Pub Date : 2024-09-01Epub Date: 2024-07-29DOI: 10.3928/01477447-20240718-04
Emily Ann Schultz, Sara L Eppler, Michael Gardner, Serena S Hu, Loretta Chou, Marc Safran, Derek F Amanatullah, Geoffrey D Abrams, Lauren M Shapiro, Robin N Kamal
Background: Patient-reported outcome measures (PROMs) were originally developed as research tools; however, there is increasing interest in using PROMs to inform clinical care. Prior work has shown the benefits of implementing PROMs at the point of care, but a patient's health numeracy (their ability to understand and work with numbers) may affect their ability to interpret PROM results.
Materials and methods: We recruited patients presenting to an outpatient orthopedic clinic. Forty-nine patients completed a survey that included demographic information, the short-form General Health Numeracy Test, and accuracy questions about four PROM displays (bar graph, table, line graph, pictograph) that indicated the same PROM results.
Results: Patients with higher health numeracy answered all display accuracy questions correctly (P=.016). Patients who preferred using the table were more likely to answer display accuracy questions incorrectly (odds ratio, 0.013, P=.024). The two most frequently preferred PROM formats were bar graphs and tables, and most patients preferred to learn about their PROM function scores via a combination of displays and verbal discussions.
Conclusion: Patient health numeracy is associated with the ability to correctly interpret visual displays of PROMs. Implementation of PROMs at point of care currently does not account for health numeracy. Efforts to account for health numeracy when using PROMs at point of care may improve the efficacy of using PROMs to improve outcomes in orthopedic surgery. [Orthopedics. 2024;47(5):e255-e260.].
{"title":"Health Numeracy Is Associated With a Patient's Ability to Interpret Patient-Reported Outcome Measures Data.","authors":"Emily Ann Schultz, Sara L Eppler, Michael Gardner, Serena S Hu, Loretta Chou, Marc Safran, Derek F Amanatullah, Geoffrey D Abrams, Lauren M Shapiro, Robin N Kamal","doi":"10.3928/01477447-20240718-04","DOIUrl":"10.3928/01477447-20240718-04","url":null,"abstract":"<p><strong>Background: </strong>Patient-reported outcome measures (PROMs) were originally developed as research tools; however, there is increasing interest in using PROMs to inform clinical care. Prior work has shown the benefits of implementing PROMs at the point of care, but a patient's health numeracy (their ability to understand and work with numbers) may affect their ability to interpret PROM results.</p><p><strong>Materials and methods: </strong>We recruited patients presenting to an outpatient orthopedic clinic. Forty-nine patients completed a survey that included demographic information, the short-form General Health Numeracy Test, and accuracy questions about four PROM displays (bar graph, table, line graph, pictograph) that indicated the same PROM results.</p><p><strong>Results: </strong>Patients with higher health numeracy answered all display accuracy questions correctly (<i>P</i>=.016). Patients who preferred using the table were more likely to answer display accuracy questions incorrectly (odds ratio, 0.013, <i>P</i>=.024). The two most frequently preferred PROM formats were bar graphs and tables, and most patients preferred to learn about their PROM function scores via a combination of displays and verbal discussions.</p><p><strong>Conclusion: </strong>Patient health numeracy is associated with the ability to correctly interpret visual displays of PROMs. Implementation of PROMs at point of care currently does not account for health numeracy. Efforts to account for health numeracy when using PROMs at point of care may improve the efficacy of using PROMs to improve outcomes in orthopedic surgery. [<i>Orthopedics</i>. 2024;47(5):e255-e260.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-05-29DOI: 10.3928/01477447-20240809-01
Anthony N Baumann, Andrew Fiorentino, Katelyn Sidloski, Hannah A Lee, Albert T Anastasio, Kempland C Walley, John D Kelly
Background: The recent addition of biceps tendon augmentation to partial arthroscopic rotator cuff repair (ARCR) for the treatment of large-to-massive rotator cuff tears is proposed to improve clinical outcomes and reduce re-tears.
Materials and methods: The purpose of this systematic review and meta-analysis (5 studies) was to compare outcomes between partial ARCR with (142 patients) and without (149 patients) biceps augmentation.
Results: Partial ARCR with and without biceps augmentation were comparable in pain, function, and range of motion. However, biceps augmentation vs no augmentation at all during ARCR may lower re-tear rates for irreparable large-to-massive rotator cuff tears (42.9% vs 72.5%, P=.007).
Conclusion: More research is needed to investigate this technique and guide surgical decision-making. [Orthopedics. 2024;47(5):e217-e224.].
