Dr. Jesus M. Villa
Dr. Juan S. Contreras

By Alfredo Arango
Medical Editor

Two studies in the field of orthopedics carried out by Latin-American doctors in Miami, were recently awarded first and second place in the Florida orthopedic Association Annual meeting in Orlando Florida.

Dr. Jesús Manuel Villa, orthopedic surgeon from Colombia, and Dr. Juan Salvador Contreras, general practitioner from México won first and second place, respectively, in a research competition. Both researchers are affiliated with the Arthritis Surgery Research Foundation and the Orthopaedic Institute of Mercy Hospital, led by orthopedic surgeon, Dr. Carlos J. Lavernia. The awards were granted jointly  by the Florida Orthopaedic Society, the Orthopaedic Research Education Foundation, and the Orthopaedic Research Society.

Dr. Contreras performed a study to determine if the use of a relatively new pain medication helps in the prevention of excessive and harmful bone formation after a hip replacement known as heterotopic ossification. This excessive bone may cause pain and limit the leg movement after this otherwise highly successful procedure.

"We studied 170 surgeries on 146 patients. Some had taken the pain medication known as Celebrex (celecoxib), and others had not taken it.  We found that those who took Celebrex had less heterotopic bone formation," explains Dr. Contreras.

Celebrex is administered to patients in pill form one day before surgery and every day after the operation for one month. This medication belongs to a specific family of drugs for pain known as enzyme Cyclooxygenase 2 inhibitors; they are anti-inflammatory, not steroidal.    

Dr. Lavernia expresses that the finding was purely accidental and that the results of the study broaden the spectrum of use of Celebrex. "We are preparing a proposal to carry out a multicenter and definitive study in the United States that will allow the formal approval for  this use. This would represent a source of income for our Research Unit made up of Latin-American doctors in Miami."

There have been other studies performed in Europe that have produced similar results as far as the relationship between the use of Celebrex and the prevention of excessive bone formation, assures Dr. Lavernia, and he clarifies that neither he nor his research center have any relationship with the company which manufactures the medication used in the study.

The other award-winning research was in the field of public health.

Dr. Villa performed a study to establish if readmissions to a hospital after total hip arthroplasty are a good indicator to measure the success of the surgery, and therefore, the quality of the medical service. There were 201 patients participating in this study who had had total hip replacement for the first time.

The doctor explains that the health system currently assumes  that if the readmission rates are low, the hospital must be doing things correctly; and if such rates are high, the hospital must be doing things badly.

"Some patients return to the hospital due to postoperative complications, but others return for reasons not related to the operation; however, on the hospital's administrative data, the reasons that led to readmissions are not always accurate or explicit. To assume that a readmission indicates in every case an adverse event  is a mistake. That was precisely what we were able to point out. There are risk-adjusted models in relation to readmission rates, but these models are based on administrative data that might not be accurate because it tends to underrepresent specific orthopedic comorbidities which affect readmissions rates. Our research confirms the results of similar studies done in other specialties," expresses Dr. Villa.

Dr. Lavernia gives as an example, the case of a hospital where the patients from several centers for the elderly were presenting readmission rates of 20% and 30% after having undergone orthopedic surgeries, simply because they were transferred to nursing homes  not providing a low-salt diet, and the excess salt was affecting the patients with high blood pressure, who returned to the hospital because of congestive heart failure; however, that reason for readmission was not made clear on the records, and it was assumed they were returning to the hospital because of complications from the surgeries.

Dr. Lavernia comments that part of the importance of this research has to do with the grading scale the government of the United States gives hospitals based on their surgery success rates. This is generally known as  "pay for performance". The renowned doctor affirms that the hospitals that serve patients with many health problems, who come from minority groups, generally Afro-American and Hispanic, end up being punished because it is assumed that they are not providing proper care for them, when in fact, in the majority of cases those patients return for problems not related to the surgeries performed and their patients have a high comorbid index sometimes not reflected in the standard severity adjustments . The underserved population may end up being a victim of politics that pretend to help them.

"Work is being done at the local and national level to achieve parameters of quality, because at this time, the government is paying according to volume and not quality. We agree with President Obama in that paying according to volume is not the best way to spend money to maintain public health. However, we believe the entire country would benefit if we work towards achieving true parameters of quality and we pay for value" adds Doctor Lavernia.   

The orthopedic research program of Mercy Hospital was created 14 years ago and every year, brings new Latin-American doctors to Miami to perform studies under the direction of Dr. Lavernia.