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Preoperative Workup of Operative Hip Fracture Patients: A Survey 髋部骨折手术患者的术前检查
Pub Date : 2023-03-09 DOI: 10.1177/15563316231158546
G. Esper, Utkarsh Anil, S. Cavaleri, David L. Furgiuele, J. Zaretsky, S. Konda, K. Egol
Background: There may be disagreement among stakeholders on the need for preoperative cardiac screening for elderly hip fracture patients. Purpose: We sought to assess preoperative workup perceptions among physicians for hip fracture patients across specialties, specifically considering a patient’s cardiovascular risk. Methods: A case-based survey was distributed to 50 physicians in each of the 4 departments involved in preoperative patient care: orthopedic surgery (OS), anesthesiology (A), cardiology (C), and hospital medicine (HM). The survey asked about which clinical presentations required a cardiology consult, as well as about further preoperative imaging and laboratory work. Single score intraclass correlation coefficient (ICC) was used to compare agreement. Results: Of the 200 surveys sent out, 33 responses (16.5% response rate) were received. Between all specialties, there was 72% agreement about preoperative cardiology consult need (intraclass correlation coefficient [ICC] = 0.063 or poor) and 71% agreement about preoperative transthoracic echocardiogram (TTE) need (ICC = 0.188 or poor). Within each specialty (A, C, HM, OS) ICCs measuring agreement for the need for cardiology consult were 0.812 (good), 0.561 (moderate), 0.457 (poor), and 0.414 (poor), respectively, and for the need for preoperative TTE were 0.852 (good), 0.441 (poor), 0.848 (good), and 0.188 (poor), respectively. Common preoperative testing requested included complete blood count, basic metabolic panel in all cases, and electrocardiogram with troponins if perioperative acute coronary syndrome symptoms were present. Conclusion: This survey suggests that there may be varying levels of agreement within specialties and poor agreement between specialties on the need for cardiology consultation and preoperative imaging for hip fracture patients. This suggests the need for established, reliable preoperative workup protocols with input from different specialties to streamline preoperative care for patients before hip fracture surgery.
背景:对于老年髋部骨折患者术前心脏筛查的必要性,利益相关方可能存在分歧。目的:我们试图评估各专科医生对髋部骨折患者术前随访的看法,特别是考虑患者的心血管风险。方法:对参与术前患者护理的骨科(OS)、麻醉科(A)、心脏科(C)和医院内科(HM) 4个科室各50名医生进行病例调查。该调查询问了哪些临床表现需要心脏病学咨询,以及进一步的术前成像和实验室工作。采用单分类内相关系数(ICC)比较一致性。结果:在发出的200份问卷中,收到33份回复,回应率为16.5%。各专科对术前心内科会诊需求的一致性为72%(类内相关系数[ICC] = 0.063或较差),对术前经胸超声心动图(TTE)需求的一致性为71% (ICC = 0.188或较差)。在每个专科(A、C、HM、OS)中,心血管学咨询需求的ICCs测量一致性分别为0.812(良好)、0.561(中等)、0.457(差)和0.414(差),术前TTE需求的ICCs测量一致性分别为0.852(良好)、0.441(差)、0.848(好)和0.188(差)。常见的术前检查包括全血细胞计数,所有病例的基本代谢检查,如果围手术期出现急性冠状动脉综合征症状,则进行肌钙蛋白心电图检查。结论:本调查表明,对于髋部骨折患者是否需要进行心脏科咨询和术前影像学检查,各专科之间可能存在不同程度的一致性,而各专科之间的一致性较差。这表明需要建立可靠的术前检查方案,从不同的专业输入,以简化髋部骨折手术前患者的术前护理。
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引用次数: 0
Did Payment Reform Lead to Patient Selection in Hip and Knee Arthroplasties? An Observational Study Using New York State Data 支付改革是否导致了髋关节和膝关节置换术患者的选择?一项使用纽约州数据的观察性研究
Pub Date : 2023-02-24 DOI: 10.1177/15563316231155387
Sara N. Kiani, S. Maron, S. Rosenzweig, N. Zubizarreta, J. Poeran, C. Moucha
Background: While the comprehensive care for joint replacement (CJR) bundled payment program for total joint replacement (TJR) emphasizes value, concerns persist regarding unintended consequences, primarily hospital selection of healthier, younger patients. Purpose: We sought to assess changes in patient characteristics and outcomes after CJR implementation in New York State. Methods: This retrospective cohort study included primary total hip and total knee arthroplasties from the New York Statewide Planning and Research Cooperative System (SPARCS) database. Procedures performed before (July 2014 to March 2016; n = 58,610) and after (April 2016 to December 2017; n = 78,728) CJR implementation were compared. Primary outcomes were patient characteristics: Deyo-Comorbidity Index and age. Secondary outcomes were increased hospitalization cost, discharge to institutional post-acute care, and prolonged length of stay. A difference-in-differences analysis estimated changes after CJR implementation, comparing CJR to non-CJR hospitals. Results: We found that CJR implementation (in 49 of 144 New York State hospitals) coincided with slightly older and more comorbid TJR recipients. The CJR program coincided with significantly reduced hospitalization cost and discharge to institutional post-acute care but not length of stay. Some CJR effects appear to have affected non-Medicare patients, as well. Conclusion: This retrospective analysis suggests that in New York State, the CJR bundled payment program did not result in hospitals selecting younger and healthier TJR recipients and coincided with decreased costs and fewer discharges to institutional postacute care.
