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Ultrasound scanning helped surgeons to locate the buried metal work: A case series.

ABSTRACT: Removal of metalwork in children can be a challenging procedure, particularly if the metalwork is deeply buried and not palpable. This article proposes a surgical tip to help locate the position of metalwork just before the operation using an ultrasound machine and methylene blue dye. The technique involves using the ultrasound machine to locate the position of metalwork and marking the tract by injection of methylene blue dye just before prepping and draping the skin. This allows the operation to be performed through a smaller wound with less trauma to the soft tissues and avoids radiation exposure to the patient and theatre personnel. Our experience in a case series of 5 patients have found this a useful technique for removing threaded wires following a Salters osteotomy, where the wires can end up being buried beneath the iliac apophysis. It could however, be used to aid removal of any metal work where difficulty finding it is anticipated. Study expanded to include case series of patients rather than just one example. We have tracked a further 4 patients who have had the same technique used to include them in the paper. Reviewer 2 wanted further examples.

SUBMITTER: Sajid S

PROVIDER: S-EPMC6977528 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Ultrasound scanning helped surgeons to locate the buried metal work: A case series.

Sajid Soha S Chaudhry Samena S Golding Steven S Freeman Robert R

Journal of clinical orthopaedics and trauma 20190926 Suppl 1

Removal of metalwork in children can be a challenging procedure, particularly if the metalwork is deeply buried and not palpable. This article proposes a surgical tip to help locate the position of metalwork just before the operation using an ultrasound machine and methylene blue dye. The technique involves using the ultrasound machine to locate the position of metalwork and marking the tract by injection of methylene blue dye just before prepping and draping the skin. This allows the operation ...[more]

PMID: 31992943

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Project description:ImportanceThe primary data sources used to generate and update work relative value units (RVUs) are surveys of small groups of specialists who are asked to estimate the time and intensity needed to perform surgical procedures. Because these surveys are conducted by specialty societies and rely on subjective data, these sources have been challenged as potentially biased.ObjectiveTo assess whether objective work measures are associated with a surgical procedure's assigned work RVUs and whether differences exist by surgical specialty.Design, setting, and participantsThis cross-sectional study obtained data from the 2016 and 2017 participant use files of the American College of Surgeons National Surgical Quality Improvement Program. The 2017 physician fee schedule of the Centers for Medicare & Medicaid Services was a secondary data source. Procedures were included if they had at least 100 patient-level observations over the 2-year period. Data were analyzed from August 29, 2018, to April 2, 2019.Main outcomes and measuresThe dependent variable was a procedure's assigned work RVU. Independent variables of work RVUs were 4 procedure-level work measures (median operative time, median postoperative length of stay, all-cause 30-day readmission rate, and all-cause 30-day reoperation rate) and surgeon specialty (10-level category using general surgery as the reference).ResultsThe data set included 628 unique Current Procedural Terminology (CPT) codes and 726 CPT-specialty combinations from 1 239 991 patient observations. Statistically significant associations were found between each work measure and assigned work RVU, as follows: median operative time (R2 = 0.74; 95% CI, 0.71-0.78), postoperative length of stay (R2 = 0.42; 95% CI, 0.36-0.48), rate of readmission (R2 = 0.18; 95% CI, 0.13-0.23), and rate of reoperation (R2 = 0.15; 95% CI, 0.10-0.20). Including all 4 measures explained 80.2% (95% CI, 77.3%-83.1%) of the variation. Adding the surgical specialty improved the overall fit of the model (likelihood ratio test χ2 = 231.27; P < .001). Cardiac (7.78; 95% CI, 4.25-11.31; P < .001) and neurosurgery (2.46; 95% CI, 1.08-3.83; P < .001) had higher work RVUs compared with general surgery, whereas orthopedics (-1.53; 95% CI, -2.48 to -0.59; P = .002), urology (-1.58; 95% CI, -2.88 to -0.29; P = .02), plastics (-2.70; 95% CI, -4.39 to -1.01; P = .002), and otolaryngology (-3.05; 95% CI, -4.69 to -1.42; P < .001) had lower work RVUs compared with general surgery.Conclusions and relevanceObjective work measures appeared to be associated with assigned work RVUs, predominantly with operative time; registry data can be used to augment and inform the generation and updating processes of the work RVUs.

Dataset Information

Ultrasound scanning helped surgeons to locate the buried metal work: A case series.

Publications

Ultrasound scanning helped surgeons to locate the buried metal work: A case series.

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