Pub Date : 2023-10-26DOI: 10.1177/15563316231204308
Stephanie I. Cheng, Cephas P. Swamidoss, Ellen M. Soffin
{"title":"Perioperative Acupuncture: A Novel and Necessary Addition to ERAS Pathways for Total Joint Arthroplasty","authors":"Stephanie I. Cheng, Cephas P. Swamidoss, Ellen M. Soffin","doi":"10.1177/15563316231204308","DOIUrl":"https://doi.org/10.1177/15563316231204308","url":null,"abstract":"","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134908211","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 : 2023-10-24DOI: 10.1177/15563316231204040
Hassaan Abdel Khalik, Manraj S. Nijjar, Jack Soeder, Darius L. Lameire, Herman Johal
Background: The study of value in orthopedic surgery aims to maximize health outcomes gained per unit cost through various health economic tools but is fragmented across various subspecialties and geographies. Therefore, it is difficult to ascertain whether this research methodology is being used to its full potential across all orthopedic subspecialties and geographies. Purpose: We sought to assess the distribution of prior health economics literature in orthopedic surgery across subspecialties and geographies. The secondary aim was to identify pertinent methodologic trends that may affect the conclusions drawn. Methods: A systematic review utilizing 3 electronic databases (Medline, Embase, and Web of Science) was performed. Inclusion criteria included prior systematic reviews assessing economic analyses across all orthopedic surgery subspecialities published between 2010 and April 24, 2021. The quality of evidence was assessed using the Assessment of Multiple Systematic Review tool. Data were qualitatively analyzed. Results: In the 44 studies included, arthroplasty (36.4%) and spine (31.8%) were the most represented subspecialties. Almost half of studies originated from the United States (45.5%), followed by the United Kingdom (18.2%). Health economic models were most commonly from the perspective of the health care or hospital system (40.5%), followed by the societal perspective (23.5%), and the payer perspective (14.8%). Conclusions: The study of value in orthopedic surgery is not uniformly leveraged across all subspecialties and geographies. Methodologically, the societal perspective was inadequately represented, despite orthopedic pathologies often incurring significant indirect costs (eg, time off work, rehabilitation expenses).
背景:骨科手术的价值研究旨在通过各种健康经济工具最大化单位成本获得的健康结果，但在不同的亚专科和地理位置上是分散的。因此，很难确定这种研究方法是否在所有骨科亚专科和地区被充分利用。目的:我们试图评估骨科外科在不同亚专科和地区的既往卫生经济学文献的分布。第二个目的是确定可能影响所得结论的相关方法学趋势。方法:利用3个电子数据库(Medline, Embase和Web of Science)进行系统评价。纳入标准包括2010年至2021年4月24日期间发表的所有骨科亚专科经济分析评估的先前系统综述。使用多系统评价工具评估证据的质量。对数据进行定性分析。结果:在纳入的44项研究中，关节成形术(36.4%)和脊柱(31.8%)是最具代表性的亚专科。几乎一半的研究来自美国(45.5%)，其次是英国(18.2%)。卫生经济模型最常见的是从卫生保健或医院系统的角度(40.5%)，其次是社会角度(23.5%)和付款人角度(14.8%)。结论:骨科手术价值的研究在所有亚专科和地区并没有统一的杠杆作用。在方法上，社会观点没有充分体现，尽管骨科疾病经常产生重大的间接成本(例如，休假，康复费用)。
{"title":"Trends and Themes in the Study of Value in Orthopedic Surgery: A Systematic Review","authors":"Hassaan Abdel Khalik, Manraj S. Nijjar, Jack Soeder, Darius L. Lameire, Herman Johal","doi":"10.1177/15563316231204040","DOIUrl":"https://doi.org/10.1177/15563316231204040","url":null,"abstract":"Background: The study of value in orthopedic surgery aims to maximize health outcomes gained per unit cost through various health economic tools but is fragmented across various subspecialties and geographies. Therefore, it is difficult to ascertain whether this research methodology is being used to its full potential across all orthopedic subspecialties and geographies. Purpose: We sought to assess the distribution of prior health economics literature in orthopedic surgery across subspecialties and geographies. The secondary aim was to identify pertinent methodologic trends that may affect the conclusions drawn. Methods: A systematic review utilizing 3 electronic databases (Medline, Embase, and Web of Science) was performed. Inclusion criteria included prior systematic reviews assessing economic analyses across all orthopedic surgery subspecialities published between 2010 and April 24, 2021. The quality of evidence was assessed using the Assessment of Multiple Systematic Review tool. Data were qualitatively analyzed. Results: In the 44 studies included, arthroplasty (36.4%) and spine (31.8%) were the most represented subspecialties. Almost half of studies originated from the United States (45.5%), followed by the United Kingdom (18.2%). Health economic models were most commonly from the perspective of the health care or hospital system (40.5%), followed by the societal perspective (23.5%), and the payer perspective (14.8%). Conclusions: The study of value in orthopedic surgery is not uniformly leveraged across all subspecialties and geographies. Methodologically, the societal perspective was inadequately represented, despite orthopedic pathologies often incurring significant indirect costs (eg, time off work, rehabilitation expenses).","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135316215","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 : 2023-10-24DOI: 10.1177/15563316231204616
Marc Meyer-Pries, Melika Hajymiri, Theodoros Lytras, Philip Manolopoulos, Dimitrios Ntourakis
