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Health Numeracy Is Associated With a Patient's Ability to Interpret Patient-Reported Outcome Measures Data. 健康计算能力与患者解释患者报告结果测量数据的能力有关。
IF 1.1 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-07-29 DOI: 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.].

背景:患者报告的结果测量(PROMs)最初是作为研究工具开发的;然而,人们对使用PROMs为临床护理提供信息的兴趣与日俱增。先前的研究表明,在护理点实施 PROMs 有很多好处,但患者的健康计算能力(理解和处理数字的能力)可能会影响他们解释 PROM 结果的能力:我们招募了在骨科门诊就诊的患者。49名患者完成了一项调查,调查内容包括人口统计学信息、简式一般健康计算能力测试以及关于四种显示相同PROM结果的PROM显示(条形图、表格、线形图、象形图)的准确性问题:健康计算能力较高的患者能正确回答所有显示准确性问题(P=0.016)。喜欢使用表格的患者更有可能错误回答显示准确性问题(几率比,0.013,P=0.024)。条形图和表格是患者最喜欢的两种 PROM 格式,大多数患者喜欢通过显示和口头讨论相结合的方式来了解他们的 PROM 功能得分:结论:患者的健康计算能力与正确理解 PROMs 视觉显示的能力有关。目前,在医疗点实施 PROM 并不考虑健康计算能力。在医疗点使用PROMs时考虑患者的健康计算能力可能会提高使用PROMs改善骨科手术疗效的效率。[骨科。202x;4x(x):xx-xx]。
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引用次数: 0
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. 关节镜下部分肩袖修复术(带或不带肱二头肌增强术)治疗大面积至严重撕裂的临床疗效和再撕裂率:系统性回顾和 Meta 分析。
IF 1.1 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-05-29 DOI: 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.].
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引用次数: 0
Risk Factors for Depression in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis. 膝骨关节炎患者抑郁的风险因素:系统回顾与元分析》。
IF 1.1 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-08-29 DOI: 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.].

背景:膝关节骨关节炎(KOA)是一种常见的慢性疾病。抑郁症经常出现在 KOA 患者中。本荟萃分析旨在确定与 KOA 患者合并抑郁症相关的风险因素:我们全面检索了 PubMed/MEDLINE、Embase、Cochrane Library 和 Web of Science 数据库中与 KOA 患者合并抑郁症相关的研究。我们进行了统计分析以获得相关结果,然后进行了异质性检验和发表偏倚评估:结果:KOA 患者中合并抑郁症的患病率为 34%(95% CI,28%-41%)。与 KOA 患者合并抑郁症相关的显著风险因素包括女性(相对风险 [RR],1.17;95% CI,1.11-1.23)、肥胖(平均差 [MD],1.30;95% CI,0.88-1.71)、使用镇痛剂(RR,1.50;95% CI,1.38-1.63)、合并症(MD,0.20;95% CI,0.10-0.31)、未婚或丧偶状态(RR,1.72;95% CI,1.56-1.91)、双侧膝关节疼痛(RR,1.38;95% CI,1.11-1.71)、西安大略和麦克马斯特大学关节炎指数(WOMAC)总分高(MD,14.92;95% CI,10.02-19.82)、WOMAC 疼痛评分高(MD,5.76;95% CI,2.86-8.67)、步速低(MD,-0.12;95% CI,-0.16--0.09)、定时上下楼测试持续时间长(MD,1.56;95% CI,0.87-2.25):根据目前的证据,女性、肥胖、使用止痛药、合并症、未婚或丧偶、双侧膝关节疼痛、WOMAC总分高、WOMAC疼痛分值高、步速低、定时站立行走测试时间长被认为是KOA患者抑郁的风险因素。在预防这些患者患抑郁症时,应重点关注这些方面。[骨科。202x.]。
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引用次数: 0
Peripheral Nerve Blocks and Opioid Use After ACL Reconstruction in Adolescents. 青少年前交叉韧带重建术后的外周神经阻滞和阿片类药物使用。
IF 1.1 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 DOI: 10.3928/01477447-20240808-01
Deepa Kattail, John G Hagen, Walid Alrayashi
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引用次数: 0
Pelvic Tilt in Adults With Cerebral Palsy and Its Relationship With Prior Hamstrings Lengthening. 脑瘫成人的骨盆倾斜及其与先前腘绳肌拉伸的关系。
IF 1.1 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-06-27 DOI: 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.].

