Journal of surgical orthopaedic advances最新文献

There is a growing trend in performing outpatient total shoulder arthroplasty (TSA). The purpose of this study was to analyze the public perception of outpatient TSA by querying a validated online market research platform regarding the public's knowledge, expectations, and beliefs on outpatient TSA. One thousand eighty respondents completed the survey in 2021. Simple and multivariable logistic regressions were performed to determine factors that were associated with an expected prolonged (2+ days) length of stay (LOS) after TSA. The mean expected LOS was 1.7 ± 1.5 days, with 48% of respondents expecting a prolonged LOS. Increasing age (p = 0.005) and unfamiliarity with outpatient TSA (p = 0.004) were significant predictors for expecting a prolonged LOS following TSA. The highest perceived risk of outpatient TSA was experiencing an avoidable complication (23%), whereas perceived benefits included reduced cost (38%) and quicker recovery (27%). Although outpatient TSA is becoming increasingly popular, a gap in public knowledge and expectations is evident. (Journal of Surgical Orthopaedic Advances 33(4):228-232, 2024).

The objective of this retrospective study was to investigate the impact of tourniquet use during intramedullary tibial nailing on clinical outcomes at a regional Level I Trauma Center. One hundred ninety-four patients with intramedullary tibial fixation over a 5-year period at a single institution were studied following Institutional Review Board (IRB) approval. Patients were stratified into 81 polytrauma patients and 113 patients with isolated tibial shaft injuries. Patients were then stratified within these two groups according to whether or not a tourniquet was used intraoperatively (including during reaming). Postoperative narcotic use, length of stay, operating room (OR) time, tourniquet time, estimated blood loss, units of blood utilized, infection rate, and age were the outcome variables. No significant differences were found for any outcome measure (p ≥ 0.05), including age, narcotic use, OR time, postoperative inpatient days, estimated blood loss, and units of blood used between tourniquet and nontourniquet patients. Statistically significant differences were found between isolated and nonisolated fracture patients for postanesthesia care unit (PACU) morphine dose equivalents (MDEs), with isolated tibia fracture patients requiring more MDEs (13.80 vs. 9.92 units; p = 0.025). Nonisolated tibia patients had more inpatient days (14.88 vs. 3.16 days; p = 0.001), greater estimated blood loss (252.44 vs. 128.07 mL; p = 0.001), and more units of blood (5.07 vs. 2.29 units; p = 0.017). Thermal necrosis of the tibia was not seen in any patient within any group. Tourniquet use did not significantly affect clinical outcomes. This provides surgeons with updated data on the impact of tourniquet use on clinical outcomes given the modernization of techniques for tibial intramedullary nailing. There were statistically significant differences between isolated tibia fractures and polytrauma patients for postoperative length of stay, estimated blood loss, and units of blood; however, this was unrelated to tourniquet use and would be expected for polytraumatic patients who commonly have a longer postoperative recovery. (Journal of Surgical Orthopaedic Advances 33(3):181-183, 2024).

Recent research efforts have focused on the complications and outcomes associated with opioid use disorder (OUD). However, there is a lack of evidence on the associated risks respective to each primary shoulder arthroplasty procedure. After separating patients by total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) and matching to controls, our study demonstrated significant association with longer LOS in both groups, higher risk of SSI and PJI in the TSA group, PJI in the RSA group, and higher costs regardless of procedure. Efforts to appropriately recognize OUD, optimize patients pre-operatively, and apply targeted surveillance postoperatively should be made. (Journal of Surgical Orthopaedic Advances 33(2):117-121, 2024).

Previous studies have shown a relationship between cigarette use and pain but never in the setting of traumatic spinal cord injury (TSCI). Therefore, the objectives of this study were to (1) determine whether smokers with TSCI experience increased pain compared with nonsmokers with TSCI and (2) determine whether smokers with TSCI experience worse functional outcomes than nonsmokers with TSCI. A retrospective analysis of the National Spinal Cord Injury Statistical Center database was performed. Pain severity, interference, and functional outcomes were compared between 514 nonsmokers and 124 smokers with American Spinal Injury Association (ASIA) C/D TSCI. Smokers reported higher scores for pain severity and interference compared with nonsmokers. These findings were significant on multivariable analysis. Smokers also reported higher rates of job loss compared with nonsmokers, but this finding was not significant on multivariable analysis. Smoking may be an independent risk factor for increased pain severity and interference in the setting of TSCI. (Journal of Surgical Orthopaedic Advances 33(2):103-107, 2024).

Victor McKusick, an iconic figure in medicine and considered the founding father of medical genetics, lived an exemplary life bound to inspire others. As a geneticist, McKusick was heavily involved in the Human Genome Project and the development of the widely used Online Mendelian Inheritance in Man. As a researcher and prolific writer, he published more than 700 research articles, reviews, and books. McKusick educated and inspired thousands of students, doctors, and scientists while performing landmark studies in hereditary disorders and skeletal dysplasias. This brief history describes the life of Dr. Victor McKusick and his tremendous impact on orthopaedic surgery. (Journal of Surgical Orthopaedic Advances 33(2):068-071, 2024).

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).