Seminars in Arthroplasty最新文献_第2页

High in-hospital preoperative anxiety levels are not associated with an increased length of stay or readmission following primary shoulder arthroplasty 高度的院内术前焦虑与原发性肩关节置换术后住院时间延长或再入院率增加无关

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-12-01 DOI: 10.1053/j.sart.2024.06.005

Rocio A.L. Crabb MD , Viraj Deshpande BS , Noemi Urquiza BS , Kyle Schoell MD , Sean Guerrero MHA , Edward J. Quilligan BS , Hafiz F. Kassam MD

Background

Anxiety is prevalent in our society, affecting all facets of patients’ lives. There is, however, a paucity of literature exploring how anxiety extends into the orthopedic perioperative setting. We sought to analyze a subset of patients undergoing primary shoulder arthroplasty to determine whether correlations exist between anxiety, patient characteristics, time spent in the hospital, and likelihood of returning to the hospital after discharge.

Methods

After obtaining institutional review board approval, our hospital prospectively identified and approached all patients undergoing total shoulder arthroplasty between February and June of 2023. Patients completed the Visual Analog Scale for Anxiety (VAS-A) and Amsterdam Preoperative Anxiety and Information Scale (APAIS), two validated tools used to assess preoperative anxiety levels and need for information, in the preoperative holding area before surgery. Patient demographics, hospital length of stay (LOS), and 30-day readmission rate were collected and analyzed.

Results

A total of 79 patients were enrolled. Nineteen percent of patients were found to be anxious using the APAIS tool, while 37.7% of patients were found to be anxious using the VAS-A tool. No significant correlation was found between APAIS or VAS-A anxiety scoring and hospital LOS. No significant correlation was found between APAIS or VAS-A anxiety scoring and 30-day readmission rate. A significant correlation was found between APAIS anxiety scoring and body mass index (BMI), as well as VAS-A scoring and BMI. However, no significant correlation was found between BMI and hospital LOS or between BMI and 30-day readmission rate.

Conclusion

Our study did not find a statistically significant correlation between immediate preoperative anxiety levels in patients undergoing shoulder arthroplasty and their length of stay or 30-day readmission rate. We did discover a linear relationship between patient BMI and their preoperative anxiety scores; however, no significant direct correlation was found between a patient’s BMI and their length of stay or their 30-day readmission rate. Our findings suggest that higher levels of preoperative anxiety should not preclude a patient from the benefits of consideration of early discharge planning such as same-day total shoulder replacement.

焦虑在我们的社会中很普遍，影响着患者生活的方方面面。然而，探讨焦虑如何延伸到骨科围手术期环境的文献很少。我们试图分析一组接受原发性肩关节置换术的患者，以确定焦虑、患者特征、住院时间和出院后重返医院的可能性之间是否存在相关性。方法在获得机构审查委员会批准后，我院前瞻性地对所有在2023年2月至6月间接受全肩关节置换术的患者进行筛选和随访。患者在手术前等待区完成视觉焦虑模拟量表（VAS-A）和阿姆斯特丹术前焦虑和信息量表（APAIS），这两种经过验证的工具用于评估术前焦虑水平和信息需求。收集并分析患者人口统计数据、住院时间（LOS）和30天再入院率。结果共纳入79例患者。19%的患者使用APAIS工具被发现焦虑，而37.7%的患者使用VAS-A工具被发现焦虑。APAIS或VAS-A焦虑评分与医院LOS无显著相关。APAIS或VAS-A焦虑评分与30天再入院率无显著相关性。APAIS焦虑评分与体重指数（BMI）、VAS-A评分与BMI之间存在显著相关性。然而，BMI与医院LOS或BMI与30天再入院率之间没有显著相关性。结论：我们的研究没有发现肩关节置换术患者术前焦虑水平与住院时间或30天再入院率之间有统计学意义的相关性。我们确实发现了患者BMI和术前焦虑评分之间的线性关系；然而，没有发现患者的BMI与他们的住院时间或30天再入院率之间有显著的直接相关性。我们的研究结果表明，术前高度焦虑不应妨碍患者考虑提前出院计划，如当天全肩关节置换术。

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引用次数: 0

Male patients experience similar improvement in clinical and functional outcomes despite higher revision rates following reverse shoulder arthroplasty compared to female patients: a systematic review and meta-analysis 一项系统回顾和荟萃分析：尽管与女性患者相比，男性患者在肩关节置换术后的翻修率更高，但在临床和功能结果方面也有类似的改善

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-12-01 DOI: 10.1053/j.sart.2024.07.008

Colton Mowers BS , Divesh Sachdev BS , Derrick M. Knapik MD , Christopher M. Brusalis MD , Benjamin T. Lack BS , Justin T. Childers BS, MS , Devin Q. John MD , Vani J. Sabesan MD , Garrett R. Jackson MD

Background

To compare patient-reported outcomes, range of motion, and rates of revision surgery following primary reverse shoulder arthroplasty (RSA) between male and female patients.

Methods

A systematic review was performed using the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A literature search was performed on January 20, 2024, using the PubMed, Embase, and Scopus library databases for human clinical studies reporting postoperative outcomes and revision rates following RSA between male and female patients. Studies were excluded if patients underwent RSA for proximal humerus fractures. Preoperative and postoperative outcome scores and revision rates were stratified by patient sex and quantitatively compared. The quality of the included studies was assessed using the Methodological Index for Non-Randomized Studies criteria.

Results

Five studies consisting of 3227 male (mean age, 72.2 years; mean follow-up, 29.4 months) and 5649 female (mean age, 72.7 years; mean follow-up, 29.2 months) patients were included. At final follow-up, male and female patients reported similar improvements in postoperative Constant scores (mean difference, −1.63; P = .17), American Shoulder and Elbow Surgeons scores (mean difference, −1.66; P = .26), external rotation (mean difference, −1.82°; P = .17), forward flexion (mean difference, 0.47°; P = .91), and abduction (mean difference, 0.85°; P = .82) when compared to female patients. Revision rates were significantly higher in males when compared to those in females (5.1% vs. 1.9%, respectively; P < .001).

