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Moore ML, Pollock JR, Doan MK, Haglin JM, Scott KL, Bingham JS, Patel KA. Publicly Available Pricing Information for Orthopaedic Upper Extremity Procedures in the United States Lacks Transparency and Consistency Between Major Hospitals. Arthrosc Sports Med Rehabil 2022; 4:e935-e941. [PMID: 35747661 PMCID: PMC9210361 DOI: 10.1016/j.asmr.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/15/2022] [Indexed: 11/01/2022] Open
Abstract
Purpose Methods Results Conclusion
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Pollock JR, Moore ML, Haglin JM, LeBlanc MP, Rosenow CS, Makovicka JL, Deckey DG, Hassebrock JD, Bingham JS, Patel KA. Between 2000 and 2020, Reimbursement for Orthopaedic Foot and Ankle Surgery Decreased by 30%. Arthrosc Sports Med Rehabil 2022; 4:e553-e558. [PMID: 35494293 PMCID: PMC9042755 DOI: 10.1016/j.asmr.2021.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/11/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose To examine and analyze Medicare reimbursement rates from 2000 to 2020 for orthopaedic foot and ankle procedures. Methods The 20 most used orthopaedic foot and ankle surgical procedures were gathered from the Centers for Medicare & Medicaid Services website using the Medicare Provider Utilization and Payment Data Public Use File 2017. The reimbursement data for each code were gathered from The Physician Fee Schedule Look-Up Tool from Centers for Medicare & Medicaid Services. The reimbursement values were adjusted for inflation to 2020 U.S. dollars using the consumer price index. Results The average inflation-adjusted reimbursement for included procedures decreased by 30% from 2000 to 2020. The greatest mean decreases were observed for “correction of hallux valgus” (–47%) and “partial excision of foot bone” (–41%). The procedures with the smallest mean decreases were observed in “treatment of “Amputation of toe” (–19%) and “closed treatment of metatarsal fracture” (–7%). Conclusions From 2000 to 2020, Inflation-adjusted Medicare reimbursement for foot and ankle surgery decreased by 30%. Level of Evidence IV; economic analysis.
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Smith JF, Moore ML, Pollock JR, Haglin JM, LeBlanc MP, Deckey DG, Arthur JR, Chhabra A. National and geographic trends in Medicare reimbursement rates for orthopedic shoulder and upper extremity surgery from 2000 to 2020. J Shoulder Elbow Surg 2022; 31:860-867. [PMID: 34619346 DOI: 10.1016/j.jse.2021.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is a paucity of information regarding financial trends in orthopedic upper extremity surgery. If progress is to be made in advancing agreeable reimbursement models, a more comprehensive understanding of these trends is needed. The purpose of this study was to assess national and geographic trends in Medicare reimbursement rates for shoulder and elbow surgical procedures over the past 2 decades. METHODS The 10 most billed Common Procedural Terminology (CPT) codes for both orthopedic shoulder surgery and elbow/upper arm surgery were determined. Medicare reimbursement data for these CPT codes were compiled between 2000 and 2020 and adjusted for inflation. The percentage change for each procedure and the average change in reimbursement each year were analyzed. Data from 2000, 2010, and 2020 were organized by state. The total percent change in physician fee and the percent change per year were tabulated for each CPT code using inflation-adjusted data and averaged by state. RESULTS From 2000 to 2020, when corrected for inflation, shoulder and elbow procedures decreased on average by 29.3% and 24.5%, respectively. Shoulder procedures experienced a greater numerical yet statistically insignificant decline in mean reimbursement percent decrease (P = .16), average percent decrease per year (P = .11), a more negative compound annual growth rate (P = .14), and a greater R-squared value as compared with elbow and upper arm procedures. For shoulder procedures, the average percent difference in inflation-adjusted Medicare reimbursement rates from 2000 to 2020 varied from -22.6% in Alaska to -34.1% in Michigan; division data varied from -27.8% in the Mountain Division to -31.2% in the East North Central Division; and region data varied from -28.3% in the West to -30.5% in the Northeast. For elbow and upper arm procedures, the average percent difference in inflation-adjusted Medicare reimbursement rates from 2000 to 2020 varied from -17.6% in Alaska to -29.8% in Michigan; division data varied from -23.0% in the Mountain Division to -26.7% in the East North Central Division; and region data varied from -23.5% in the West to -25.7% in the Northeast. DISCUSSION Inflation-adjusted Medicare reimbursement in upper extremity surgery has decreased markedly between 2000 and 2020. The degree of decrease varies geographically. If access to quality and sustainable surgical orthopedic care is to persist in the United States, increased awareness of these trends is important. The trends identified in this study can serve to customize regional health care policymaking.
