Eoghan T Hurley, Tyler A Luthringer, Amit K Manjunath, Daire J Hurley, James P Toale, Eric J Strauss
Purpose: The purpose of this study was to systematically review and analyze the current evidence in the literature to determine the relative complication rates of the singleincision versus dual-incision approach to distal biceps tendon repair.
Methods: The literature search was performed based on the PRISMA guidelines. Cohort studies comparing the single-incision or dual-incision approach to biceps tendon repair alone were included. Clinical outcomes were compared, with all statistical analysis performed using Review Manager Version 5.3. A p-value < 0.05 was considered to be statistically significant.
Results: Twelve clinical studies with varying levels of evidence (LOE I: 1, LOE II: 1, LOE III: 10) with 2,429 patients were included. Overall, there was a significantly lower rate of total complications with the dual-incision approach (16.1% vs. 23.1%, p < 0.01) and a lower rate of neurological injuries (9.1% vs. 24.1%, p < 0.01). There was a lower rate of lateral antebrachial cutaneous nerve injuries with the dual-incision approach (5.2% vs. 19.5%, p < 0.01), and superficial radial nerve injuries (2.5% vs. 4.8%, p < 0.01), but there was no significant difference in the rate of posterior interosseous nerve injuries (2.2% vs. 1.2%, p = 0.20). There was a significantly lower rate of heterotopic bone formation with the single-incision approach (1.3% vs. 2.7%, p = 0.01).
Conclusion: The dual-incision approach decreases the risk of total, overall postoperative complications and sensory nerve injuries following distal biceps repair. However, it has a higher risk of heterotopic bone formation.
目的:本研究的目的是系统地回顾和分析目前文献中的证据,以确定单切口与双切口入路在肱二头肌远端肌腱修复中的相对并发症发生率。方法:根据PRISMA指南进行文献检索。比较单切口或双切口入路与单独二头肌肌腱修复的队列研究被纳入。临床结果比较,所有统计分析使用Review Manager Version 5.3进行。p值< 0.05被认为具有统计学意义。结果:纳入了12项具有不同证据水平的临床研究(LOE I: 1, LOE II: 1, LOE III: 10),共2,429例患者。总体而言,双切口入路总并发症发生率(16.1%比23.1%,p < 0.01)和神经损伤发生率(9.1%比24.1%,p < 0.01)均显著降低。双切口入路臂前外侧皮神经损伤率(5.2%比19.5%,p < 0.01)和桡浅神经损伤率(2.5%比4.8%,p < 0.01)较低,但后骨间神经损伤率(2.2%比1.2%,p = 0.20)差异无统计学意义。单切口入路异位骨形成率明显较低(1.3% vs. 2.7%, p = 0.01)。结论:双切口入路降低了肱二头肌远端修复术后总并发症和感觉神经损伤的风险。然而,它具有较高的异位骨形成风险。
{"title":"Complications of Single-Incision Versus Dual-Incision Distal Biceps Repair A Systematic Review and Meta-Analysis of Comparative Studies.","authors":"Eoghan T Hurley, Tyler A Luthringer, Amit K Manjunath, Daire J Hurley, James P Toale, Eric J Strauss","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to systematically review and analyze the current evidence in the literature to determine the relative complication rates of the singleincision versus dual-incision approach to distal biceps tendon repair.</p><p><strong>Methods: </strong>The literature search was performed based on the PRISMA guidelines. Cohort studies comparing the single-incision or dual-incision approach to biceps tendon repair alone were included. Clinical outcomes were compared, with all statistical analysis performed using Review Manager Version 5.3. A p-value < 0.05 was considered to be statistically significant.</p><p><strong>Results: </strong>Twelve clinical studies with varying levels of evidence (LOE I: 1, LOE II: 1, LOE III: 10) with 2,429 patients were included. Overall, there was a significantly lower rate of total complications with the dual-incision approach (16.1% vs. 23.1%, p < 0.01) and a lower rate of neurological injuries (9.1% vs. 24.1%, p < 0.01). There was a lower rate of lateral antebrachial cutaneous nerve injuries with the dual-incision approach (5.2% vs. 19.5%, p < 0.01), and superficial radial nerve injuries (2.5% vs. 4.8%, p < 0.01), but there was no significant difference in the rate of posterior interosseous nerve injuries (2.2% vs. 1.2%, p = 0.20). There was a significantly lower rate of heterotopic bone formation with the single-incision approach (1.3% vs. 2.7%, p = 0.01).</p><p><strong>Conclusion: </strong>The dual-incision approach decreases the risk of total, overall postoperative complications and sensory nerve injuries following distal biceps repair. However, it has a higher risk of heterotopic bone formation.</p>","PeriodicalId":72481,"journal":{"name":"Bulletin of the Hospital for Joint Disease (2013)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40644136","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}
Devan Mehta, Abhishek Ganta, Vivian Bradaschia-Correa, Sanjit R Konda, Kenneth A Egol, Philipp Leucht
Purpose: Chronic use of selective serotonin reuptake inhibitors (SSRIs) for the treatment of depression has been linked to an imbalance in bone metabolism leading to osteoporosis. More recently, the use of SSRIs in murine models has been shown to delay bone healing both in vivo and in vitro by decreasing the osteoblastic differentiation and mineralization. The purpose of this study was to evaluate whether or not chronic use of SSRI's in nonunion patients increases their time to union after surgical intervention.
