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Comments on "Readability Analysis of Patient Education Material on Rotator Cuff Injuries From the Top 25 Ranking Orthopedic Institutions". 关于 "排名前 25 位骨科机构的肩袖损伤患者教育材料可读性分析 "的评论
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-11-05 eCollection Date: 2024-11-01 DOI: 10.5435/JAAOSGlobal-D-24-00236
Neda Mirzaei, Mohammad Ghorbani, Ali Parsa
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引用次数: 0
Sacral U-type Fractures in Patients Older Than 65 years. 65 岁以上患者的骶骨 U 型骨折。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-10-21 eCollection Date: 2024-10-01 DOI: 10.5435/JAAOSGlobal-D-24-00030
Avrey A Novak, Joseph T Patterson, Michael F Githens, Reza Firoozabadi, Conor P Kleweno

Introduction: The purpose of this study was to determine the degree of disability that geriatric patients with sacral U-type fractures experience.

Methods: Patients older than 65 years presenting from 2013 to 2019 with a U-type sacral fracture were included. Patient demographics, treatment type, preinjury domicile, preinjury use of assistive devices, and neurologic deficits were recorded. Outcomes included mortality, return to preinjury domicile, and use of assistive devices for mobility.

Results: Among 46 patients in the treatment period, ground-level fall was the most common mechanism of injury (60.8%). Thirty-four patients (74%) were treated surgically, most commonly with closed percutaneous fixation (n = 27). Thirteen percent of patients died during the admission. At the final follow-up, 14 (45%) had not returned to their prior domicile and 18 (58%) required more supportive assistive devices. Seventy-three percent of patients who presented delayed required a new gait aid, compared with 47% presenting acutely. Between those presenting with low-energy versus high-energy mechanisms, similar rates of need were observed for new assistive devices (50% low and 73% high) and lack of return to preinjury domicile (40% low, 50% high).

Discussion: Many geriatric patients were disabled by or died after sustaining a sacral U-type fracture, highlighting the morbidity regardless of high-energy or low-energy trauma.

导言本研究旨在确定骶骨U型骨折老年患者的残疾程度:方法:纳入 2013 年至 2019 年期间因骶骨 U 型骨折就诊的 65 岁以上患者。记录了患者的人口统计学特征、治疗类型、受伤前住所、受伤前辅助设备使用情况以及神经功能缺损情况。结果包括死亡率、恢复到受伤前的居住地以及使用辅助设备进行移动:在治疗期间的 46 名患者中,地面跌倒是最常见的受伤机制(60.8%)。34名患者(74%)接受了手术治疗,其中最常见的是经皮闭合固定术(27人)。13%的患者在入院期间死亡。在最后的随访中,有14名患者(45%)没有回到原来的住所,18名患者(58%)需要更多的辅助设备。73%的延迟入院患者需要新的步态辅助设备,而急性入院患者的这一比例为47%。在出现低能量机制和高能量机制的患者中,需要新辅助设备(低50%,高73%)和无法返回受伤前住所(低40%,高50%)的比例相似:讨论:许多老年患者在骶骨U型骨折后致残或死亡,这凸显了高能量或低能量创伤的发病率。
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引用次数: 0
A Systematic Review and Meta-Analysis of Supercapsular Percutaneously Assisted Total Hip Arthroplasty Versus Standard Posterior Approach for Femoral Neck Fracture in Elderly Patients. 上囊经皮辅助全髋关节置换术与标准后路治疗老年股骨颈骨折的系统性回顾和荟萃分析。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-10-21 eCollection Date: 2024-10-01 DOI: 10.5435/JAAOSGlobal-D-24-00226
Zhicheng Pan, Shibo Zhou, Wangxin Liu, Enpeng Gu

Introduction: This meta-analysis aimed to evaluate the efficacy and safety of the supercapsular percutaneously assisted total hip arthroplasty (SuperPATH) and the standard posterior approach in hip arthroplasty in treating femoral neck fractures in elderly patients.