Background: Arthroscopy can be used to assist the open reduction internal fixation (ORIF) approach in the treatment of acute ankle fractures. Arthroscopy can also help to assess the articular surface but is performed in only 1% of ankle fracture cases. Purpose: We aimed to investigate (1) whether arthroscopy-assisted ORIF (AORIF) would lead to improved postoperative functional outcomes compared to conventional ORIF and (2) whether differences in postoperative complication rates exist between these 2 techniques. Methods: A systematic review was performed; 2 researchers independently searched the online databases of PubMed, Scopus, Embase, Cochrane, and Google Scholar. All studies that directly investigated the outcomes of AORIF versus conventional ORIF in the treatment of ankle fractures and contained quantitative data were eligible for inclusion. The Cochrane tools for bias assessment were applied independently by 2 researchers. Results: Six articles (2 randomized controlled trials and 4 retrospective cohort studies) were included in this systematic review. The meta-analysis of functional outcome scores resulted in a standardized mean difference of 0.6 (confidence interval [CI]: [0.3, 0.9]) favoring AORIF, after excluding 2 studies due to missing standard deviations. The overall complication rate was similar between the 2 groups, with a pooled odds ratio of 1.1 (CI: [0.4, 3.0]). Conclusion: The findings of this systematic review and meta-analysis suggest that AORIF might improve postoperative outcomes without increasing the complication rate when compared to conventional ORIF. However, due to the inherent clinical heterogeneity of the included studies, further well-designed randomized controlled trials are required.
{"title":"Arthroscopy-Assisted Open Reduction Internal Fixation Versus Conventional Open Reduction Internal Fixation in the Treatment of Ankle Fractures: A Systematic Review With Meta-Analysis","authors":"Marc Meyer-Pries, Melika Hajymiri, Theodoros Lytras, Philip Manolopoulos, Dimitrios Ntourakis","doi":"10.1177/15563316231204616","DOIUrl":"https://doi.org/10.1177/15563316231204616","url":null,"abstract":"Background: Arthroscopy can be used to assist the open reduction internal fixation (ORIF) approach in the treatment of acute ankle fractures. Arthroscopy can also help to assess the articular surface but is performed in only 1% of ankle fracture cases. Purpose: We aimed to investigate (1) whether arthroscopy-assisted ORIF (AORIF) would lead to improved postoperative functional outcomes compared to conventional ORIF and (2) whether differences in postoperative complication rates exist between these 2 techniques. Methods: A systematic review was performed; 2 researchers independently searched the online databases of PubMed, Scopus, Embase, Cochrane, and Google Scholar. All studies that directly investigated the outcomes of AORIF versus conventional ORIF in the treatment of ankle fractures and contained quantitative data were eligible for inclusion. The Cochrane tools for bias assessment were applied independently by 2 researchers. Results: Six articles (2 randomized controlled trials and 4 retrospective cohort studies) were included in this systematic review. The meta-analysis of functional outcome scores resulted in a standardized mean difference of 0.6 (confidence interval [CI]: [0.3, 0.9]) favoring AORIF, after excluding 2 studies due to missing standard deviations. The overall complication rate was similar between the 2 groups, with a pooled odds ratio of 1.1 (CI: [0.4, 3.0]). Conclusion: The findings of this systematic review and meta-analysis suggest that AORIF might improve postoperative outcomes without increasing the complication rate when compared to conventional ORIF. However, due to the inherent clinical heterogeneity of the included studies, further well-designed randomized controlled trials are required.","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135315695","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 : 2023-10-23DOI: 10.1177/15563316231201126
Chengcheng Zhao, Qiuru Wang, Lijun Cai, Liyile Chen, Pengde Kang
Background: There is no consensus on whether adductor canal block (ACB) combined with infiltration between the popliteal artery and capsule of the posterior knee (IPACK) block can further increase analgesia and reduce opioid consumption after total knee arthroplasty (TKA) compared with ACB and periarticular infiltration analgesia (PIA). Purpose: This study aimed to evaluate the effectiveness of combining ACB and PACK block on analgesia and functional recovery following TKA. Methods: A retrospective cohort study was conducted involving 386 patients who underwent primary unilateral TKA at our institution from January 2020 to October 2022. Patients were divided into 3 groups and treated with PIA, ACB, or ACB combined with IPACK block, respectively. Primary outcomes were postoperative morphine consumption and visual analogue scale (VAS) pain scores. Secondary outcomes included functional recovery, evaluated by knee range of motion, quadriceps strength, daily mobilization distance, and postoperative length of stay. Other outcomes included incidence of complications. Results: Patients in the ACB + IPACK group had significantly less morphine consumption on postoperative day 1 and during hospitalization than patients in the PIA and ACB groups. Furthermore, the ACB + IPACK group had significantly lower VAS scores at rest and during motion at 6, 12, and 24 hours postoperatively (but not at other time points), better knee range of motion on postoperative days 1 and 2 (but not day 3), and a greater daily mobilization distance on postoperative day 1 (but not days 2 and 3). The ACB + IPACK group had significantly lower incidences of postoperative nausea and vomiting than the PIA and ACB groups. Conclusion: This retrospective cohort study suggests that a combination of ACB and IPACK block may have a greater effect than PIA or ACB alone on analgesia following TKA, while providing better functional recovery. Further study is warranted.