背景:最近,在关节镜下肩袖部分修复术(ARCR)中增加了肱二头肌肌腱增强术,用于治疗大到重度肩袖撕裂,以改善临床疗效并减少再次撕裂:本系统综述和荟萃分析(5 项研究)的目的是比较有(142 名患者)和无(149 名患者)肱二头肌增强术的部分 ARCR 的疗效:结果:在疼痛、功能和活动范围方面,进行和未进行肱二头肌增强手术的部分 ARCR 具有可比性。然而,在ARCR过程中进行肱二头肌增强与不进行肱二头肌增强可能会降低不可修复的肩袖大面积撕裂的再撕裂率(42.9% vs 72.5%,P=.007):结论:需要更多的研究来探讨这一技术并指导手术决策。[Orthopedics.20XX;4X(X):XXXXX.].
{"title":"Clinical Outcomes and Re-Tear Rates for Partial Arthroscopic Rotator Cuff Repair With or Without Biceps Augmentation for Large-to-Massive Tears: A Systematic Review and Meta-analysis.","authors":"Anthony N Baumann, Andrew Fiorentino, Katelyn Sidloski, Hannah A Lee, Albert T Anastasio, Kempland C Walley, John D Kelly","doi":"10.3928/01477447-20240809-01","DOIUrl":"10.3928/01477447-20240809-01","url":null,"abstract":"<p><strong>Background: </strong>The recent addition of biceps tendon augmentation to partial arthroscopic rotator cuff repair (ARCR) for the treatment of large-to-massive rotator cuff tears is proposed to improve clinical outcomes and reduce re-tears.</p><p><strong>Materials and methods: </strong>The purpose of this systematic review and meta-analysis (5 studies) was to compare outcomes between partial ARCR with (142 patients) and without (149 patients) biceps augmentation.</p><p><strong>Results: </strong>Partial ARCR with and without biceps augmentation were comparable in pain, function, and range of motion. However, biceps augmentation vs no augmentation at all during ARCR may lower re-tear rates for irreparable large-to-massive rotator cuff tears (42.9% vs 72.5%, <i>P</i>=.007).</p><p><strong>Conclusion: </strong>More research is needed to investigate this technique and guide surgical decision-making. [<i>Orthopedics</i>. 2024;47(5):e217-e224.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-08-29DOI: 10.3928/01477447-20240821-10
Jiajun Liu, Hongfu Jin, Dong Keon Yon, Pinar Soysal, Ai Koyanagi, Lee Smith, Jae Il Shin, Yu-Sheng Li, Masoud Rahmati, Jun Zhang
Background: Knee osteoarthritis (KOA) is a widespread chronic condition. Depression frequently occurs among patients with KOA. The objective of this meta-analysis was to identify risk factors associated with comorbid depression in patients with KOA.
Materials and methods: A comprehensive search of the PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science databases was conducted for studies related to comorbid depression in patients with KOA. We conducted statistical analyses to obtain relevant results, followed by heterogeneity tests and assessment for publication bias.
Results: The prevalence of comorbid depression among patients with KOA was 34% (95% CI, 28%-41%). Notable risk factors linked to comorbid depression in patients with KOA included female sex (relative risk [RR], 1.17; 95% CI, 1.11-1.23), obesity (mean difference [MD], 1.30; 95% CI, 0.88-1.71), use of analgesics (RR, 1.50; 95% CI, 1.38-1.63), comorbidities (MD, 0.20; 95% CI, 0.10-0.31), unmarried or widowed status (RR, 1.72; 95% CI, 1.56-1.91), bilateral knee pain (RR, 1.38; 95% CI, 1.11-1.71), high total Western Ontario and Mc-Master Universities Arthritis Index (WOMAC) score (MD, 14.92; 95% CI, 10.02-19.82), high WOMAC pain score (MD, 5.76; 95% CI, 2.86-8.67), low gait velocity (MD, -0.12; 95% CI, -0.16 to -0.09), and extended duration in the Timed Up and Go Test (MD, 1.56; 95% CI, 0.87-2.25).
Conclusion: Based on the current evidence, female sex, obesity, use of analgesics, comorbidities, unmarried or widowed status, bilateral knee pain, high total WOMAC score, high WOMAC pain score, low gait velocity, and prolonged time on the Timed Up and Go Test were identified as risk factors for depression in patients with KOA. Focus should be given to these aspects when preventing depression among these patients. [Orthopedics. 2024;47(5):e225-e232.].
