Anderson, Megan L.

Background: A growing body of research has connected electronic health record (EHR) workload to physician burnout. In orthopedic surgery, burn-out rates are rising. This study analyzed orthopedic surgeons' EHR use by sex and practice experience. Materials and Methods: EHR activity was analyzed among attending orthopedic surgeons at a single institution from May 2022 to May 2023. Demographic information included self-reported sex and practice years. Outcomes included time spent in notes, orders, clinical review, and in-basket daily; time spent outside of scheduled clinical responsibilities; volume of in-basket messages received daily; and proportion of orders with team contributions. Multivariable linear regression compared outcomes by sex and practice years. Results: A total of 105 orthopedic surgeons were included (91% male; mean 15.5 ± 9.8 practice years). Female surgeons logged 31% more time in the EHR overall (62.2 vs 47.4 minutes daily; P = .05) and on unscheduled days (10.1 additional daily minutes; P = .03), and received more messages from patients (2.4 vs 1.0 messages daily; P = .002) compared to male surgeons. Senior surgeons spent significantly less time on documentation and orders ( P ≤ .048) and on unscheduled days (3.3 less minutes daily per practice decade; P = .013), and had more support with placing orders ( P < .001). Conclusion: Female sex and fewer practice years were associated with increased EHR use. Female orthopedic surgeons tended to have higher patient message volumes, whereas junior surgeons tended to have less team support, spending more time on orders and documentation. Given known factors contributing to burnout, these findings warrant further investigation into targeted interventions to improve physician EHR use.

Background: Nerve transfers have been heralded as a “quantum leap” in peripheral nerve surgery, fundamentally altering the reconstructive paradigm over the past 2 decades. This study analyzed national trends in adult traumatic brachial plexus injury (BPI) management, tracking specialty-specific adoption of nerve transfers and comparing 30-day postoperative outcomes with traditional reconstruction. Methods: Data were extracted from the National Surgical Quality Improvement Program (2006 to 2022). Adult patients (18 years or older) with a primary BPI diagnosis, who underwent nerve reconstruction, were included. Cases were categorized by the presence of a nerve transfer using CPT code 64905. Analyses included descriptive statistics, standardized mean differences, and multivariable logistic regression. Results: Among 544 BPI patients, 80 underwent reconstruction involving a nerve transfer. Plastic surgeons performed 60% of nerve transfers despite accounting for only 33.5% of all BPI reconstructions. Neurosurgeons had the lowest overall nerve transfer utilization but increased to a rate matching orthopedic surgeons in the final 4 years. Nerve transfers were associated with lower 30-day complication rates than traditional reconstruction (2.5% vs. 11%, P =0.034), despite being performed on patients with higher preoperative morbidity risk. In multivariable analysis, orthopedic and neurosurgeons remained significantly less likely than plastic surgeons to perform nerve transfers (OR: 0.26, P <0.001; OR: 0.18, P <0.001, respectively). Conclusion: Nerve transfer use in BPI reconstruction has increased steadily, with a recent increase among neurosurgeons. Despite being used in higher-risk patients, nerve transfers were associated with significantly lower short-term complication rates. These findings support continued adoption of nerve transfers and highlight their favorable safety profile.