背景:目前评估脑性瘫痪(CP)患者手术腿筋延长(SHL)后骨盆倾斜度变化的研究缺乏未接受过SHL的对比人群,且仅限于年轻患者。本研究介绍了患有 CP 的中年成人的步态数据,主要关注骨盆,并比较了曾接受过 SHL 和未接受过 SHL 的患者的骨盆倾斜、躯干倾斜和膝关节屈曲情况:本研究连续收集了 54 名患有脊髓灰质炎的成年人,平均年龄(36±13)岁,粗大运动功能分级系统(GMFCS)I-III 级。32人(59%)在平均年龄(8±5)岁时接受了SHL手术。对术后平均 28±14 年的三维步态分析数据进行了回顾性分析。采用卡方检验比较人口统计学和手术史数据,采用统计参数映射比较SHL组和SHL-无手术组在步态周期中的膝关节屈曲、骨盆和躯干倾斜情况:结果:各组间的年龄、GMFCS水平、性别、种族、地形和民族均无差异(P=.217-.612)。与 SHL 无反应组相比,SHL 组在整个步态过程中骨盆前倾的程度明显更高(63%-87%;P=.033)。在考虑其他手术史和翻修SHL后,这一差异进一步扩大(0%-32%,P=.019;46%-93%,P=.007):结论:在一组患有CP、GMFCS等级为I-III、平均年龄为36岁的成人中,在进行三维步态分析前平均28年有过SHL病史的人与无SHL病史的人相比,行走时骨盆前倾程度增加。[骨科。202x;4x(x):xx-xx]。
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引用次数: 0
Effect of Gabapentin on Tendon-to-Bone Healing in a Rat Model of Rotator Cuff Repair. 加巴喷丁对大鼠肩袖修复模型中肌腱与骨愈合的影响
IF 1.1 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-07-29 DOI: 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.].

背景:加巴喷丁常被用作肩袖修复手术后的镇痛剂,并被推荐作为关节镜肩袖修复手术的额外镇痛剂。然而,有关加巴喷丁对生物愈合机制影响的证据还很缺乏。本研究的目的是利用大鼠模型研究加巴喷丁改善肩袖修复术后肌腱与骨愈合的潜力:共 20 只雄性大鼠被随机分配到两组中的一组:第 1 组(仅修复,n=10)或第 2 组(注射加巴喷丁,n=10)。实验组(第 2 组)的大鼠在手术前 30 分钟皮下注射 80 毫克/千克的加巴喷丁,之后每 24 小时皮下注射 80 毫克/千克,持续 48 小时。我们使用每只大鼠的左肩,而生物力学分析则使用右肩:结果:两组大鼠的破坏载荷、极限应力和伸长率均无明显差异。结论:在大鼠肩袖模型中,第 2 组的胶原连续性、方向性和密度均优于第 1 组:在大鼠肩袖修复模型中,加巴喷丁对肌腱和骨骼交界处胶原组织的质量有积极影响,同时还能保持生物力学特性。我们建议使用加巴喷丁作为关节镜下肩袖修复术后止痛的辅助镇痛剂,但还需要进一步研究加巴喷丁对生物愈合机制的影响。[骨科。202x;4x(x):xx-xx]。
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引用次数: 0
External Validation of a Predictive Score for Fracture-Related Infections in Orthopedic Trauma Surgery. 创伤骨科手术中骨折相关感染预测评分的外部验证。
IF 1.1 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-08-20 DOI: 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.].