{"title":"Risk Factors for Depression in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis.","authors":"Jiajun Liu, Hongfu Jin, Dong Keon Yon, Pinar Soysal, Ai Koyanagi, Lee Smith, Jae Il Shin, Yu-Sheng Li, Masoud Rahmati, Jun Zhang","doi":"10.3928/01477447-20240821-10","DOIUrl":"10.3928/01477447-20240821-10","url":null,"abstract":"<p><strong>Background: </strong>Knee osteoarthritis (KOA) is a widespread chronic condition. Depression frequently occurs among patients with KOA. The objective of this meta-analysis was to identify risk factors associated with comorbid depression in patients with KOA.</p><p><strong>Materials and methods: </strong>A comprehensive search of the PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science databases was conducted for studies related to comorbid depression in patients with KOA. We conducted statistical analyses to obtain relevant results, followed by heterogeneity tests and assessment for publication bias.</p><p><strong>Results: </strong>The prevalence of comorbid depression among patients with KOA was 34% (95% CI, 28%-41%). Notable risk factors linked to comorbid depression in patients with KOA included female sex (relative risk [RR], 1.17; 95% CI, 1.11-1.23), obesity (mean difference [MD], 1.30; 95% CI, 0.88-1.71), use of analgesics (RR, 1.50; 95% CI, 1.38-1.63), comorbidities (MD, 0.20; 95% CI, 0.10-0.31), unmarried or widowed status (RR, 1.72; 95% CI, 1.56-1.91), bilateral knee pain (RR, 1.38; 95% CI, 1.11-1.71), high total Western Ontario and Mc-Master Universities Arthritis Index (WOMAC) score (MD, 14.92; 95% CI, 10.02-19.82), high WOMAC pain score (MD, 5.76; 95% CI, 2.86-8.67), low gait velocity (MD, -0.12; 95% CI, -0.16 to -0.09), and extended duration in the Timed Up and Go Test (MD, 1.56; 95% CI, 0.87-2.25).</p><p><strong>Conclusion: </strong>Based on the current evidence, female sex, obesity, use of analgesics, comorbidities, unmarried or widowed status, bilateral knee pain, high total WOMAC score, high WOMAC pain score, low gait velocity, and prolonged time on the Timed Up and Go Test were identified as risk factors for depression in patients with KOA. Focus should be given to these aspects when preventing depression among these patients. [<i>Orthopedics</i>. 2024;47(5):e225-e232.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142110502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.3928/01477447-20240808-01
Deepa Kattail, John G Hagen, Walid Alrayashi
{"title":"Peripheral Nerve Blocks and Opioid Use After ACL Reconstruction in Adolescents.","authors":"Deepa Kattail, John G Hagen, Walid Alrayashi","doi":"10.3928/01477447-20240808-01","DOIUrl":"https://doi.org/10.3928/01477447-20240808-01","url":null,"abstract":"","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-06-27DOI: 10.3928/01477447-20240619-01
Peter M Cirrincione, Erikson T Nichols, Colson P Zucker, Vishnu Chandran, Silvia Zanini, Jennifer Jezequel, Bridget Assip, Sherry I Backus, Shevaun M Doyle, David Scher, Paulo Selber
Background: Current studies assessing the change in pelvic tilt for ambulatory patients with cerebral palsy (CP) after surgical hamstring lengthening (SHL) lack a comparison cohort without prior SHL and are limited to younger patients. This study presents gait data of middle-aged adults with CP, primarily focusing on the pelvis, and compares pelvic tilt, trunk tilt, and knee flexion between those with and without prior SHL.
Materials and methods: A consecutive series of 54 adults with CP, a mean age of 36±13 years, and Gross Motor Function Classification System (GMFCS) levels I-III were included. Thirty-two (59%) had SHL performed at a mean age of 8±5 years. Three-dimensional gait analysis data prospectively collected at a mean of 28±14 years postoperatively were retrospectively analyzed. Chi-square tests were used to compare demographic and surgical history data and statistical parameter mapping was used to compare knee flexion during stance and pelvic and trunk tilts during the gait cycle between SHL and SHL-naive groups.
Results: Age, GMFCS level, sex, race, topography, and ethnicity were not different between the groups (P=.217-.612). Anterior pelvic tilt throughout gait was significantly greater in the SHL group compared with the SHL-naive group (63%-87%; P=.033). This difference was augmented after accounting for other surgical history and revision SHL (0%-32%, P=.019; and 46%-93%, P=.007).
Conclusion: Within a cohort of adults with CP, GMFCS levels I-III, and a mean age of 36 years, those with a history of SHL, performed a mean of 28 years prior to 3-dimensional gait analysis, walked with increased anterior pelvic tilt compared with those without a history of SHL. [Orthopedics. 2024;47(5):270-275.].
