Surgical Societies Release Choosing Wisely Lists

Larry Hand

September 11, 2013

The American Academy of Orthopaedic Surgeons (AAOS) released a statement today calling for orthopedic surgeons to take a second look at 5 commonly ordered procedures that are not always necessary. AAOS developed the list as part of the growing Choosing Wisely campaign, an initiative of the American Board of Internal Medicine Foundation.

AAOS made the following 5 evidence-based recommendations:

  1. "Avoid performing routine post-operative deep vein thrombosis ultrasonography screening in patients who undergo elective hip or knee arthroplasty.

  2. Don't use needle lavage to treat patients with symptomatic osteoarthritis of the knee for long-term relief.

  3. Don't use glucosamine and chondroitin to treat patients with symptomatic osteoarthritis of the knee.

  4. Don't use lateral wedge insoles to treat patients with symptomatic medial compartment osteoarthritis of the knee.

  5. Don't use post-operative splinting of the wrist after carpal tunnel release for long-term relief."

The AAOS announcement follows closely an announcement, reported on previously, by the American College of Surgeons, in which that group recommended the following 5 recommendations:

  1. "Don't perform axillary lymph node dissection for clinical stages I and II breast cancer with clinically negative lymph nodes without attempting sentinel node biopsy.

  2. Avoid the routine use of 'whole-body' diagnostic computed tomography (CT) scanning in patients with minor or single system trauma.

  3. Avoid colorectal cancer screening tests on asymptomatic patients with a life expectancy of less than ten years and no family or personal history of colorectal neoplasia.

  4. Avoid admission or preoperative chest x-rays for ambulatory patients with unremarkable history and physical exam.

  5. Don't do computed tomography (CT) for the evaluation of suspected appendicitis in children until after ultrasound has been considered as an option."

The AAOS announcement also precedes the release of further recommendations during the next year by about 30 other specialty society partners in the Choosing Wisely campaign.

"More than one in four Americans require medical attention due to a musculoskeletal condition and that number continues to grow," AAOS President Joshua J. Jacobs, MD, said in a news release. "As orthopaedic surgeons, our duty to our patients is to restore mobility and improve their quality of life through evidence-based, high-quality treatment. Our participation in the Choosing Wisely campaign will help shape patient-physician dialogue, which as we all know is the cornerstone of optimal care. Identifying tests, procedures or treatments that show little to no value not only helps our patients by preventing unnecessary care, but will end up saving health care dollars."

The Choosing Wisely lists are designed to reduce waste and overuse in the US healthcare system, according to Richard J. Baron, MD, president and chief executive office of the American Board of Internal Medicine. "The content of this list and all of the others developed through this effort are helping physicians and patients across the country engage in conversations about what care they need," Dr. Baron said in a news release.

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