Methods: We retrospectively analyzed 343 patients in a nonunion database to determine which patients were on SSRI medication. Of these patients, 139 could be contacted and of those 102 were not taking SSRIs and 37 were taking SSRIs. Patient's time to union from nonunion surgical intervention between each cohort at our institution was recorded as the primary outcome. Patient's medical comorbidities that could affect union rates such as diabetes and smoking status were also noted. Baseline Short Musculoskeletal Function Assessment (SMFA) index for bother and function were recorded from the time of nonunion surgery as well as last follow-up.
Results: Compared to recent census data, we found significantly more patients in the nonunion cohort using SSRIs (26.6%) than patients in the general population using any type of antidepressant (11%). There was no significant difference in the patients' baseline characteristics other than patients on SSRI treatment had a higher body mass index (BMI) and age (p = 0.048 and p = 0.043, respectively). There was no significant difference noted in the fracture types (p = 0.2063). Patients on SSRIs had a higher SMFA bother index and function index on follow-up (p = 0.0103, p = 0.0147). Patients in the SSRI group had a mean time to union from nonunion surgery of 6.1 months compared to 6.0 in patients without SSRI usage (p = 0.74). These did not reach statistical significance when subcohort analysis for long bone fractures was performed for the femur, tibia, and humerus.
Conclusion: To our knowledge, this is the first clinical study to investigate the effects of SSRIs on fracture healing. While in vivo and in vitro murine models have shown that SSRIs can have a deleterious effect on osteoblastic activity, our retrospective analysis did not show a significant difference in time to union between patients with chronic SSRI use and patients who have not been on SSRIs. However, this investigation did show a higher incidence of SSRI use in the nonunion cohort when compared to the general population. In the context of the recent animal model study, this may point to a negative effect of SSRI use on the acute fracture healing process.