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Pollock JR, Richman EH, Estipona BI, Moore ML, Brinkman JC, Hinckley NB, Haglin JM, Chhabra A. Inflation-Adjusted Medicare Reimbursement Has Decreased for Orthopaedic Sports Medicine Procedures: Analysis From 2000 to 2020. Orthop J Sports Med 2022; 10:23259671211073722. [PMID: 35174250 PMCID: PMC8842183 DOI: 10.1177/23259671211073722] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Decreases in Medicare reimbursement have been noted among many medical specialties. An in-depth analysis of the subspecialty of orthopaedic sports medicine is needed to determine changes in Medicare reimbursement in this field. Purpose/Hypothesis: The purpose was to elucidate the trends in inflation-adjusted Medicare reimbursement for orthopaedic sports medicine procedures between 2000 and 2020. It was hypothesized that Medicare reimbursement decreased substantially during the study period. Study Design: Economic decision and analysis; Level of evidence, 4. Methods: The Physician Fee Schedule Look-up Tool was used to extract Medicare reimbursement information between 2000 and 2020 for 67 procedures related to orthopaedic sports medicine. These values were adjusted for inflation using the Consumer Price Index. The compound annual growth rate (CAGR) was calculated to measure the annual rate of change, and descriptive analyses were performed using the Student t test. Results: Between 2000 and 2020, inflation-adjusted Medicare reimbursement for the 67 included procedures decreased by an average of 33% (CAGR = –2.2%; R 2 = 0.78). Reimbursement decreased for procedures related to the shoulder and elbow by 34% (CAGR = –2.3%; R 2 = 0.80), for hip-related procedures by 23% (CAGR = –1.4%; R 2 = 0.77), for knee-related procedures by 31% (CAGR = –2.0%; R 2 = 0.81), and for procedures relating to the foot and ankle by 38% (CAGR = –2.5%; R 2 = 0.79). Conclusion: Study findings indicated that inflation-adjusted Medicare reimbursement decreased substantially between 2000 and 2020 for orthopaedic sports medicine procedures, ranging from a 23% decrease for hip-related procedures to a 38% decrease for foot and ankle–related procedures. The results of this study could be used to provide further context for health care policy decisions and help ensure sustainable financial environments for orthopaedic sports medicine surgeon.
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McQuivey KS, Moore ML, Pollock JR, Hassebrock JD, Patel KA, Chhabra A. Top-100 Most-Cited Sports-Related Concussion Articles Focus on Symptomatology, Epidemiology, and Demographics. Arthrosc Sports Med Rehabil 2021; 3:e1585-e1597. [PMID: 34977610 PMCID: PMC8689224 DOI: 10.1016/j.asmr.2021.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/30/2021] [Indexed: 11/06/2022] Open
Abstract
Purpose To analyze the top-100 cited articles on sports-related concussions together with a bibliometric analysis to determine citations by year, level of evidence, study design, and several other factors related to the top referenced articles in sports concussions. Methods The Clarivate Analytics Web of Knowledge database was used to gather data using Boolean queries to capture all possible iterations of sports-related concussion research. Articles were organized in descending order based on the number of citations and included or excluded based on relevance to concussion. Collected information included author name, publication year, country of origin, journal name, article type, study focus, and the level of evidence. Results The top-100 articles were cited 31,197 times with an average of 312.0 citations per publication. More than one half were published in 2006 or later (52). Cohort studies and descriptive articles were the most prevalent study types (22 each). Studies with Level V evidence were the most common (33). The most common areas of study were symptomatology (short term, long term) with 17 articles, followed by epidemiology/demographics with 16 articles. The least common area of study was concussion prevention (2 articles), followed by management/treatment, diagnostics (labs, imaging) with 4 articles each. Conclusions We identified the most influential studies in sports-related concussion based on number of citations and citation density. A majority of these articles were published in the United States after 2006 and are most commonly cohort studies (Level IV evidence) and descriptive articles (Level V evidence). Current research focuses most heavily on the symptomatology and epidemiology/demographics of sports concussion. Clinical Relevance This study serves to identify the most influential articles in sports-related concussion and identify research topics with general deficiencies within the field of sports-related concussion research.
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Pollock JR, Moore ML, Hogan JS, Haglin JM, Brinkman JC, Doan MK, Chhabra A. Orthopaedic Group Practice Size Is Increasing. Arthrosc Sports Med Rehabil 2021; 3:e1937-e1944. [PMID: 34977651 PMCID: PMC8689279 DOI: 10.1016/j.asmr.2021.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/20/2021] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To analyze recent trends in orthopaedic surgery consolidation and quantify these changes temporally and geographically from 2012 to 2020. METHODS We performed a retrospective cross-sectional analysis of orthopaedic surgeon practice size in the United States using 2012 and 2020 data obtained from the Physician Compare database. RESULTS Although we observed an increase from 21,216 unique orthopaedic surgeons in 2012 to 21,553 in 2020 (1.6% increase), the number of practices experienced a large decrease from 7,299 practices in 2012 to 5,829 in 2020 (20.1% decrease). The proportion of orthopaedic surgeons working in solo practices decreased from 13.2% (2,790) in 2012 to 7.4% (1,595) in 2020, and the proportion of orthopaedic surgeons working in groups sized 2 to 24 decreased from 35.3% (7,482) in 2012 to 22.2% (4,775) in 2020. In contrast, groups sized 25 to 99 have grown from 20.7% (4,387) of all orthopaedic surgeons to 23.4% (5,048) in 2020. Groups sized 100 to 499 have increased from 16.9% (3,593) in 2012 to 24.1% (5,190) in 2020, whereas groups sized 500 or greater have grown from 14% (2,964) in 2012 to 22.9% (4,945) in 2020. The number of unique group practices showed a significant decrease in the number of solo groups, which comprised 43.8% (3,200) of the total number of individual practices in 2012, decreasing to 32% (1,886) in 2020. All other groups increased in number and proportionally from 2012 to 2020. CONCLUSIONS This study shows that over the period from 2012 to 2020, there has been a substantial trend of orthopaedic surgeons shifting to increasing practice sizes, potentially indicating that more orthopaedic surgeons are working for large health care organizations rather than small independent practices. CLINICAL RELEVANCE The impact of these changes should be examined to determine large-scale effects on patient care, payment models, access, and outcomes, along with physician compensation, lifestyle, and satisfaction.
