additional pack-year significantly contributed to total reoperations." Smokers Show 80 Percent Increase in Risk of Reoperations for Infection The researchers looked at how smoking history affected the risk of hospital readmissions among patients undergoing total joint replacement--either hip or knee replacement. The study included data on 15,264 patients who underwent a total of 17,394 total joint replacements between 2000 and 2014--8,917 hip and 8,477 knee replacements. At the time of surgery, nine percent of patients were current smokers, 34 percent were former smokers, and 57 percent were nonsmokers. Current smokers were younger than nonsmokers: average age was about 58 versus 63 years. Smokers also had higher rates of certain major respiratory and cardiovascular diseases. The absolute risk of reoperation for infectious complications within 90 days was low: 0.71 percent. However, this risk was substantially higher for current smokers: 1.2 percent, compared to 0.56 percent for nonsmokers. After adjustment for other characteristics, current smokers remained at significantly increased risk of reoperation for infectious complications--the relative risk was 80 percent higher, compared to nonsmokers. As a group, former smokers were not at increased risk. However, for current and former smokers alike, the risk of 90-day nonoperative readmission increased with the number of "pack-years" smoked. Smoking an extra pack per day for a decade was associated with a 12 percent increase in that relative risk. Smoking overall, however, was unrelated to the risk of readmission without surgery, or for reoperation for reasons other than infections. Total joint replacement (also called arthroplasty) is an effective treatment for advanced degenerative joint disease. Nearly one million total joint replacements--most commonly of the hip and knee-- were performed in the United States in 2011. The demand for these procedures is expected to increase over the next decade. Although some important risk factors for complications have been identified, the relationship between smoking and complications after total hip or knee replacement has been unclear. Minimizing unplanned hospital readmissions is a major focus of efforts to improve the quality and value of healthcare. While there's no difference in the total readmission rate, the new results suggest that current smokers are at substantially higher risk of reoperation for septic complications. Patients with a history of heavier smoking are also at increased risk, even if they have since quit smoking. "If smoking is associated with elevated perioperative risk of readmission and/or reoperation, then it may be reasonable to engage the patient in a smoking cessation program prior to total joint arthroplasty," Dr. Austin and coauthors write. However, further studies would be needed to determine whether quitting smoking before joint replacement surgery can reduce the risk of complications. Click here to read "Smoking Increases the Rate of Reoperation for Infection within 90 Days After Primary Total Joint Arthroplasty." Article: "Smoking Increases the Rate of Reoperation for Infection within 90 Days After Primary Total Joint Arthroplasty" (doi: 10.2106/JBJS.16.00311) About The Journal of Bone & Joint Surgery The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal. Wolters Kluwer is a global leader in professional information services. Professionals in the areas of legal, business, tax, accounting, finance, audit, risk, compliance and healthcare rely on Wolters Kluwer's market leading information-enabled tools and software solutions to manage their business efficiently, deliver results to their clients, and succeed in an ever more dynamic world. Wolters Kluwer reported 2015 annual revenues of €4.2 billion. The group serves customers in over 180 countries, and employs over 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands. Wolters Kluwer shares are listed on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Wolters Kluwer has a sponsored Level 1 American Depositary Receipt program. The ADRs are traded on the over-the-counter market in the U.S. (WTKWY). Wolters Kluwer Health is a leading global provider of information and point of care solutions for the healthcare industry. For more information about our products and organization, visit http://www. , follow @WKHealth or @Wolters_Kluwer on Twitter, like us on Facebook, follow us on LinkedIn, or follow WoltersKluwerComms on YouTube.
News Article | December 19, 2016
JACKSON, Mich.--(BUSINESS WIRE)--TelePREOP, the first and premier provider of a telemedicine solution designed to manage the complex workflows associated with the pre-operative, post-operative and transitional management of patients, is pleased to announce that it is serving as a platinum sponsor at the Interdisciplinary Conference on Orthopedic Value Based Care. The biggest names in orthopedics are coming together on January 21-22 in Newport Beach, California at the Interdisciplinary Conference on Orthopedic Value-Based Care. Sponsored by the American College of Perioperative Medicine, the conference will focus on the Perioperative Surgical Home, comprehensive care for joint replacement (CJR) and enhanced recovery. Dr. Kevin Bozic, orthopedic surgeon and thought leader from the University of Texas, states, “This conference is a great opportunity to move the field forward with an impressive group of committed innovators. My session will discuss how we as a clinical community can lead a successful transition to value in healthcare. I'm looking forward to a great meeting!” The speaker lineup is amazing, including 22 nationally-renown multi-disciplinary faculty, including orthopedic leaders from esteemed academic institutions like Hospital for Special Surgery and Rothman Institute. Tony Mira, CEO of TelePREOP, expounds, “With its timely topics, this is a not-to-miss conference for orthopedic surgeons, anesthesiologists, hospitalists, hospital executives, orthopedic nurses, CRNAs, OR directors and others interested in top-notch learning on the Perioperative Surgical Home, comprehensive care for joint replacement (CJR) and enhanced recovery. TelePREOP is pleased to serve as a platinum sponsor to this elucidating conference.” TelePREOP™ is the first and leading provider of telemedicine solutions suited to manage the complex workflows associated with the pre-surgical clinical environments. It is designed to streamline the process between surgeons, hospitals, ASCs, and anesthesia. TelePREOP employs and partners with industry leaders, and continues to set the precedent on centralized pre-surgical screening. For more information, contact us at info@TelePREOP.com or visit www.TelePREOP.com.