{"title":"Adductor Canal Block Combined With IPACK Block for Postoperative Analgesia After Total Knee Arthroplasty: A Retrospective Cohort Study","authors":"Chengcheng Zhao, Qiuru Wang, Lijun Cai, Liyile Chen, Pengde Kang","doi":"10.1177/15563316231201126","DOIUrl":"https://doi.org/10.1177/15563316231201126","url":null,"abstract":"Background: There is no consensus on whether adductor canal block (ACB) combined with infiltration between the popliteal artery and capsule of the posterior knee (IPACK) block can further increase analgesia and reduce opioid consumption after total knee arthroplasty (TKA) compared with ACB and periarticular infiltration analgesia (PIA). Purpose: This study aimed to evaluate the effectiveness of combining ACB and PACK block on analgesia and functional recovery following TKA. Methods: A retrospective cohort study was conducted involving 386 patients who underwent primary unilateral TKA at our institution from January 2020 to October 2022. Patients were divided into 3 groups and treated with PIA, ACB, or ACB combined with IPACK block, respectively. Primary outcomes were postoperative morphine consumption and visual analogue scale (VAS) pain scores. Secondary outcomes included functional recovery, evaluated by knee range of motion, quadriceps strength, daily mobilization distance, and postoperative length of stay. Other outcomes included incidence of complications. Results: Patients in the ACB + IPACK group had significantly less morphine consumption on postoperative day 1 and during hospitalization than patients in the PIA and ACB groups. Furthermore, the ACB + IPACK group had significantly lower VAS scores at rest and during motion at 6, 12, and 24 hours postoperatively (but not at other time points), better knee range of motion on postoperative days 1 and 2 (but not day 3), and a greater daily mobilization distance on postoperative day 1 (but not days 2 and 3). The ACB + IPACK group had significantly lower incidences of postoperative nausea and vomiting than the PIA and ACB groups. Conclusion: This retrospective cohort study suggests that a combination of ACB and IPACK block may have a greater effect than PIA or ACB alone on analgesia following TKA, while providing better functional recovery. Further study is warranted.","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135412879","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 : 2023-10-11DOI: 10.1177/15563316231199493
Samuel S. Rudisill, Alexander L. Hornung, Nathan H. Varady, Christian A. Pean, Joseph M. Lane, Troy B. Amen
Background: Hip fractures are common injuries that result in substantial loss of quality of life to elderly patients. To date, no meta-analyses have been performed to consolidate findings related to racial and ethnic disparities in hip fracture care. Purpose: We sought to examine associations between racial or ethnic identity and several metrics of hip fracture care. Methods: For a systematic review and meta-analysis, we searched PubMed, Scopus, CINAHL, and SPORTDiscus databases in December 2021 for articles examining racial and ethnic disparities in hip fracture surgery among White, Black, Hispanic, Asian, Pacific Islander (PI), and American Indian/Alaska Native (AIAN) patients. Twenty-three studies reported time to surgery (TTS), complications, mortality, length of stay (LOS), discharge disposition, readmissions, or reoperations. Meta-analyses were conducted for outcomes for which there were at least 3 comparable studies with requisite data available. Results: Compared with White patients, Black patients experienced greater rates of TTS longer than 2 days, 30-day complication, 90-day readmission, 1-year reoperation, and longer LOS, though odds of 30-day mortality were reduced. Hispanic patients had higher 90-day complication rates and longer LOS but lower risk of mortality and nonhome discharge than other racial and ethnic groups. Time to surgery of longer than 2 days was more common among Asian patients, though mortality, nonhome discharge, and readmission rates were lower. There were higher mortality rates in White patients compared with Hispanic patients at all timepoints and compared with Black patients until 1 year following surgery, when rates were higher among Black patients. Conclusions: This systematic review and meta-analysis found evidence of disparities in hip fracture surgery, with minority patients facing greater rates of surgical delay and perioperative complications. Even though the studies may not have been uniform in defining race or ethnicity or in accounting for the effects of systemic racism, these findings suggest that concerted efforts are needed to understand these gaps and promote equity in hip fracture care.