Method: A systematic search was conducted for studies from 2012 to December 2022. Meta-analysis was conducted using Review Manager 5.3 on surgical time, intraoperative blood loss, Harris hip scores, and visual analog scale scores.

Result: A total of 26 studies involving 2,236 patients with femoral neck fractures were included. The SuperPATH group performed better than traditional posterior approach group in reducing intraoperative blood loss (in ml), shortening incision length (in cm), length of hospitalization period (in days) and improving Harris Hip score (HHS). The operation time took longer than the traditional posterior approach, with statistically significant differences. The VAS scores at 1 week and 3 months after surgery in the SuperPATH group were lower than those of the traditional posterior approach, with statistically significant differences. There was no statistical significance between the two groups in VAS scores 2 weeks and 1 month after surgery.

Conclusion: The SuperPATH group resulted in better effects in reducing intraoperative blood loss (in ml), shortening incision length (in cm), length of hospitalization period (in days), and improving Harris hip score (HHS), which is conducive to the rapid postoperative recovery of patients.

简介:这项荟萃分析旨在评估经皮辅助上囊全髋关节置换术(SuperPATH)和标准后路髋关节置换术治疗老年患者股骨颈骨折的有效性和安全性:对2012年至2022年12月期间的研究进行了系统检索。使用Review Manager 5.3对手术时间、术中失血量、Harris髋关节评分和视觉模拟评分进行了元分析:共纳入26项研究,涉及2236名股骨颈骨折患者。SuperPATH 组在减少术中失血量(毫升)、缩短切口长度(厘米)、缩短住院时间(天)和改善 Harris 髋关节评分(HHS)方面均优于传统后路组。手术时间比传统后路法长,差异有统计学意义。SuperPATH 组术后 1 周和 3 个月的 VAS 评分低于传统后路手术组,差异有统计学意义。两组术后 2 周和 1 个月的 VAS 评分差异无统计学意义:结论:SuperPATH 组在减少术中失血量(毫升)、缩短切口长度(厘米)、缩短住院时间(天)和改善 Harris 髋关节评分(HHS)方面效果更好,有利于患者术后快速康复。
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引用次数: 0
Impact of Atopic Dermatitis (Eczema) and Its Treatment on the Risk of Adverse Events Following Total Knee Arthroplasty. 特应性皮炎(湿疹)及其治疗对全膝关节置换术后不良事件风险的影响。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-10-21 eCollection Date: 2024-10-01 DOI: 10.5435/JAAOSGlobal-D-23-00267
Julian J Smith-Voudouris, Meera M Dhodapkar, Scott J Halperin, Jeffrey M Cohen, Jonathan N Grauer

Background: Atopic dermatitis (AD), also known as eczema, is a highly prevalent, chronic inflammatory skin condition. The perioperative outcomes of patients with AD after total knee arthroplasty (TKA) have not been characterized.

Methods: Adult patients who underwent TKA were identified in the PearlDiver administrative database. After matching based on patient characteristics, 90-day adverse events and 5-year revisions were compared by multivariable analyses and log-rank tests, respectively. Patients with atopic dermatitis were then stratified by medication status for repeated analysis between resultant subcohorts.

Results: Relative to age, sex, and comorbidity matched patients without AD, those with AD had increased odds of aggregated adverse events (OR = 1.36), pneumonia (OR = 2.07), urinary tract infection (UTI, OR = 1.77), and emergency department (ED) visits (OR = 1.70) (P < 0.0001 for each). Those on medication for moderate-to-severe disease had similar associations as the primary analysis. Those not on medications were similar, but not found to have elevated odds of pneumonia. 5-year revisions were not markedly different.

Conclusion: TKA patients with AD were at increased odds of pneumonia, UTI, and ED visits, but these risks were not exacerbated by immunosuppressive medications. Surgeons who are managing patients with AD for TKA should be vigilant but reassured by overall similar 5-year survival to revision.