背景:虽然关节置换术综合护理(CJR)与全关节置换术(TJR)捆绑支付计划强调价值,但对意外后果的担忧持续存在,主要是医院选择更健康、更年轻的患者。目的:我们试图评估纽约州实施CJR后患者特征和结果的变化。方法:这项回顾性队列研究包括来自纽约州规划和研究合作系统(SPARCS)数据库的原发性全髋关节和全膝关节置换术。(2014年7月至2016年3月)之前的手术;n = 58,610)及之后(2016年4月至2017年12月;n = 78,728)比较CJR的实施情况。主要结局是患者特征:deyo合并症指数和年龄。次要结局是住院费用增加、急症后机构护理出院和住院时间延长。差异中差异分析估计了实施CJR后的变化,比较了CJR与非CJR医院。结果:我们发现CJR的实施(144所纽约州医院中的49所)与年龄稍大且合并症较多的TJR受者相吻合。CJR项目显著降低了住院费用,减少了机构急性后护理的出院时间,但没有延长住院时间。一些CJR效应似乎也影响了非医保患者。结论:这一回顾性分析表明,在纽约州,CJR捆绑支付计划并没有导致医院选择更年轻、更健康的TJR受者,同时也降低了成本,减少了机构急性后护理的出院率。
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引用次数: 0
Are Grit and Self-Control Associated With Patient-Reported Outcomes Following Spine Surgery? 毅力和自我控制与脊柱手术后患者报告的结果有关吗?
Pub Date : 2023-01-27 DOI: 10.1177/15563316221147193
M. Dupont, Kasra Araghi, Daniel Shinn, S. Qureshi, S. Iyer
Background: Grit, defined as perseverance and passion for long-term goals, and self-control, defined as the capacity to regulate impulses in the presence of momentarily gratifying temptations or diversion, have shown to be predictors of professional achievement. Their role in health care outcomes is less well understood. Purpose: We sought to determine whether grit and self-control are associated with patient-reported outcome measures (PROMs) following spine surgery. Methods: We conducted a retrospective review of adult patients who underwent cervical or lumbar procedures by a single fellowship-trained spine surgeon between March 2017 and October 2020. We included patients who underwent anterior cervical discectomy and fusion, cervical disk replacement, minimally invasive laminectomy/laminoplasty (MI-D), or minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) with minimum 1-year follow-up. Grit and self-control scores were collected 1 year after the surgery. PROMs were collected preoperatively and at 6 postoperative timepoints. Grit and self-control were compared between patients who achieved substantial clinical benefit (SCB) in either physical or mental health versus those who did not. The association between grit/self-control and change in PROMs was also assessed. Results: In the 129 patients included in the analysis, we found that patients who achieved SCB in mental health had significantly higher grit scores than those who did not. In bivariate analysis, self-control was associated with greater improvement in leg pain scores at 1-year and 2-year follow-up following an MI-D. For the MI-TLIF cohort, grit was associated with a smaller change in Short Form 12 mental component score at 6 weeks, and self-control was associated with a smaller change in Patient-Reported Outcome Measurement Information System Physical Function at the 6-month timepoint. Grit and self-control were not associated with PROMs at other timepoints. Conclusion: This retrospective review found that grit and self-control were not significantly associated with PROMs at most postoperative timepoints in patients who underwent spine surgery.