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Elahi MA, Moore ML, Doan MK, Pollock JR, Hassebrock JD, Makovicka JL, Brinkman JC, Patel KA. Orthopaedic Foot and Ankle Surgery Fellowship Directors Are Typically White Men in Their Early 50s With Strong Achievements in Research. Arthrosc Sports Med Rehabil 2021; 3:e1629-e1636. [PMID: 34977614 PMCID: PMC8689204 DOI: 10.1016/j.asmr.2021.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/26/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To determine the objective characteristics of orthopaedic foot and ankle fellowship directors (FDs) by concentrating on the demographic characteristics, academic background, institutional history, research experience, and professional affiliations of these leaders. Methods Data for each FD were collected by searching institutional biographies, personal websites, or publicly available curricula vitae. Data collection included the following variables: age, sex, race/ethnicity, previous training institutions, residency and fellowship graduation years, advanced degrees, military affiliation, institutional loyalty, year hired, FD career timeline, total number of publications, total number of citations, and h-index. Results Of the 47 FDs, 44 (93.6%) were men and 3 (6.4%) were women. The mean age was 50.8 ± 9.4 years. Most orthopaedic foot and ankle FDs were white (n = 42, 89.4%), followed by Asian (n = 4, 8.5%) and black or African American (n = 1, 2.1%). The mean Scopus h-index, total number of publications, and total number of citations for all foot and ankle FDs were 13.3 ± 9.5, 47.5 ± 45.8, and 898.1 ± 1,040.3, respectively. Among all foot and ankle FDs, the mean tenure in the FD position was 5.8 ± 4.6 years. Conclusions Orthopaedic foot and ankle FDs are primarily white men in their 50s, with minimal female and minority representations. These FDs are distinguished by their high level of research productivity. Additionally, orthopaedic foot and ankle training backgrounds seem to play an important role, given that most of the appointed FDs trained in only a few select programs. Clinical Relevance This study outlines some of the most important characteristics among foot and ankle FDs and identifies important disparities within this population of leaders that may have detrimental effects on the field.
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Pollock JR, Doan MK, Moore ML, Hassebrock JD, Makovicka JL, Deckey DG, Kile TA, Patel KA. 30-Day Outcomes for Total Ankle Arthroplasty in Patients With Anemia. Foot Ankle Int 2021; 42:1463-1468. [PMID: 34109838 DOI: 10.1177/10711007211017512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND While anemia has been associated with poor surgical outcomes in total knee arthroplasty and total hip arthroplasty, the effects of anemia on total ankle arthroplasty remain unknown. This study examines how preoperative anemia affects postoperative outcomes in total ankle arthroplasty. METHODS A retrospective analysis was performed using the American College of Surgeons National Surgery Quality Improvement Project database from 2011 to 2018 for total ankle arthroplasty procedures. Hematocrit (HCT) levels were used to determine preoperative anemia. RESULTS Of the 1028 patients included in this study, 114 patients were found to be anemic. Univariate analysis demonstrated anemia was significantly associated with an increased average hospital length of stay (2.2 vs 1.8 days, P < .008), increased rate of 30-day readmission (3.5% vs 1.1%, P = .036), increased 30-day reoperation (2.6% vs 0.4%, P = .007), extended length of stay (64% vs 49.9%, P = .004), wound complication (1.75% vs 0.11%, P = .002), and surgical site infection (2.6% vs 0.6%, P = .017). Multivariate logistic regression analysis found anemia to be significantly associated with extended hospital length of stay (odds ratio [OR], 1.62; 95% CI, 1.07-2.45; P = .023) and increased reoperation rates (OR, 5.47; 95% CI, 1.15-26.00; P = .033). Anemia was not found to be a predictor of increased readmission rates (OR, 3.13; 95% CI, 0.93-10.56; P = .066) or postoperative complications (OR, 1.27; 95% CI, 0.35-4.56; P = .71). CONCLUSION This study found increasing severity of anemia to be associated with extended hospital length of stay and increased reoperation rates. Providers and patients should be aware of the increased risks of total ankle arthroplasty with preoperative anemia. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Moore ML, Elahi MA, Doan MK, Pollock JR, Makovicka JL, Hassebrock JD, Brinkman JC, Patel KA. Orthopaedic Sports Medicine Fellowship Directors Are Predominantly White Men With a High Degree of Research Productivity. Arthrosc Sports Med Rehabil 2021; 3:e1449-e1455. [PMID: 34746846 PMCID: PMC8551397 DOI: 10.1016/j.asmr.2021.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/12/2021] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To determine the objective characteristics of fellowship directors (FDs) in orthopaedic sports medicine by focusing on the demographics, academic background, institutional history, research experience, and professional affiliations of FDs in this field. METHODS Data was collected for each FD via institutional biographies or publicly available curriculum vitae (CV). The data collected for each FD included age, gender, race/ethnicity, previous training institutions, residency and fellowship graduation years, additional advanced degrees, military affiliation, institutional loyalty, year hired by current institution, career timeline, Scopus H-index, number of publications, and total number of citations. RESULTS Of the 88 FDs, 87 (98.9%) were male and 1 (1.1%) was female. The mean age for all FDs was 54.7 years (± 9.1 standard deviation). The majority of FDs were White (n = 80; 90.9%). The mean Scopus H-index, total number of publications, and total number of citations were 22.5 ± 16.6, 90.0 ± 91.6, and 2773.9 ± 3962.9, respectively. On average, it took 9.5 ± 7.3 years from fellowship graduation until FD appointment. Additionally, the mean number of years of employment or affiliation with the current institution was 17.2 ± 9.4, and the mean number of years in an FD role was 10.9 ± 9.3. CONCLUSION Orthopaedic sports medicine fellowship directors are largely distinguished by their high level of research productivity and accomplishment. Additionally, orthopaedic training pedigree seems to play a role in FD role attainment, with a handful of orthopaedic residency and sports medicine fellowship programs producing a large percentage of current FDs. Finally, FDs are overwhelmingly white males with little female or minority representation. CLINICAL RELEVANCE This study outlines some of the most important characteristics among orthopaedic sports medicine fellowship directors and identifies racial and gender disparities within this population of leaders that may have detrimental effects on the field as a whole.
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Moore ML, Singh R, McQueen K, Doan MK, Dodd H, Makovicka JL, Hassebrock JD, Patel NP. Workforce Trends in Spinal Surgery: Geographic Distribution and Primary Specialty Characteristics from 2012 to 2017. World Neurosurg 2021; 156:e392-e397. [PMID: 34563716 DOI: 10.1016/j.wneu.2021.09.073] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Although both neurosurgeons and orthopedic surgeons specialize in spinal care, it is not clear how this increased demand for spine surgeons has affected these fields. In this study, we aim to characterize the total number, geographic distribution, and procedural rate of laminectomies of spine surgeons by their primary specialty from 2012 to 2017. METHODS Neurosurgical and orthopedic data from 2012 to 2017 were obtained from the Medicare Provider Utilization Database. The databases were filtered by the primary specialty to include "Neurosurgeons" and "Orthopedic surgery." To select specifically for spine surgeons, the 203 Healthcare Common Procedure Coding System codes relating to spinal procedures were chosen as additional filters. RESULTS Between 2012 and 2017, the total number of spine surgeons in the United States increased by 9.6% from 3,861 to 4,241 total surgeons. The South experienced the largest percentage increase in spine surgeons from 1,584 surgeons in 2012 to 1,769 in 2017 (11.7%). Over this 5-year span, neurosurgeons performed a greater share of both cervical and lumbar laminectomies, but orthopedic spine surgeons saw a greater increase in procedural growth (+87.2% cervical and +16.7% lumbar). CONCLUSIONS There is relatively slow growth in the workforce of spinal surgery, with orthopedic spine specialists outpacing the growth seen in neurosurgical spine. This growth is seen at different rates across different regions in the U.S., with the South experiencing the highest rate of growth. Finally, although neurologic surgery performs more laminectomies in both the lumbar and cervical region, orthopedic surgeons are quickly increasing their proportion of performed procedures.