{"title":"Pelvic Tilt in Adults With Cerebral Palsy and Its Relationship With Prior Hamstrings Lengthening.","authors":"Peter M Cirrincione, Erikson T Nichols, Colson P Zucker, Vishnu Chandran, Silvia Zanini, Jennifer Jezequel, Bridget Assip, Sherry I Backus, Shevaun M Doyle, David Scher, Paulo Selber","doi":"10.3928/01477447-20240619-01","DOIUrl":"10.3928/01477447-20240619-01","url":null,"abstract":"<p><strong>Background: </strong>Current studies assessing the change in pelvic tilt for ambulatory patients with cerebral palsy (CP) after surgical hamstring lengthening (SHL) lack a comparison cohort without prior SHL and are limited to younger patients. This study presents gait data of middle-aged adults with CP, primarily focusing on the pelvis, and compares pelvic tilt, trunk tilt, and knee flexion between those with and without prior SHL.</p><p><strong>Materials and methods: </strong>A consecutive series of 54 adults with CP, a mean age of 36±13 years, and Gross Motor Function Classification System (GMFCS) levels I-III were included. Thirty-two (59%) had SHL performed at a mean age of 8±5 years. Three-dimensional gait analysis data prospectively collected at a mean of 28±14 years postoperatively were retrospectively analyzed. Chi-square tests were used to compare demographic and surgical history data and statistical parameter mapping was used to compare knee flexion during stance and pelvic and trunk tilts during the gait cycle between SHL and SHL-naive groups.</p><p><strong>Results: </strong>Age, GMFCS level, sex, race, topography, and ethnicity were not different between the groups (<i>P</i>=.217-.612). Anterior pelvic tilt throughout gait was significantly greater in the SHL group compared with the SHL-naive group (63%-87%; <i>P</i>=.033). This difference was augmented after accounting for other surgical history and revision SHL (0%-32%, <i>P</i>=.019; and 46%-93%, <i>P</i>=.007).</p><p><strong>Conclusion: </strong>Within a cohort of adults with CP, GMFCS levels I-III, and a mean age of 36 years, those with a history of SHL, performed a mean of 28 years prior to 3-dimensional gait analysis, walked with increased anterior pelvic tilt compared with those without a history of SHL. [<i>Orthopedics</i>. 2024;47(5):270-275.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141469901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-07-29DOI: 10.3928/01477447-20240718-01
Seok Won Chung, Seung Ho Chung, Dong-Hyun Kim, Hyun Joo Lee, Eugene Jae Jin Park, Bum-Jin Shim, Du Han Kim, Jong Pil Yoon
Background: Gabapentin is often used as an analgesic after rotator cuff repair surgery and is recommended as an additional analgesic for arthroscopic rotator cuff repairs. However, evidence of its effects on biological healing mechanisms is lacking. The objective of this study was to investigate the potential of gabapentin in improving tendon-to-bone healing after rotator cuff repair using a rat model.
Materials and methods: A total of 20 male rats were randomly allocated to one of two groups: group 1 (repair only, n=10) or group 2 (gabapentin injection, n=10). The rats in the experimental group (group 2) were administered 80 mg/kg of gabapentin subcutaneously 30 minutes before surgery, followed by 80 mg/kg subcutaneously every 24 hours for 48 hours. We used the left shoulder of every rat, while for biomechanical analysis, we used the right shoulder.
Results: There was no significant difference in the load to failure, ultimate stress, or elongation between the groups. Collagen continuity, orientation, and density were better in group 2 than group 1.
Conclusion: In a rat model of rotator cuff repair, gabapentin had a positive impact on the quality of collagen organization at the junction between the tendon and bone, while preserving the biomechanical properties. We propose the use of gabapentin as a supplementary analgesic agent for postoperative pain relief after arthroscopic rotator cuff repair; however, further studies of the effect of gabapentin on biological healing mechanisms are required. [Orthopedics. 2024;47(5):e241-e246.].