背景:坚毅被定义为对长期目标的坚持和热情,而自我控制被定义为在暂时满足的诱惑或消遣面前调节冲动的能力,它们被证明是职业成就的预测因素。它们在卫生保健结果中的作用还不太清楚。目的:我们试图确定毅力和自我控制是否与脊柱手术后患者报告的结果测量(PROMs)相关。方法:我们对2017年3月至2020年10月期间由一名接受过奖学金培训的脊柱外科医生接受颈椎或腰椎手术的成年患者进行了回顾性研究。我们纳入了接受前路颈椎椎间盘切除术和融合术、颈椎椎间盘置换术、微创椎板切除术/椎板成形术(MI-D)或微创经椎间孔腰椎椎体间融合术(MI-TLIF)的患者,随访至少1年。术后1年收集毅力和自我控制评分。术前和术后6个时间点采集prom。在身体或心理健康方面获得实质性临床益处(SCB)的患者与没有获得实质性临床益处的患者之间,比较了毅力和自我控制能力。还评估了毅力/自我控制与PROMs变化之间的关系。结果:在纳入分析的129例患者中,我们发现在心理健康方面达到SCB的患者比没有达到SCB的患者具有显著更高的毅力得分。在双变量分析中,自我控制与MI-D后1年和2年随访中腿部疼痛评分的更大改善相关。对于MI-TLIF队列,在6周时,毅力与短表12心理成分评分的较小变化相关,而在6个月时,自我控制与患者报告的结果测量信息系统身体功能的较小变化相关。毅力和自我控制在其他时间点与prom无关。结论:本回顾性研究发现,在大多数脊柱手术患者的术后时间点,毅力和自我控制与prom没有显著相关。
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引用次数: 0
Preoperative Cannabis Use Did Not Increase Opioid Utilization After Primary Total Knee Arthroplasty in a Propensity Score–Matched Model 在倾向评分匹配模型中,术前使用大麻不会增加初次全膝关节置换术后阿片类药物的使用
Pub Date : 2023-01-26 DOI: 10.1177/15563316221151158
Simar Puri, Christian B. Ong, Yu-fen Chiu, Juliana Lebowitz, A. Sideris, A. Gonzalez Della Valle, B. Chalmers
Background: Recreational and medicinal cannabis use is becoming increasingly popular, but there are little data on its effect on postoperative pain and opioid consumption after primary total knee arthroplasty (TKA). Purpose: We sought to evaluate the relationship between self-reported preoperative cannabis use and postoperative opioid consumption and post-discharge opioid prescriptions following elective primary TKA. Methods: We identified all patients who underwent unilateral, primary TKA for a diagnosis of osteoarthritis at a single institution between February 1, 2019, and April 30, 2021, and subdivided them into current cannabis users and non-users based on self-reported data. Regular users were propensity score-matched 1:6 with non-users using logistic regression on age, sex, body mass index (BMI), history of chronic pain, smoking status, history of anxiety/depression, American Society of Anesthesiology (ASA) classification, and type of anesthesia. Outcomes of interest included median inpatient (total, daily, and hourly) morphine milligram equivalents (MMEs), discharge MMEs, and outpatient MMEs within 90 days after surgery. Results: A cohort of 70 current cannabis users was matched with 420 non-users. There were no significant differences in opioid use in inpatient MMEs (hourly, daily, or total), discharge MMEs, or outpatient MMEs between cohorts. Also, there was no significant difference in hospital stay between cohorts. Conclusion: In this retrospective propensity score–matched model, preoperative cannabis use did not independently increase opioid use post-TKA in the inpatient or outpatient setting when compared with non-use. More rigorous, prospective study is warranted.