Conclusion

Males undergoing RSA report similar improvement in postoperative patient-reported outcomes and range of motion values at a mean final follow-up of 29.4 months when compared to females with a mean final follow-up of 29.2 months. However, revision rates were significantly higher in males.

研究背景：比较男性和女性初次肩关节置换术（RSA）后患者报告的结果、活动范围和翻修手术率。方法采用2020年系统评价和荟萃分析指南首选报告项目进行系统评价。文献检索于2024年1月20日进行，使用PubMed， Embase和Scopus数据库进行人类临床研究，报告男性和女性患者RSA术后结果和翻修率。如果患者因肱骨近端骨折而行RSA手术，则排除研究。术前和术后结果评分和翻修率按患者性别分层并进行定量比较。纳入研究的质量采用非随机研究的方法学指数标准进行评估。结果5项研究共纳入3227名男性(平均年龄72.2岁；平均随访29.4个月)，女性5649人(平均年龄72.7岁；平均随访29.2个月)。在最后的随访中，男性和女性患者报告术后常数评分的改善相似(平均差为- 1.63；P = .17)，美国肩肘外科医生评分(平均差值为- 1.66；P = 0.26)，外旋(平均差为- 1.82°；P = 0.17)，前屈(平均差0.47°；P = 0.91)，外展(平均差0.85°；P = .82)。与女性相比，男性的复习率明显更高(分别为5.1%对1.9%；P & lt;措施)。结论：在平均29.4个月的最终随访中，与女性平均29.2个月的最终随访相比，接受RSA的男性在术后患者报告的结果和活动范围值方面有相似的改善。然而，男性的修改率明显更高。

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引用次数: 0

Readability of English and Spanish online patient education materials for shoulder arthroplasty 肩关节置换术英语和西班牙语在线患者教育材料的可读性

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-12-01 DOI: 10.1053/j.sart.2024.07.002

Jacob S. Ghahremani BA , Jenna E. Ogi BS , Michael T. Kody MD , Ronald A. Navarro MD

Background

Online patient educational materials (OPEMs) are a vital source of information for those undergoing shoulder arthroplasty, though their utility is limited by patient health literacy as the average American reads at an eighth-grade level. To promote optimal reading comprehension, the American Medical Association and National Institutes of Health recommend that OPEMs be written at or below a sixth-grade level. The purpose of this study is to analyze the readability of English and Spanish shoulder arthroplasty OPEMs.

Methods

Google Search was used to identify the first 25 eligible Shoulder Arthroplasty OPEMs in both English and Spanish using the search terms “shoulder replacement” and “reemplazo de hombro.” Readability of the English OPEMs was calculated using the Flesch-Kincaid Grade Level, Flesch Reading Ease Index (FRE), Flesch Reading Ease Grade Level, Gunning-Fog Index, Coleman-Liau Index, and Simple Measure of Gobbledygook Index. The readability of Spanish OPEMs was calculated using the Fernandez-Huerta Index (FHI; the Spanish version of FRE), Fernandez-Huerta Index Grade Level, Gutiérrez de Polini's Fórmula de compresibilidad, and Índice Flesch-Szigriszt.

Results

The mean FHI of Spanish OPEMs was significantly higher than the mean FRE of English OPEMs (60.09 vs. 51.48). As such, Spanish OPEMs were written at a significantly lower grade level than English OPEMs (9.70 vs. 11.53). There was not an English or Spanish OPEM that was written at or below a sixth-grade reading level. 4% of Spanish OPEMs and 4% of English OPEMs were written below an eighth-grade reading level. 52% of Spanish OPEMs and 8% of English OPEMs were written between an eighth- and ninth-grade reading level. The designation of OPEMs as being Very Easy/Easy, Standard/Normal, Fairly/Somewhat Difficult, or Difficult/Very Difficult was significantly dependent on whether the OPEM was written in English or Spanish.

Discussion and conclusion

English shoulder arthroplasty OPEMs were written at a higher reading difficulty than Spanish OPEMs. However, neither English nor Spanish OPEMs were written at a reading level at or below the recommended sixth-grade reading level. As older adults and those in the United States with limited English proficiency are susceptible to low health literacy, OPEMs must be written at an accessible reading level for all. Addressing these disparities in OPEM readability will improve patient care and understanding of shoulder arthroplasty and other orthopedic procedures.

背景：在线患者教育材料（OPEMs）是接受肩关节置换术患者的重要信息来源，尽管其效用受到患者健康素养的限制，因为美国人的平均阅读水平为八年级。为了促进最佳的阅读理解，美国医学协会和国立卫生研究院建议，opem的写作水平应达到或低于六年级的水平。本研究的目的是分析英语和西班牙语肩关节置换术OPEMs的可读性。方法通过搜索“肩关节置换”和“reemplazo de hombro”，用英语和西班牙语进行谷歌搜索，确定前25例符合条件的肩关节置换OPEMs。采用Flesch- kincaid等级、Flesch阅读轻松指数（FRE）、Flesch阅读轻松等级、Gunning-Fog指数、Coleman-Liau指数和简单测量的Gobbledygook指数来计算英文OPEMs的可读性。西班牙语OPEMs的可读性采用Fernandez-Huerta指数(FHI；（西班牙语版的FRE）， Fernandez-Huerta指数等级水平，gutimacimrez de Polini的Fórmula de compressibidad和Índice Flesch-Szigriszt。结果西班牙语OPEMs的平均FHI显著高于英语OPEMs的平均FRE（60.09比51.48）。因此，西班牙语OPEMs的年级水平明显低于英语OPEMs（9.70比11.53）。没有一份英语或西班牙语的OPEM达到或低于六年级的阅读水平。4%的西班牙语opem和4%的英语opem低于八年级的阅读水平。52%的西班牙语opem和8%的英语opem是在八年级到九年级的阅读水平之间完成的。OPEM的名称是非常容易/容易，标准/正常，相当困难/有点困难，或困难/非常困难，这在很大程度上取决于OPEM是用英语还是西班牙语编写的。讨论与结论英文肩关节置换术OPEMs的阅读难度高于西班牙文OPEMs。然而，英语和西班牙语的OPEMs的阅读水平都没有达到或低于六年级推荐阅读水平。由于美国的老年人和英语水平有限的人容易受到低健康素养的影响，opem必须以所有人都能阅读的水平编写。解决OPEM可读性的这些差异将改善患者的护理和对肩关节置换术和其他骨科手术的理解。