{"title":"Racial and Ethnic Disparities in Hip Fracture Surgery: A Systematic Review and Meta-Analysis","authors":"Samuel S. Rudisill, Alexander L. Hornung, Nathan H. Varady, Christian A. Pean, Joseph M. Lane, Troy B. Amen","doi":"10.1177/15563316231199493","DOIUrl":"https://doi.org/10.1177/15563316231199493","url":null,"abstract":"Background: Hip fractures are common injuries that result in substantial loss of quality of life to elderly patients. To date, no meta-analyses have been performed to consolidate findings related to racial and ethnic disparities in hip fracture care. Purpose: We sought to examine associations between racial or ethnic identity and several metrics of hip fracture care. Methods: For a systematic review and meta-analysis, we searched PubMed, Scopus, CINAHL, and SPORTDiscus databases in December 2021 for articles examining racial and ethnic disparities in hip fracture surgery among White, Black, Hispanic, Asian, Pacific Islander (PI), and American Indian/Alaska Native (AIAN) patients. Twenty-three studies reported time to surgery (TTS), complications, mortality, length of stay (LOS), discharge disposition, readmissions, or reoperations. Meta-analyses were conducted for outcomes for which there were at least 3 comparable studies with requisite data available. Results: Compared with White patients, Black patients experienced greater rates of TTS longer than 2 days, 30-day complication, 90-day readmission, 1-year reoperation, and longer LOS, though odds of 30-day mortality were reduced. Hispanic patients had higher 90-day complication rates and longer LOS but lower risk of mortality and nonhome discharge than other racial and ethnic groups. Time to surgery of longer than 2 days was more common among Asian patients, though mortality, nonhome discharge, and readmission rates were lower. There were higher mortality rates in White patients compared with Hispanic patients at all timepoints and compared with Black patients until 1 year following surgery, when rates were higher among Black patients. Conclusions: This systematic review and meta-analysis found evidence of disparities in hip fracture surgery, with minority patients facing greater rates of surgical delay and perioperative complications. Even though the studies may not have been uniform in defining race or ethnicity or in accounting for the effects of systemic racism, these findings suggest that concerted efforts are needed to understand these gaps and promote equity in hip fracture care.","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136212320","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 : 2023-09-28DOI: 10.1177/15563316231201335
David H. Kim, Genewoo Hong, Edward Lin, Sang Jo Kim, Jonathan Beathe, Douglas Wetmore, Jiabin Liu
Introduction: Ambulatory hip arthroscopies are associated with moderate-to-severe pain often requiring opioid analgesia. Novel motor-sparing blocks, the pericapsular nerve group (PENG) and lateral femoral cutaneous nerve (LFCN) block, have shown efficacy in hip surgery. Purpose: We sought to investigate the analgesic benefits of these novel blocks in terms of opioid-sparing and discharge efficiency. Methods: We conducted a retrospective cohort study with propensity score matching of 224 patients who underwent ambulatory elective unilateral hip arthroscopy. One group received a combined PENG and LFCN block (PENG/LFCN, n = 86), while a second group received only a PENG block (n = 26). A control group (n = 112) received no blocks. The primary outcome was postanesthesia care unit (PACU) mean opioid consumption. Secondary outcomes were maximum numeric rating scale (NRS) pain score, intravenous rescue analgesia, and PACU readiness-for-discharge times. Results: The PENG/LFCN-block group required significantly less opioids than the control group in the PACU (25.98 ± 13.04 vs 14.58 ± 5.77, respectively) and were discharged earlier 2.72 ± 1.16 vs 4.42 ± 1.63 hours, respectively). The combined PENG/LFCN group also used less intravenous rescue opioids than the control group (0.47 ± 1.18 vs 1.44 ± 2.1 mg, respectively) and showed a significant difference in the highest NRS pain scores than the control group (6.01 ± 2.38 vs 6.77 ± 2.1 respectively). The PENG block alone group did not show a significant difference in opioid reduction (21.95 ± 15.83 vs 27.72 ± 15.01, respectively). Conclusions: This retrospective study found that in patients who underwent ambulatory elective unilateral hip arthroscopy, a combined PENG and LFCN block was associated with expedited PACU discharge and a clinically significant reduction in postoperative opioid use. Further study is warranted.