背景:特应性皮炎(AD)又称湿疹,是一种高发的慢性炎症性皮肤病。全膝关节置换术(TKA)后特应性皮炎患者的围手术期疗效尚无定论:在 PearlDiver 管理数据库中识别了接受全膝关节置换术的成年患者。根据患者特征进行匹配后,通过多变量分析和对数秩检验分别比较了90天不良事件和5年翻修率。然后根据用药情况对特应性皮炎患者进行分层,在由此产生的亚群之间进行重复分析:与年龄、性别和合并症相匹配的非特应性皮炎患者相比,特应性皮炎患者发生综合不良事件(OR = 1.36)、肺炎(OR = 2.07)、尿路感染(UTI,OR = 1.77)和急诊科(ED)就诊(OR = 1.70)的几率增加(P < 0.0001)。因中度至重度疾病而服药的患者与主要分析结果的相关性相似。未服药者的情况类似,但未发现肺炎发生几率升高。结论:AD患者在TKA手术中患肺炎的几率较高:结论:TKA AD 患者发生肺炎、UTI 和急诊就诊的几率增加,但免疫抑制药物不会加剧这些风险。外科医生在管理接受 TKA 的 AD 患者时应保持警惕,但总体上相似的 5 年生存率和翻修率让他们感到放心。
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引用次数: 0
Is Magnetic Resonance Imaging Overused Among Patients Undergoing Total Knee Arthroplasty? 接受全膝关节置换术的患者是否过度使用了磁共振成像?
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-10-21 eCollection Date: 2024-10-01 DOI: 10.5435/JAAOSGlobal-D-24-00258
Lekya Mukkamala, Sabina L Schaffer, Matthew G Weber, Jeffrey M Wilde, Adam S Rosen

Introduction: With increasing healthcare costs, it is important to quantify the number of total knee arthroplasty (TKA) patients who have MRIs that are not considered clinically necessary. The purpose of this study was to determine the number of unnecessary preconsultation MRIs done among TKA patients at our institution.

Methods: Eight hundred and sixty-nine patients who underwent a primary TKA were identified. Review of medical records and imaging results was conducted to determine which patients had received preconsult MRIs and whether they were necessary or unnecessary.

Results: Of the 869 TKA, 177 (20.4%) presented with a preconsultation MRI, of which, 112 met the study inclusion criteria. Of the 112 MRIs, 18 (20.7%) were done without radiographic imaging, and 69 (79.3%) were completed after radiographically evident moderate-to-severe arthritis. Overall, 87 MRIs (10.0%) were deemed clinically unnecessary.

Conclusions: Referring physicians are overusing MRIs before consultation with an orthopaedic surgeon. The 87 patients who had unnecessary MRIs at our institution over a one-year period represented a cost of $20,706. Extrapolating that number to the scale of patients affected by arthritis each year is potentially a staggering amount of money. Evidence-based guidelines should be put into place to optimize healthcare utilization.

导言:随着医疗成本的不断增加,量化临床上没有必要进行核磁共振成像检查的全膝关节置换术(TKA)患者数量非常重要。本研究的目的是确定我院 TKA 患者在就诊前进行不必要 MRI 检查的人数:方法:确定了 869 名接受初级 TKA 的患者。对医疗记录和成像结果进行审查,以确定哪些患者接受了会诊前磁共振成像检查,以及这些检查是必要的还是不必要的:在 869 例 TKA 患者中,177 例(20.4%)在就诊前接受了磁共振成像检查,其中 112 例符合研究纳入标准。在这112例磁共振成像中,18例(20.7%)是在未进行放射成像的情况下完成的,69例(79.3%)是在放射成像显示为中重度关节炎后完成的。总体而言,87 例(10.0%)核磁共振成像被认为是临床上不必要的:结论:转诊医生在咨询骨科医生之前过度使用核磁共振成像。我们医院在一年时间内对 87 名患者进行了不必要的核磁共振成像检查,花费达 20,706 美元。将这一数字推算到每年受关节炎影响的患者人数中,可能是一笔惊人的数字。应制定循证指南,优化医疗服务的利用率。
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引用次数: 0
Biomechanical Evaluation of Suture Augmentation of Dorsal Locking Plate Fixation in Transverse Patella Fractures. 髌骨横向骨折背侧锁定钢板固定的缝合增强生物力学评估
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-10-21 eCollection Date: 2024-10-01 DOI: 10.5435/JAAOSGlobal-D-24-00194
Christen E Chalmers, Min-Shik Chung, Michelle H McGarry, Thay Q Lee, John A Scolaro