目的:长期使用选择性血清素再摄取抑制剂(SSRIs)治疗抑郁症与骨代谢失衡导致骨质疏松症有关。最近,在小鼠模型中使用SSRIs已被证明通过减少成骨细胞分化和矿化来延缓体内和体外的骨愈合。本研究的目的是评估不愈合患者长期使用SSRI类药物是否会增加手术干预后的愈合时间。方法:我们回顾性分析了343例骨不连数据库中的患者,以确定哪些患者正在服用SSRI药物。在这些患者中,139人可以联系到,其中102人没有服用SSRIs, 37人正在服用SSRIs。在我们机构的每个队列中,记录患者从手术不愈合到愈合的时间作为主要结局。患者的医疗合并症,如糖尿病和吸烟状况也可能影响结合率。从手术不愈合时及最后一次随访开始,记录患者的基线短肌骨骼功能评估(SMFA)指数。结果:与最近的人口普查数据相比,我们发现使用SSRIs的不连症患者(26.6%)明显多于使用任何类型抗抑郁药的普通人群(11%)。两组患者基线特征差异无统计学意义(p = 0.048, p = 0.043),仅SSRI组患者BMI和年龄较高。骨折类型差异无统计学意义(p = 0.2063)。SSRIs组患者随访时SMFA困扰指数和功能指数较高(p = 0.0103, p = 0.0147)。SSRI组患者术后不愈合的平均时间为6.1个月,而未使用SSRI的患者为6.0个月(p = 0.74)。当对股骨、胫骨和肱骨的长骨骨折进行亚队列分析时,这些结果没有达到统计学意义。结论:据我们所知,这是第一个研究SSRIs对骨折愈合影响的临床研究。虽然体内和体外小鼠模型显示SSRI类药物对成骨细胞活性有有害影响,但我们的回顾性分析并未显示慢性SSRI患者和未服用SSRI类药物的患者在愈合时间上存在显著差异。然而,这项调查确实显示,与一般人群相比,非骨连队列中SSRI的使用发生率更高。在最近的动物模型研究中,这可能表明SSRI对急性骨折愈合过程有负面影响。
{"title":"Clinical Effect of Selective Serotonin Reuptake Inhibitors (SSRIs) on Fracture Healing.","authors":"Devan Mehta, Abhishek Ganta, Vivian Bradaschia-Correa, Sanjit R Konda, Kenneth A Egol, Philipp Leucht","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>Chronic use of selective serotonin reuptake inhibitors (SSRIs) for the treatment of depression has been linked to an imbalance in bone metabolism leading to osteoporosis. More recently, the use of SSRIs in murine models has been shown to delay bone healing both in vivo and in vitro by decreasing the osteoblastic differentiation and mineralization. The purpose of this study was to evaluate whether or not chronic use of SSRI's in nonunion patients increases their time to union after surgical intervention.</p><p><strong>Methods: </strong>We retrospectively analyzed 343 patients in a nonunion database to determine which patients were on SSRI medication. Of these patients, 139 could be contacted and of those 102 were not taking SSRIs and 37 were taking SSRIs. Patient's time to union from nonunion surgical intervention between each cohort at our institution was recorded as the primary outcome. Patient's medical comorbidities that could affect union rates such as diabetes and smoking status were also noted. Baseline Short Musculoskeletal Function Assessment (SMFA) index for bother and function were recorded from the time of nonunion surgery as well as last follow-up.</p><p><strong>Results: </strong>Compared to recent census data, we found significantly more patients in the nonunion cohort using SSRIs (26.6%) than patients in the general population using any type of antidepressant (11%). There was no significant difference in the patients' baseline characteristics other than patients on SSRI treatment had a higher body mass index (BMI) and age (p = 0.048 and p = 0.043, respectively). There was no significant difference noted in the fracture types (p = 0.2063). Patients on SSRIs had a higher SMFA bother index and function index on follow-up (p = 0.0103, p = 0.0147). Patients in the SSRI group had a mean time to union from nonunion surgery of 6.1 months compared to 6.0 in patients without SSRI usage (p = 0.74). These did not reach statistical significance when subcohort analysis for long bone fractures was performed for the femur, tibia, and humerus.</p><p><strong>Conclusion: </strong>To our knowledge, this is the first clinical study to investigate the effects of SSRIs on fracture healing. While in vivo and in vitro murine models have shown that SSRIs can have a deleterious effect on osteoblastic activity, our retrospective analysis did not show a significant difference in time to union between patients with chronic SSRI use and patients who have not been on SSRIs. However, this investigation did show a higher incidence of SSRI use in the nonunion cohort when compared to the general population. In the context of the recent animal model study, this may point to a negative effect of SSRI use on the acute fracture healing process.</p>","PeriodicalId":72481,"journal":{"name":"Bulletin of the Hospital for Joint Disease (2013)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40644134","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}
Tyler Luthringer, David A Bloom, Amit Manjunath, Lorraine Hutzler, Eric J Strauss, Laith Jazrawi, Kirk Campbell, Joseph A Bosco
Purpose: Given the wide variation that exists in the amount and duration of postoperative opioid medication prescribed by orthopedic surgeons, the purpose of the current study was to analyze the opioid prescribing patterns at our institution for adolescent patients undergoing outpatient sports medicine procedures Methods: A total of 468 adolescent patients (between the ages of 13 and 18 years old) who underwent outpatient shoulder, hip, or knee arthroscopy (including ACL reconstruction) between 2016 and 2018 were retrospectively identified, and demographic data were collected. Opioid prescriptions following surgery were converted to morphine milligram equivalents (MME) for direct comparison. Prescribing patterns of the 44 surgeons included in our cohort were evaluated with respect to procedures performed and overall surgical volume. High-dose prescriptions were defined as ≥ 300 MME (equivalent to 40 tabs of oxycodone/ acetaminophen [Percocet] 5/325 mg) and low-dose prescriptions were defined as < 300 MME.