动态髋关节镜检查与中重度疼痛相关，通常需要阿片类药物镇痛。新型运动保留阻滞，包膜神经组(PENG)和股外侧皮神经(LFCN)阻滞在髋关节手术中显示出疗效。目的:我们试图从阿片类药物节约和放电效率的角度来研究这些新型阻滞的镇痛作用。方法:我们对224例门诊选择性单侧髋关节镜患者进行了倾向评分匹配的回顾性队列研究。一组接受PENG和LFCN联合区块(PENG/LFCN, n = 86)，而第二组仅接受PENG区块(n = 26)。对照组(n = 112)不接受阻滞治疗。主要终点是麻醉后护理单位(PACU)平均阿片类药物消耗量。次要结果是最大数值评定量表(NRS)疼痛评分、静脉救援镇痛和PACU准备出院时间。结果:在PACU中，PENG/ lfn -block组所需阿片类药物明显少于对照组(分别为25.98±13.04 vs 14.58±5.77)，提前出院(分别为2.72±1.16 vs 4.42±1.63小时)。彭/LFCN联合组静脉救援阿片类药物的使用也少于对照组(分别为0.47±1.18 mg vs 1.44±2.1 mg)， NRS疼痛评分最高与对照组(分别为6.01±2.38 mg vs 6.77±2.1 mg)差异有统计学意义。单独使用彭阻滞组在阿片类药物减少方面没有显着差异(分别为21.95±15.83 vs 27.72±15.01)。结论:这项回顾性研究发现，在接受门诊选择性单侧髋关节镜检查的患者中，联合PENG和LFCN阻滞与PACU加速出院和术后阿片类药物使用的临床显著减少有关。值得进一步研究。
{"title":"Combined Pericapsular Nerve Group Block and Intrapelvic Lateral Femoral Cutaneous Nerve Block Is Associated With Decreased Opioid Consumption After Hip Arthroscopy: A Retrospective Cohort Study","authors":"David H. Kim, Genewoo Hong, Edward Lin, Sang Jo Kim, Jonathan Beathe, Douglas Wetmore, Jiabin Liu","doi":"10.1177/15563316231201335","DOIUrl":"https://doi.org/10.1177/15563316231201335","url":null,"abstract":"Introduction: Ambulatory hip arthroscopies are associated with moderate-to-severe pain often requiring opioid analgesia. Novel motor-sparing blocks, the pericapsular nerve group (PENG) and lateral femoral cutaneous nerve (LFCN) block, have shown efficacy in hip surgery. Purpose: We sought to investigate the analgesic benefits of these novel blocks in terms of opioid-sparing and discharge efficiency. Methods: We conducted a retrospective cohort study with propensity score matching of 224 patients who underwent ambulatory elective unilateral hip arthroscopy. One group received a combined PENG and LFCN block (PENG/LFCN, n = 86), while a second group received only a PENG block (n = 26). A control group (n = 112) received no blocks. The primary outcome was postanesthesia care unit (PACU) mean opioid consumption. Secondary outcomes were maximum numeric rating scale (NRS) pain score, intravenous rescue analgesia, and PACU readiness-for-discharge times. Results: The PENG/LFCN-block group required significantly less opioids than the control group in the PACU (25.98 ± 13.04 vs 14.58 ± 5.77, respectively) and were discharged earlier 2.72 ± 1.16 vs 4.42 ± 1.63 hours, respectively). The combined PENG/LFCN group also used less intravenous rescue opioids than the control group (0.47 ± 1.18 vs 1.44 ± 2.1 mg, respectively) and showed a significant difference in the highest NRS pain scores than the control group (6.01 ± 2.38 vs 6.77 ± 2.1 respectively). The PENG block alone group did not show a significant difference in opioid reduction (21.95 ± 15.83 vs 27.72 ± 15.01, respectively). Conclusions: This retrospective study found that in patients who underwent ambulatory elective unilateral hip arthroscopy, a combined PENG and LFCN block was associated with expedited PACU discharge and a clinically significant reduction in postoperative opioid use. Further study is warranted.","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135426142","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 : 2023-09-26DOI: 10.1177/15563316231200496
Varag Abed, Cale Jacobs, Matthew Skinner, Mitchell Owens, Dro Keshishi, Austin V. Stone
Background: The Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) guidelines for mesenchymal stem cell (MSC) research, published in 2017, contain a suggested checklist for reporting items in manuscripts involving MSCs. Purpose: We sought to determine how well randomized controlled trials (RCTs) on MSC intervention for knee osteoarthritis (OA) adhered to the MIBO guidelines. Methods: A comprehensive literature search was performed in the PubMed/MEDLINE and Web of Science databases. Inclusion criteria included English-only RCTs that assessed MSC intervention for knee OA published between 2018 and 2022. Metrics were extracted, including year of publication, study design, first author name, journal name, patient demographics, and MIBO checklist criteria. Results: In 27 RCTs analyzed, 1006 patients were included, with a weighted male percentage of 41.8% and weighted mean age of 60.5 ± 7.2 years. On average, 70.5% (range, 30.2%–90.6%) of the modified 53-point MIBO checklist elements were reported per article. Seven (25.9%) articles had adherence rates of 80% or more, 13 (48.1%) had rates between 60% and 79.9%, and 7 (25.9%) had rates of 59.9% or less. The MIBO “intervention” category had the greatest adherence (100%), while the other categories had more variability. Six (50.0%) categories had an adherence level of 80% or more, 3 (25.0%) had adherence levels of 60% to 79.9%, and 3 (25.0%) had an adherence level of 59.9% or less. Conclusion: The overall mean adherence to MIBO guidelines of RCTs on MSC intervention for knee OA was 70.5%. Authors should better integrate the MIBO guidelines into their methodology to improve transparency, reproducibility, and reporting.