Introduction: Adjunctive suture augmentation of patellar plate fixation has yet to be investigated. Our biomechanical study sought to evaluate whether suture augmentation improves dorsal patellar locking plate fixation. Our hypothesis was that suture augmentation would improve fixation of this construct.

Methods: A transverse patella fracture in six matched cadaveric pairs was stabilized using a patellar locking plate with or without suture augmentation. Specimens were tested at 60° knee flexion with load placed through quadriceps. Cyclic loading followed by load to failure was done. Stiffness, deformation at peak, and nonrecoverable deformation were calculated.

Results: During cyclic loading, suture augmentation demonstrated a higher average stiffness throughout all loads. At the final cycle, deformation was markedly higher without suture augmentation. Average load to failure was higher with suture augmentation. Maximum load to failure occurred at 2500 N in both groups.

Conclusion: Suture augmentation in a transverse patellar fracture model improved dorsal plate fixation, leading to less fracture displacement at the final load. Although suture augmentation demonstrated higher stiffness and lower deformation, these trends were not statistically significant. In both groups, plate fixation sustained very high loads, which reflects the fixation strength of the dorsal locking plate and screw construct in this fracture model.

导言:髌骨钢板固定的辅助缝合增量尚未得到研究。我们的生物力学研究旨在评估缝合增强是否能改善髌骨背侧锁定钢板的固定。我们的假设是,缝合增量将改善该结构的固定:方法:使用带或不带缝合增量的髌骨锁定钢板稳定六对匹配尸体的横向髌骨骨折。在膝关节屈曲 60°、通过股四头肌加载的情况下对标本进行测试。进行循环加载,然后加载至破坏。计算了刚度、峰值变形和不可恢复变形:结果:在循环加载过程中,缝合增强在所有加载过程中都表现出较高的平均刚度。在最后一个周期,未进行缝合增强的变形明显增大。缝合线增强后的平均破坏载荷更高。两组的最大破坏载荷均为 2500 N:结论:在髌骨横向骨折模型中进行缝合增强可改善背板固定,从而在最终负荷下减少骨折移位。尽管缝合增强显示出更高的硬度和更低的变形,但这些趋势在统计学上并不显著。在这两组中,钢板固定都能承受很高的负荷,这反映了背侧锁定钢板和螺钉结构在该骨折模型中的固定强度。
{"title":"Biomechanical Evaluation of Suture Augmentation of Dorsal Locking Plate Fixation in Transverse Patella Fractures.","authors":"Christen E Chalmers, Min-Shik Chung, Michelle H McGarry, Thay Q Lee, John A Scolaro","doi":"10.5435/JAAOSGlobal-D-24-00194","DOIUrl":"https://doi.org/10.5435/JAAOSGlobal-D-24-00194","url":null,"abstract":"<p><strong>Introduction: </strong>Adjunctive suture augmentation of patellar plate fixation has yet to be investigated. Our biomechanical study sought to evaluate whether suture augmentation improves dorsal patellar locking plate fixation. Our hypothesis was that suture augmentation would improve fixation of this construct.</p><p><strong>Methods: </strong>A transverse patella fracture in six matched cadaveric pairs was stabilized using a patellar locking plate with or without suture augmentation. Specimens were tested at 60° knee flexion with load placed through quadriceps. Cyclic loading followed by load to failure was done. Stiffness, deformation at peak, and nonrecoverable deformation were calculated.</p><p><strong>Results: </strong>During cyclic loading, suture augmentation demonstrated a higher average stiffness throughout all loads. At the final cycle, deformation was markedly higher without suture augmentation. Average load to failure was higher with suture augmentation. Maximum load to failure occurred at 2500 N in both groups.</p><p><strong>Conclusion: </strong>Suture augmentation in a transverse patellar fracture model improved dorsal plate fixation, leading to less fracture displacement at the final load. Although suture augmentation demonstrated higher stiffness and lower deformation, these trends were not statistically significant. In both groups, plate fixation sustained very high loads, which reflects the fixation strength of the dorsal locking plate and screw construct in this fracture model.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11498937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510048","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
Ewing Sarcoma in the Pediatric Population: Predictors of Survival Within the United States. 小儿尤文肉瘤:美国境内的生存预测因素。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-10-21 eCollection Date: 2024-10-01 DOI: 10.5435/JAAOSGlobal-D-24-00281
Matthew E Wells, Michael D Eckhoff, William Davis, Vishwajeet Singh, Rajiv Rajani, Elizabeth M Polfer