{"title":"Effect of Gabapentin on Tendon-to-Bone Healing in a Rat Model of Rotator Cuff Repair.","authors":"Seok Won Chung, Seung Ho Chung, Dong-Hyun Kim, Hyun Joo Lee, Eugene Jae Jin Park, Bum-Jin Shim, Du Han Kim, Jong Pil Yoon","doi":"10.3928/01477447-20240718-01","DOIUrl":"10.3928/01477447-20240718-01","url":null,"abstract":"<p><strong>Background: </strong>Gabapentin is often used as an analgesic after rotator cuff repair surgery and is recommended as an additional analgesic for arthroscopic rotator cuff repairs. However, evidence of its effects on biological healing mechanisms is lacking. The objective of this study was to investigate the potential of gabapentin in improving tendon-to-bone healing after rotator cuff repair using a rat model.</p><p><strong>Materials and methods: </strong>A total of 20 male rats were randomly allocated to one of two groups: group 1 (repair only, n=10) or group 2 (gabapentin injection, n=10). The rats in the experimental group (group 2) were administered 80 mg/kg of gabapentin subcutaneously 30 minutes before surgery, followed by 80 mg/kg subcutaneously every 24 hours for 48 hours. We used the left shoulder of every rat, while for biomechanical analysis, we used the right shoulder.</p><p><strong>Results: </strong>There was no significant difference in the load to failure, ultimate stress, or elongation between the groups. Collagen continuity, orientation, and density were better in group 2 than group 1.</p><p><strong>Conclusion: </strong>In a rat model of rotator cuff repair, gabapentin had a positive impact on the quality of collagen organization at the junction between the tendon and bone, while preserving the biomechanical properties. We propose the use of gabapentin as a supplementary analgesic agent for postoperative pain relief after arthroscopic rotator cuff repair; however, further studies of the effect of gabapentin on biological healing mechanisms are required. [<i>Orthopedics</i>. 2024;47(5):e241-e246.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-08-20DOI: 10.3928/01477447-20240809-02
Tanner Campbell, Mateo Kirwan, Vafa Behzadpour, Tanner Langvardt, Johnathan Dallman, Yanjie Huang, Renan C Castillo, Nathan N O'Hara, Robert V O'Toole, Brent Wise
Background: The purpose of this study was to externally validate a predictive score for fracture-related infections, establishing generalizability for absolute and relative risk of infection in the setting of orthopedic fracture surgery.
Materials and methods: This was a retrospective, case-control study performed at a level I academic trauma center that included 147 patients with fracture-related infection in the study group and 300 control patients. We analyzed the same 8 independent predictors of fracture-related infection cited by a previous study. We then used the area under the receiver operating characteristics curve (AUC) to compare the derivation and validation cohorts. The validation and derivation cohorts were then compared by grouping patients into 4 strata of Wise score groups. This allowed for comparison of AUC and risk of fracture-related infection in our institution with those in the previously studied institution.
Results: The resulting data yielded an AUC (0.74) nearly identical to that of the previously studied institution. It was also found that the relative risk of infection correlated with the Wise score in the same way the initial model did with the absolute risks being similar.
Conclusion: The previous predictive model was externally validated and shown to be generalizable to a different patient population. The relative risk of a fracture-related infection can be determined using this scoring model preoperatively with the goal of aiding in patient counseling and surgical decision-making, giving a quantitative value to patient risk factors. [Orthopedics. 2024;47(5):e268-e272.].
{"title":"External Validation of a Predictive Score for Fracture-Related Infections in Orthopedic Trauma Surgery.","authors":"Tanner Campbell, Mateo Kirwan, Vafa Behzadpour, Tanner Langvardt, Johnathan Dallman, Yanjie Huang, Renan C Castillo, Nathan N O'Hara, Robert V O'Toole, Brent Wise","doi":"10.3928/01477447-20240809-02","DOIUrl":"10.3928/01477447-20240809-02","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to externally validate a predictive score for fracture-related infections, establishing generalizability for absolute and relative risk of infection in the setting of orthopedic fracture surgery.</p><p><strong>Materials and methods: </strong>This was a retrospective, case-control study performed at a level I academic trauma center that included 147 patients with fracture-related infection in the study group and 300 control patients. We analyzed the same 8 independent predictors of fracture-related infection cited by a previous study. We then used the area under the receiver operating characteristics curve (AUC) to compare the derivation and validation cohorts. The validation and derivation cohorts were then compared by grouping patients into 4 strata of Wise score groups. This allowed for comparison of AUC and risk of fracture-related infection in our institution with those in the previously studied institution.</p><p><strong>Results: </strong>The resulting data yielded an AUC (0.74) nearly identical to that of the previously studied institution. It was also found that the relative risk of infection correlated with the Wise score in the same way the initial model did with the absolute risks being similar.</p><p><strong>Conclusion: </strong>The previous predictive model was externally validated and shown to be generalizable to a different patient population. The relative risk of a fracture-related infection can be determined using this scoring model preoperatively with the goal of aiding in patient counseling and surgical decision-making, giving a quantitative value to patient risk factors. [<i>Orthopedics</i>. 2024;47(5):e268-e272.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-06-27DOI: 10.3928/01477447-20240619-02
Justin Leal, Samuel S Wellman, William A Jiranek, Thorsten M Seyler, Michael P Bolognesi, Sean P Ryan
Background: This retrospective study investigated the impact of continuing vs discontinuing home oral hypoglycemic medications for patients with diabetes undergoing total hip arthroplasty.