背景:2017年发布的间充质干细胞(MSC)研究的最小信息研究评估(MIBO)指南包含了涉及间充质干细胞的手稿报告项目的建议清单。目的:我们试图确定MSC干预膝关节骨性关节炎(OA)的随机对照试验(rct)是否符合MIBO指南。方法:在PubMed/MEDLINE和Web of Science数据库中进行全面的文献检索。纳入标准包括2018年至2022年间发表的评估MSC干预膝关节OA的全英文随机对照试验。提取指标，包括发表年份、研究设计、第一作者姓名、期刊名称、患者人口统计数据和MIBO检查表标准。结果:27项随机对照试验共纳入1006例患者，加权男性比例为41.8%，加权平均年龄为60.5±7.2岁。平均每篇文章报告了修改后的53点MIBO检查表元素的70.5%(范围30.2%-90.6%)。7篇(25.9%)文章的依从率在80%或以上，13篇(48.1%)的依从率在60%至79.9%之间，7篇(25.9%)的依从率在59.9%或以下。MIBO“干预”类别的依从性最高(100%)，而其他类别的差异更大。6个(50.0%)类别的依从性水平在80%及以上，3个(25.0%)类别的依从性水平在60%至79.9%之间，3个(25.0%)类别的依从性水平在59.9%及以下。结论:mscs干预膝关节OA的随机对照试验中，总体平均遵守MIBO指南的比例为70.5%。作者应该更好地将MIBO指南整合到他们的方法中，以提高透明度、可重复性和报告。
{"title":"How Well Do Studies of Mesenchymal Stem Cell Intervention and Knee Osteoarthritis Adhere to the Minimum Information for Studies Evaluating Biologics Guidelines? A Systematic Review of Randomized Controlled Trials","authors":"Varag Abed, Cale Jacobs, Matthew Skinner, Mitchell Owens, Dro Keshishi, Austin V. Stone","doi":"10.1177/15563316231200496","DOIUrl":"https://doi.org/10.1177/15563316231200496","url":null,"abstract":"Background: The Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) guidelines for mesenchymal stem cell (MSC) research, published in 2017, contain a suggested checklist for reporting items in manuscripts involving MSCs. Purpose: We sought to determine how well randomized controlled trials (RCTs) on MSC intervention for knee osteoarthritis (OA) adhered to the MIBO guidelines. Methods: A comprehensive literature search was performed in the PubMed/MEDLINE and Web of Science databases. Inclusion criteria included English-only RCTs that assessed MSC intervention for knee OA published between 2018 and 2022. Metrics were extracted, including year of publication, study design, first author name, journal name, patient demographics, and MIBO checklist criteria. Results: In 27 RCTs analyzed, 1006 patients were included, with a weighted male percentage of 41.8% and weighted mean age of 60.5 ± 7.2 years. On average, 70.5% (range, 30.2%–90.6%) of the modified 53-point MIBO checklist elements were reported per article. Seven (25.9%) articles had adherence rates of 80% or more, 13 (48.1%) had rates between 60% and 79.9%, and 7 (25.9%) had rates of 59.9% or less. The MIBO “intervention” category had the greatest adherence (100%), while the other categories had more variability. Six (50.0%) categories had an adherence level of 80% or more, 3 (25.0%) had adherence levels of 60% to 79.9%, and 3 (25.0%) had an adherence level of 59.9% or less. Conclusion: The overall mean adherence to MIBO guidelines of RCTs on MSC intervention for knee OA was 70.5%. Authors should better integrate the MIBO guidelines into their methodology to improve transparency, reproducibility, and reporting.","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134957955","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 : 2023-09-26DOI: 10.1177/15563316231201410
Erika L. Cyphert, Shannon Clare, Alexander Dash, Jacob C. Nixon, Joseph Raphael, Jonathan Harrison, Alison Heilbronner, Han Jo Kim, Matthew Cunningham, Darren Lebl, Frank Schwab, Christopher J. Hernandez, Emily M. Stein
Background: The microbiome has been identified as a contributor to bone quality. As skeletal health is critical to success of orthopedic surgery, the gut microbiome may be a modifiable factor associated with postoperative outcomes. For spine fusion surgery in particular, de novo bone formation and sufficient bone mineral density are essential for successful outcomes. Given the prevalence and complexity of these procedures, the identification of novel factors that may be related to operative success is important. Questions/purposes: We sought to investigate how the composition of the microbiota related to bone health in a focused spinal fusion surgery cohort. Methods: We investigated the composition of the microbiome in a cohort of 31 patients prior to spinal fusion surgery, as well as changes in the microbiome over 6 weeks postoperatively. Preoperative areal bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. Results: Composition of gut microbiota differed among spinal fusion patients with low bone mass ( T-score ≤ −1.0) and those with normal BMD ( P = .03). There was no significant change in composition of the gut microbiota between preoperative evaluation and 6 weeks postoperatively. Conclusions: Our findings in this small sample suggest there may be a relationship between BMD and composition of the gut microbiome in patients who undergo spinal fusion surgery. Further work is needed to investigate these relationships as well as potential interventions to foster a favorable microbial composition in spinal fusion surgery patients.