Introduction: Bone and joint tumors are the third most common cause of pediatric cancer-related deaths in the United States. Although there have been improvements in survival rates among pediatric cancer patients over the past few decades, bone and joint cancers remain the exception. Considering current clinical trials involving novel targeted therapies, the establishment of updated mortality rates and predictors of survival for this cancer would be prudent. This investigation sought to determine updated 5-year survival rates and predictors of survival among pediatric Ewing sarcoma (ES) of bone treated within the United States.

Methods: The National Cancer Database was retrospectively inquired for all pediatric ES cases within the most updated bone and joint public use file available in September 2022. The reported data were truncated to only include patients with reported 5-year vital (ie, survival) status. Cox proportional hazard regression was conducted on both the truncated data and the entire cohort to validate the findings. The patients were then separated into alive versus deceased cohorts, and univariate regression analysis was done followed by multivariable regression of notable variables of interest.

Results: Overall, an aggregated 5-year survival rate of 74.5% was found in the included patient cohort. Patients with localized cancer had a comparatively improved 5-year survival rate of 84.70% as opposed to those with macrometastatic disease on presentation with a survival rate of 50.4%. Patient demographic-, tumor-, and treatment-specific variables all demonstrated an effect on survival. The multivariable predictors of worse mortality were found to include older age, larger tumor size (>8 cm), macrometastatic disease on presentation, and positive surgical margins.

Conclusion: This analysis serves to establish updated survival rates of pediatric ES treated within the United States to set standards for comparison among future studies. Continued multi-institutional and international collaboration is needed to optimize current treatment results and develop novel targeted therapies.

导言:在美国,骨与关节肿瘤是导致儿童癌症相关死亡的第三大常见原因。尽管过去几十年来儿科癌症患者的存活率有所提高,但骨与关节癌症仍然是个例外。考虑到目前涉及新型靶向疗法的临床试验,确定这种癌症的最新死亡率和生存预测指标将是非常谨慎的。这项调查旨在确定在美国接受治疗的小儿骨尤文肉瘤(ES)患者的最新 5 年生存率和生存预测指标:美国国家癌症数据库对2022年9月更新的骨与关节公共使用文件中的所有小儿ES病例进行了回顾性查询。对报告的数据进行了截断,仅包括报告了5年生存期(即存活率)的患者。对截断数据和整个队列进行了 Cox 比例危险回归,以验证研究结果。然后将患者分为存活组群和死亡组群,进行单变量回归分析,然后对相关显著变量进行多变量回归分析:结果:总体而言,所纳入患者队列的 5 年生存率为 74.5%。局部癌症患者的 5 年生存率为 84.70%,相比之下,出现大转移疾病的患者的 5 年生存率仅为 50.4%。患者的人口统计学变量、肿瘤变量和治疗变量都对生存率有影响。死亡率较低的多变量预测因素包括年龄较大、肿瘤较大(>8 厘米)、发病时为大转移性疾病以及手术切缘阳性:这项分析有助于确定在美国接受治疗的小儿 ES 的最新生存率,为今后的研究设定比较标准。需要继续开展多机构和国际合作,以优化目前的治疗效果并开发新型靶向疗法。
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引用次数: 0
Outcomes After Total Knee Arthroplasty in Patients With a History of Patella Fracture: A Propensity Score-Matched Analysis. 有髌骨骨折史的患者接受全膝关节置换术后的疗效:倾向评分匹配分析
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-10-18 eCollection Date: 2024-10-01 DOI: 10.5435/JAAOSGlobal-D-24-00007
Brian P McCormick, Sean B Sequeira, Mark D Hasenauer, Robert P McKinstry, Frank R Ebert, Henry R Boucher

