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Peterman N, Shivdasani K, Naik A, Dharnipragada R, Harrop J, Vaccaro AR, Arnold PM. Geospatial Evaluation of Disparities in Access to Cervical Spine Fusion in Metropolitan Areas Across the United States. Clin Spine Surg 2024; 37:E208-E215. [PMID: 38158598 DOI: 10.1097/bsd.0000000000001564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024]
Abstract
STUDY DESIGN Retrospective study with epidemiologic analysis of public Medicare data. OBJECTIVE The purpose of this study is to use geospatial analysis to identify disparities in access to cervical spine fusions in metropolitan Medicare populations. SUMMARY OF BACKGROUND DATA Cervical spine fusion is among the most common elective procedures performed by spine surgeons and is the most common surgical intervention for degenerative cervical spine disease. Although some studies have examined demographic and socioeconomic trends in cervical spine fusion, few have attempted to identify where disparities exist and quantify them at a community level. METHODS Center for Medicare and Medicaid Services physician billing and Medicare demographic data sets from 2013 to 2020 were filtered to contain only cervical spine fusion procedures and then combined with US Census socioeconomic data. The Moran Index geospatial clustering algorithm was used to identify statistically significant hotspot and coldspots of cervical spine fusions per 100,000 Medicare members at a county level. Univariate and multivariate analysis was subsequently conducted to identify demographic and socioeconomic factors that are associated with access to care. RESULTS A total of 285,405 cervical spine fusions were analyzed. Hotspots of cervical spine fusion were located in the South, while coldspots were throughout the Northern Midwest, the Northeast, South Florida, and West Coast. The percent of Medicare patients that were Black was the largest negative predictor of cervical spine fusions per 100,000 Medicare members ( β =-0.13, 95% CI: -0.16, -0.10). CONCLUSIONS Barriers to access can have significant impacts on health outcomes, and these impacts can be disproportionately felt by marginalized groups. Accounting for socioeconomic disadvantage and geography, this analysis found the Black race to be a significant negative predictor of access to cervical spine fusions. Future studies are needed to further explore potential socioeconomic barriers that exist in access to specialized surgical care. LEVEL OF EVIDENCE Level III-retrospective.
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Affiliation(s)
- Nicholas Peterman
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign
| | - Krishin Shivdasani
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign
- Department of Orthopaedic Surgery & Rehabilitation, Loyola Medicine, Maywood IL
| | - Anant Naik
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign
- Department of Neurosurgery, University of Minnesota Twin-Cities, Minneapolis MN
| | - Rajiv Dharnipragada
- Department of Neurosurgery, University of Minnesota Twin-Cities, Minneapolis MN
| | - James Harrop
- Department of Neurosurgery, Thomas Jefferson Hospital
| | - Alexander R Vaccaro
- Department of Orthopedic Surgery, Rothman Orthopedic Institute, Philadelphia PA
| | - Paul M Arnold
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign
- Department of Neurosurgery, Carle Foundation Hospital, Urbana IL
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Kim JH, Chegal Y, Kim S, Park H, Kim YR, Kim S, Kim K, Lee CH, Kim CH, Chung CK. Healthcare burden changes by restricted physical activities in lumbar spinal stenosis and spondylolisthesis: a retrospective large cohort study during the COVID-19 pandemic. BMC Musculoskelet Disord 2024; 25:411. [PMID: 38783291 PMCID: PMC11118721 DOI: 10.1186/s12891-024-07332-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/04/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) and spondylolisthesis (SPL) are characterized as degenerative spinal pathologies and share considerable similarities. However, opinions vary on whether to recommend exercise or restrict it for these diseases. Few studies have objectively compared the effects of daily physical activity on LSS and SPL because it is impossible to restrict activities ethnically and practically. We investigated the effect of restricting physical activity due to social distancing (SoD) on LSS and SPL, focusing on the aspect of healthcare burden changes during the pandemic period. METHODS We included first-visit patients diagnosed exclusively with LSS and SPL in 2017 and followed them up for two years before and after the implementation of the SoD policy. As controls, patients who first visited in 2015 and were followed for four years without SoD were analyzed. The common data model was employed to analyze each patient's diagnostic codes and treatments. Hospital visits and medical costs were analyzed by regression discontinuity in time to control for temporal effects on dependent variables. RESULTS Among 33,484 patients, 2,615 with LSS and 446 with SPL were included. A significant decrease in hospital visits was observed in the LSS (difference, -3.94 times/month·100 patients; p = 0.023) and SPL (difference, -3.44 times/month·100 patients; p = 0.026) groups after SoD. This decrease was not observed in the data from the control group. Concerning medical costs, the LSS group showed a statistically significant reduction in median copayment (difference, -$45/month·patient; p < 0.001) after SoD, whereas a significant change was not observed in the SPL group (difference, -$19/month·patient; p = 0.160). CONCLUSION Restricted physical activity during the SoD period decreased the healthcare burden for patients with LSS or, conversely, it did not significantly affect patients with SPL. Under circumstances of physical inactivity, patients with LSS may underrate their symptoms, while maintaining an appropriate activity level may be beneficial for patients with SPL.