Results: The mean discharge prescription following outpatient arthroscopy in this patient population was 299.8 ± 271 MME. When each individual case-type was analyzed, there were significant positive correlations between surgeonvolume and MME prescribed following shoulder arthroscopy (r = 0.387, p < 0.001) and knee arthroscopy, (r = 0.350, p < 0.001). Results of logistic regression demonstrated that for every 10 additional cases performed, the odds that a given surgeon would prescribe ≥ 300 MME postoperatively increased by a factor of 1.14 (p < 0.001). There were no significant correlations observed following hip arthroscopy, anterior cruciate ligament reconstruction, or meniscus repair. Over the course of the observation period, a significant reduction in opioid prescribing was seen among the participating surgeons.
Conclusion: Surgeons who perform a greater volume of outpatient shoulder and knee arthroscopy on adolescent patients were more likely to prescribe high opioid dosages postoperatively. Awareness of existing variation in narcotic prescribing patterns for patients in this age group is important for quality of care and safety improvement amidst the opioid epidemic.
{"title":"A Surgeon-Volume Comparison of Opioid Prescribing Patterns to Adolescents Following Outpatient Shoulder, Hip, and Knee Arthroscopy.","authors":"Tyler Luthringer, David A Bloom, Amit Manjunath, Lorraine Hutzler, Eric J Strauss, Laith Jazrawi, Kirk Campbell, Joseph A Bosco","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>Given the wide variation that exists in the amount and duration of postoperative opioid medication prescribed by orthopedic surgeons, the purpose of the current study was to analyze the opioid prescribing patterns at our institution for adolescent patients undergoing outpatient sports medicine procedures Methods: A total of 468 adolescent patients (between the ages of 13 and 18 years old) who underwent outpatient shoulder, hip, or knee arthroscopy (including ACL reconstruction) between 2016 and 2018 were retrospectively identified, and demographic data were collected. Opioid prescriptions following surgery were converted to morphine milligram equivalents (MME) for direct comparison. Prescribing patterns of the 44 surgeons included in our cohort were evaluated with respect to procedures performed and overall surgical volume. High-dose prescriptions were defined as ≥ 300 MME (equivalent to 40 tabs of oxycodone/ acetaminophen [Percocet] 5/325 mg) and low-dose prescriptions were defined as < 300 MME.</p><p><strong>Results: </strong>The mean discharge prescription following outpatient arthroscopy in this patient population was 299.8 ± 271 MME. When each individual case-type was analyzed, there were significant positive correlations between surgeonvolume and MME prescribed following shoulder arthroscopy (r = 0.387, p < 0.001) and knee arthroscopy, (r = 0.350, p < 0.001). Results of logistic regression demonstrated that for every 10 additional cases performed, the odds that a given surgeon would prescribe ≥ 300 MME postoperatively increased by a factor of 1.14 (p < 0.001). There were no significant correlations observed following hip arthroscopy, anterior cruciate ligament reconstruction, or meniscus repair. Over the course of the observation period, a significant reduction in opioid prescribing was seen among the participating surgeons.</p><p><strong>Conclusion: </strong>Surgeons who perform a greater volume of outpatient shoulder and knee arthroscopy on adolescent patients were more likely to prescribe high opioid dosages postoperatively. Awareness of existing variation in narcotic prescribing patterns for patients in this age group is important for quality of care and safety improvement amidst the opioid epidemic.</p>","PeriodicalId":72481,"journal":{"name":"Bulletin of the Hospital for Joint Disease (2013)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40644137","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}
Objectives: The cast index is the most commonly used measurement of cast quality in pediatric forearm fractures, with low values representing a good quality cast and higher values suggesting poor technique. However, in some instances the cast index may not accurately reflect cast quality. The purpose of this study was to critically evaluate the quality of casts deemed "good" or "bad" based on the cast index against other measurements in order to identify these examples.