背景:本研究旨在从外部验证骨折相关感染的预测性评分:本研究的目的是对骨折相关感染的预测评分进行外部验证,确定骨科骨折手术中感染的绝对和相对风险的普遍性:这是一项回顾性病例对照研究,在一家一级学术创伤中心进行,研究组包括 147 名骨折相关感染患者,对照组包括 300 名患者。我们分析了与之前研究相同的 8 个骨折相关感染独立预测因子。然后,我们使用接收器操作特征曲线下面积(AUC)来比较推导组和验证组。然后将患者分成 4 个明智评分组,对验证组和推导组进行比较。这样就能将本机构与之前研究机构的 AUC 和骨折相关感染风险进行比较:结果:得出的数据 AUC(0.74)与之前研究机构的数据几乎相同。研究还发现,感染的相对风险与 Wise 评分的相关性与初始模型相同,而绝对风险则相似:结论:之前的预测模型已经过外部验证,并证明可以推广到不同的患者群体。使用该评分模型可以在术前确定骨折相关感染的相对风险,从而为患者咨询和手术决策提供帮助,并为患者的风险因素赋予量化价值。[骨科。202x;4x(x):xx-xx]。
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引用次数: 0
Continuing Home Oral Hypoglycemic Medications Was Associated With Superior Postoperative Glycemic Control Versus Initiating Sliding Scale Insulin After Total Hip Arthroplasty. 全髋关节置换术后继续使用家庭口服降糖药与使用滑动胰岛素相比,术后血糖控制效果更佳。
IF 1.1 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-06-27 DOI: 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]。
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引用次数: 0
Differences in Perioperative Metrics by Race and Ethnicity and Insurance After Pelvic Fracture: A Nationwide Study. 骨盆骨折后不同种族、族裔和保险在围手术期指标上的差异:一项全国性研究。
IF 1.1 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-06-12 DOI: 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.].

背景:据报道,少数种族和社会弱势群体患者在创伤骨科护理方面存在差异。我们研究了美国全国样本中骨盆骨折后不同种族、族裔和保险患者围手术期指标的差异:对 2016-2019 年全国住院病人样本中 18 至 64 岁、有私人、医疗补助或自费保险、接受非选择性骨盆骨折手术的白人、黑人和西班牙裔病人进行了查询。使用多变量广义线性回归模型和逻辑回归模型评估了种族、民族和保险亚群与围手术期指标(手术时间、住院时间、院内并发症、出院情况)之间的关系。结果:共纳入了 14,375 例加权手术(白人患者占 68.8%,黑人患者占 16.1%,西班牙裔患者占 15.1%;私人保险占 60.0%,医疗补助占 26.3%,自费占 13.7%)。与有私人保险的白人患者相比,所有黑人保险亚组的住院时间都更长(+15.38% 到 +38.78%,P≤.001),有医疗补助的西班牙裔患者也是如此(+28.03%,PPP=.04)。此外,与有私人保险的白人患者相比,所有自费患者(OR,0.24-0.37,PP=.003)和有医疗补助的西班牙裔患者(OR,0.57,P=.002)出院的几率都有所下降。经调整后,种族、民族和保险亚群与院内并发症或手术时间之间无明显关联:这些围手术期指标的差异,主要是黑人患者和自费保险患者的差异,值得进一步研究,以确定它们是否反映了为促进创伤骨科护理的公平性而应解决的差异问题。[骨科。202x;4x(x):xx-xx]。
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引用次数: 0
Factors Affecting Operating Room Scheduling Accuracy for Primary and Revision Total Knee Arthroplasty: A Retrospective Study. 影响初次和翻修全膝关节置换术手术室排班准确性的因素:回顾性研究
IF 1.1 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-07-08 DOI: 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.].

背景:优化手术室(OR)调度的准确性对于提高手术室效率和最大化全膝关节置换术(TKA)的价值非常重要。然而,有关可能影响 TKA 手术室时间安排准确性的因素的数据却很有限:对 2020 年 1 月至 2023 年 5 月间进行的 7655 例膝关节置换术(6999 例初次 TKA 和 656 例翻修 TKA)进行了回顾性分析。收集了患者基线特征、外科医生经验(从业年限)以及实际手术时间与计划手术时间。实际手术时间比计划手术时间至少缩短或延长 15%,则被认为具有临床意义。采用逻辑回归分析评估特定患者和外科医生因素对手术排期不准确性的影响:结果:使用调整后的几率比,体重指数(PPPP=.037)较低的初级TKA患者、体重指数(PP=.021)较高的患者和早上手术开始时间(P=.038)与高估计划手术时间有关,而经验少于10年的外科医生(P=.014)和接受脊髓/硬膜外/阻滞麻醉的患者(P=.038)与低估计划手术时间有关:本研究强调了影响 TKA 手术时间安排准确性的患者、外科医生和术中变量。医疗系统在制定手术室时间表时应将这些变量考虑在内,以充分优化资源和可用空间。[骨科。202x;4x(x):xx-xx]。
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