Abstract
Introduction
Although multiple studies have consistently demonstrated that orthopaedic surgeons receive greater transfers of value than other specialties, the industry payments of providers involved in practice guideline formation have not been explored. Therefore, the purpose of our analysis was to evaluate the industry payments among authors of the Appropriate Use Criteria (AUC) from the American Academy of Orthopaedic Surgeons (AAOS).
Methods
The publicly available web portal (OrthoGuidelines.org) from the AAOS was queried for all AUCs released over the past decade for the management of musculoskeletal pathologies. For each AUC available through this portal, information related to the AUC and its respective voting members were recorded. We used this information to conduct a retrospective cross-sectional analysis of the CMS Open Payments Database. This information was utilized to determine the number of total value of industry payments to AUC voting committee members during the year of voting for AUC criteria. The total amount of industry payment to AUC voting members was calculated, per each AUC, annually, as well as per orthopaedic subspecialty. The average total industry payment per voting member was calculated for each AUC and compared with the average total industry payment per orthopaedic surgeon nationally, in the same year. All descriptive data analyses were performed in Microsoft Excel 2016 (MicrosoftCorp).
Results
A total of 18 different AUCs were included in our analysis. Among the 214 voting members of these AUCs, there was a mean (± standard deviation) of 16.23 (± 39.80) payments totaling USD$20,886.30 (± $123,268.95). Combined industry payments for the voting authors of each guideline ranged from $1,432.53 (Carpal Tunnel Syndrome guideline) to $2,757,444.88 (Surgery for Degenerative Lumbar Scoliosis guideline) (Table 1). Notably, the average payment per voting member was less than the average for all orthopaedic providers in the respective year for a majority (16/18) of AUCs (Table 1). Only average payments of voting members for the Non-Surgical Management Knee Osteoarthritis guideline (13,089.38 vs. $8,183.93) and Surgery for Degenerative Lumbar Scoliosis ($250,676.81 vs. $16,477.55) exceeded yearly averages among all orthopaedic surgeons with payment disclosures. Although authors for AUCs related to osteoarthritis management received the largest quantity of payments (n=491; Figure 1), the AUCs for spine related pathologies received the largest amount of industry payments ($2,757,444.88; Figure 2).
Discussion and Conclusion
Our analysis demonstrated that authors on current AAOS appropriate use criteria voting panels collectively received low amounts of industry payments. Specifically, a majority of authors declared industry payments lower than the average value reported among all orthopadic providers per respective year. Therefore, our analysis suggests that there has been limited industry influence in the formation of these practice guidelines. This information should provide peace of mind for invested parties and encourage providers engaged in the formation of future guidelines to limit and fully disclose relationships with industry. Future analyses are needed to evaluate if and how industry relationships among individual providers and the boards of orthopaedic societies shape practice decisions.
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