Materials and methods: Patients who were not exclusively receiving home oral hypoglycemic regimens were excluded. Additionally, patients whose diabetes was not managed inpatient postoperatively were excluded. Included patients were retrospectively evaluated for early postoperative glycemic control, renal function, and metabolic abnormalities. Patients were then compared based on whether their home oral hypoglycemic regimen was continued vs discontinued in favor of initiating insulin while inpatient and analyzed using multivariable regression analysis.
Results: A total of 532 patients undergoing total hip arthroplasty met inclusion criteria, with 78.6% continuing their home oral hypoglycemic regimen. Those who continued showed significantly lower median maximum inpatient blood glucose (178.5 mg/dL vs 249.5 mg/dL; P<.001) and median average inpatient blood glucose (138.4 mg/dL vs 178.6 mg/dL; P<.001). Linear regression analysis, adjusting for various potential confounding factors, revealed a positive correlation between discontinuation of home hypoglycemic medications and higher maximum in-patient blood glucose (β=70.15 [95% CI, 59.27-81.03]; P<.001). Patients in the continuation group had lower proportions of acute kidney injury (18.7% vs 41.2%; P<.001) and metabolic acidosis (4.3% vs 17.5%; P<.001), along with a shorter length of stay (1.0 vs 2.0 days; P<.001).
Conclusion: These findings suggest that continuing a home oral hypoglycemic regimen for patients with diabetes after total hip arthroplasty is associated with superior glycemic control without exacerbating renal abnormalities or increasing metabolic complications. [Orthopedics. 2024;47(5):276-282.].
背景:这项回顾性研究调查了对接受全髋关节置换术的糖尿病患者继续与停止家庭口服降糖药的影响:排除了不完全接受家庭口服降糖药治疗的患者。此外,还排除了术后未住院治疗的糖尿病患者。对纳入患者的术后早期血糖控制、肾功能和代谢异常进行回顾性评估。然后根据患者在住院期间是否继续使用家庭口服降糖药与停止使用胰岛素进行比较,并使用多变量回归分析进行分析:共有532名接受全髋关节置换术的患者符合纳入标准,其中78.6%的患者继续使用家庭口服降糖药。这些患者的住院血糖最高值中位数明显降低(178.5 mg/dL vs 249.5 mg/dL; PPPPPPC结论:这些研究结果表明,对全髋关节置换术后的糖尿病患者继续采用家庭口服降糖药治疗与良好的血糖控制有关,同时不会加剧肾功能异常或增加代谢并发症。[骨科。202x;4x(x):xx-xx]。
{"title":"Continuing Home Oral Hypoglycemic Medications Was Associated With Superior Postoperative Glycemic Control Versus Initiating Sliding Scale Insulin After Total Hip Arthroplasty.","authors":"Justin Leal, Samuel S Wellman, William A Jiranek, Thorsten M Seyler, Michael P Bolognesi, Sean P Ryan","doi":"10.3928/01477447-20240619-02","DOIUrl":"10.3928/01477447-20240619-02","url":null,"abstract":"<p><strong>Background: </strong>This retrospective study investigated the impact of continuing vs discontinuing home oral hypoglycemic medications for patients with diabetes undergoing total hip arthroplasty.</p><p><strong>Materials and methods: </strong>Patients who were not exclusively receiving home oral hypoglycemic regimens were excluded. Additionally, patients whose diabetes was not managed inpatient postoperatively were excluded. Included patients were retrospectively evaluated for early postoperative glycemic control, renal function, and metabolic abnormalities. Patients were then compared based on whether their home oral hypoglycemic regimen was continued vs discontinued in favor of initiating insulin while inpatient and analyzed using multivariable regression analysis.</p><p><strong>Results: </strong>A total of 532 patients undergoing total hip arthroplasty met inclusion criteria, with 78.6% continuing their home oral hypoglycemic regimen. Those who continued showed significantly lower median maximum inpatient blood glucose (178.5 mg/dL vs 249.5 mg/dL; <i>P</i><.001) and median average inpatient blood glucose (138.4 mg/dL vs 178.6 mg/dL; <i>P</i><.001). Linear regression analysis, adjusting for various potential confounding factors, revealed a positive correlation between discontinuation of home hypoglycemic medications and higher maximum in-patient blood glucose (β=70.15 [95% CI, 59.27-81.03]; <i>P</i><.001). Patients in the continuation group had lower proportions of acute kidney injury (18.7% vs 41.2%; <i>P</i><.001) and metabolic acidosis (4.3% vs 17.5%; <i>P</i><.001), along with a shorter length of stay (1.0 vs 2.0 days; <i>P</i><.001).</p><p><strong>Conclusion: </strong>These findings suggest that continuing a home oral hypoglycemic regimen for patients with diabetes after total hip arthroplasty is associated with superior glycemic control without exacerbating renal abnormalities or increasing metabolic complications. [<i>Orthopedics</i>. 2024;47(5):276-282.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141469872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-06-12DOI: 10.3928/01477447-20240605-03
Jeffrey Okewunmi, Brocha Z Stern, Juan Sebastian Arroyave Villada, Mateo Restrepo Mejia, Nicole Zubizarreta, Jashvant Poeran, David A Forsh
Background: Disparities in orthopedic trauma care have been reported for racial-ethnic minority and socially disadvantaged patients. We examined differences in perioperative metrics by patient race and ethnicity and insurance after pelvic fracture in a national sample in the United States.