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Pollock JR, Doan MK, Asprey WL, Dulle DL, Moore ML, Makovicka JL, Hassebrock JD, Foley BM, Chhabra A. Can NFL Combine Results be Used to Estimate NFL Defensive Players Longevity? Sports Med Int Open 2021; 5:E59-E64. [PMID: 34395825 PMCID: PMC8354768 DOI: 10.1055/a-1485-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/15/2021] [Indexed: 11/06/2022] Open
Abstract
The National Football League Scouting Combine is an annual event held to evaluate football players. The results of the combine are used to identify talent and player potential. Our study aims to examine the relationship between combine drill performance (e.g., speed, power, agility, explosiveness) and career longevity. We performed a retrospective review of The National Football League combine test results for all defensive players from 2005-2015 to determine the association of each player's combine test results with career longevity. The position that had the most significant associations for 1-year status was linebackers, with weight, 10-yard dash, 20-yard dash, 40-yard dash, broad jump, 3-cone drill, and shuttle being significantly associated with 1-year roster status. The position that had the most significant associations for 5-year status was cornerbacks, with weight, 10-yard dash, 20-yard dash, 40-yard dash, 3-cone drill, and shuttle being significantly associated with 1-year roster status. The least number of significant associations was found for safeties, with no drill being associated with 1-year roster status and only height and shuttle time significantly associated with 5-year career longevity. Our study demonstrates the utility of the combine results to help estimate the career longevity of NFL defensive players.
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Tinsley GM, Moore ML, Rafi Z, Griffiths N, Harty PS, Stratton MT, Benavides ML, Dellinger JR, Adamson BT. Explaining Discrepancies Between Total and Segmental DXA and BIA Body Composition Estimates Using Bayesian Regression. J Clin Densitom 2021; 24:294-307. [PMID: 32571645 DOI: 10.1016/j.jocd.2020.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/16/2020] [Accepted: 05/05/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION/BACKGROUND Few investigations have sought to explain discrepancies between dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) body composition estimates. The purpose of this analysis was to explore physiological and anthropometric predictors of discrepancies between DXA and BIA total and segmental body composition estimates. METHODOLOGY Assessments via DXA (GE Lunar Prodigy) and single-frequency BIA (RJL Systems Quantum V) were performed in 179 adults (103 F, 76 M, age: 33.6 ± 15.3 yr; BMI: 24.9 ± 4.3 kg/m2). Potential predictor variables for differences between DXA and BIA total and segmental fat mass (FM) and lean soft tissue (LST) estimates were obtained from demographics and laboratory techniques, including DXA, BIA, bioimpedance spectroscopy, air displacement plethysmography, and 3-dimensional optical scanning. To determine meaningful predictors, Bayesian robust regression models were fit using a t-distribution and regularized hierarchical shrinkage "horseshoe" prior. Standardized model coefficients (β) were generated, and leave-one-out cross validation was used to assess model predictive performance. RESULTS LST hydration (i.e., total body water:LST) was a predictor of discrepancies in all FM and LST variables (|β|: 0.20-0.82). Additionally, extracellular fluid percentage was a predictor for nearly all outcomes (|β|: 0.19-0.40). Height influenced the agreement between whole-body estimates (|β|: 0.74-0.77), while the mass, length, and composition of body segments were predictors for segmental LST estimates (|β|: 0.23-3.04). Predictors of segmental FM errors were less consistent. Select sex-, race-, or age-based differences between methods were observed. The accuracy of whole-body models was superior to segmental models (leave-one-out cross-validation-adjusted R2 of 0.83-0.85 for FMTOTAL and LSTTOTAL vs. 0.20-0.76 for segmental estimates). For segmental models, predictive performance decreased in the order of: appendicular lean soft tissue, LSTLEGS, LSTTRUNK and FMLEGS, FMARMS, FMTRUNK, and LSTARMS. CONCLUSIONS These findings indicate the importance of LST hydration, extracellular fluid content, and height for explaining discrepancies between DXA and BIA body composition estimates. These general findings and quantitative interpretation based on the presented data allow for a better understanding of sources of error between 2 popular segmental body composition techniques and facilitate interpretation of estimates from these technologies.
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Doan MK, Pollock JR, Moore ML, Hassebrock JD, Makovicka JL, Tokish JM, Patel KA. Increasing severity of anemia is associated with poorer 30-day outcomes for total shoulder arthroplasty. JSES Int 2021; 5:360-364. [PMID: 34136840 PMCID: PMC8178617 DOI: 10.1016/j.jseint.2021.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Total shoulder arthroplasty (TSA) has increased in utilization over the past several decades. Anemia is a common preoperative condition among patients undergoing TSA and has been associated with poorer outcomes in other surgical procedures. To the best of our knowledge, no study has analyzed the association between anemia severity and TSA outcomes. Therefore, the purpose of this study is to determine the effects that increasing severity of anemia may have on the postoperative outcomes in patients receiving primary TSA. Methods A retrospective analysis was performed using the American College of Surgeons National Surgery Quality Improvement Project database from the years 2015 to 2018. Current Procedure Terminology code 23472 was used to identify all primary TSA procedures recorded during this time frame. Patients with greater than 38% preoperative hematocrit (HCT) were classified as having normal HCT levels. Patients with HCT values between 33% and 38% were classified as having mild anemia. All patients with less than 33% HCT were classified as having moderate/severe anemia. Patient demographic information, preoperative risk factors, and postoperative outcomes were compared among the 3 cohorts. A multivariate logistic regression including demographic factors and comorbidities was performed to determine whether increasing severity of anemia is independently associated with poorer postoperative outcomes. Results Of the 15,185 patients included in this study, 11,404 had normal HCT levels, 2962 patients were mildly anemic, and 819 patients had moderate to severe anemia. With increasing severity of anemia, there was an increased average hospital length of stay (1.6 vs. 2.1 vs. 3.0 days, P < .001), rate of readmissions (2.3% vs. 4.8% vs. 7.0%, P < .001), and rate of all reoperations (1.1% vs. 1.8% vs. 3.1%, P < .001). There was a statistically significant increase in both minor (1.9% vs. 2.7% vs. 4.4%, P < .001) and major (1.2% vs. 2.4% vs. 4.3%, P < .001) postoperative complication rates as well. Multivariate analysis identified anemia as an independent predictor of readmissions, reoperations, minor complications, and major complications. Conclusion We found increasing severity of anemia to be associated with progressively worse 30-day postoperative outcomes. This is consistent with the outcomes found for increasing severity of anemia in patients receiving other total joint procedures. Using preoperative HCT levels may be a useful tool for predicting the risk of postoperative complications in patients undergoing TSA. This information could be used to further optimize patient selection for primary TSA.