Background: Gender-based reimbursement disparities in orthopedic surgery remain poorly understood, particularly when accounting for practice composition and setting. The purpose of this study was to compare and evaluate gender-based differences in Medicare reimbursement and practice patterns among female and male orthopedic surgeons. Methods: A cross sectional analysis of public Medicare data from 2013 to 2021 was performed. Outcomes included annual Medicare payments, submitted charges, total services, service categories, and beneficiaries treated by orthopedic surgeons who bill Medicare. Univariate and multivariable analyses quantified differences in payment, practice volume and composition, geographic adjustment, and Current Procedural Terminology (CPT)-matched reimbursements. Results: A total of 29,357 orthopedic surgeons (27,442 men and 1,919 women) billed Medicare fee-for-service during the study period. Female surgeons, on average, submitted 48.3% fewer total charges and received 44.1% lower annual Medicare payments per surgeon compared with male surgeons. These differences persisted after multivariable regression adjusted for practice metrics and excluded top and bottom earners. Female surgeons also billed fewer services, treated fewer beneficiaries, and submitted fewer unique CPT codes. However, payment disparities persisted even after matching surgeons by volume of services, beneficiaries, and years in practice. Male surgeons performed higher volumes of all 10 highest-paying orthopedic CPT codes. In CPT matched analyses, female surgeons received lower reimbursement per service than male surgeons performing identical procedures. Conclusion: These findings suggest that the observed gender-based disparities in orthopedic surgery Medicare reimbursement cannot be explained by differences in volume, procedural mix, or geographic practice cost. Instead, they likely reflect a combination of structural and behavioral mechanisms described in prior literature that may influence how access to clinical opportunities, referrals, and reimbursement practices unfold in surgical practices. Variations in coding practices may represent an important focus for future investigation and targeted educational initiatives. Level of Evidence: Level III , Retrospective Cohort Study. See Instructions for Authors for a complete description of levels of evidence.

OBJECTIVES: To compare whether femoral version more closely mirrors the contralateral femur or a population norm estimate of 15 degrees of anteversion. METHODS: Design: Radiologic observational study. Setting: Level I Trauma Center. Patient Selection Criteria: Patients with no history of anatomy-altering femoral injury who underwent bilateral lower extremity computed tomography scans. Outcome Measures and Comparisons: Computed tomographies were analyzed to measure femoral version on each side. The asymmetry in femoral version between left and right in each patient (interfemoral rotational variance [IRV]) was recorded. The difference of each femur's version from a proposed population mean of 15 degrees of anteversion was also recorded. RESULTS: A total of 219 patients with a mean femoral version of 14.9 degrees ± 10.5 degrees of anteversion were included. Mean IRV was 5.3 degrees, compared with 8.2 degrees of mean variation from the population norm of 15 degrees of anteversion (P < 0.001). Five percent of patients had IRV >15 degrees compared with 15% that had femoral rotation >15 degrees from the population mean of 15 degrees (P < 0.001). CONCLUSIONS: In the setting of a comminuted diaphyseal femur fracture, knowledge of the appropriate target for restoration of rotational alignment is critical. This radiologic cohort study found that on average, femoral version more closely mirrors an individual patient's contralateral femur as opposed to a population norm of 15 degrees of anteversion.

Background: Artificial intelligence (AI) is a promising tool to aid in diagnostic accuracy and patient communication. Prior literature has shown that ChatGPT answers medical questions and can accurately diagnose surgical conditions. The purpose of this study was to determine the accuracy of ChatGPT 4.0 in evaluating radiologic imaging of common orthopedic upper extremity bony pathologies, including identifying the imaging modality and diagnostic accuracy. Methods: Diagnostic imaging was sourced from an open-source radiology database for 6 common upper extremity bony pathologies: distal radius fracture (DRF), metacarpal fracture (MFX), carpometacarpal osteoarthritis (CMC), humerus fracture (HFX), scaphoid fracture (SFX), and scaphoid nonunion (SN). X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) modalities were included. Fifty images were randomly selected from each pathology where possible. Images were uploaded to ChatGPT 4.0 and queried for imaging modality, laterality, and diagnosis. Each image query was completed in a new ChatGPT search tab. Multinomial linear regression was used to identify variations in ChatGPT’s diagnostic accuracy across imaging modalities and medical conditions. Results: Overall, ChatGPT provided a diagnosis for 52% of images, with accuracy ranging from 0% to 55%. Diagnostic accuracy was significantly lower for SFX and MFX relative to HFX. ChatGPT was significantly less likely to provide a diagnosis for MRI relative to CT. Diagnostic accuracy ranged from 0% to 40% with regard to imaging modality (x-ray, CT, MRI) though this difference was not statistically significant. Conclusions: ChatGPT’s accuracy varied significantly between conditions and imaging modalities, though its iterative learning capabilities suggest potential for future diagnostic utility within hand surgery.