Materials and methods: The 2016-2019 National Inpatient Sample was queried for White, Black, and Hispanic patients 18 to 64 years old with private, Medicaid, or self-pay insurance who underwent non-elective pelvic fracture surgery. Associations between combined race and ethnicity and insurance subgroups and perioperative metrics (time to surgery, length of stay, inhospital complications, institutional discharge) were assessed using multivariable generalized linear and logistic regression models. Adjusted percent differences or odds ratios (ORs) were reported.
Results: A weighted total of 14,375 surgeries were included (68.8% in White patients, 16.1% in Black patients, and 15.1% in Hispanic patients; 60.0% private insurance, 26.3% Medicaid, and 13.7% self-pay). Compared with White patients with private insurance, all Black insurance subgroups had longer length of stay (+15.38% to +38.78%, P≤.001), as did Hispanic patients with Medicaid (+28.03%, P<.001), White patients with Medicaid (+13.08%, P<.001), and White patients with self-pay (+9.47%, P=.04). Additionally, compared with White patients with private insurance, decreased odds of institutional discharge were observed for all patients with self-pay (OR, 0.24-0.37, P<.001) as well as White patients with Medicaid (OR, 0.70, P=.003) and Hispanic patients with Medicaid (OR, 0.57, P=.002). There were no significant adjusted associations between race and ethnicity and insurance subgroups and in-hospital complications or time to surgery.
Conclusion: These differences in perioperative metrics, primarily for Black patients and patients with self-pay insurance, warrant further examination to identify whether they reflect disparities that should be addressed to promote equitable orthopedic trauma care. [Orthopedics. 2024;47(5):e233-e240.].
{"title":"Differences in Perioperative Metrics by Race and Ethnicity and Insurance After Pelvic Fracture: A Nationwide Study.","authors":"Jeffrey Okewunmi, Brocha Z Stern, Juan Sebastian Arroyave Villada, Mateo Restrepo Mejia, Nicole Zubizarreta, Jashvant Poeran, David A Forsh","doi":"10.3928/01477447-20240605-03","DOIUrl":"10.3928/01477447-20240605-03","url":null,"abstract":"<p><strong>Background: </strong>Disparities in orthopedic trauma care have been reported for racial-ethnic minority and socially disadvantaged patients. We examined differences in perioperative metrics by patient race and ethnicity and insurance after pelvic fracture in a national sample in the United States.</p><p><strong>Materials and methods: </strong>The 2016-2019 National Inpatient Sample was queried for White, Black, and Hispanic patients 18 to 64 years old with private, Medicaid, or self-pay insurance who underwent non-elective pelvic fracture surgery. Associations between combined race and ethnicity and insurance subgroups and perioperative metrics (time to surgery, length of stay, inhospital complications, institutional discharge) were assessed using multivariable generalized linear and logistic regression models. Adjusted percent differences or odds ratios (ORs) were reported.</p><p><strong>Results: </strong>A weighted total of 14,375 surgeries were included (68.8% in White patients, 16.1% in Black patients, and 15.1% in Hispanic patients; 60.0% private insurance, 26.3% Medicaid, and 13.7% self-pay). Compared with White patients with private insurance, all Black insurance subgroups had longer length of stay (+15.38% to +38.78%, <i>P</i>≤.001), as did Hispanic patients with Medicaid (+28.03%, <i>P</i><.001), White patients with Medicaid (+13.08%, <i>P</i><.001), and White patients with self-pay (+9.47%, <i>P</i>=.04). Additionally, compared with White patients with private insurance, decreased odds of institutional discharge were observed for all patients with self-pay (OR, 0.24-0.37, <i>P</i><.001) as well as White patients with Medicaid (OR, 0.70, <i>P</i>=.003) and Hispanic patients with Medicaid (OR, 0.57, <i>P</i>=.002). There were no significant adjusted associations between race and ethnicity and insurance subgroups and in-hospital complications or time to surgery.</p><p><strong>Conclusion: </strong>These differences in perioperative metrics, primarily for Black patients and patients with self-pay insurance, warrant further examination to identify whether they reflect disparities that should be addressed to promote equitable orthopedic trauma care. [<i>Orthopedics</i>. 2024;47(5):e233-e240.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141306520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-07-08DOI: 10.3928/01477447-20240702-01
Casey Cardillo, Conor Garry, Jonathan L Katzman, Morteza Meftah, Joshua C Rozell, Ran Schwarzkopf, Claudette Lajam
Background: Optimizing operating room (OR) scheduling accuracy is important for improving OR efficiency and maximizing value of total knee arthroplasty (TKA). However, data on factors that may impact TKA OR scheduling accuracy are limited.