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Moore ML, Haglin JM, Hassebrock JD, Anastasi MB, Chhabra A. Management of ankle injuries in professional basketball players: Prevalence and rehabilitation. Orthop Rev (Pavia) 2021; 13:9108. [PMID: 33953893 PMCID: PMC8077287 DOI: 10.4081/or.2021.9108] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/27/2021] [Indexed: 11/23/2022] Open
Abstract
Basketball is a popular internationally played sport. With the physical requirements the game has on athletes, players are at risk of injury. Ankle injuries are the most common injury type suffered by basketball players. In this comprehensive review, we present an analysis and overview of the most common ankle injuries among basketball players, including sprains, fractures, impingement, and Achilles tendon pathology. The review includes treatment modalities for such injuries. More research is warranted regarding prevention strategies.
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Moore ML, Pollock JR, McQuivey KS, Bingham JS. The Top 50 Most-Cited Shoulder Arthroscopy Studies. Arthrosc Sports Med Rehabil 2021; 3:e277-e287. [PMID: 33615275 PMCID: PMC7879187 DOI: 10.1016/j.asmr.2020.09.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/04/2020] [Indexed: 01/02/2023] Open
Abstract
Purpose To determine the 50 most frequently cited studies in the orthopaedic shoulder arthroscopy literature and to conduct a bibliometric analysis of these studies. Methods The Clarivate Analytics Web of Knowledge database was used to gather data and metrics using Boolean queries to capture all possible iterations of shoulder arthroscopy research. The search list was sorted so that articles were organized in descending order based on the number of citations and included or excluded based on relevance to shoulder arthroscopy. The information extracted for each article included author name, publication year, country of origin, journal name, article type, and the level of evidence. Results For these 50 studies, the total number of citations was calculated to be 13,910, with an average of 278.2 citations per paper. The most-cited article was cited 1134 times, whereas the second- and third-most cited articles were cited 920 and 745 times, respectively. All 50 articles were published in English and came from 7 different orthopaedic journals. The United States was responsible for most of the included articles (31), followed by France (9) and Japan (3). Conclusions The majority of the most-cited articles in shoulder arthroscopy are case series and descriptive studies originating from the United States. In addition, more than one half of the top 50 most-cited studies were published after 2004, which suggests that article age may be less important in the accumulation of citations for a rapidly growing field like shoulder arthroscopy. Clinical Relevance The top 50 most-cited studies list will provide researchers, medical students, residents, and fellows with a foundational list of the most important and influential academic contributions to shoulder arthroscopy.