News Article | October 27, 2016
ATLANTA--(BUSINESS WIRE)--AMNIOX Medical, Inc., a TissueTech™, Inc., company, announced the results of a prospective randomized clinical study of its proprietary cryopreserved Amniotic Membrane (AM) as an adjunct to lumbar discectomy. The findings will be presented at the North American Spine Society 2016 Annual Meeting, by the study’s lead investigator, D. Greg Anderson, M.D. of the Rothman Institute in Philadelphia, PA. The study included 80 patients, with half of the patients receiving CLARI
Fowler J.R.,University of Pittsburgh |
Ilyas A.M.,Rothman Institute
Journal of Hand Surgery | Year: 2013
Purpose: To define the current epidemiology of adult acute hand infections in an urban setting, with the aim of helping to improve empiric treatment, as hand infections represent a major source of morbidity and can result in stiffness and, possibly, amputation. Methods: We performed an electronic medical record search to identify all patients admitted to our urban academic medical center with diagnoses related to open wounds and infections in the hand and fingers over a 6-year period (2005-2010). We recorded demographic data, location of infection, medical comorbidities, and culture data. Results: Of the 2,287 patients admitted with diagnoses related to open wounds and infections in the hand and fingers, 1,507 incision and drainage procedures were performed, which resulted in 458 patients (30%) with culture-positive infections. Wound cultures identified 39 different species of bacteria. Most of these were methicillin-resistant Staphylococcus aureus, which compromised 53% of positive cultures, followed by methicillin-sensitive S aureus in 23% of positive cultures. The cultures were polymicrobial in 19%. History of intravenous drug use or diabetes mellitus was a strong predictor of polymicrobial infection. Conclusions: Methicillin-resistant Staphylococcus aureus was the most common bacteria cultured from these infections. Empiric antibiotic coverage should routinely cover methicillin-resistant S aureus. We noted a higher incidence of polymicrobial infections than previously reported, particularly with intravenous drug use, diabetes, and human bites. Volar hand infections had the highest percentage of positive cultures, whereas paronychia had the lowest percentage. Type of study/level of evidence: Prognostic IV. © 2013 American Society for Surgery of the Hand.
Beatty T.,Rothman Institute
Current Sports Medicine Reports | Year: 2012
Osteitis pubis is one of many etiologies of groin pain in athletes. It is a painful overuse injury of the pubic symphysis and the parasymphyseal bone that typically is found in athletes whose sports involve kicking, rapid accelerations, decelerations, and abrupt directional changes. Athletes most commonly present with a complaint of anterior and/or medial groin pain but also can present with lower abdominal, adductor, inguinal, perineal, and/or scrotal pain. Symptoms can be severe and can limit participation in sport until treatment is instituted. Imaging is useful for ruling out other etiologies of groin pain, identifying concomitant pathology, and confirming the diagnosis itself. Treatment is varied but usually includes nonoperative measures of rest, rehabilitation, and/or pharmacotherapy and alsomay include injections and/or surgical procedures. A high clinical suspicion should existwhen evaluating soccer, rugby, orAmerican football players and distance runners who present with complaints of groin pain. Copyright © 2012 by the American College of Sports Medicine.
Raphael I.J.,Rothman Institute
The journal of knee surgery | Year: 2013
Obesity has been associated with osteoarthritis and increased morbidity and mortality. Most joint arthroplasty patients have a high body mass index (BMI). Some surgeons are reluctant to operate on obese patients due to technical difficulties and the anticipated higher complication rate. The purpose of this prospective study was to determine whether obesity is associated with longer operative times. We attended 100 consecutive primary total joint arthroplasties. Patients were divided into four groups depending on their BMI: the normal group (BMI: 18 to 24.9 kg/m2), the overweight group (BMI: 25 to 29.9 kg/m2), the obese group (BMI: 30 to 39.9 kg/m2), and the morbidly obese group (BMI ≥ 40 kg/m2). Anesthesia type and time, duration of surgery, time needed for scrubbing, draping, and transferring the patient to the operating table were all documented. The mean operative time for total hip arthroplasty (THA) was significantly increased in morbidly obese patients (R2 = 0.197, p = 0.003). The mean scrubbing time for total knee arthroplasty varied with BMI (p = 0.028). Time to administer spinal anesthesia was significantly increased in morbidly obese patients (R2 = 0.1466, p = 0.018). Morbid obesity is associated with a significant increase in the time needed to administer spinal anesthesia and the overall time needed to perform a THA. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Adeli B.,Rothman Institute |
Parvizi J.,Rothman Institute
Journal of Bone and Joint Surgery - Series B | Year: 2012
Periprosthetic joint infection (PJI) is a devastating complication which can follow a total joint arthroplasty (TJA). Although rare, this ongoing threat undermines the success of TJA, a historically reputable procedure. It has haunted the orthopedic community for decades and several ongoing studies have provided insights and new approaches to effectively battle this multilayered problem. ©2012 British Editorial Society of Bone and Joint Surgery.