Materials and methods: A retrospective review of 7655 knee arthroplasties (6999 primary TKAs and 656 revision TKAs) performed between January 2020 and May 2023 was conducted. Patient baseline characteristics, surgeon experience (years in practice), as well as actual vs scheduled OR times were collected. Actual OR times that were at least 15% shorter or longer than scheduled OR times were considered to be clinically important. Logistic regression analyses were employed to assess the influence of specific patient and surgeon factors on OR scheduling inaccuracies.
Results: Using adjusted odds ratio, patients with primary TKA who had a lower body mass index (P<.001) were independently associated with overestimation of scheduled surgical time. Conversely, younger age (P<.001), afternoon procedure start time (P<.001), surgeons with less than 10 years of experience (P=.037), and higher patient body mass index (P<.001) were associated with underestimation of scheduled surgical time. For revision TKA, female sex (P=.021) and morning procedure start time (P=.038) were associated with overestimation of scheduled surgical time, while surgeons with less than 10 years of experience (P=.014) and patients who underwent spinal/epidural/block anesthesia (P=.038) were associated with underestimation of scheduled surgical time.
Conclusion: This study highlights patient, surgeon, and intraoperative variables that impact the accuracy of scheduling for TKA procedures. Health systems should take these variables into consideration when creating OR schedules to fully optimize resources and available space. [Orthopedics. 2024;47(5):313-319.].
{"title":"Factors Affecting Operating Room Scheduling Accuracy for Primary and Revision Total Knee Arthroplasty: A Retrospective Study.","authors":"Casey Cardillo, Conor Garry, Jonathan L Katzman, Morteza Meftah, Joshua C Rozell, Ran Schwarzkopf, Claudette Lajam","doi":"10.3928/01477447-20240702-01","DOIUrl":"10.3928/01477447-20240702-01","url":null,"abstract":"<p><strong>Background: </strong>Optimizing operating room (OR) scheduling accuracy is important for improving OR efficiency and maximizing value of total knee arthroplasty (TKA). However, data on factors that may impact TKA OR scheduling accuracy are limited.</p><p><strong>Materials and methods: </strong>A retrospective review of 7655 knee arthroplasties (6999 primary TKAs and 656 revision TKAs) performed between January 2020 and May 2023 was conducted. Patient baseline characteristics, surgeon experience (years in practice), as well as actual vs scheduled OR times were collected. Actual OR times that were at least 15% shorter or longer than scheduled OR times were considered to be clinically important. Logistic regression analyses were employed to assess the influence of specific patient and surgeon factors on OR scheduling inaccuracies.</p><p><strong>Results: </strong>Using adjusted odds ratio, patients with primary TKA who had a lower body mass index (<i>P</i><.001) were independently associated with overestimation of scheduled surgical time. Conversely, younger age (<i>P</i><.001), afternoon procedure start time (<i>P</i><.001), surgeons with less than 10 years of experience (<i>P</i>=.037), and higher patient body mass index (<i>P</i><.001) were associated with underestimation of scheduled surgical time. For revision TKA, female sex (<i>P</i>=.021) and morning procedure start time (<i>P</i>=.038) were associated with overestimation of scheduled surgical time, while surgeons with less than 10 years of experience (<i>P</i>=.014) and patients who underwent spinal/epidural/block anesthesia (<i>P</i>=.038) were associated with underestimation of scheduled surgical time.</p><p><strong>Conclusion: </strong>This study highlights patient, surgeon, and intraoperative variables that impact the accuracy of scheduling for TKA procedures. Health systems should take these variables into consideration when creating OR schedules to fully optimize resources and available space. [<i>Orthopedics</i>. 2024;47(5):313-319.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141559440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}