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Moore ML, Benavides ML, Dellinger JR, Adamson BT, Tinsley GM. Segmental body composition evaluation by bioelectrical impedance analysis and dual-energy X-ray absorptiometry: Quantifying agreement between methods. Clin Nutr 2020; 39:2802-2810. [PMID: 31874783 DOI: 10.1016/j.clnu.2019.12.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/15/2019] [Accepted: 12/04/2019] [Indexed: 11/17/2022]
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Harty PS, Stratton MT, Griffiths N, Moore ML, Benavides ML, Dellinger JR, Adamson BT, Tinsley GM. Physiological And Anthropometric Predictors Of Discrepancies Between Bioelectrical Impedance Analysis And Dual-energy X-ray Absorptiometry. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000685056.74015.fc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Stratton MT, Harty PS, Moore ML, Griffiths N, Dellinger JR, Benavides ML, Adamson BT, Tinsley GM. Explaining Segmental Lean Soft Tissue Discrepancies Between Bioelectrical Impedance Analysis And Dual-Energy X-Ray Absorptiometry. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000685060.59897.5e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Tinsley GM, Moore ML. Body fat gain and loss differentially influence validity of dual-energy x-ray absorptiometry and multifrequency bioelectrical impedance analysis during simultaneous fat-free mass accretion. Nutr Res 2020; 75:44-55. [DOI: 10.1016/j.nutres.2019.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 01/10/2023]
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Tinsley GM, Moore ML, Benavides ML, Dellinger JR, Adamson BT. 3-Dimensional optical scanning for body composition assessment: A 4-component model comparison of four commercially available scanners. Clin Nutr 2020; 39:3160-3167. [PMID: 32113641 DOI: 10.1016/j.clnu.2020.02.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/04/2019] [Accepted: 02/10/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Body composition assessment via 3-dimensional optical (3DO) scanning has emerged as a rapid and simple evaluation method. The aim of this study was to establish the precision of body composition estimates from four commercially available 3DO scanners and evaluate their validity as compared to a reference 4-component (4C) model. METHODS The body composition of 171 participants was assessed using four commercially-available 3DO scanners (FIT3D®, Naked Labs®, Size Stream®, and Styku®) and a 4C model utilizing data from dual-energy x-ray absorptiometry, air displacement plethysmography, and bioimpedance spectroscopy. Body composition estimates were compared via equivalence testing, Deming regression, Bland-Altman analysis, concordance correlation coefficients (CCC), root mean square error (RMSE), and related metrics. Precision metrics, including the root mean square coefficient of variation (RMS-%CV), precision error, and intraclass correlation coefficient, were generated for duplicate scans in 139 participants. RESULTS All scanners produced reasonably reliable estimates, with RMS-%CV of 2.3-4.3% for body fat percentage (BF%), 2.5-4.3% for fat mass (FM), and 0.7-1.4% for fat-free mass (FFM). ICC values ranged from 0.975 to 0.996 for BF% and 0.990 to 0.999 for FM and FFM. All scanners except Styku® demonstrated equivalence with 4C, using 5% equivalence regions, and constant errors of <1% for BF% and ≤0.5 kg for FM and FFM. However, the slopes of regression lines differed from the line of identity for most scanners and variables. CCC values ranged from 0.74 to 0.90 for BF%, 0.85 to 0.95 for FM, and 0.93 to 0.97 for FFM. RMSE values ranged from 3.7 to 6.1% for BF% and 2.8-4.6 kg for FM and FFM. Bland-Altman analysis indicated proportional bias of varying magnitudes was present for all scanners. CONCLUSIONS Commercially available 3DO scanners produce relatively reliable body composition estimates. Three out of four scanners demonstrated equivalence with a 4C model for assessments of BF%, FM, and FFM, although other metrics of validity varied among scanners, and proportional bias was present for all scanners.
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Tinsley GM, Harty PS, Moore ML, Grgic J, Silva AM, Sardinha LB. Changes in total and segmental bioelectrical resistance are correlated with whole-body and segmental changes in lean soft tissue following a resistance training intervention. J Int Soc Sports Nutr 2019; 16:58. [PMID: 31783760 PMCID: PMC6883592 DOI: 10.1186/s12970-019-0325-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/13/2019] [Indexed: 12/18/2022] Open
Abstract
Background Raw bioelectrical values can be used to assess physiological outcomes, though limited information is available concerning the relationships between changes in these values and changes in other variables of interest. Methods This investigation quantified the relationships between total and segmental changes in raw bioelectrical variables (i.e., resistance, reactance, and phase angle) and corresponding whole-body and segmental changes in independently assessed body composition. Resistance-trained females (n = 31, body mass index: 22.8 ± 2.6 kg/m2, body fat: 28 ± 6%) completed eight weeks of supervised resistance training. Before and after the intervention, body composition was assessed via dual-energy x-ray absorptiometry (GE® Lunar Prodigy), and raw bioelectrical variables were assessed via 8-point multi-frequency bioelectrical impedance analysis (Seca® mBCA 515/514) at 19 frequencies ranging from 1 to 1000 kHz. Results Lean soft tissue of the whole body (+ 3.2% [2.1, 4.4]; mean [95% confidence interval]) and each body segment (+ 2.8 to 6.3%) increased as a result of the intervention. Group-level changes in total (− 2.4% [− 5.2, 0.3]) and segmental fat mass were not statistically significant. Significant decreases in total resistance (− 2.1% [− 3.7, − 0.6] at 50 kHz) and increases in phase angle (+ 4.2% [2.5, 5.9] at 50 kHz) were observed, with minimal changes in reactance and varying changes in segmental values. Moderate to strong negative correlations (0.63 ≤ |r| ≤ 0.83, p ≤ 0.001) were found between changes in lean soft tissue and changes in resistance for the whole body, trunk, and arms. No significant correlations were identified between changes in fat mass or bone mineral content and changes in any bioelectrical variable. Conclusions Total and segmental changes in resistance were associated with corresponding total and segmental changes in lean soft tissue following a resistance training intervention, while fewer associations were identified between changes in other bioelectrical parameters (i.e., reactance and phase angle) and body composition variables (e.g., fat mass and bone mineral content). Measurement frequency and body segment appeared to influence the presence and strength relationships between bioelectrical and body composition variables. These findings suggest that researchers and practitioners utilizing bioimpedance technology may benefit from examining raw resistance values to enhance detection of physiological adaptations to exercise interventions.