{"title":"A Pilot Study of the Gut Microbiota in Spine Fusion Surgery Patients","authors":"Erika L. Cyphert, Shannon Clare, Alexander Dash, Jacob C. Nixon, Joseph Raphael, Jonathan Harrison, Alison Heilbronner, Han Jo Kim, Matthew Cunningham, Darren Lebl, Frank Schwab, Christopher J. Hernandez, Emily M. Stein","doi":"10.1177/15563316231201410","DOIUrl":"https://doi.org/10.1177/15563316231201410","url":null,"abstract":"Background: The microbiome has been identified as a contributor to bone quality. As skeletal health is critical to success of orthopedic surgery, the gut microbiome may be a modifiable factor associated with postoperative outcomes. For spine fusion surgery in particular, de novo bone formation and sufficient bone mineral density are essential for successful outcomes. Given the prevalence and complexity of these procedures, the identification of novel factors that may be related to operative success is important. Questions/purposes: We sought to investigate how the composition of the microbiota related to bone health in a focused spinal fusion surgery cohort. Methods: We investigated the composition of the microbiome in a cohort of 31 patients prior to spinal fusion surgery, as well as changes in the microbiome over 6 weeks postoperatively. Preoperative areal bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. Results: Composition of gut microbiota differed among spinal fusion patients with low bone mass ( T-score ≤ −1.0) and those with normal BMD ( P = .03). There was no significant change in composition of the gut microbiota between preoperative evaluation and 6 weeks postoperatively. Conclusions: Our findings in this small sample suggest there may be a relationship between BMD and composition of the gut microbiome in patients who undergo spinal fusion surgery. Further work is needed to investigate these relationships as well as potential interventions to foster a favorable microbial composition in spinal fusion surgery patients.","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134957844","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}
{"title":"Osteolytic Schwannoma in an Older Patient With Lumbar Degenerative Disk Disease: A Case Report","authors":"Changjun Chen, Qingwei Ma, Yubin Qi, Yingguang Wu, Jingkun Li, Yanjun Ren, Yun Yang","doi":"10.1177/15563316231200862","DOIUrl":"https://doi.org/10.1177/15563316231200862","url":null,"abstract":"","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135817517","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 : 2023-09-12DOI: 10.1177/15563316231195299
Adam M. Gordon, Bhavya K. Sheth, Charles A. Conway, Andrew R. Horn, Ramin Sadeghpour, Jack Choueka
Background: Social determinants of health are prognostic indicators for patients undergoing orthopedic procedures. Purpose: Using the area deprivation index (ADI), a validated, weighted index of material deprivation and poverty (a 0%-to-100% scale, with higher percentages indicating greater disadvantage), we sought to evaluate whether there are associations in shoulder arthroplasty patients between higher ADI and rates of (1) medical complications, (2) emergency department (ED) utilizations, (3) readmissions, and (4) costs. Methods: We queried the PearlDiver nationwide database for patients who had undergone primary shoulder arthroplasty from 2010 to 2020. Patients from regions associated with high ADI (95%+) were 1:1 propensity matched to a comparison group by age, sex, and Elixhauser Comorbidity Index. This yielded 49,440 patients in total. Outcomes included 90-day complications, ED utilizations, readmissions, and costs. Logistic regression models computed odds ratios (ORs) of ADI on the dependent variables. P values of < .05 were significant. Results: Patients from high ADI regions showed higher rates and odds of complications than those in the comparison group (10.84% vs 9.45%; OR: 1.10), including acute kidney injuries (1.73% vs 1.38%; OR: 1.23), urinary tract infections (3.19% vs 2.80%; OR: 1.13), and respiratory failures (0.49% vs 0.33%; OR: 1.44), but not increased ED visits (2.66% vs 2.71%; OR: 0.99) or readmissions (3.07% vs 2.96%; OR: 1.03). Patients from high ADI regions incurred higher costs on day of surgery ($8251 vs $7337) and at 90 days ($10,999 vs $9752). Conclusions: This 10-year retrospective database study found that patients from high ADI regions undergoing primary shoulder arthroplasty had increased rates of all 90-day medical complications, suggesting that measures of social determinants of health could inform health care policy and improve post-discharge care in these patients.