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引用次数: 0

Fibromyalgia syndrome is an independent predictor of increased complications, revision, and cost of admission within 180 days of total shoulder arthroplasty 纤维肌痛综合征是全肩关节置换术后180天内并发症、翻修和住院费用增加的独立预测因子

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-12-01 DOI: 10.1053/j.sart.2024.07.009

John W. Moore BS , Alexander S. Guareschi MD , Brandon L. Rogalski MD , Josef K. Eichinger MD , Richard J. Friedman MD, FRCSC

Background

Fibromyalgia syndrome (FMS) frequently afflicts patients undergoing total shoulder arthroplasty (TSA), yet research investigating the effects of FMS on postoperative outcomes following TSA is lacking. The purpose of this study is to determine if patients with FMS are at increased risk for complications, readmission, revision, and mortality following primary elective TSA compared to a matched cohort of patients without FMS.

Methods

The Nationwide Readmissions Database was queried from 2016 to 2020 to identify patients who underwent elective primary TSA. Patients were stratified into two groups based on the presence of preoperative FMS. Patients with FMS were matched 1:1 based on age, sex, and Charlson-Deyo Comorbidity Index using an optimized matching algorithm to patients without FMS to generate an equal sized control group for statistical comparison. 5506 matched pairs of patients with and without FMS were identified and used for statistical analysis. Preoperative demographic and comorbidity data, postoperative outcomes, and economic and hospital metrics were compared between the two groups. Multivariate analysis was conducted to control for the influence of independent risk factors other than FMS on postoperative outcomes.

Results

Patients with FMS were more likely to be active smokers (P < .001) and have chronic kidney disease (P < .001) prior to surgery. Patients with FMS exhibited increased rates of complications, including requiring a transfusion (P = .002), acute respiratory distress syndrome (P < .001), surgical site infection (P < .001), dislocation (P < .001), prosthetic loosening (P < .001), and fracture (P < .001) compared to patients without FMS. Patients with FMS also exhibited higher rates of all-cause complications (P < .001) and revision TSA (P < .001) and decreased rates of readmission (P = .002) within 180 days of surgery. Mean cost of admission was found to be $1639 higher in patients with FMS (P < .001), despite no difference in total hospital length of stay or discharge disposition.

Conclusion

Patients with FMS are more likely to develop medical and surgical complications following primary TSA. Though associated with multiple comorbidities, FMS is an independent predictor of several adverse events. Orthopedic surgeons should be aware of the increased risk of FMS on TSA when determining treatment plans.

背景：纤维肌痛综合征（FMS）经常困扰全肩关节置换术（TSA）患者，但关于纤维肌痛综合征对TSA术后预后影响的研究尚缺乏。本研究的目的是确定与没有FMS的匹配队列患者相比，FMS患者在原发性选择性TSA后并发症、再入院、修正和死亡率的风险是否增加。方法查询2016年至2020年全国再入院数据库，以确定择期原发性TSA患者。根据术前FMS的存在将患者分为两组。根据年龄、性别、Charlson-Deyo合并症指数对FMS患者进行1:1匹配，采用优化后的匹配算法与非FMS患者进行匹配，形成同等规模的对照组进行统计学比较。5506对配对的FMS患者和非FMS患者进行统计分析。比较两组患者术前人口学和合并症数据、术后结果、经济指标和医院指标。通过多因素分析控制FMS以外的独立危险因素对术后预后的影响。结果FMS患者多为活跃吸烟者(P <；.001)和有慢性肾脏疾病(P <；.001)。FMS患者的并发症发生率增加，包括需要输血（P = 0.002）、急性呼吸窘迫综合征(P <；.001)，手术部位感染(P <；.001)，位错(P <；.001)，假体松动(P <；.001)，骨折(P <；.001)。FMS患者也表现出更高的全因并发症发生率(P <；.001)和修订TSA (P <；.001)，手术180天内再入院率降低（P = .002）。FMS患者的平均住院费用高出1639美元(P <；.001)，尽管在总住院时间或出院处置方面没有差异。结论原发性TSA后，FMS患者更容易出现内科和外科并发症。虽然与多种合并症有关，但FMS是几种不良事件的独立预测因子。在确定治疗方案时，骨科医生应该意识到FMS对TSA的风险增加。

{"title":"Fibromyalgia syndrome is an independent predictor of increased complications, revision, and cost of admission within 180 days of total shoulder arthroplasty","authors":"John W. Moore BS , Alexander S. Guareschi MD , Brandon L. Rogalski MD , Josef K. Eichinger MD , Richard J. Friedman MD, FRCSC","doi":"10.1053/j.sart.2024.07.009","DOIUrl":"10.1053/j.sart.2024.07.009","url":null,"abstract":"<div><h3>Background</h3><div>Fibromyalgia syndrome (FMS) frequently afflicts patients undergoing total shoulder arthroplasty (TSA), yet research investigating the effects of FMS on postoperative outcomes following TSA is lacking. The purpose of this study is to determine if patients with FMS are at increased risk for complications, readmission, revision, and mortality following primary elective TSA compared to a matched cohort of patients without FMS.</div></div><div><h3>Methods</h3><div>The Nationwide Readmissions Database was queried from 2016 to 2020 to identify patients who underwent elective primary TSA. Patients were stratified into two groups based on the presence of preoperative FMS. Patients with FMS were matched 1:1 based on age, sex, and Charlson-Deyo Comorbidity Index using an optimized matching algorithm to patients without FMS to generate an equal sized control group for statistical comparison. 5506 matched pairs of patients with and without FMS were identified and used for statistical analysis. Preoperative demographic and comorbidity data, postoperative outcomes, and economic and hospital metrics were compared between the two groups. Multivariate analysis was conducted to control for the influence of independent risk factors other than FMS on postoperative outcomes.</div></div><div><h3>Results</h3><div>Patients with FMS were more likely to be active smokers (<em>P</em> < .001) and have chronic kidney disease (<em>P</em> < .001) prior to surgery. Patients with FMS exhibited increased rates of complications, including requiring a transfusion (<em>P</em> = .002), acute respiratory distress syndrome (<em>P</em> < .001), surgical site infection (<em>P</em> < .001), dislocation (<em>P</em> < .001), prosthetic loosening (<em>P</em> < .001), and fracture (<em>P</em> < .001) compared to patients without FMS. Patients with FMS also exhibited higher rates of all-cause complications (<em>P</em> < .001) and revision TSA (<em>P</em> < .001) and decreased rates of readmission (<em>P</em> = .002) within 180 days of surgery. Mean cost of admission was found to be $1639 higher in patients with FMS (<em>P</em> < .001), despite no difference in total hospital length of stay or discharge disposition.</div></div><div><h3>Conclusion</h3><div>Patients with FMS are more likely to develop medical and surgical complications following primary TSA. Though associated with multiple comorbidities, FMS is an independent predictor of several adverse events. Orthopedic surgeons should be aware of the increased risk of FMS on TSA when determining treatment plans.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 936-942"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The impact of nutritional status on revision total shoulder arthroplasty: perioperative outcomes and complications 营养状况对翻修全肩关节置换术的影响：围手术期结果和并发症