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Moore ML. 2193 To Review Informed Patient Decisions Regarding Morcellation of Fibroids Since the FDA Guidance Statement of November 2014.Michael L Moore M.D., Advanced Womens Health Institute, Denver, CO. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Moore ML. 2271 Patient Informed Decision in Minimally Invasive Surgery for Fibroids and Morcellation. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tinsley GM, Moore ML, Graybeal AJ, Paoli A, Kim Y, Gonzales JU, Harry JR, VanDusseldorp TA, Kennedy DN, Cruz MR. Time-restricted feeding plus resistance training in active females: a randomized trial. Am J Clin Nutr 2019; 110:628-640. [PMID: 31268131 PMCID: PMC6735806 DOI: 10.1093/ajcn/nqz126] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/10/2019] [Accepted: 05/31/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND A very limited amount of research has examined intermittent fasting (IF) programs, such as time-restricted feeding (TRF), in active populations. OBJECTIVE Our objective was to examine the effects of TRF, with or without β-hydroxy β-methylbutyrate (HMB) supplementation, during resistance training (RT). METHODS This study employed a randomized, placebo-controlled, reduced factorial design and was double-blind with respect to supplementation in TRF groups. Resistance-trained females were randomly assigned to a control diet (CD), TRF, or TRF plus 3 g/d HMB (TRFHMB). TRF groups consumed all calories between 1200 h and 2000 h, whereas the CD group ate regularly from breakfast until the end of the day. All groups completed 8 wk of supervised RT and consumed supplemental whey protein. Body composition, muscular performance, dietary intake, physical activity, and physiological variables were assessed. Data were analyzed prior to unblinding using mixed models and both intention-to-treat (ITT) and per protocol (PP) frameworks. RESULTS Forty participants were included in ITT, and 24 were included in PP. Energy and protein intake (1.6 g/kg/d) did not differ between groups despite different feeding durations (TRF and TRFHMB: ∼7.5 h/d; CD: ∼13 h/d). Comparable fat-free mass (FFM) accretion (+2% to 3% relative to baseline) and skeletal muscle hypertrophy occurred in all groups. Differential effects on fat mass (CD: +2%; TRF: -2% to -4%; TRFHMB: -4% to -7%) were statistically significant in the PP analysis, but not ITT. Muscular performance improved without differences between groups. No changes in physiological variables occurred in any group, and minimal side effects were reported. CONCLUSIONS IF, in the form of TRF, did not attenuate RT adaptations in resistance-trained females. Similar FFM accretion, skeletal muscle hypertrophy, and muscular performance improvements can be achieved with dramatically different feeding programs that contain similar energy and protein content during RT. Supplemental HMB during fasting periods of TRF did not definitively improve outcomes. This study was prospectively registered at clinicaltrials.gov as NCT03404271.
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Tinsley GM, Graybeal AJ, Moore ML. Resting metabolic rate in muscular physique athletes: validity of existing methods and development of new prediction equations. Appl Physiol Nutr Metab 2019; 44:397-406. [DOI: 10.1139/apnm-2018-0412] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Estimation of resting metabolic rate (RMR) is an important step for prescribing an individual’s energy intake. The purpose of this study was to evaluate the validity of portable indirect calorimeters and RMR prediction equations in muscular physique athletes. Twenty-seven males (n = 17; body mass index (BMI): 28.8 ± 2.0 kg/m2; body fat: 12.5% ± 2.7%) and females (n = 10; BMI: 22.8 ± 1.6 kg/m2; body fat: 19.2% ± 3.4%) were evaluated. The reference RMR value was obtained from the ParvoMedics TrueOne 2400 indirect calorimeter, and the Cosmed Fitmate and Breezing Metabolism Tracker provided additional RMR estimates. Existing RMR prediction equations based on body weight (BW) or dual-energy X-ray absorptiometry fat-free mass (FFM) were also evaluated. Errors in RMR estimates were assessed using validity statistics, including t tests with Bonferroni correction, linear regression, and calculation of the standard error of the estimate, total error, and 95% limits of agreement. Additionally, new prediction equations based on BW (RMR (kcal/day) = 24.8 × BW (kg) + 10) and FFM (RMR (kcal/day) = 25.9 × FFM (kg) + 284) were developed using stepwise linear regression and evaluated using leave-one-out cross-validation. Nearly all existing BW- and FFM-based prediction equations, as well as the Breezing Tracker, did not exhibit acceptable validity and typically underestimated RMR. The ten Haaf and Weijs (PLoS ONE, 9: e1084602014 (2014)) and Cunningham (1980) (Am. J. Clin. Nutr. 33: 2372–2374 (1980)) FFM-based equations may produce acceptable RMR estimates, although the Cosmed Fitmate and newly developed BW- and FFM-based equations may be most suitable for RMR estimation in male and female physique athletes. Future research should provide additional external cross-validation of the newly developed equations to refine the ability to predict RMR in physique athletes.
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