背景:娱乐性和药用大麻的使用正变得越来越流行,但关于其对原发性全膝关节置换术(TKA)术后疼痛和阿片类药物消耗的影响的数据很少。目的:我们试图评估自我报告的术前大麻使用与术后阿片类药物消耗和选择性原发性TKA后出院后阿片类药物处方之间的关系。方法:我们确定了2019年2月1日至2021年4月30日期间在单一机构接受单侧原发性TKA诊断为骨关节炎的所有患者,并根据自我报告的数据将其细分为当前大麻使用者和非大麻使用者。使用logistic回归对年龄、性别、体重指数(BMI)、慢性疼痛史、吸烟状况、焦虑/抑郁史、美国麻醉学会(ASA)分类和麻醉类型等因素进行logistic回归,常规服用者与非服用者的倾向评分匹配为1:6。研究结果包括术后90天内住院(总、每日和每小时)吗啡毫克当量(MMEs)、出院时MMEs和门诊时MMEs的中位数。结果:70名目前的大麻使用者与420名非使用者相匹配。在住院MMEs(每小时、每天或总)、出院MMEs或门诊MMEs中,阿片类药物的使用在队列之间没有显著差异。此外,两组患者的住院时间也没有显著差异。结论:在这个回顾性倾向评分匹配模型中,与未使用相比,术前使用大麻不会独立增加住院或门诊tka后阿片类药物的使用。更严格的前瞻性研究是必要的。
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引用次数: 1
Is There Gender Disparity in Orthopedic Surgery Resident Research Productivity? 骨科住院医师科研效率存在性别差异吗?
Pub Date : 2023-01-23 DOI: 10.1177/15563316221150934
Bridget K. Ellsworth, Nicolas Pascual-Leone, Preston W. Gross, Kathryn A. Barth, Shevaun M. Doyle
Background: Compared with male senior authors, female senior authors publish less often in orthopedic journals than expected based on their population proportion. It is unknown whether this trend is also present among orthopedic trainees. Purpose: We sought to determine whether there is a gender discrepancy in the publication volume and authorship status among orthopedic residents. Methods: We conducted a cross-sectional analysis to evaluate the research productivity of male and female orthopedic residents. The top 10 ranked US orthopedic surgery residencies by research output in 2021–2022 were obtained from Doximity. Residents’ names were recorded from each institution’s residency website. We classified each resident as male or female, searched on PubMed, and recorded the number of publications relevant to orthopedic surgery. Resident contribution to each publication was recorded as either a first/last author or a middle author. To assess contributions by postgraduate year, we compared male and female junior residents (PGY1-3) and senior residents (PGY4-5) using the number of total publications, middle author publications, first/last author publications, and the difference between the number of middle and first/last author publications. Results: Among the 335 male and 117 female residents included, male residents had more total publications than female residents. Among PGY4-5, male residents had more total publications and middle author publications. There was no difference in the number of first/last author publications between male and female PGY4-5 residents. Conclusions: Our cross-sectional analysis found that in the 2021–2022 academic year, male orthopedic surgery residents published more often than female residents, although among PGY4-5 residents, we found no gender differences in number of first/last author publications. The difference in total publications among PGY4-5 residents is likely due to differences in middle author publications. Future research should consider residents’ self-identified gender, including non-binary and gender-fluid identity.
