Journal of surgical orthopaedic advances最新文献

Bracing reduces the need for surgical intervention in patients with adolescent idiopathic scoliosis (AIS). However, bracing outcomes with variable body mass index (BMI) are understudied. The authors sought to determine the association of BMI with bracing outcomes. The authors performed a retrospective cohort study of 104 patients presenting with AIS. Initial Risser score, hours of bracing per day, BMI percentile, and curve magnitude pre- and postbracing were collected. There was no detectable difference between years of brace wear or primary curve magnitude at time of presentation between both groups. Overall, 29% (25/87) of underweight/normal weight patients and 59% (10/17) of overweight/obese patients had curves ≥ 45 degrees at the end of bracing (p = 0.016). Odds of having a curve ≥ 45 degrees after bracing were 3.5 (95% confidence interval: 1.2 to 10.3, p = 0.021) times higher for overweight/obese patients compared with underweight/normal weight patients. Increased overlying adipose tissue may reduce the corrective forces required to straighten the spine. (Journal of Surgical Orthopaedic Advances 33(1):029-032, 2024).

The SARS-CoV-2 pandemic affected surgical management in Orthopaedics. This study explores the effect of COVID-19-positive patients on time to surgery from admission, total time spent in preoperative preparation, costs of orthopaedic care, and inpatient days in COVID-19-positive patients. The authors' case-matched study was based on the surgeon, procedure type, and patient demographics. The authors reviewed 58 cases, 23 males and 35 females. The results for the COVID-19-positive and -negative groups are time to admission (362.9; 388.4), time in preparation (127.8; 122.3), inpatient days to surgery (0.2; 0.2), and orthopaedic cost ($81,938; $86,352). With available numbers, no significant difference could be detected for inpatient days until surgery, any associated time to surgery, or orthopaedic costs for operating on COVID-19-positive patients during the pandemic. Perceived increased time and cost of care of COVID-19-positive patients were not proven in this study. (Journal of Surgical Orthopaedic Advances 33(1):014-016, 2024).

Dehydration is an overlooked modifiable risk factor that should be optimized prior to elective total hip arthroplasty (THA) to reduce postoperative complications and inpatient costs. All primary THA from 2005 - 2019 were queried from the National Surgical Quality Improvement Program database, and patients were compared based on dehydration status: blood urea nitrogen (BUN): creatinine ratio (Cr) (BUN/Cr) < 20 (nondehydrated), 20 ≤ BUN/Cr ≤ 25 (moderately dehydrated), 25 < BUN/Cr (severely dehydrated). A subgroup analysis involving only elderly patients > 65 years and normalized gender-adjusted Cr values was also performed. The analysis included 212,452 patients who underwent THA. Adjusted multivariate logistic regression analysis showed that the severely dehydrated cohort had a greater risk of overall complications, postoperative anemia requiring transfusion, nonhome discharge, and increased length of stay (all p < 0.01). Among the elderly, dehydrated patients had a greater risk of postoperative transfusion, cardiac complications, and nonhome discharge (all p < 0.01). BUN/Cr > 20 is an important preoperative diagnostic tool to identify at-risk dehydrated patients. Providers should optimize dehydration to prevent complications, decrease costs, and improve discharge planning. (Journal of Surgical Orthopaedic Advances 33(1):017-025, 2024).

There is conflicting literature regarding the effect of surgical start time for total hip arthroplasty (THA) on morbidity. This study examined outcomes between start time groups in elective THA. A retrospective review identified patients undergoing elective cementless primary THA between 2009 and 2019. Patients were divided into morning or evening start time groups. Chi-squared analysis and independent sample t-tests were run to detect differences between groups in matched and unmatched analysis. Five hundred fifteen patients were identified based on selection criteria. Chi-squared analysis and independent sample t-tests identified no significant differences in duration of surgery, estimated blood loss, length of stay, or other complications between start time groups. This study provided clinical data over a 10-year period supporting that surgical start time in elective THA does not have a significant impact on outcomes. (Journal of Surgical Orthopaedic Advances 33(4):240-243, 2024).

The authors hypothesized that the infection rates of open hand fractures treated in a delayed manner would not be higher than those treated immediately. The authors performed a retrospective chart review of patients treated between January 2008 and July 2014 at a Level 1 Trauma Center. Delayed (> 24 hours) versus early (< 24 hours) surgical treatment groups were identified for comparison to determined infection rates. One hundred twenty-nine patients with open hand fractures were compared. Fifty-eight received delayed treatment (> 24 hours), and 71 received immediate surgical treatment (< 24 hours). When adjusted for the severity of injury, there were no significant differences on the rate of infection and rate of reoperation between washout and antibiotics in the emergency department versus immediate surgical treatment. There were no differences in infection rates or reoperation for nonunions with respect to surgical intervention timing. (Journal of Surgical Orthopaedic Advances 33(4):222-224, 2024).