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-12-01 DOI: 10.1053/j.sart.2024.06.002

Skye Jacobson BS, Jacqueline G. Tobin MS, Lawrence C. Vanderham MS, PA, Nikhil Vallabhaneni BS, Alexander S. Guareschi BS, William R. Barfield PhD, Josef K. Eichinger MD, Richard J. Friedman MD, FRCSC

Background

As the prevalence of primary total shoulder arthoplasty (TSA) increases in the United States so does the number of revision TSA. Those undergoing primary TSA with lower nutritional status have been shown to have worse outcomes; however, little knowledge exists regarding the effects of malnutrition on outcomes following revision TSA. The purpose of this study is to determine the clinical outcomes and complication rates following revision TSA, as well as the prevalence of diabetes mellitus (DM) in malnourished patients undergoing revision TSA.

Methods

The American College of Surgeons National Surgical Quality Improvement Program Database was queried from 2013 to 2020 and found 783 cases of revision TSA. Albumin was used as a surrogate marker for nutritional status. Patients were stratified into unmatched cohorts of normal (albumin ≥ 3.5 g/dL, n = 700) and low (albumin < 3.5 g/dL, n = 83) nutritional status, as well as by diagnosis of DM. Comparative differences in demographics, comorbidities, length of stay (LOS), readmission, reoperation, and 30-day postoperative complications related to their nutritional status and presence of DM were analyzed using chi-squared tests, independent sample t tests, and multivariate analysis on SPSS.

Results

Patients within the low albumin cohort were more likely to be female (P = .008), increased mean age (P = .018), on dialysis (P = .002), had undergone an emergency procedure (P < .001), classified with a dependent functional status (P < .001), and had a higher American Society of Anesthesiologists classification (P < .001). There was a higher percentage of patients with a DM diagnosis and hypoalbuminemia compared to nondiabetic patients (36.2% vs. 19.4%, P < .001). Compared to the normal albumin cohort, the low albumin cohort was found to have significantly longer LOS (P = .025), increased bleeding/transfusion complications (8.4% vs. 3.3%, P = .021), and increased reoperation rate (8.4% vs. 0.71%, P = .034). No significant difference in readmission was found (P = .226).

Conclusion

Eleven percentage of patients undergoing revision TSA were malnourished and had higher LOS and reoperation rates. Patients with DM had a significantly higher incidence of being malnourished than those without DM. Malnourishment represents a potential modifiable risk factor for patients undergoing revision TSA, and surgeons should screen patients preoperatively, especially those patients with DM.

背景：随着原发性全肩关节置换术（TSA）在美国的普及，TSA翻修术的数量也在增加。营养状况较差的初级TSA患者的预后较差；然而，关于营养不良对修订后TSA结果的影响，目前知之甚少。本研究的目的是确定改良TSA后的临床结果和并发症发生率，以及营养不良患者接受改良TSA后糖尿病（DM）的患病率。方法查询2013 - 2020年美国外科医师学会国家手术质量改进项目数据库，收集783例TSA改版病例。白蛋白被用作营养状况的替代标记物。患者被分为正常（白蛋白≥3.5 g/dL, n = 700）和低(白蛋白<；3.5 g/dL, n = 83)营养状况，以及DM的诊断。统计学、合并症、住院时间（LOS）、再入院、再手术、术后30天并发症与营养状况和DM相关的比较差异采用卡方检验、独立样本t检验和SPSS多因素分析。结果低白蛋白组患者多为女性（P = 0.008）、平均年龄增加（P = 0.018）、正在透析（P = 0.002）、接受过急诊手术(P <；.001)，分类为依赖功能状态(P <；.001)，且具有较高的美国麻醉医师学会分级(P <；措施)。与非糖尿病患者相比，糖尿病诊断和低白蛋白血症患者的比例更高(36.2% vs. 19.4%, P <；措施)。与白蛋白正常组相比，低白蛋白组的LOS明显延长（P = 0.025），出血/输血并发症明显增加（8.4%比3.3%,P = 0.021），再手术率明显增加（8.4%比0.71%,P = 0.034）。两组再入院率无显著差异（P = 0.226）。结论接受改良TSA的患者中有11%营养不良，有较高的LOS和再手术率。糖尿病患者的营养不良发生率明显高于非糖尿病患者。对于接受TSA改良的患者，营养不良是一个潜在的可改变的危险因素，外科医生应在手术前筛查患者，特别是糖尿病患者。

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引用次数: 0

Reaching MCID, SCB, and PASS for ASES, SANE, SST, and VAS following shoulder arthroplasty does not correlate with patient satisfaction 肩关节置换术后的 ASES、SANE、SST 和 VAS 指标达到 MCID、SCB 和 PASS 与患者满意度无关

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-12-01 DOI: 10.1053/j.sart.2024.03.017

Adam Z. Khan MD , Alayna Vaughan MD , Zachary S. Aman BS , Mark D. Lazarus MD , Gerald R. Williams MD , Surena Namdari MD

Background

Minimally clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) have been established in the literature to gauge shoulder arthroplasty treatment effectiveness. These metrics are established based on anchoring questions that do not account for a patient’s satisfaction with their surgical outcome. This study evaluates if reaching MCID, SCB, or PASS values for American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), Simple Shoulder Test (SST), and visual analog scale (VAS) at 2 years following shoulder arthroplasty correlates with overall patient satisfaction.