背景:与男性资深作者相比,女性资深作者在骨科期刊上的发表次数低于其人口比例预期。目前尚不清楚这种趋势是否也存在于骨科实习生中。目的:我们试图确定骨科住院医师在出版物数量和作者地位方面是否存在性别差异。方法:采用横断面分析对骨科住院医师的研究效率进行评估。2021-2022年美国骨科住院医师研究产出排名前10位的数据来自docximity。居民的名字从每个机构的居住网站上记录下来。我们将每位住院医师分类为男性或女性,在PubMed上进行检索,并记录与骨科手术相关的出版物数量。对每份出版物的常驻贡献被记录为第一/最后作者或中间作者。为了评估研究生年度的贡献,我们比较了男性和女性初级住院医师(PGY1-3)和高级住院医师(PGY4-5),使用了总发表论文数量、中间作者发表论文数量、第一/最后作者发表论文数量以及中间和第一/最后作者发表论文数量的差异。结果:在335名男性居民和117名女性居民中,男性居民的出版物总量高于女性居民。在PGY4-5中,男性居民的总发表量和中间作者发表量均高于男性居民。在PGY4-5的男性和女性居民之间,第一/最后作者出版物的数量没有差异。结论:我们的横断面分析发现,在2021-2022学年,男性骨科住院医生发表论文的频率高于女性住院医生,尽管在PGY4-5住院医生中,我们发现第一/最后作者发表论文的数量没有性别差异。PGY4-5居民的总出版物的差异可能是由于中间作者出版物的差异。未来的研究应考虑居民自我认同的性别,包括非二元认同和性别流动认同。
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引用次数: 0
Descriptive Epidemiology of Injuries Sustained in National Collegiate Athletic Association Men’s and Women’s Lacrosse, 2004–2005 Through 2013–2014 Seasons 2004-2005至2013-2014赛季,全国大学体育协会男子和女子长曲棍球受伤的描述性流行病学研究
Pub Date : 2023-01-12 DOI: 10.1177/15563316221147204
Ambar Garcia, Lauren H. Redler
Background: Men’s and women’s lacrosse operate with significantly different rules, equipment, and contact. Previous studies have assessed injury rates (IRs) in either men’s or women’s lacrosse, but a few studies have compared injury patterns in the National Collegiate Athletic Association (NCAA) men’s and women’s lacrosse. Purpose: We sought to examine whether there were differences in injury type, mechanism, setting, and time loss in men and women playing lacrosse in the NCAA. Methods: We performed a retrospective case-control study using data collected by the NCAA Injury Surveillance Program (ISP) during a 10-season period (2004–2005 to 2013–2014). The data were assessed for potential differences in injuries between male and female lacrosse players and analyzed to obtain descriptive statistics through calculations of rates, percentages, and confidence intervals (CIs). Main outcomes measured were IRs per 1000 athletic exposures (AEs) and injury rate ratios (IRRs) with 95% CIs. Results: The IRs were 5.19 per 1000 AEs in women’s lacrosse and 6.52 per 1000 AEs in men’s lacrosse. Men had more injuries overall than women in competitions and practices and in preseason, regular season, and postseason play. Preseason IRs were higher than the regular season, and competition injuries were greater than practice injuries in both sexes. Women had more injuries to the head/face, knee, lower leg, and foot. Sprains, strains, concussions, and contusions were the most common types of injuries in both sexes. Overuse/gradual onset, cartilage, concussion, inflammation, and tendinosis injuries were more common in women than men. Injuries in men resulted in time loss more often than injuries in women. Conclusions: Our retrospective study’s findings suggest that there were differences in injury patterns between men’s and women’s lacrosse. Future prospective research should assess whether these disparities are due to differences in equipment and rules and whether changes to these factors can reduce injuries.
背景:男子和女子曲棍球在规则、设备和接触上有明显不同。以前的研究已经评估了男子或女子长曲棍球的受伤率(ir),但少数研究比较了全国大学体育协会(NCAA)男子和女子长曲棍球的受伤模式。目的:我们试图研究在NCAA中,男女长曲棍球运动员在损伤类型、机制、环境和时间损失方面是否存在差异。方法:采用NCAA损伤监测项目(ISP)收集的10个赛季(2004-2005年至2013-2014年)数据进行回顾性病例对照研究。这些数据被评估为男性和女性长曲棍球运动员之间受伤的潜在差异,并通过计算比率、百分比和置信区间(ci)来分析获得描述性统计数据。测量的主要结果是每1000次运动暴露的ir (ae)和95% ci的损伤率比(IRRs)。结果:女子曲棍球运动员的ir为5.19 / 1000 ae,男子曲棍球运动员的ir为6.52 / 1000 ae。在比赛、训练、季前赛、常规赛和季后赛中,男性总体上比女性受伤更多。季前赛的ir高于常规赛,比赛损伤大于训练损伤。女性在头部/面部、膝盖、小腿和足部受伤较多。扭伤、拉伤、脑震荡和挫伤是男女中最常见的伤害类型。过度使用/逐渐发作、软骨、脑震荡、炎症和肌腱损伤在女性中比男性更常见。男性受伤比女性受伤更容易导致时间损失。结论:我们的回顾性研究结果表明,在男子和女子曲棍球之间的损伤模式存在差异。未来的前瞻性研究应该评估这些差异是否由于设备和规则的差异,以及这些因素的改变是否可以减少伤害。
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引用次数: 1
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HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery
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