Publications by authors named "B C Werner"

911 Publications

Male Sex, Cartilage Surgery, Tobacco Use, and Opioid Disorders are Associated with an Increased Risk of Infection after ACL Reconstruction.

Arthroscopy 2021 Jul 28. Epub 2021 Jul 28.

Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA. Electronic address:

Purpose: To identify patient-related risk factors for infection following anterior cruciate ligament reconstruction (ACLR).

Methods: The Mariner database within PearlDiver was queried for patients from 2010 to 2019 undergoing primary arthroscopic ACLR. Patients undergoing ACLR with concomitant open surgery or additional ligament reconstructions were excluded. Postoperative diagnoses or procedures for superficial or deep infection within 6 months were assessed. A multivariable logistic regression analysis was then used to evaluate patient-related risk factors for postoperative infection. Adjusted odds ratios (OR) and 95% confidence intervals (CIs) were calculated for each risk factor, with p < 0.05 considered statistically significant.

Results: 217,541 patients underwent ACLR and 1,779 (0.8%) patients had a postoperative infection within 6 months. Significant independent risk factors included male sex (OR 1.58, 95% CI 1.43-1.75, p < 0.001), obesity (OR 1.22, 95% CI 1.05-1.43, p = 0.020), morbid obesity (OR 2.54, 95% CI 2.11-3.06, p = 0.002), tobacco use (OR 1.36, 95% CI 1.19-1.55, p <0.001), age under 40 years (OR 1.21, 95% CI 1.07-1.37, p = 0.033), depression (OR 1.18, 95% CI 1.04-1.34, p = 0.012), opioid disorder (OR 1.50, 95% CI 1.22-1.85, p < 0.001), concomitant simple cartilage surgery (OR 1.63, 95% CI 1.43-1.86, p < 0.001) and complex cartilage surgery (OR 1.67, 95% CI 1.20 - 2.32, p = 0.002). Partial meniscectomy and meniscal repair at the time of ACLR were not associated with an increased risk of infection.

Conclusions: In a large national sample, male sex, obesity, tobacco use, older age, depression, opioid disorders and concomitant cartilage surgery were significant risk factors for infection following ACLR.
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http://dx.doi.org/10.1016/j.arthro.2021.07.025DOI Listing
July 2021

Last Year of Life Study-Cologne (LYOL-C) (Part II): study protocol of a prospective interventional mixed-methods study in acute hospitals to analyse the implementation of a trigger question and patient question prompt sheets to optimise patient-centred care.

BMJ Open 2021 Jul 26;11(7):e048681. Epub 2021 Jul 26.

Department of Palliative Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany.

Introduction: The Last Year of Life Study-Cologne Part I (LYOL-C I) has identified general hospital units as the most important checkpoints for transitions in the last year of life of patients. Yet, satisfaction with hospitals, as reported by bereaved relatives, is the lowest of all health service providers. Thus, the LYOL-C Part II (LYOL-C II) focuses on optimising patient-centred care in acute hospitals for patients identified to be in their last year of life. LYOL-C II aims to test an intervention for hospitals by using a two-sided (healthcare professionals (HCPs) and patients) trigger question-based intervention to 'shake' the system in a minimally invasive manner.

Methods And Analysis: Prospective interventional mixed-methods study following a two-phase approach: phase I, individual interviews with HCPs and patient representatives to design the intervention to maximise ease of implementation and phase II, exploratory study with two arms and a prepost design with patients in their last year of life. The intervention will consist of the Surprise Question and the German version of the Supportive and Palliative Care Indicators Tool (SPICT-DE) for HCPs to identify patients and provide patient-centred care, plus question prompt sheets for patients, encouraging them to initiate discussions with their HCPs. Data on transitions, changes in therapy, quality of care, palliative care integration and death of patients will be analysed. Furthermore, a staff survey (pre/post) and guided interviews with staff, patients and relatives (post) will be conducted. Finally, a formative socioeconomic impact assessment to provide evidence regarding the sustainability of the intervention will be performed.

Ethics And Dissemination: The study was approved by the Ethics Committee of the Faculty of Medicine of the University of Cologne (#20-1431). Results will be published in peer-reviewed journals and presented at national and international conferences.

Trial Registration Number: DRKS00022378.
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http://dx.doi.org/10.1136/bmjopen-2021-048681DOI Listing
July 2021

Analysis of Charges and Payments for Outpatient Arthroscopic Meniscectomy From 2005 to 2014: Hospital Reimbursement Increased Steadily as Surgeon Payments Declined.