Methods

This was a single-institution, retrospective, cohort study of all patients who underwent shoulder replacement from 2015 to 2019. Preoperative and 2-year postoperative ASES, SANE, SST, and VAS scores were recorded. Previously established MCID, SCB, and PASS values were used. Patients were contacted and underwent a survey to assess: (1) on a scale of 1 to 10, what is your overall satisfaction with your surgical outcome? (2) if you could go back in time, would you undergo this operation again? (yes/no); and (3) for the same condition, would you recommend this operation to a friend or family member? (yes/no). Spearman correlation coefficients were run to assess the relationship between reaching MCID, SCB, or PASS and the 3 outcome metrics above.

Results

Three hundred fifty two patients were included. Mean preoperative ASES was 42.2 ± 16.4, SANE was 35.5 ± 18.9, SST was 4.5 ± 2.6, and VAS was 5.3 ± 2.4. Mean 2-year ASES was 87.8 ± 16.0, SANE was 87.1 ± 15.7, SST was 9.8 ± 2.4, and VAS was 0.9 ± 1.8. Mean patient satisfaction was 9.0 ± 2.0, 331 (94.0%) patients would undergo surgery again, and 330 (93.8%) patients would recommend surgery. Spearman correlation coefficients were weak or very weak for reaching MCID, SCB, and PASS in ASES, SANE, SST, and VAS and all 3 study outcome metrics.

Discussion

Patient overall satisfaction is one of many considerations when indicating a patient for shoulder replacement and evaluating their ultimate long-term outcome. Reaching MCID, SCB, and PASS in ASES, SANE, SST, and VAS following shoulder arthroplasty did not correlate with a patient’s overall satisfaction, willingness to undergo surgery again, or willingness to recommend surgery to a friend or family member. Further investigation into the reliability and clinical value of currently defined MCID, SCB, and PASS metrics is needed.

文献中已经建立了最小临床重要差异（MCID）、实际临床获益（SCB）和患者可接受症状状态（PASS）来衡量肩关节置换术的治疗效果。这些指标是建立在锚定问题的基础上，不考虑患者对手术结果的满意度。本研究评估美国肩关节外科医生（ASES）、单一评估数值评估（SANE）、简单肩关节测试（SST）和视觉模拟量表（VAS）在肩关节置换术后2年达到MCID、SCB或PASS值是否与患者总体满意度相关。方法：这是一项单机构、回顾性、队列研究，纳入了2015年至2019年所有接受肩关节置换术的患者。记录术前和术后2年的as、SANE、SST和VAS评分。使用先前确定的MCID、SCB和PASS值。患者被联系并接受了一项调查，以评估：(1)在1到10的范围内，您对手术结果的总体满意度是多少？如果你能回到过去，你会再做一次手术吗？(是/否);(3)对于同样的情况，你会向朋友或家人推荐这个手术吗？(是/否)。使用Spearman相关系数来评估达到MCID、SCB或PASS与上述3个结果指标之间的关系。结果共纳入352例患者。术前平均ase为42.2±16.4，SANE为35.5±18.9，SST为4.5±2.6，VAS为5.3±2.4。平均2年as为87.8±16.0，SANE为87.1±15.7，SST为9.8±2.4，VAS为0.9±1.8。患者平均满意度为9.0±2.0,331例（94.0%）患者会再次手术，330例（93.8%）患者会推荐手术。在as、SANE、SST和VAS及所有3个研究结果指标中，达到MCID、SCB和PASS的Spearman相关系数较弱或非常弱。患者总体满意度是建议患者进行肩关节置换术和评估其最终长期预后的众多考虑因素之一。肩关节置换术后在as、SANE、SST和VAS中达到MCID、SCB和PASS与患者的总体满意度、再次接受手术的意愿或向朋友或家人推荐手术的意愿无关。需要进一步研究目前定义的MCID、SCB和PASS指标的可靠性和临床价值。

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引用次数: 0

Comparing comorbidity burden between patients undergoing ambulatory rotator cuff repair vs. inpatient anatomic total shoulder arthroplasty 比较非住院肩袖修复术与住院解剖型全肩关节置换术患者的并发症负担

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-12-01 DOI: 10.1053/j.sart.2024.03.004

Zoe W. Hinton MD, Colleen W. Wixted MBA, Kevin A. Wu BS, John Atwater BS, Daniel E. Goltz MD, MBA, John R. Wickman MD, MBA, Jay M. Levin MD, MBA, Joshua K. Helmkamp MD, Tally E. Lassiter MD, MHA, Christopher S. Klifto MD, Oke A. Anakwenze MD, MBA

Background

Rotator cuff repair (RCR) patients routinely undergo same-day discharge in an ambulatory setting, while anatomic total shoulder arthroplasty (TSA) cases have historically been performed in an inpatient hospital setting. For healthier patients, however, TSA has increasingly transitioned to same-day discharge. Understanding whether a true difference in comorbidity burden exists between these patient groups would inform the appropriateness of outpatient TSA in an ambulatory setting.

Methods

A retrospective review was performed of patients undergoing primary TSA and same-day, ambulatory RCR performed between September 2017 and May 2021 at a single institution by 3 fellowship-trained orthopedic surgeons. Selected sociodemographic factors and the Elixhauser Comorbidity Index (30 variables) were used to summarize and compare comorbidity burden. Only patients >50 year old were included. Chi-square and Kruskal-Wallis testing was used to compare the prevalence or severity for categorical and continuous variables, respectively.