Methods: Pediatric patients casted for a distal or midshaft forearm fracture were identified from a prospectively gathered database. There were 121 casts on 97 forearms. Measurements were made on forearm or wrist x-rays to calculate the cast index, gap index, and the anatomic dimensions of the forearm at the level of the fracture. Fisher's exact test was used to assess the likelihood of a good cast index (< 0.75) to also have an acceptable gap index (< 0.15). Pearson's correlation compared the anatomic measurements of the forearm and the cast index.
Results: There were 65 casts with a good cast index, and 58% also had an acceptable gap index (< 0.15). Among the 56 casts with a bad cast index, 20% had an acceptable gap index (p < 0.001). The anatomic measurements of the forearm and the cast index were strongly correlated (r = 0.96).
Conclusion: Many casts with a good cast index have an unacceptable gap index. Forearm measurements and cast index are highly correlated, suggesting that a well-molded cast may have a higher cast index due to the shape of the forearm. While the cast index is a useful tool, "good" or "bad" casts are not uniformly captured by this measurement.
{"title":"Does a Good Cast Index Always Reflect a Good Cast?","authors":"Demetrios Roussos, Leah Gonzalez, Jody Litrenta","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>The cast index is the most commonly used measurement of cast quality in pediatric forearm fractures, with low values representing a good quality cast and higher values suggesting poor technique. However, in some instances the cast index may not accurately reflect cast quality. The purpose of this study was to critically evaluate the quality of casts deemed \"good\" or \"bad\" based on the cast index against other measurements in order to identify these examples.</p><p><strong>Methods: </strong>Pediatric patients casted for a distal or midshaft forearm fracture were identified from a prospectively gathered database. There were 121 casts on 97 forearms. Measurements were made on forearm or wrist x-rays to calculate the cast index, gap index, and the anatomic dimensions of the forearm at the level of the fracture. Fisher's exact test was used to assess the likelihood of a good cast index (< 0.75) to also have an acceptable gap index (< 0.15). Pearson's correlation compared the anatomic measurements of the forearm and the cast index.</p><p><strong>Results: </strong>There were 65 casts with a good cast index, and 58% also had an acceptable gap index (< 0.15). Among the 56 casts with a bad cast index, 20% had an acceptable gap index (p < 0.001). The anatomic measurements of the forearm and the cast index were strongly correlated (r = 0.96).</p><p><strong>Conclusion: </strong>Many casts with a good cast index have an unacceptable gap index. Forearm measurements and cast index are highly correlated, suggesting that a well-molded cast may have a higher cast index due to the shape of the forearm. While the cast index is a useful tool, \"good\" or \"bad\" casts are not uniformly captured by this measurement.</p>","PeriodicalId":72481,"journal":{"name":"Bulletin of the Hospital for Joint Disease (2013)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40644139","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}
David N. Kugelman, S. Owusu‐Sarpong, Ariana Lott, M. Karamitopoulos, E. Strauss, R. Schwarzkopf
As the world continues to battle the COVID-19 pandemic, health care providers are committed to providing care not only to our patients but also to our community. Schools in New York City (NYC) went remote on March 15, 2020. This can prove detrimental to student development and education. Numerous leaders in education and public health have noted that the remote learning will further widen educational and income disparities in those from underserved and underrepresented areas. A group of orthopedic residents who attended NYC public schools and were current house staff at a major academic tertiary medical center in NYC developed and implemented a virtual high-school mentorship program. This program incorporated weekly lectures and discussions given by health care providers to students interested in health care from NYC public high schools. The goal of this program was to provide mentorship during the COVID pandemic to a high-school audience where greater than 80% of students are considered to be living below the poverty level. Although school is now back in session, these programs should be continued in person. It is the aim of the authors that other orthopedic residents and health care providers implement similar programs in their communities.
