Last week the world's top orthopedic surgeons descended upon a breezy, temperate Louisiana for the AAOS annual meeting. From Tuesday to Saturday we were miles from Washington, but contentious legislation passed down from the nation's capital was top of mind and agenda in several well-attended symposiums.

As an increasingly lucid reality for those in the US, the impact and implications of the Affordable Care Act have been painstakingly diagnosed by politicians, pundits, and patient advocacy groups but this week, orthopedic surgeons got introspective. Panels in multiple sessions considered the topic and drew disparate coping strategies. We'll highlight two.

The first, titled Obesity, Orthopaedics, and Outcomes, probed clinical data relating to the impact of obesity on orthopedic surgery. It was a salient topic, weighing heavily (no pun intended) on attendees contemplating the pros and cons of an all-Muffaletta, mac n' cheese diet (warranted by the conference hall's close proximity to Cochon Butcher a mere four-minute walk away).

With a reactive bent to the implementation of patient satisfaction and surgical complications measures in consideration of reimbursement, one of the presenting surgeons posed a question would you, a practicing orthopedic surgeon, take a patient with a BMI in excess of 40 Responses were collected before and after his presentation outlining various co-morbidities, postoperative care issues, and other complications relating to this demographic. Survey results collected before the presentation were at extremes surgeons were either in favor of a cut-off for patients with a BMI above 40 or believed that there should be no limits for surgery, with few accepting any middle ground. By the end of the session, nearly two-thirds of the crowd reported an aversion to admission of such patients into their operating room. Economically sensible and socially questionable, the symposium showcased a dark, unintended consequence of the new algebra in orthopedic care.

A second session, Complexities of Delivering Orthopedic Care: The Stakeholders Speak, took a considerably more proactive approach to the issue at hand. Orthopedic surgeons have always been able to find the money, they reasoned evident in substantial pay checks and the high degree of control they hold in their pens over orthopedic healthcare spending. There's no reason, they argued, that surgeons shouldn't be able to find the money in a new system, even as the model shifts from fee-for-service to fee-for-health. Standardization of operating procedures, minimization of "change-resistant organisms" in facility ranks, and leverage of strong teamwork and tech skills inherent to a new generation of orthopedic surgeons rounded the session's proposed strategy for continued success. It was a breath of fresh air in an auditorium often choked with murmuring uncertainty.

All in all, the two sessions offered a fascinating double-take, a valuable perspective from the minds of those stationed on the front lines of healthcare reform. For what it's worth, these authors hope to see social responsibility trump the free market in orthopedic care stay tuned for updates from Las Vegas in 2015.

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