Results

1433 cases met inclusion criteria, including 146 (34%) primary inpatient TSAs and 287 (66%) ambulatory RCRs. There were few differences in comorbidity burden between TSA and RCR, with TSA having a significantly higher prevalence for only 4 Elixhauser comorbidities and RCR having a higher prevalence of 1 comorbidity, although none survive a Bonferroni correction. TSA patients had a significantly higher prevalence of uncomplicated (P = .04192) and complicated hypertension (P = .0336), chronic pulmonary disease (P = .0045), and cardiac arrhythmia (P = .0031). The prevalence of diabetes (P = .029758) was significantly higher among RCR patients. Additionally, age (P = .011) was significantly higher among TSA patients. Of the TSA cohort, there were 10 incidences (1%) of 90-day readmission whereas there were 14 incidences (5%) of 90-day readmissions after RCR.

Conclusion

Overall, few differences in the prevalence of individual comorbidities (and sociodemographic parameters) existed between patients undergoing outpatient RCR and inpatient primary anatomic TSA. Comorbidities with larger differences can be either optimized preoperatively or managed chronically, and given these similarities, TSA may be similarly appropriate for ambulatory settings, particularly as efficiencies in operative time and improvements in regional anesthesia continue to evolve.

背景：肩袖修复术（RCR）患者通常在门诊进行当天出院，而解剖性全肩关节置换术（TSA）患者历来在住院医院进行。然而，对于健康的患者，TSA越来越多地过渡到当天出院。了解这些患者组之间合病负担是否存在真正的差异，将为门诊TSA在门诊环境中的适宜性提供信息。方法回顾性分析2017年9月至2021年5月在同一机构由3名接受过奖学金培训的骨科医生进行的初级TSA和当日门诊RCR的患者。选取社会人口学因素和Elixhauser共病指数（共30个变量）对共病负担进行总结和比较。仅包括50岁的患者。卡方检验和Kruskal-Wallis检验分别用于比较分类变量和连续变量的患病率或严重程度。结果1433例符合纳入标准，其中住院患者tsa 146例（34%），门诊rcr 287例（66%）。TSA和RCR之间的合并症负担差异不大，TSA只有4种Elixhauser合并症的患病率明显更高，而RCR有1种合并症的患病率更高，尽管没有人在Bonferroni校正后存活下来。TSA患者无并发症（P = 0.04192）、合并高血压（P = 0.0336）、慢性肺部疾病（P = 0.0045）和心律失常（P = 0.0031）的患病率均显著高于TSA患者。RCR患者的糖尿病患病率（P = 0.029758）显著高于RCR患者。此外，TSA患者的年龄（P = 0.011）明显高于TSA患者。在TSA队列中，RCR后90天再入院发生率为10例（1%），而90天再入院发生率为14例（5%）。结论总体而言，门诊RCR患者和住院原发性解剖性TSA患者的个体合并症患病率（和社会人口学参数）差异不大。差异较大的合并症可以术前优化或长期管理，鉴于这些相似之处，TSA可能同样适用于门诊环境，特别是随着手术时间的效率和区域麻醉的改进不断发展。

{"title":"Comparing comorbidity burden between patients undergoing ambulatory rotator cuff repair vs. inpatient anatomic total shoulder arthroplasty","authors":"Zoe W. Hinton MD, Colleen W. Wixted MBA, Kevin A. Wu BS, John Atwater BS, Daniel E. Goltz MD, MBA, John R. Wickman MD, MBA, Jay M. Levin MD, MBA, Joshua K. Helmkamp MD, Tally E. Lassiter MD, MHA, Christopher S. Klifto MD, Oke A. Anakwenze MD, MBA","doi":"10.1053/j.sart.2024.03.004","DOIUrl":"10.1053/j.sart.2024.03.004","url":null,"abstract":"<div><h3>Background</h3><div>Rotator cuff repair (RCR) patients routinely undergo same-day discharge in an ambulatory setting, while anatomic total shoulder arthroplasty (TSA) cases have historically been performed in an inpatient hospital setting. For healthier patients, however, TSA has increasingly transitioned to same-day discharge. Understanding whether a true difference in comorbidity burden exists between these patient groups would inform the appropriateness of outpatient TSA in an ambulatory setting.</div></div><div><h3>Methods</h3><div>A retrospective review was performed of patients undergoing primary TSA and same-day, ambulatory RCR performed between September 2017 and May 2021 at a single institution by 3 fellowship-trained orthopedic surgeons. Selected sociodemographic factors and the Elixhauser Comorbidity Index (30 variables) were used to summarize and compare comorbidity burden. Only patients >50 year old were included. Chi-square and Kruskal-Wallis testing was used to compare the prevalence or severity for categorical and continuous variables, respectively.</div></div><div><h3>Results</h3><div>1433 cases met inclusion criteria, including 146 (34%) primary inpatient TSAs and 287 (66%) ambulatory RCRs. There were few differences in comorbidity burden between TSA and RCR, with TSA having a significantly higher prevalence for only 4 Elixhauser comorbidities and RCR having a higher prevalence of 1 comorbidity, although none survive a Bonferroni correction. TSA patients had a significantly higher prevalence of uncomplicated (<em>P</em> = .04192) and complicated hypertension (<em>P</em> = .0336), chronic pulmonary disease (<em>P</em> = .0045), and cardiac arrhythmia (<em>P</em> = .0031). The prevalence of diabetes (<em>P</em> = .029758) was significantly higher among RCR patients. Additionally, age (<em>P</em> = .011) was significantly higher among TSA patients. Of the TSA cohort, there were 10 incidences (1%) of 90-day readmission whereas there were 14 incidences (5%) of 90-day readmissions after RCR.</div></div><div><h3>Conclusion</h3><div>Overall, few differences in the prevalence of individual comorbidities (and sociodemographic parameters) existed between patients undergoing outpatient RCR and inpatient primary anatomic TSA. Comorbidities with larger differences can be either optimized preoperatively or managed chronically, and given these similarities, TSA may be similarly appropriate for ambulatory settings, particularly as efficiencies in operative time and improvements in regional anesthesia continue to evolve.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 813-818"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140786950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Morphometry of the proximal humerus and the relationship to global offset 肱骨近端形态测量及其与全球偏移的关系

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-12-01 DOI: 10.1053/j.sart.2024.07.005

John J. Heifner MD , Gabriel Pertierra MD , Austin T. Vegas DO , Robert J. Rowland DO , Deana M. Mercer MD , Jorge L. Orbay MD

Background

Previous research has consistently identified the medial and posterior offset of the native humeral head in relation to the intramedullary canal. These anatomic parameters and others such as humeral head and intramedullary diameter provide valuable insight for prosthesis development. However, it is critical to understand the relationship of morphometry to the native center of rotation. Our objective was to use 3-dimensional analysis to demonstrate the native morphometry of the proximal humerus and those relationships to global offset.

