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This study identifies modifiable factors that may lead to cost reductions for CTR surgery.

Pin site infections are a common complication of external fixation that places a significant burden on the patient and healthcare system. Such infections increase the number of clinic visits required during a patient’s course of treatment, can result in the need for additional treatment including antibiotics and surgery, and most importantly can compromise patient outcomes should osteomyelitis or instability result from pin loosening or need for pin or complete construct removal. Factors that may influence the development of pin site infections include patient-specific risk factors, surgical technique, pin design characteristics, use of prophylactic antibiotics, and the post-operative pin care protocol including cleansing, dressing changes, and showering. Despite numerous studies that work to derive evidence-based recommendations for prevention of pin site infections, substantial controversy exists in regard to the optimal protocol. This review comprehensively evaluates the current literature to provide an overview of factors that may influence the incidence of pin site infections in patients undergoing treatment with external fixators, and concludes with a description of the preferred surgical and post-operative pin site protocols employed by the senior authors (ATF and SRR).

Purpose: Our purpose was to test the null hypothesis that no patient or clinic visit characteristics affect satisfaction of hand surgery outpatients, as measured by the Press Ganey Outpatient Medical Practice Survey (PGOMPS).Methods: Adult patients (≥ 18 years) evaluated by five fellowship-trained hand surgeons between January 2014 and December 2016 for a new patient clinic visit at a single tertiary academic medical center, were included. Prospectively-collected PGOMPS data were reviewed retrospectively for each visit. Chart review was performed to collect demographic and visit characteristics data. Satisfaction was defined a priori as achieving a PGOMPS score above the 33rd percentile. Both the PGOMPS Total Score (primary outcome) and Provider Sub-Score (secondary outcome) were analyzed using univariate and multivariable logistic regression.Results: Of 748 included patients, mean age was 51.7 ± 15.5 years, and 64% were female. Leading diagnoses included tendonitis (19%), neuropathy (19%), arthritis (16%), and fracture/ dislocation (13%). Multivariable modelling of the PGOMPS Total Score revealed that older age, shorter wait times, and scheduling surgery were significantly associated with greater satisfaction. PGOMPS Provider Sub-Score multivariable modelling revealed that older age, shorter wait times, scheduling surgery, and administering injections were significantly associated with greater satisfaction. Diagnostic category and insurance status did not affect satisfaction. Conclusions:Increasing patient age, decreased wait time, and receiving an intervention (scheduling of surgery or injection) are associated with increased satisfaction among newlypresenting hand surgery clinic patients as measured by the Press Ganey Outpatient Medical Practice Survey. Diagnosis and access to healthcare (insurance status and distance to clinic) did not influence patient satisfaction.

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