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Affiliation(s)
- Jun-Hoe Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Yebin Chegal
- Department of Statistics, Korea University, Seoul, South Korea
| | - Suhyun Kim
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul, South Korea
| | - Hangeul Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Young Rak Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Sum Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul, South Korea.
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea.
- Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea.
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
- Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
- Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, 03080, Republic of Korea
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Gray R, Ryan MA, Mehta V. Volume and Practice-Setting Shift of Laryngology Procedures During the COVID-19 Pandemic: A Reg-ENT Database Analysis. OTO Open 2024; 8:e128. [PMID: 38590586 PMCID: PMC11000131 DOI: 10.1002/oto2.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/03/2024] [Indexed: 04/10/2024] Open
Abstract
Objective The onset of the coronavirus disease 2019 (COVID-19) pandemic changed practice patterns throughout medicine. The purpose of this study is to evaluate changes in the volume and location setting of laryngology procedures after the onset of COVID-19. Study Design Retrospective database cohort study. Setting Reg-ENT registry. Methods Retrospective review from 2017 to 2022 of patients who underwent a laryngology procedure identified by procedure code categorized by site of service code-"ambulatory surgical" versus "office" setting. Based on March 2020 as the cutoff point, the procedures were designated as pre-COVID versus COVID time period. Results A total of 5989 patients underwent laryngology procedures. Forty-two percent more procedures were performed in the COVID period (n = 3780) versus pre-COVID (n = 2209). Pre-COVID, the procedure distribution between office and ambulatory surgical setting was 70% (n = 1546) compared with 30% (663). This shifted to 77% (n = 2920) and 23% (n = 860) during COVID, P = .9. The most common diagnoses associated with laryngology procedures during the study period were vocal fold paralysis 47% (n = 2831), dysphonia 33% (n = 1392), and laryngotracheal stenosis 14% (n = 838). These trends remained in both pre-COVID and COVID time periods. After the start of the pandemic, among patients undergoing laryngology procedures, there was a 93% increase (n = 284-549) in the diagnosis of laryngotracheal stenosis, 70% increase (n = 520-882 patients) in dysphonia and 69% increase (n = 1054-1777) in vocal fold paralysis. Conclusion An increase in laryngology procedures performed after the onset of the COVID-19 pandemic was identified with an overall procedural shift to the office-setting.