{"title":"Orthopedic Surgery Resident Development and Implementation of a Virtual High-School Mentorship Program During the COVID-19 Pandemic.","authors":"David N. Kugelman, S. Owusu‐Sarpong, Ariana Lott, M. Karamitopoulos, E. Strauss, R. Schwarzkopf","doi":"10.1258/j.joint.258.236","DOIUrl":"https://doi.org/10.1258/j.joint.258.236","url":null,"abstract":"As the world continues to battle the COVID-19 pandemic, health care providers are committed to providing care not only to our patients but also to our community. Schools in New York City (NYC) went remote on March 15, 2020. This can prove detrimental to student development and education. Numerous leaders in education and public health have noted that the remote learning will further widen educational and income disparities in those from underserved and underrepresented areas. A group of orthopedic residents who attended NYC public schools and were current house staff at a major academic tertiary medical center in NYC developed and implemented a virtual high-school mentorship program. This program incorporated weekly lectures and discussions given by health care providers to students interested in health care from NYC public high schools. The goal of this program was to provide mentorship during the COVID pandemic to a high-school audience where greater than 80% of students are considered to be living below the poverty level. Although school is now back in session, these programs should be continued in person. It is the aim of the authors that other orthopedic residents and health care providers implement similar programs in their communities.","PeriodicalId":72481,"journal":{"name":"Bulletin of the Hospital for Joint Disease (2013)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75968428","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}
Andrew J Clair, David H Mai, Siddharth A Mahure, Joseph D Zuckerman, Mandeep S Virk
Background: The purpose of this study was to determine the relationship between admission source and postoperative length of stay (LOS), index admission hospital charges, and discharge disposition, in patients undergoing shoulder arthroplasty.
Methods: The New York Statewide Planning and Research Cooperative System (SPARCS) was used to identify all patients that underwent elective shoulder arthroplasty from 1994 through 2015. Patients were grouped into institutionalized (INS) versus non-institutionalized (n-INS) groups based on admission source. The two groups were compared regarding demographics, Charleston comorbidity index (CCI), postoperative blood transfusion requirement, LOS, and total charges.
Results: A total of 33,248 patients were identified (32,875 n-INS, 373 INS). Patientsin the INS cohort were significantly older (71.9 versus 68.1 years) and had a higher CCI (1.3 vs. 0.7). The mean LOS in the INS group was nearly 1 week longer(9.5 days vs. 2.8 days) and had a significantly higher postoperative blood transfusion rate (37.5% vs. 9.2%, odds ratio: 5.9). The mean total hospital charges in the INS group were also significantly higher ($63,988 vs. $36,826).
Discussion: Institutionalized patients undergoing shoulder arthroplasty have a protracted postoperative hospital course and this ultimately resulted in poorer outcomes and increased resource utilization.
{"title":"Impact of Admission Source on Shoulder Arthroplasty.","authors":"Andrew J Clair, David H Mai, Siddharth A Mahure, Joseph D Zuckerman, Mandeep S Virk","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to determine the relationship between admission source and postoperative length of stay (LOS), index admission hospital charges, and discharge disposition, in patients undergoing shoulder arthroplasty.</p><p><strong>Methods: </strong>The New York Statewide Planning and Research Cooperative System (SPARCS) was used to identify all patients that underwent elective shoulder arthroplasty from 1994 through 2015. Patients were grouped into institutionalized (INS) versus non-institutionalized (n-INS) groups based on admission source. The two groups were compared regarding demographics, Charleston comorbidity index (CCI), postoperative blood transfusion requirement, LOS, and total charges.</p><p><strong>Results: </strong>A total of 33,248 patients were identified (32,875 n-INS, 373 INS). Patientsin the INS cohort were significantly older (71.9 versus 68.1 years) and had a higher CCI (1.3 vs. 0.7). The mean LOS in the INS group was nearly 1 week longer(9.5 days vs. 2.8 days) and had a significantly higher postoperative blood transfusion rate (37.5% vs. 9.2%, odds ratio: 5.9). The mean total hospital charges in the INS group were also significantly higher ($63,988 vs. $36,826).</p><p><strong>Discussion: </strong>Institutionalized patients undergoing shoulder arthroplasty have a protracted postoperative hospital course and this ultimately resulted in poorer outcomes and increased resource utilization.</p>","PeriodicalId":72481,"journal":{"name":"Bulletin of the Hospital for Joint Disease (2013)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40644140","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}
David Kugelman, Stephane Owusu-Sarpong, Ariana Lott, Mara Karamitopoulos, Eric J Strauss, Ran Schwarzkopf
As the world continues to battle the COVID-19 pandemic, health care providers are committed to providing care not only to our patients but also to our community. Schools in New York City (NYC) went remote on March 15, 2020. This can prove detrimental to student development and education. Numerous leaders in education and public health have noted that the remote learning will further widen educational and income disparities in those from underserved and underrepresented areas. A group of orthopedic residents who attended NYC public schools and were current house staff at a major academic tertiary medical center in NYC developed and implemented a virtual high-school mentorship program. This program incorporated weekly lectures and discussions given by health care providers to students interested in health care from NYC public high schools. The goal of this program was to provide mentorship during the COVID pandemic to a high-school audience where greater than 80% of students are considered to be living below the poverty level. Although school is now back in session, these programs should be continued in person. It is the aim of the authors that other orthopedic residents and health care providers implement similar programs in their communities.