Background: Posttraumatic osteoarthritis is a common indication for total knee arthroplasty (TKA). The purpose of this study was to evaluate the association between a history of patella fracture and postoperative complication rates after TKA.

Methods: Patients diagnosed with a patella fracture before undergoing TKA were identified from a large national database and matched to a control cohort using propensity scoring. Rates of medical complications occurring within 90 days of TKA and surgery-related complications occurring within 1 year of TKA were compared using odds ratios. Healthcare utilization outcomes including 90-day emergency department (ED) presentation, hospital readmission, and total cost were also compared.

Results: Compared with a propensity-matched control cohort, TKA patients with a history of patella fracture had a lower incidence of pulmonary embolism (OR 0.74, P = 0.0442) and higher incidences of periprosthetic joint infection (OR 1.68, P < 0.0001), revision surgery (OR 1.84, P < 0.0001), dislocation (OR 1.61, P = 0.026), lysis of adhesions (OR 2.21, P = 0.0082), and wound disruption (OR 1.52, P < 0.0001). A history of patella fracture was also associated with an increased rate of ED presentation (OR 1.08, P = 0.0454) and increased total cost ($14,359 vs. $12,786, P = 0.0003).

Conclusion: A history of patella fracture is associated with early surgery-related complications after TKA including periprosthetic joint infection, revision surgery, dislocation, lysis of adhesions, and wound disruption. Healthcare utilization is increased among these patients with higher rates of ED presentation and increased total cost. These findings allow for more accurate risk stratification and counseling of patients.

Level of evidence: III, Retrospective review.

背景:创伤后骨关节炎是全膝关节置换术(TKA)的常见适应症。本研究旨在评估髌骨骨折史与 TKA 术后并发症发生率之间的关系:从一个大型国家数据库中找出在接受 TKA 手术前被诊断为髌骨骨折的患者,并采用倾向评分法与对照组进行匹配。采用几率比较大的方法比较了TKA术后90天内发生的内科并发症发生率和TKA术后1年内发生的手术相关并发症发生率。同时还比较了医疗服务利用率,包括90天急诊就诊率、再次入院率和总费用:结果:与倾向匹配的对照组相比,有髌骨骨折史的 TKA 患者肺栓塞发生率较低(OR 0.74,P = 0.0442),假体周围关节感染发生率较高(OR 1.68,P < 0.0001)、翻修手术(OR 1.84,P < 0.0001)、脱位(OR 1.61,P = 0.026)、粘连溶解(OR 2.21,P = 0.0082)和伤口破坏(OR 1.52,P < 0.0001)的发生率较高。髌骨骨折史也与急诊室就诊率增加(OR 1.08,P = 0.0454)和总费用增加(14,359 美元对 12,786 美元,P = 0.0003)有关:结论:髌骨骨折史与TKA术后早期手术相关并发症有关,包括假体周围关节感染、翻修手术、脱位、粘连溶解和伤口破坏。这些患者对医疗服务的利用率更高,急诊室就诊率更高,总费用也更高。这些发现有助于对患者进行更准确的风险分层和咨询:III,回顾性研究。
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引用次数: 0
Accessibility and Characterization of Parental Leave Policies for Orthopaedic Surgery Residency Training in the United States. 美国矫形外科住院医师培训育儿假政策的可及性和特点。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-10-16 eCollection Date: 2024-08-01 DOI: 10.5435/JAAOSGlobal-D-24-00230
Jason Silvestre, Taylor Neal, Matthew A Dow, Dawn M LaPorte, Ann Van Heest, Sara S Van Nortwick