Methods

Fourteen cadaveric humeri were manually measured then digitally analyzed following 3-dimensional scanning. Pearson’s r was used to determine the relationship between variables.

Results

The mean digital humeral head diameter (Hd^d) was 46.5 (± 4.67) mm and the mean manual humeral head diameter was 46.8 (± 4.42) mm. The mean global offset (GO) was 6.36 (± 2.21) mm, and the mean best fit sphere diameter was 46.5 (± 4.63) mm. Pearson’s r = 0.58 (95% confidence interval 0.07-0.84, P = .021) for GO and Hd^d which indicates a moderate correlation. Pearson’s r = 0.96 (95% confidence interval 0.89-0.99, P < .001) for Hd^d and manual humeral head diameter which indicates a strong correlation.

Discussion

Native GO demonstrated a moderately positive correlation to humeral head diameter. The manual measurement of head diameter was strongly correlated to the 3-dimensional software value which reinforces the importance of intraoperative measurement. These data contribute to further understanding of shoulder morphometry which is integral to prosthesis design which impacts postoperative function and complications.

背景：先前的研究一致地确定了与髓内管有关的固有肱骨头的内侧和后部偏置。这些解剖参数和其他如肱骨头和髓内直径为假体的发育提供了有价值的见解。然而，了解形态测量与天然旋转中心的关系至关重要。我们的目的是使用三维分析来证明肱骨近端原生形态及其与全球偏移的关系。方法对14具尸体肱骨进行手工测量，三维扫描后进行数字分析。Pearson’s r用于确定变量之间的关系。结果数字肱骨头平均直径（Hdd）为46.5（±4.67）mm，手肱骨头平均直径为46.8（±4.42）mm，平均整体偏置（GO）为6.36（±2.21）mm，平均最佳拟合球直径为46.5（±4.63）mm， GO与Hdd的Pearson’s r = 0.58(95%可信区间0.07-0.84,P = 0.021)，相关性中等。皮尔逊r = 0.96(95%置信区间0.89-0.99,P <；.001)的Hdd和手肱头直径，这表明强相关性。原生氧化石墨烯显示与肱骨头直径中度正相关。手工测量头径与三维软件值密切相关，强化了术中测量的重要性。这些数据有助于进一步了解肩关节形态测量学，这对于影响术后功能和并发症的假体设计是不可或缺的。

{"title":"Morphometry of the proximal humerus and the relationship to global offset","authors":"John J. Heifner MD , Gabriel Pertierra MD , Austin T. Vegas DO , Robert J. Rowland DO , Deana M. Mercer MD , Jorge L. Orbay MD","doi":"10.1053/j.sart.2024.07.005","DOIUrl":"10.1053/j.sart.2024.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Previous research has consistently identified the medial and posterior offset of the native humeral head in relation to the intramedullary canal. These anatomic parameters and others such as humeral head and intramedullary diameter provide valuable insight for prosthesis development. However, it is critical to understand the relationship of morphometry to the native center of rotation. Our objective was to use 3-dimensional analysis to demonstrate the native morphometry of the proximal humerus and those relationships to global offset.</div></div><div><h3>Methods</h3><div>Fourteen cadaveric humeri were manually measured then digitally analyzed following 3-dimensional scanning. Pearson’s r was used to determine the relationship between variables.</div></div><div><h3>Results</h3><div>The mean digital humeral head diameter (Hd<sup>d</sup>) was 46.5 (± 4.67) mm and the mean manual humeral head diameter was 46.8 (± 4.42) mm. The mean global offset (GO) was 6.36 (± 2.21) mm, and the mean best fit sphere diameter was 46.5 (± 4.63) mm. Pearson’s r = 0.58 (95% confidence interval 0.07-0.84, <em>P</em> = .021) for GO and Hd<sup>d</sup> which indicates a moderate correlation. Pearson’s r = 0.96 (95% confidence interval 0.89-0.99, <em>P</em> < .001) for Hd<sup>d</sup> and manual humeral head diameter which indicates a strong correlation.</div></div><div><h3>Discussion</h3><div>Native GO demonstrated a moderately positive correlation to humeral head diameter. The manual measurement of head diameter was strongly correlated to the 3-dimensional software value which reinforces the importance of intraoperative measurement. These data contribute to further understanding of shoulder morphometry which is integral to prosthesis design which impacts postoperative function and complications.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 4","pages":"Pages 907-914"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142747735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prediction of overnight stay following shoulder arthroplasty utilizing machine learning 利用机器学习预测肩关节置换术后的过夜时间

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-12-01 DOI: 10.1053/j.sart.2024.07.010

Benjamin Miltenberg MD , Teja Yeramosu MD , William L. Johns MD , Gabriel Onor MD , Brandon Martinazzi MD , Michael Chang MD , Surena Namdari MD

Background

Total shoulder arthroplasty (TSA) has evolved from requiring extended inpatient hospital stays to favoring same-day discharges, influenced by improved surgical techniques, patient optimization, and the risks associated with inpatient stays. The removal of TSA from Medicare's inpatient-only list in 2021 underscores this shift. However, the need for accurate prediction of post-TSA admission remains, as hospital admissions are costly and linked to increased morbidity and mortality. Machine learning algorithms offer potential advantages over traditional predictive models by identifying complex, nonlinear relationships. This study aimed to demonstrate and compare the performance of commonly used machine learning algorithms to predict overnight hospital stay (OHS) admission.

Methods

This study used data from the American College of Surgeons National Quality Improvement Program 2021 database to analyze patients who underwent primary, elective TSA. Patients were divided into short hospital stay of 0-1 days and OHS of >1 day cohorts. Machine learning models, including Random Forest, Artificial Neural Network (ANN), Gradient Boosted Tree, Naïve Bayes, and Support Vector Machine, were trained and validated to predict OHS. The models' predictive capacities were compared using the area under the receiver operating characteristics curve, calibration, and decision curve analysis.