背景:健康的社会决定因素是骨科手术患者的预后指标。目的:使用面积剥夺指数(ADI)，一种经过验证的物质剥夺和贫困加权指数(从0%到100%的比例，百分比越高表明劣势越大)，我们试图评估肩关节置换术患者较高的面积剥夺指数与(1)医疗并发症、(2)急诊科(ED)使用率、(3)再入院率和(4)成本之间是否存在关联。方法:我们查询了PearlDiver全国数据库中2010年至2020年间接受过原发性肩关节置换术的患者。来自高ADI相关地区(95%以上)的患者按年龄、性别和Elixhauser合并症指数与对照组进行1:1的倾向匹配。总共有49,440名患者。结果包括90天并发症、ED使用率、再入院率和费用。Logistic回归模型计算了因变量上ADI的比值比(ORs)。P值<0.05有显著性差异。结果:高ADI区患者并发症发生率和发生率均高于对照组(10.84% vs 9.45%;OR: 1.10)，包括急性肾损伤(1.73% vs 1.38%;OR: 1.23)，尿路感染(3.19% vs 2.80%;OR: 1.13)和呼吸衰竭(0.49% vs 0.33%;OR: 1.44)，但没有增加急诊科就诊(2.66% vs 2.71%;OR: 0.99)或再入院(3.07% vs 2.96%;或者:1.03)。来自高ADI地区的患者在手术当天(8251美元对7337美元)和90天(10,999美元对9752美元)的费用更高。结论:这项为期10年的回顾性数据库研究发现，来自高ADI地区接受初级肩关节置换术的患者所有90天医疗并发症的发生率增加，这表明健康的社会决定因素可以为医疗保健政策提供信息，并改善这些患者的出院后护理。
{"title":"Neighborhood Deprivation and Association With Medical Complications, Emergency Department Use, and Readmissions in Shoulder Arthroplasty Patients","authors":"Adam M. Gordon, Bhavya K. Sheth, Charles A. Conway, Andrew R. Horn, Ramin Sadeghpour, Jack Choueka","doi":"10.1177/15563316231195299","DOIUrl":"https://doi.org/10.1177/15563316231195299","url":null,"abstract":"Background: Social determinants of health are prognostic indicators for patients undergoing orthopedic procedures. Purpose: Using the area deprivation index (ADI), a validated, weighted index of material deprivation and poverty (a 0%-to-100% scale, with higher percentages indicating greater disadvantage), we sought to evaluate whether there are associations in shoulder arthroplasty patients between higher ADI and rates of (1) medical complications, (2) emergency department (ED) utilizations, (3) readmissions, and (4) costs. Methods: We queried the PearlDiver nationwide database for patients who had undergone primary shoulder arthroplasty from 2010 to 2020. Patients from regions associated with high ADI (95%+) were 1:1 propensity matched to a comparison group by age, sex, and Elixhauser Comorbidity Index. This yielded 49,440 patients in total. Outcomes included 90-day complications, ED utilizations, readmissions, and costs. Logistic regression models computed odds ratios (ORs) of ADI on the dependent variables. P values of < .05 were significant. Results: Patients from high ADI regions showed higher rates and odds of complications than those in the comparison group (10.84% vs 9.45%; OR: 1.10), including acute kidney injuries (1.73% vs 1.38%; OR: 1.23), urinary tract infections (3.19% vs 2.80%; OR: 1.13), and respiratory failures (0.49% vs 0.33%; OR: 1.44), but not increased ED visits (2.66% vs 2.71%; OR: 0.99) or readmissions (3.07% vs 2.96%; OR: 1.03). Patients from high ADI regions incurred higher costs on day of surgery ($8251 vs $7337) and at 90 days ($10,999 vs $9752). Conclusions: This 10-year retrospective database study found that patients from high ADI regions undergoing primary shoulder arthroplasty had increased rates of all 90-day medical complications, suggesting that measures of social determinants of health could inform health care policy and improve post-discharge care in these patients.","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135878225","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}
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