Introduction: This study assesses the accessibility and nature of parental leave policies during orthopaedic surgery residency training after implementation of the Accreditation Council for Graduate Medical Education (GME) mandate for 6 weeks of paid parental leave effective July of 2022.

Materials and methods: An audit of orthopaedic surgery residency and affiliated GME websites was conducted to assess the accessibility of parental leave policies during the 2023-2024 academic year. Details on length of leave and nature of renumeration during the leave were recorded. Bivariate analyses were conducted to determine residency program characteristics associated with the accessibility of a parental leave policy. Results were compared with a previous analysis during the 2017-2018 academic year.

Results: A total of 200 residency programs were evaluated, and 152 had parental leave policies (76.0%). Compared with 2017 to 2018, a similar percentage of parental leave policies were accessible on residency program websites (3.0% vs. 2.0%, P = 0.777) but fewer were accessible on GME websites (55.5% vs. 80.7%, P < 0.001). More contemporary policies were obtained from program coordinators (18.5% vs. 7.2%, P = 0.003), and more were not available (24.0% vs. 9.0%, P < 0.001). Most policies offered renumeration (86.7%) and leave for 6 weeks in length (75.0%). A higher prevalence of parental leave policy accessibility was found among orthopaedic residency programs with university affiliation (P < 0.001), more faculty members (P = 0.008) and residents (P = 0.017), a higher percentage of female faculty (P = 0.008), affiliation with a top 50 ranked National Institutes of Health-funded orthopaedic surgery department, and accreditation achieved before 2017 to 2018 (P = 0.004).

Discussion: Most orthopaedic surgery residency programs do not have accessible parental leave policies on their websites. The new Accreditation Council for GME mandate will require orthopaedic residency programs to provide residents with 6 weeks of paid parental leave during residency training. Accessible policies may be useful to applicants interested in child rearing during orthopaedic residency training.

导言:本研究评估了自2022年7月起,毕业后医学教育认证委员会(GME)规定6周带薪育儿假后,骨科外科住院医师培训期间育儿假政策的可获得性和性质:对骨科外科住院医师培训和附属 GME 网站进行了审核,以评估 2023-2024 学年育儿假政策的可及性。记录了休假时间和休假期间报酬性质的详细信息。我们进行了二元分析,以确定与育儿假政策可获得性相关的住院医师培训项目特征。结果与之前在2017-2018学年进行的分析进行了比较:共评估了 200 个住院医师培训项目,其中 152 个有育儿假政策(76.0%)。与2017至2018学年相比,在住院医师培训项目网站上可获取的育儿假政策比例相似(3.0% vs. 2.0%,P = 0.777),但在GME网站上可获取的育儿假政策较少(55.5% vs. 80.7%,P < 0.001)。更多的当代政策是从项目协调员那里获得的(18.5% vs. 7.2%,P = 0.003),而更多的政策是无法获得的(24.0% vs. 9.0%,P < 0.001)。大多数政策提供薪酬(86.7%)和 6 周假期(75.0%)。在以下情况的骨科住院医师培训项目中,育儿假政策的普及率更高:与大学有关联(P < 0.001)、有更多的教职员工(P = 0.008)和住院医师(P = 0.017)、女性教职员工比例更高(P = 0.008)、隶属于国家卫生研究院资助的排名前50位的骨科外科部门,以及在2017年至2018年之前获得认证(P = 0.004).讨论:大多数矫形外科住院医师培训项目的网站上都没有可访问的育儿假政策。新的 GME 评审委员会要求骨科住院医师培训项目在住院医师培训期间为住院医师提供 6 周的带薪育儿假。对于有兴趣在骨科住院医师培训期间养育子女的申请者来说,可访问的政策可能会有所帮助。
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引用次数: 0
After Primary Total Shoulder Arthroplasty, Factors Associated with Returning to the Same Surgeon for Subsequent Total Shoulder Arthroplasty. 初次全肩关节置换术后,再次找同一位外科医生进行全肩关节置换术的相关因素。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-10-14 eCollection Date: 2024-10-01 DOI: 10.5435/JAAOSGlobal-D-24-00117
Michael J Gouzoulis, Scott J Halperin, Anthony E Seddio, Christopher Wilhelm, Jay Moran, Kenneth W Donohue, Andrew E Jimenez, Jonathan N Grauer

