A chart review was conducted on all eligible patients from 2009 to 2014. 47 patients were identified, 19 of whom had two attending surgeons while 28 underwent PSF performed by a single attending surgeon assisted by a resident or PA. All patients underwent similar operative procedures with pedicle-screw only constructs. Patients in the two groups underwent identical surgical and anesthetic protocols, including use of tranexemic acid. Percent EBL was calculated as EBL divided by total estimated blood volume, which was estimated as weight in kilograms multiplied by either 75ml/kg for males or 65ml/kg for females. All patients were followed out to a minimum of one year. The Student's T-test was used to compared the three major variables of blood loss, anesthesia time, and hospital length of stay. A Chi-Square test was used to compare categorical variables between the groups. AbstractBackground and Significance: Surgical correction of AIS carries a substantial risk of complication. The literature supports improved perioperative outcomes through the two surgeon strategy in other complex orthopedic procedures. Research Question: Does the presence of 2 versus 1 attending affect the perioperative morbidity of posterior spinal fusion (PSF) in patients with adolescent idiopathic scoliosis (AIS) curves greater than 70°. Methods: We reviewed the database from a large regional children's hospital of all patients with AIS curves greater than 70°who underwent PSF from 2009-2014 and divided the cohort into single versus 2-surgeon groups (28 vs. 19 cases, respectively). We analyzed cases for length of surgery, estimated blood loss, and length of stay. Results: The groups were identical when comparing age, gender, spinal levels fused, and average ASA score. However, the average Cobb angle in the single surgeon group was significantly less than in the 2 surgeon group at 78.4 vs 84.0 degrees, respectively (p=0.049). Mean operative time for single versus 2 surgeons was 238 vs 212 minutes (p=0.078). Mean percent estimated blood loss was 26% for single surgeon vs 31% for 2 surgeons (p=0.236), and mean estimated blood loss for single surgeon vs 2 surgeons was 830ml vs 1045ml (p=0.052). Mean length of stay was significantly decreased in the 2 surgeon group at 5.16 days versus the single surgeon group at 6.82 days (p=0.002). Conclusions:The use of 2 surgeons in AIS deformity correction at an experienced regional children's hospital had a variable effect on clinical outcomes; the mean length of stay was reduced in the twosurgeon group but there was no difference in operative time or blood loss. This study does not rule out the potential for positive impact with a two-surgeon strategy, and given previous supportive data in the literature, this approach should further evaluated to determine its effect on improving perioperative outcomes.

unicompartmental knee arthroplasty outpatient inpatient reimbursement cost complications a b s t r a c tBackground: Increasing utilization of unicompartmental knee arthroplasty (UKA) has driven a greater push for outpatient treatment and cost containment in the setting of bundled payments. The purpose of this study is to evaluate utilization trends of inpatient vs outpatient UKA, index episode and 90-day reimbursement, and any differences in medical or surgical complications. Methods: The PearlDiver database was employed to identify all inpatient and outpatient UKAs performed between 2007 and 2016 with 2-year follow-up. Patients were matched by age, gender, and Elixhauser Comorbidity Index. We tracked index procedure and global period reimbursement, 90-day medical and surgical complications, and 2-year surgical complications. Results: The reimbursement and utilization cohort included 3181 outpatient and 5490 inpatient UKAs. Outpatient UKA and overall utilization of UKA increased over the study period. Mean index reimbursement of inpatient UKA was $2486.16 higher per procedure (P < .001) while mean global period reimbursement was $2782.13 higher per inpatient procedure (P < .001). Ninety-day medical complications including postoperative anemia (P < .001), transfusion (P ¼ .024), and arrhythmia (P ¼ .004) were more common with inpatient UKAs, whereas surgical wound complications (P ¼ .001) and operative debridement (P ¼ .028) were more common among outpatient UKAs. Outpatient UKA was not associated with an increased risk of periprosthetic joint infection (P > .05), aseptic loosening (P > .05), or revision surgery (P > .05) when compared to inpatient UKA. Conclusion: Outpatient UKA utilization is increasing and is associated with decreased reimbursement compared to inpatient UKA without increased risk of major medical complications, although it is associated with increased risk of wound complication and need for operative debridement at 90 days.

Objective: To evaluate the fit of distal femur locking plates. Secondarily, we sought to compare plate fit among patients with and without a total knee arthroplasty (TKA). Design: Retrospective. Setting: University hospital. Intervention: Standard length precontoured distal femur locking plates from 4 manufacturers were digitally templated onto each patient's pre-TKA and post-TKA radiographs. Main Outcome Measurements: The maximum distance from the plate to the lateral femoral cortex (plate-bone distance) was measured in the metaphyseal region. Mean plate-bone distances were compared between manufacturers and between pre-TKA and post-TKA radiographs. Results: All implants tested were undercontoured in all patients. Plate-bone distances ranged from 6.6 ± 0.4 mm to 8.0 ± 0.4 mm (mean ± SE) pre-TKA and 8.2 ± 0.3 mm to 8.6 ± 0.3 mm after TKA, indicating worse fit after arthroplasty (P < 0.001). There were also intermanufacturer differences, with Synthes and Smith & Nephew implants demonstrating the lowest plate-bone distances in the pre-TKA and post-TKA groups, respectively. Proportionally, plate-bone increase was greater in the female cohort (16%) compared with the male cohort (8%). Conclusions: There was plate-bone mismatch for the distal femur locking plates tested in this study, due to undercontouring of the implants. After patients underwent TKA, poor implant fit was exacerbated. Surgeons must be aware of the potential for deformity if the proximal segment is brought into contact with the implant. These finding may help optimize implant design for the treatment of periprosthetic distal femur fractures.

PURPOSE: Progressive scoliosis significantly impacts the quality of life in patients with cerebral palsy (CP). Spinal fusion is the mainstay of treatment of progressive spinal curves. The current study aims to identify approaches used by pediatric spine surgeons to optimize care of patients with CP undergoing scoliosis surgery. METHODS: A 33-question survey was distributed electronically to 181 POSNA/SRS members with an established interest in pediatric spinal deformity surgery. Eighty one responses were obtained (45%). Using the Delphi consensus guidelines, agreement > 75% was considered as consensus. RESULTS: There was a consensus on 15 out of 33 questions (46%). 97% of responders identified nutrition status as a comorbidity which could be optimized. However, the timing and method of obtaining nutritional assessment varied. 92% of the surgeons stated that they used shared decision making with the family but only 22% used a formal decision aid. 83% use antifibrinolytics routinely, 81% used a surgical site infection prevention protocol, 78% obtained preoperative pulmonary consult, and 88% took steps postoperatively to prevent pulmonary complications. CONCLUSION: There is significant variability in the current practices of perioperative management of patients with CP undergoing scoliosis surgery. This data can be used in future studies to create a standardized integrated care pathway.