Orthop J Sports Med 2021 Jun 8;9(6):23259671211010482. Epub 2021 Jun 8.

Department of Orthopaedic Surgery University of Virginia Health System, Charlottesville, Virginia, USA.

Background: Charge and reimbursement trends for arthroscopic partial meniscectomies among orthopaedic surgeons, anesthesiologists, and hospital/surgery centers have not been formally analyzed, even though meniscectomies are the most commonly performed orthopaedic surgery.

Purpose: To analyze Medicare charge and reimbursement trends for surgeons, anesthesiologists, and hospital/surgery centers for outpatient arthroscopic partial meniscectomies performed in the United States.

Study Design: Economic and decision analysis; Level of evidence, 4.

Methods: We analyzed trends in surgeon, anesthesiologist, and hospital charges and reimbursements for outpatient isolated arthroscopic partial meniscectomies from 2005 to 2014. Current Procedural Terminology codes were used to capture charge and reimbursement information using the nationally representative 5% Medicare sample. National and regional trends for charge, reimbursement, and Charlson Comorbidity Index (CCI) were evaluated using linear regression analysis.

Results: A total of 31,717 patients were analyzed in this study. Charges across all groups increased significantly ( < .001) during the 10-year study period, with an increase of 18.4% ($2754-$3262) for surgeons, 85.5% ($802-$1480) for anesthesiologists, and 116.8% ($2743-$5947) for hospitals. Surgeon reimbursements declined by 15.5% ($504-$426; = .072) during this period. Anesthesiologist and hospital reimbursements increased significantly during by 36.5% ($133-$182; < .001) and 28.9% ($1540-$1984; < .001) during the 10-year study period, respectively. The annual incidence of partial meniscectomies per 10,000 database patients decreased significantly from 18.3 to 15.6 over the course of the study (14.8% decrease; = .009), while the CCI did not change significantly ( = .798).

Conclusion: Hospital and anesthesiologist Medicare reimbursements for outpatient arthroscopic partial meniscectomies increased significantly, while surgeon reimbursements decreased. In 2005, hospitals were reimbursed 205% more ($1540 vs $504) than surgeons, and by 2014, they were reimbursed 365% more ($1984 vs $426), indicating that the gap between hospital and surgeon reimbursement is rising. Improved understanding of charge and reimbursement trends represents an opportunity for key stakeholders to improve financial alignment across the field of orthopaedics.
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http://dx.doi.org/10.1177/23259671211010482DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8191089PMC
June 2021

Increased Reimbursement for Surgical Fixation of Hip Fractures: The Difference Between the Hospital and the Surgeon.

J Orthop Trauma 2021 07;35(7):339-344

Department of Orthopaedic Surgery, UVA Health System, Charlottesville, VA.

Objectives: To evaluate trends and variations in hospital charges and payments relative to surgeon charges and payments for surgical treatment of hip fractures in the US Medicare population.

Methods: Hospital and surgeon charges and payments after treatment of hip fractures by closed reduction and percutaneous pinning (CRPP), open reduction internal fixation (ORIF), or intramedullary nail (IMN), along with corresponding patient demographics, 90-day and 1-year mortality, Charlson Comorbidity Index (CCI), and length of stay (LOS) from 2005 to 2014 were captured from the 5% Medicare Standard Analytic Files. The ratio of hospital to surgeon charges (CM: Charge Multiplier) and the ratio of hospital to surgeon payments (PM: Payment Multiplier) were calculated for each year and region of the United States and trended over time. Correlations between the CM and PM and LOS were evaluated using a Pearson correlation coefficient (r).

Results: Three thousand twenty-eight patients who underwent CRPP and 25,341 patients who underwent ORIF/IMN were included. The CM for CRPP increased from 10.1 to 15.6, P < 0.0001. The CM for ORIF/IMN increased from 11.9 to 17.2, P < 0.0001. The PM for CRPP increased from 15.1 to 19.2, P < 0.0001. The PM for ORIF/IMN increased from 11.5 to 17.4, P < 0.0001.

Conclusions: Hospital charges and payments have continually increased relative to surgeon charges and payments for treatment of hip fractures despite decreasing LOS.
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http://dx.doi.org/10.1097/BOT.0000000000002092DOI Listing
July 2021
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