Background: Total shoulder arthroplasty (TSA) is commonly done for degenerative conditions. Patients may need additional contralateral TSA or ipsilateral revision TSA. As a marker of patient satisfaction and practice integrity, factors associated with return to the same or different surgeon are of interest.

Methods: Patients undergoing TSA were abstracted from the PearlDiver data set. Subsequent TSA within 2 years was identified. Factors analyzed included age, sex, comorbidity burden, prior depression diagnosis, insurance type, reverse versus anatomic TSA, ipsilateral versus contralateral surgery, and postoperative adverse events. Patients returning to the same surgeon versus different surgeon were compared with multivariable analysis.

Results: 98,048 TSA patients were identified, with 8483 patients (8.7%) undergoing subsequent TSA within 2 years. Of those, 1,237 (14.6%) chose a different surgeon. Factors associated with changing surgeons were revision surgery on the ipsilateral shoulder (OR:2.47), Medicaid insurance (OR:1.46), female sex (OR:1.36), any adverse events (OR:1.23), and higher Elixhauser Comorbidity Index (OR:1.07 per point), while prior depression diagnosis was associated with decreased odds (OR:0.74) of changing surgeon (P < 0.05 for all).

Discussion: When pursuing a subsequent TSA, only a minority of patients changed to a different surgeon. Factors identified associated with changing to a different surgeon may help guide measures to improve patient satisfaction and practice integrity.

背景:全肩关节置换术(TSA)通常用于治疗退行性病变。患者可能需要额外的对侧 TSA 或同侧翻修 TSA。作为患者满意度和诊疗完整性的标志,患者再次选择同一或不同外科医生的相关因素值得关注:方法:从PearlDiver数据集中抽取接受TSA手术的患者。方法:从 PearlDiver 数据集中摘录了接受 TSA 的患者,并对 2 年内再次接受 TSA 的患者进行了识别。分析的因素包括年龄、性别、合并症负担、既往抑郁症诊断、保险类型、反向TSA与解剖TSA、同侧手术与对侧手术以及术后不良事件。通过多变量分析比较了返回同一外科医生与不同外科医生的患者:共发现98048名TSA患者,其中8483名患者(8.7%)在2年内接受了后续TSA手术。其中有1237人(14.6%)选择了不同的外科医生。与更换外科医生相关的因素包括同侧肩部的翻修手术(OR:2.47)、医疗补助保险(OR:1.46)、女性(OR:1.36)、任何不良事件(OR:1.23)和较高的Elixhauser合并症指数(OR:1.07/点),而之前的抑郁症诊断与更换外科医生的几率降低(OR:0.74)相关(所有因素的P<0.05):讨论:在寻求后续TSA时,只有少数患者更换了外科医生。已发现的与更换外科医生相关的因素可能有助于指导提高患者满意度和诊疗完整性的措施。
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Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews
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