Results

Out of 5811 patients analyzed, 926 (15.9%) were discharged on the same day. The ANN model demonstrated the highest area under the receiver operating characteristics curve (0.811), indicating superior predictive ability. Important variables influencing OHS predictions included operative time, body mass index, functional status, and patient demographics, such as age, race, and home support. Machine learning models showed better predictive performance than multivariate logistic regression.

Conclusion

Machine learning models, particularly the ANN model, outperform traditional regression methods in predicting post-TSA admission, highlighting their utility in optimizing patient selection for outpatient surgery. These models identify important variables associated with increased risk of OHS, aiding in preoperative planning and patient counseling. Integrating machine learning into clinical practice may enhance surgical outcomes and patient satisfaction while reducing health-care costs.

背景：全肩关节置换术（TSA）已经从需要延长住院时间演变为倾向于当天出院，这是受手术技术改进、患者优化和住院风险的影响。2021年，TSA从医疗保险的住院病人名单中删除，凸显了这一转变。然而，由于住院费用昂贵且与发病率和死亡率增加有关，因此仍然需要准确预测tsa后入院情况。通过识别复杂的非线性关系，机器学习算法比传统的预测模型具有潜在的优势。本研究旨在展示和比较常用的机器学习算法在预测过夜住院（OHS）住院方面的性能。方法：本研究使用来自美国外科医师学会国家质量改进计划2021数据库的数据来分析接受原发性选择性TSA的患者。患者分为短住院0 ~ 1天组和OHS 1天组。对随机森林、人工神经网络、梯度增强树、Naïve贝叶斯和支持向量机等机器学习模型进行了训练和验证，以预测OHS。采用受试者工作特征曲线下面积、校准和决策曲线分析比较模型的预测能力。结果5811例患者中，926例（15.9%）同日出院。人工神经网络模型在受者工作特征曲线下的面积最大（0.811），具有较好的预测能力。影响OHS预测的重要变量包括手术时间、体重指数、功能状态和患者人口统计数据，如年龄、种族和家庭支持。机器学习模型的预测性能优于多元逻辑回归。结论机器学习模型，特别是人工神经网络模型，在预测tsa后入院方面优于传统的回归方法，突出了它们在优化门诊手术患者选择方面的实用性。这些模型确定了与OHS风险增加相关的重要变量，有助于术前规划和患者咨询。将机器学习整合到临床实践中可以提高手术效果和患者满意度，同时降低医疗保健成本。

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引用次数: 0

Bariatric surgery patients have 5-year risk of revision following total shoulder arthroplasty comparable to that of class III obesity patients 减肥手术患者在全肩关节置换术后的5年翻修风险与III级肥胖患者相当

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2024-12-01 DOI: 10.1053/j.sart.2024.05.005

Sanjay Kubsad BS , Arman Kishan MBBS , Jordan Holland MPH , Henry Maxwell Fox MD , Jacob D. Mikula MD , Sarah Y. Nelson MD, MS , Umasuthan Srikumaran MD, MPH, MBA

Background

Obesity has been correlated with heightened risk of complications after orthopedic surgeries. Bariatric surgery (BS) is an effective tool commonly utilized for the reduction of body mass index. However, the impact of BS on complications in total shoulder arthroplasty (TSA) remains inadequately investigated. This study examines the 5-year risk of revision following TSA in patients with a history of BS compared to matched cohorts without history of BS.

Methods

Utilizing the PearlDiver Mariner database, a retrospective cohort analysis was conducted on over 157 million U.S. patients from January 2010 to October 2021. Inclusion criteria identified patients undergoing primary TSA with a minimum 2-year follow-up. Propensity-score matching was employed to control for covariates, comparing BS patients with a matched control and a matched class III obesity control without history of BS. Demographics, comorbidities, and outcomes, including 5-year cumulative incidence of revision were analyzed.

Results

The 5-year cumulative incidence of all-cause revision within the BS group was found to be 4.6%. While this represented a higher risk than that of the general population (hazard ratio 1.70; 95% confidence interval 1.21-2.39), there was no significant difference when compared to controls with class III obesity. The BS cohort had higher risk of revision secondary to dislocation/subluxation and rotator cuff tear than in the general population. When compared to the class III obesity cohort, only the risk of revision due to rotator cuff tear was found to be higher.

Conclusion

Individuals with a history of BS showed a higher risk of revision than a cohort without history of BS and an equivalent risk of revision compared to a cohort of class III obesity controls after undergoing TSA. Though obesity is an important risk factor for complications after TSA, BS might not be an effective tool for preoperative risk optimization.

背景：肥胖与骨科手术后并发症的高风险相关。减肥手术（BS）是一种有效的工具，通常用于降低身体质量指数。然而，BS对全肩关节置换术（TSA）并发症的影响仍未充分研究。本研究考察了有BS病史的患者与无BS病史的匹配队列相比，TSA后5年的修订风险。方法利用PearlDiver Mariner数据库，对2010年1月至2021年10月期间超过1.57亿美国患者进行回顾性队列分析。纳入标准确定接受初级TSA的患者，随访至少2年。采用倾向评分匹配法控制变量，将BS患者与匹配的对照组和匹配的无BS病史的III类肥胖对照组进行比较。分析了人口统计学、合并症和结局，包括5年累计修订发生率。结果BS组5年累积全因修正发生率为4.6%。虽然这代表着比一般人群更高的风险(风险比1.70；95%可信区间为1.21-2.39)，与III类肥胖对照组相比无显著差异。与一般人群相比，BS组继发于脱位/半脱位和肩袖撕裂的翻修风险更高。与III级肥胖组相比，只有肩袖撕裂导致的翻修风险较高。结论：与没有BS病史的队列相比，有BS病史的个体在接受TSA后的修订风险更高，与III类肥胖对照组相比，其修订风险相当。虽然肥胖是TSA术后并发症的重要危险因素，但BS可能不是术前风险优化的有效工具。

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引用次数: 0