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The sociocultural effects on orthopedic surgeries in Taiwan.

ABSTRACT: Various sociocultural factors affect healthcare-seeking behaviors. In Taiwanese society, superstitions and lunar festivals play important roles in people's lives. We investigated the impact of "Ghost Month" (the 7th lunar month) and Chinese New Year (the 12th lunar month and the 1st lunar month of the following year) on the number of elective surgeries and emergent surgeries in Taiwan. The number of total knee replacement (TKR) surgeries and proximal femur fracture (PFF) surgeries in each lunar month from 2000 to 2011 were extracted from the Taiwan National Health Insurance Database, a computerized and population-based database. Patients were then sorted by location of residence or gender. The average number of TKR surgeries performed was significantly lower during the 1st, 7th, and 12th lunar months in urban areas, whereas in rural areas this trend was only evident in the 7th and 12th lunar months. There was however, no significant difference in the average number of PFF surgeries in each lunar month except for an increase seen in the 1st lunar month in rural patients (p<0.05). When sorted by gender, the average number of TKR surgeries was significantly decreased in the 7th and 12th lunar months in male patients, and decreased in the 1st, 7th, and 12th lunar months in female patients. In contrast, there was no difference in the average numbers of PFF surgeries in the 7th and 12th lunar months either in male or female patients. We proposed that the timing of elective surgeries such as TKR might be influenced by Ghost Month and Chinese New Year; however, emergent PFF surgeries were not significantly influenced by sociocultural beliefs and taboos in Taiwan.

SUBMITTER: Chiu SL

PROVIDER: S-EPMC5875864 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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The sociocultural effects on orthopedic surgeries in Taiwan.

Chiu Shin-Lin SL Gee Mei-Jih MJ Muo Chih-Hsin CH Chu Chiao-Lee CL Lan Shou-Jen SJ Chen Chiu-Liang CL

PloS one 20180329 3

Various sociocultural factors affect healthcare-seeking behaviors. In Taiwanese society, superstitions and lunar festivals play important roles in people's lives. We investigated the impact of "Ghost Month" (the 7th lunar month) and Chinese New Year (the 12th lunar month and the 1st lunar month of the following year) on the number of elective surgeries and emergent surgeries in Taiwan. The number of total knee replacement (TKR) surgeries and proximal femur fracture (PFF) surgeries in each lunar ...[more]

PMID: 29596539

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Project description:PurposeTo assess whether reimbursement for orthopaedic sports procedures adequately compensates for operative time and surgical complexity.MethodsThe National Surgical Quality Improvement Program (NSQIP) database was queried for all orthopedic sports medicine procedures performed greater than 150 times from 2016 to 2018 with regard to operative time, preoperative risk factors, morbidity, and mortality data. Physician work relative value units (wRVU) data were obtained from the 2020 Centers for Medicare & Medicaid Services (CMS) fee schedule. The primary outcome was wRVU per minute operative time (wRVU/min). Linear regressions were used to assess wRVU, operative time, and wRVU/min.ResultsA total of 42 CPT codes, including 84,966 cases, were stratified into the top and bottom 50%, according to mean operative time, complications, mortality, reoperations, and readmissions. Mean wRVU/min was significantly lower for longer procedures (.153 vs .187; P = .02), and comparable with regard to ASA score, complications, mortality, readmissions, and reoperations. Arthroscopy reimbursed more (.187 vs .148 wRVU/min; P = .008), with lower complications (1.5 vs 2.6%; P = .115) and operative time (56.1 vs 82.8 min; P = .001) compared to open. Multivariate linear regression revealed that after adjusting for complication rate, there was a decrease of .054 wRVU/h (P = .026) and $116.90/hour less for every additional hour of operative time.ConclusionThe current 2020 RVU scale does not fairly compensate sports procedures with longer operative times. When examining the hourly reimbursement rates for the most commonly performed sports procedures, there is a significant trend toward lower reimbursement for longer procedures even after accounting for complication rates. Furthermore, procedures of the knee reimbursed at higher rates relative to the general pool of sports procedures and open procedures are compensated at a lower rate compared to arthroscopic procedures.

Project description:BackgroundAdministration of adjuvant drugs epidurally in combination with local anesthetics offers new dimensions in the management of postoperative pain. This study aimed to compare the addition of either nalbuphine or dexmedetomidine to epidural bupivacaine for postoperative analgesia in lower limb orthopedic surgeries under combined spinal-epidural anesthesia.MethodsThis prospective randomized double-blind study included 69 patients scheduled for lower limb orthopedic surgeries. Anesthesia was started with 15 mg hyperbaric bupivacaine 0.5% intrathecally, and then an epidural bolus dose of 12 ml (10 ml 0.25% bupivacaine with 2 ml normal saline in group C, 2 ml (10 mg) nalbuphine in group N or dexmedetomidine 2 ml (100 µg) in group D was administered when sensory regression to T10. Postoperatively, when visual analogue scale (VAS) was ≥ 3, an epidural top-up dose of 8 ml (6 ml 0.25% bupivacaine plus 2 ml normal saline in group C, 2 ml (2 mg) nalbuphine in group N or 20 µg dexmedetomidine (2 ml) in group D was given. The primary outcome was to evaluate the duration of postoperative analgesia and secondary outcomes were any side effects and patient satisfaction.ResultsThe onset of epidural analgesia was 17.83 ± 2.53 versus 13.39 ± 1.27 versus 12.17 ± 1.27 min in groups C, N and D, respectively (p value < 0.001). The mean duration of analgesia was 241.3 ± 14.24 versus 318.38 ± 22.54 versus 365.87 ± 18.01 min in groups C, N and D, respectively (p value < 0.001). The mean sedation score was less in group C than group N and D (P < 0.001). The patient satisfaction score showed the lowest degree of satisfaction in group C (p value < 0.001). Top-up doses consumed and total analgesic requirements were lower in groups N and D than in group C. There was a statistically significant difference between the studied groups regarding VAS over time (p value < 0.001), intraoperative bradycardia (p value 0.029), and shivering (p value 0.029).ConclusionThe addition of either nalbuphine or dexmedetomidine to epidural bupivacaine was effective for postoperative analgesia in terms of onset, duration, and patient satisfaction with the superiority of dexmedetomidine over nalbuphine.Trial registrationApproval from the research ethics committee of the Faculty of Medicine, Zagazig University was obtained with the reference number (ZU-IRB#:7045-15-8-2021) and it was registered under clinicaltrials.gov (NCT05041270) on registration date 13/09/2021.

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The sociocultural effects on orthopedic surgeries in Taiwan.

Publications

The sociocultural effects on orthopedic surgeries in Taiwan.

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