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Affiliation(s)
- Raluca Gray
- Department of Otolaryngology–Head and Neck SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
| | | | - Vikas Mehta
- Department of OtolaryngologyMontefiore Medical Center/Albert Einstein College of MedicineBronxNew YorkUSA
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Oshima Y, Ohtomo N, Kawamura N, Higashikawa A, Hara N, Ono T, Takeshita Y, Fukushima M, Azuma S, Kato S, Matsubayashi Y, Taniguchi Y, Tanaka S. Impact of the COVID-19 pandemic on surgical volume and outcomes in spine surgery: a multicentre retrospective study in Tokyo. BMJ Open 2023; 13:e077110. [PMID: 38030245 PMCID: PMC10689418 DOI: 10.1136/bmjopen-2023-077110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES To investigate the effect of the COVID-19 pandemic on surgical volume and outcomes in spine surgery. DESIGN A retrospective cohort study using prospectively collected data. SETTING AND PARTICIPANTS A total of 9935 patients who underwent spine surgery between January 2019 and December 2021 at eight high-volume spine centres in the Greater Tokyo metropolitan area were included. OUTCOME MEASURES The primary outcome measures were the number of surgical cases, perioperative complications and patient-reported outcomes, including numerical rating scales for each body part, Euro quality of life 5-dimension (EQ5D), Neck Disability Index and Oswestry Disability Index (ODI). RESULTS The total number of surgeries in 2020 and 2021 remained lower than that of 2019, with respective percentages of 93.1% and 95.7% compared with the prepandemic period, with a marked reduction observed in May 2020 compared with the same period in 2019 (56.1% decrease). There were no significant differences between the prepandemic and postpandemic groups in the incidence of perioperative complications, although the frequency of reoperation tended to be higher in the postpandemic group (3.04% vs 3.76%, p=0.05). Subgroup analysis focusing on cervical spine surgery revealed significantly worse preoperative EQ5D scores in the postpandemic group (0.57 vs 0.54, p=0.004). Similarly, in lumbar spine surgery, the postpandemic group showed higher levels of leg pain (5.7 vs 6.1 to 0.002) and worse ODI scores (46.2 vs 47.7 to 0.02). However, postoperative outcomes were not different between pre and post-pandemic groups. CONCLUSIONS The COVID-19 pandemic has significantly impacted spinal surgeries in Japan, leading to a decrease in surgical volumes and changes in patient characteristics and surgical procedures. However, surgical outcomes remained comparable between the pre and postpandemic periods, indicating the resilience and adaptability of healthcare systems.
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Affiliation(s)
- Yasushi Oshima
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo-ku, Japan
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
| | - Nozomu Ohtomo
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo-ku, Japan
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
| | - Naohiro Kawamura
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Akiro Higashikawa
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, Kanto Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Nobuhiro Hara
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Takashi Ono
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Spinal Surgery, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Yujiro Takeshita
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Masayoshi Fukushima
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Toranomon Hospital, Minato-ku, Japan
| | - Seiichi Azuma
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - So Kato
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo-ku, Japan
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
| | - Yoshitaka Matsubayashi
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopaedic Surgery and Spinal Surgery, National Center for Global Health and Medicine, Shinjuku-ku, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo-ku, Japan
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Bunkyo-ku, Japan
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Ha CM, Nam Y, Lee S, Park SJ, Lee SH, Kim ES. Impact on Spine Surgery during the First Two Years of COVID-19 Pandemic: A Nationwide Study in South Korea. J Clin Med 2023; 12:4155. [PMID: 37373848 DOI: 10.3390/jcm12124155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/07/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
Since December 2019, the novel coronavirus (COVID-19) has infected people worldwide. Owing to its rapid spread, elective surgeries, including spine surgery, have been re-scheduled. We analyzed nationwide data to investigate changes in the volume of spine surgery during the first two years of the pandemic. Nationwide data from January 2016 to December 2021 were obtained. We compared the total number of patients who underwent spine surgery and related medical expenses before and during the COVID-19 pandemic. In February and September, the number of patients was significantly smaller compared to January and August, respectively. Despite the pandemic, the proportion of patients undergoing spine surgery for degenerative diseases in 2021 was the highest. In contrast, the proportions of patients undergoing spine surgery for tumors showed a continuous decrease from 2019 to 2021. Although the number of spine surgeries performed at tertiary hospitals was lowest in 2020, it was not significantly smaller than that in 2019.The number of patients who underwent spine surgery in March 2020, during the first outbreak, decreased compared to the previous month, which differed from the trend observed in the pre-COVID-19 period. However, as the pandemic continues, the impact of COVID-19 on spine surgery has become less evident.