{"title":"Orthopedic Surgery Resident Development and Implementation of a Virtual High-School Mentorship Program During the COVID-19 Pandemic.","authors":"David Kugelman, Stephane Owusu-Sarpong, Ariana Lott, Mara Karamitopoulos, Eric J Strauss, Ran Schwarzkopf","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>As the world continues to battle the COVID-19 pandemic, health care providers are committed to providing care not only to our patients but also to our community. Schools in New York City (NYC) went remote on March 15, 2020. This can prove detrimental to student development and education. Numerous leaders in education and public health have noted that the remote learning will further widen educational and income disparities in those from underserved and underrepresented areas. A group of orthopedic residents who attended NYC public schools and were current house staff at a major academic tertiary medical center in NYC developed and implemented a virtual high-school mentorship program. This program incorporated weekly lectures and discussions given by health care providers to students interested in health care from NYC public high schools. The goal of this program was to provide mentorship during the COVID pandemic to a high-school audience where greater than 80% of students are considered to be living below the poverty level. Although school is now back in session, these programs should be continued in person. It is the aim of the authors that other orthopedic residents and health care providers implement similar programs in their communities.</p>","PeriodicalId":72481,"journal":{"name":"Bulletin of the Hospital for Joint Disease (2013)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40644141","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}
{"title":"Henry L. Jaffe, MD: The Foundation of Orthopedic Pathology.","authors":"David Kugelman, Daniel J Kaplan, Timothy Rapp","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":72481,"journal":{"name":"Bulletin of the Hospital for Joint Disease (2013)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39675362","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}
{"title":"Henry Milch, MD: Pioneer in Understanding Orthopedic Disease.","authors":"Noah Kirschner, Michael Dinizo, Mandeep Virk","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":72481,"journal":{"name":"Bulletin of the Hospital for Joint Disease (2013)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39675360","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}
John F Dankert, David J Kirby, John G Kennedy, Raymond Walls
Paul W. Lapidus' work has formed the foundation of modern foot and ankle surgery. Variations of his popularizedtechnique, the Lapidus procedure, remain in regular usetoday for the management and correction of hallux valgus.We revisit Dr. Lapidus' career and accomplishments withan emphasis on his importance to the expanding divisionof foot and ankle surgery at the Hospital for Joint Diseases.
{"title":"Paul W. Lapidus: The Father of Foot and Ankle Surgery.","authors":"John F Dankert, David J Kirby, John G Kennedy, Raymond Walls","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Paul W. Lapidus' work has formed the foundation of modern foot and ankle surgery. Variations of his popularizedtechnique, the Lapidus procedure, remain in regular usetoday for the management and correction of hallux valgus.We revisit Dr. Lapidus' career and accomplishments withan emphasis on his importance to the expanding divisionof foot and ankle surgery at the Hospital for Joint Diseases.</p>","PeriodicalId":72481,"journal":{"name":"Bulletin of the Hospital for Joint Disease (2013)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39675381","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}