The authors sent a 13-question web-based survey to all American Shoulder and Elbow Surgeons members regarding a timeline of return to shooting sports after shoulder surgery and received 107 responses from all 50 states and eight from outside the United States. Of the respondents, 74.8% considered their rehabilitation protocol "conservative." Surgeons who considered their rehabilitation protocol to be "aggressive" were more likely to return patients to shooting earlier after rotator cuff repair (p = 0.008), anatomic total shoulder arthroplasty (p = 0.015), and reverse total shoulder arthroplasty (p = 0.003). Most surgeons released their patients after 12 weeks. The majority (95.3%) of respondents were asked by patients about shooting after shoulder surgery. Longer duration of practice correlated significantly with the likelihood of being asked about shooting (p = 0.015). Most surgeons would release their patients to return to shooting sports 12 weeks after surgery. It is unknown how shooting affects implant fixation in vivo. (Journal of Surgical Orthopaedic Advances 33(4):225-227, 2024).

Traditional skin preparation and prophylactic antibiotics have not uniformly been successful in preventing surgical site infection (SSI) following total joint arthroplasties. Iodophor-impregnated adhesive dressings, such as Ioban, have shown promising effects in reducing the incidence of SSI. A systematic review and meta-analysis were conducted according to PRISMA checklist and the Cochrane Handbook for Systematic Reviews of Interventions. Non-stratified and stratified meta-analysis were conducted to test for confounding and biases. The methodological quality and risk of bias were analyzed and appraised. Five studies including 1,655 patients were eligible. In these studies, 51.6% of the included patients had antimicrobial incise drape in the setting of knee and hip arthroplasties. Both non-stratified and stratified analyses revealed that the antimicrobial incise drape significantly reduced the risk of contamination as compared with no drape (odds ratio = 0.54, p < 0.0001). Iodophor-impregnated incise drapes, such as Ioban, significantly reduce the risk of contamination in total joint arthroplasties. (Journal of Surgical Orthopaedic Advances 33(4):206-211, 2024).

The role of tranexamic acid (TXA) in orthopaedic surgery is expanding. It has been shown to decreased blood loss in orthopaedic trauma, total joint arthroplasty, and spine surgery. Although significant blood loss with arthroscopic surgery is rare, the use of TXA in these procedures has been advocated to help with intraoperative visualization and decreased postoperative swelling and hemarthrosis. TXA in shoulder arthroscopy may improve visual clarity, decrease the amount of fluid used during arthroscopy, and decrease postoperative pain. Although several studies have shown TXA in shoulder and knee arthroscopy may decrease early pain, swelling, and hemarthrosis, others have shown no difference in short- or long-term outcomes when compared with placebo. Although there is a low reported rate of complications after TXA use in shoulder and knee arthroscopy, TXA may be chondrotoxic in high concentrations. Further investigation is warranted, but TXA may have some early benefits in arthroscopic shoulder and knee surgeries. (Journal of Surgical Orthopaedic Advances 33(3):131-134, 2024).

The purpose of this study was to determine if implementation of an enhanced recovery pathway (ERP) for elective spine surgery reduced opioid use and pain scores in elective spine surgery. A historical cohort study of 171 patients undergoing elective spine procedures between 2017 and 2021 was performed. The primary outcomes were opioid use and average daily pain scores. A group of 92 patients received the novel ERP (2019 - 2021) in comparison to a historical control group of 79 patients without the ERP (2017 - 2019). On postoperative days 1 to 3, the ERP group received 36% (p < 0.001), 36% (p < 0.001), and 37% (p = 0.005) less milligram morphine equivalents, respectively. On postoperative days 1 to 3, the ERP group pain scores were 1.5 (p < 0.001), 1.0 (p = 0.003), and 1.1 (p = 0.004) points lower, respectively. Length of stay was similar (4.3 vs. 4.5 days, p = 0.693). Adoption of this ERP protocol was associated with clinically significant reduced opioid consumption and pain scores in elective spine surgery. (Journal of Surgical Orthopaedic Advances 33(3):162-167, 2024).

California's Controlled Substance Utilization Review and Evaluation System (CURES) was mandated in 2018 to monitor and limit opiate prescriptions. This study evaluated the effects of this legislation on postoperative opioid prescriptions of patients undergoing soft tissue hand surgery. Patients receiving carpal tunnel release, trigger finger release, and ganglion excisions 18 months prior to and 18 months after CURES were selected. The primary outcome was milligram morphine equivalent (MME) prescribed at the surgical encounter and at first postoperative visit. There were 758 patients in the pre-CURES cohort and 701 patients in the post-CURES cohort. In the pre-CURES cohort, there was 116.9 ± 123.8 MME prescribed post op and 10.2 ± 70.8 at first follow-up, whereas post-CURES had 58.8 ± 68.4 MME and 1.1 ± 14.1 for post-op and first follow-up respectively. Findings of this study indicate state regulations may play a role in reducing narcotic consumption following soft tissue hand surgery. (Journal of Surgical Orthopaedic Advances 33(2):122-124, 2024).