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Affiliation(s)
- Chang-Min Ha
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Yunjin Nam
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea
| | - Sungjoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Se-Jun Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Eun-Sang Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
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Lucke-Wold B, Cerillo JL, Becsey AN, Chernicki BP, Root KT. Minimally Invasive Procedures, Perioperative Telemedicine, and Decreased Hospital Stays Following Covid-19 Surgical Restrictions: Spinal Surgery. ARCHIVES OF MEDICAL CASE REPORTS AND CASE STUDY 2022; 6:153. [PMID: 36844926 PMCID: PMC9956112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The 2019 severe acute respiratory syndrome coronavirus 2 pandemic had devastating impacts on healthcare system operations. Disruption of this delicate system led to international healthcare challenges with new policy changes that affected all specialties, including the global spine surgery community. The pandemic disrupted normal spine surgery proceedings, restricting, and postponing elective procedures, which comprise a large proportion of spine surgeries. This disruption may have contributed to significant economic losses for providers and resulted in the prolonged impairment of patients who were forced to postpone their procedures. However, response to the pandemic precipitated new procedural guidelines and practices that prioritize health outcomes and satisfaction. These new changes and innovations are positioned to provide lasting economic and procedural impacts in favor of both providers and patients. Thus, the objective of our review is to explore how spinal surgical practices and post-op recovery changed following COVID-19 and highlight some lasting impacts the pandemic created for future patients.
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Affiliation(s)
| | - John L Cerillo
- Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, FL, USA
| | | | - Brendan P Chernicki
- Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, FL, USA
| | - Kevin T Root
- College of Medicine, University of Florida, Gainesville, Florida, USA
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Lin GX, Kotheeranurak V, Chen CM, Hu BS, Rui G. Global research hotspots and trends in the field of spine surgery during the COVID-19 pandemic: A bibliometric and visual analysis. Front Surg 2022; 9:976546. [PMID: 36157412 PMCID: PMC9500354 DOI: 10.3389/fsurg.2022.976546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background The Coronavirus disease-2019 (COVID-19) significantly affected the healthcare and research systems, including spine surgery, throughout the world. A bibliometric analysis allows graphical visualization of the development of an academic field and its frontiers. Since research concerning spine surgery during the COVID-19 pandemic is being constantly upgraded, we conducted a bibliometric analysis of this literature to investigate the current status, research hotspots, and trends in this field. Methods We searched the Web of Science database for literature published (from December 1, 2019, to March 24, 2022) using the terms “COVID-19” OR “2019-nCoV” OR “SARS-CoV-2” AND “spine surgery” OR “spinal surgery” OR “discectomy” OR “decompression” OR “laminectomy” OR “interbody fusion” OR “pedicle screws.” Detailed bibliometric and visual analysis of the number of publications, geographical distribution, institutions, journals, authors, and keywords was done using CiteSpace, VOSviewer, and R-Bibliometrix. Results Of the initially screened 173 articles, we included 84 relevant articles—62 original articles, 10 editorial materials, 8 reviews, and 4 others. The United States, China, Egypt, and Argentina were most actively publishing in the field of spine surgery and COVID-19. The AOSpine International community contributed 7 articles (24 citations). The Hospital for Special Surgery (13.1%) and Johns Hopkins University (13.1%) were institutions with the most publications. Using the Law of Bradford, we found that World Neurosurgery, Global Spine Journal, and European Spine Journal are the core journals in this field, with P. K. Louie being the most influential author. “Elective surgery,” “intensive care,” “telehealth,” “patient satisfaction,” and “follow-up” had the strongest citation bursts. Conclusions During the COVID-19 pandemic, spine surgeons were more concerned with surgical timing, care, treatment, and patient’s quality of life. Accordingly, research hotspots in spine surgery during the pandemic shifted from “early healthcare” to “virus management” and “experience and education.”
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Affiliation(s)
- Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Correspondence: Chien-Min Chen Gang Rui Bao-Shan Hu
| | - Bao-Shan Hu
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
- Correspondence: Chien-Min Chen Gang Rui Bao-Shan Hu
| | - Gang Rui
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
- Correspondence: Chien-Min Chen Gang Rui Bao-Shan Hu
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