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Lower-Extremity Amputations: Assessing Variations

Lower-Extremity Amputations: Assessing Variations

Studies have shown that people with diabetes are about 10 times more likely to undergo a lower extremity amputation (LEA) than those without the disease. About 90% of diabetics who undergo an LEA have a pre-existing foot ulcer. Researchers have made many discoveries about how wounds heal, but these innovations have not led to the development of many new products for treating diabetic foot ulcers. “Many existing therapies are difficult to use, and the overall rate of healing after care hasn’t changed substantially,” says David J. Margolis, MD, PhD. Explaining Variability Previous studies have shown that there are regional variations in the rate of LEA among people with diabetes. A 2011 study found a nearly four-fold variation within the United States, but the reasons for this are unclear. To explore the issue further, Dr. Margolis and colleagues examined whether behaviors relating to diabetic foot ulcer treatment could explain geographic variations in the prevalence of LEA. Published in Diabetes Care, the study merged data from the U.S. Census, Medicare Part A and B, and the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS monitors the state-level prevalence of behavioral risks in adults with diseases. According to the study, LEA varied in the U.S., and regions with higher rates of LEA tended to be clustered together. The mean and median incidence of LEA was 4.5 per 1,000 persons with diabetes, but varied from 2.4 to 7.9 LEA per 1,000 persons by health referral region. “Areas where BRFSS participants noted more diabetes-based education reported lower rates of LEA,” Dr. Margolis says. “Interestingly, areas that had higher rates of LEA had lower rates...
Elective Major Orthopedic Surgery in Octogenarians

Elective Major Orthopedic Surgery in Octogenarians

By 2030, patients aged 85 and older are projected to account for 2.3% of the United States population, but this figure is expected to nearly double by 2050. There has also been an increasing trend in surgery being performed in the very elderly, but these patients have multiple risk factors that may increase their risk for adverse outcomes after surgery. As a result, there has been some controversy around performing elective surgeries to enhance quality of life (QOL) in this patient population. Typically, major orthopedic procedures like spinal fusion, total hip arthroplasty (THA), and total knee arthroplasty (TKA) are performed electively to alleviate pain and improve QOL. In a study published in the Journal of Bone & Joint Surgery, Hiroyuki Yoshihara, MD, PhD, and colleagues examined the trends and in-hospital outcomes of elective major orthopedic surgeries in patients who were at least 80 years old from 2000 to 2009 using data from the National Inpatient Sample on patients who underwent spinal fusion, THA, and TKA. The analysis included more than 70,000 spinal fusion cases, 233,000 THAs, and 417,000 TKAs. Complication and mortality rates were also compared for patients aged 80 and older with those aged 65 to 79. Incidence, Complications, & Mortality According to the study, there was an increasing trend in the age-adjusted incidence of spinal fusion, THA, and TKA in patients at least 80 years of age from 2000 to 2009. The age-adjusted incidence of spinal fusion increased from 40 to 101 per 100,000 people per year. For THA, the incidence increased from 181 to 257 per 100,000 people. For TKA, the incidence rose from 300 to...
Life Expectancy in 2013

Life Expectancy in 2013

Life expectancy at birth represents the average number of years that a group of infants would live if the group was to experience throughout life the age-specific death rates present for their year of...

Reducing Attrition Rates: Finding True Grit

In case you haven’t noticed, a hot new topic in education is “grit.” In order to reduce the long-standing 20% attrition rate of surgical residents, some say we should select applicants who have more conscientiousness or grit. A few months ago, a paper reported that surgery residents who dropped out of programs had decreased levels of grit as measured by a short-form survey. But due to unexpectedly low attrition rates in the programs participating in the research, the study was underpowered to show a significant difference in outcomes of high- vs low-grit individuals. It’s hard to argue with the premise that choosing applicants with high reserves of grit might lead to better retention and performance of residents. I blogged about this 3 years ago in a post called “Harvard says train residents and medical students like Navy SEALs.” Unfortunately, identifying who has grit will be much more difficult than simply testing those applying for surgical residency training. Below is the 8-item grit survey, which is scored on a 1 to 5 Likert scale. 1. New ideas and projects sometimes distract me from previous ones 2. Setbacks don’t discourage me 3. I have been obsessed with a certain idea or project for a short time but later lost interest 4. I am a hard worker 5. I often set a goal but later choose to pursue a different one 6. I have difficulty maintaining my focus on projects that take more than a few months to complete 7. I finish whatever I begin 8. I am diligent The survey is rather easy to “game.” You can take it online and...
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