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Siljander BR, Chandi SK, Cororaton AD, Debbi EM, McLawhorn AS, Sculco PK, Chalmers BP. A Comparison of Clinical Outcomes After Total Knee Arthroplasty in Patients Who Have and Do Not Have Self-Reported Nickel Allergy: Matched and Unmatched Cohort Comparisons. J Arthroplasty 2024:S0883-5403(24)00476-5. [PMID: 38759819 DOI: 10.1016/j.arth.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The impact of a preoperative self-reported nickel allergy in patients undergoing primary total knee arthroplasty (TKA) remains unclear. The aim of this study was to compare the revision rates and outcomes of patients who have a self-reported nickel allergy undergoing primary TKA to patients who do not have a self-reported nickel allergy. METHODS Over 5 years, a total of 284 TKAs in patients who have and 17,735 in patients who do not have a self-reported nickel allergy were performed. Revision rates and differences in preoperative and postoperative patient-reported outcome measures, including Knee Osteoarthritis Outcome Score Joint Replacement (KOOS JR), Visual Analog Scale, Lower Extremity Activity Scale, and the Patient-Reported Outcomes Measurement Information System Mental and Physical Scores, were compared. RESULTS Survivorship free of all-cause revision at 1 year was similar for patients who have and do not have a self-reported nickel allergy (99.5% [95% CI (confidence interval): 98.6 to 100.0] versus 99.3% [95% CI: 99.1 to 99.4]), P = .49). Patients who have a self-reported nickel allergy undergoing primary TKA had no difference in KOOS JR, Visual Analog Scale, or Lower Extremity Activity Scale scores at 6 weeks and 1 year and slightly worse Patient-Reported Outcomes Measurement Information System mental and physical scores at 6 weeks compared to patients who did not have an allergy. Matched analysis revealed no difference in 6-week or 1-year KOOS, JR scores between patients who did and did not have a self-reported nickel allergy when stratified by implant class (nickel-free versus standard cobalt-chromium) (P = .113 and P = .415, respectively). CONCLUSIONS Patients who have a self-reported nickel allergy can be advised that, on average, their clinical outcome scores will improve similarly to patients who do not have a self-reported nickel allergy, and revision rates will be similar.
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Palosaari AA, White CA, Gross BD, Patel A, Li T, Flatow EL, Cagle PJ. Effect of patient-reported allergies on reverse total shoulder arthroplasty outcomes at over two years follow-up. J Orthop 2024; 51:87-90. [PMID: 38357439 PMCID: PMC10862396 DOI: 10.1016/j.jor.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
Background/aims Understanding the factors that lead to poor outcomes after reverse total shoulder arthroplasty (rTSA) is important to appropriate patient counseling. While patient-reported allergies (PRAs) have been shown to be associated with poorer outcomes after both TKA and THA, their effect on rTSA outcomes remains unclear. This study investigated the effect of zero, one, and two or more preoperative PRAs on clinical outcomes after rTSA at over two years follow-up in a cohort of fifty-two patients from our institution. Methods Patients who underwent rTSA and had a minimum follow-up time of two years were identified from an institutional database. Patients were split into cohorts of zero, one, and two or more PRAs. Range of motion (ROM) was assessed by degrees of forward elevation, external rotation, and internal rotation. Patient-reported outcomes (PROs) were assessed by the Visual Analog Scale (VAS), American Shoulder and Elbow Surgeon (ASES) score, and Simple Shoulder Test (SST) score. Results Fifty-two patients, 10 of whom reported one allergy and 11 of whom reported two or more allergies, were included in our analysis. Mean ROM and PROs improved after rTSA in each cohort. Differences in ROM and PROs between cohorts did not reach statistical significance; however, patients with PRAs tended to have worse preoperative forward elevation, VAS score, and ASES score. Two patients in the zero-allergy cohort required revision (6 %). Conclusion This study found no statistically significant difference in clinical outcomes among cohorts of patients with zero, one, or two or more preoperative PRAs after rTSA at over two years follow-up. However, patients with PRAs tended to have lower preoperative functional scores. We postulate that this may be the result of psychosomatic factors at play in these patients. PRAs should not dissuade patients or clinicians from pursuing rTSA.
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Affiliation(s)
- Andrew A. Palosaari
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, USA
| | - Christopher A. White
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, USA
| | - Benjamin D. Gross
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, USA
| | - Akshar Patel
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, USA
| | - Troy Li
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, USA
| | - Evan L. Flatow
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, USA
| | - Paul J. Cagle
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, USA
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Zgouridou A, Kenanidis E, Potoupnis M, Tsiridis E. Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1219-1251. [PMID: 37768398 PMCID: PMC10858160 DOI: 10.1007/s00590-023-03691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
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Affiliation(s)
- Aikaterini Zgouridou
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece.
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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Tille E, Beyer F, Lützner C, Postler A, Thomas P, Summer B, Lützner J. No difference in patient reported outcome and inflammatory response after coated and uncoated total knee arthroplasty - a randomized controlled study. BMC Musculoskelet Disord 2023; 24:968. [PMID: 38098024 PMCID: PMC10720193 DOI: 10.1186/s12891-023-07061-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Allergies against implant materials are still not fully understood. Despite controversies about its relevance, some patients need treatment with hypoallergenic implants. This study compared coated and standard total knee arthroplasty (TKA) regarding inflammatory response and patient-reported outcome measures (PROMs). METHODS 76 patients without self-reported allergies against implant materials were included in a RCT and received a coated or standard TKA of the same cemented posterior-stabilized knee system. 73 patients completed the 3-year follow-up. Two patients died and there was one revision surgery. Serum levels of cytokines with a possible role in implant allergy were measured in patient`s serum (IL-1beta, IL-5, IL-6, IL-8, IL-10, IFN γ, TNF α) prior to, one and three years after surgery. Furthermore, PROMs including knee function (Oxford Knee Score, Knee Society Score) and health-related quality of life (QoL, EuroQuol questionnaire) were assessed. Additionally, 8 patients with patch-test proven skin allergy against implant materials who received the coated implant were assessed similarly and compared to a matched-pair group receiving the same implant. RESULTS There were no differences in function and QoL between the assessed groups at any follow-up. The majority of patients demonstrated no elevation of the measured blood cytokines. Cytokine patterns showed no differences between study groups at any follow-up. The allergy patients demonstrated slower functional improvement and minor differences in cytokine pattern. Yet these results were not significant. There were no differences in the matched-pair analysis. CONCLUSION We observed no relevant increase in serum cytokine levels in any group. The inflammatory response measured seems limited, even in allergy patients. Furthermore, there were no differences between coated and standard TKA in non-allergy patients in the 3-year Follow-Up period. TRIAL REGISTRATION The study protocol was registered in the US National Institutes of Health's database ( http://www. CLINICALTRIALS gov ) registry under NCT03424174 on 03/17/2016.
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Affiliation(s)
- Eric Tille
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany.
| | - Franziska Beyer
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany
| | - Cornelia Lützner
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany
| | - Anne Postler
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany
| | - Peter Thomas
- Department of Dermatology und Allergology, Ludwig-Maximilians-University, Munich, Germany
| | - Burkhard Summer
- Department of Dermatology und Allergology, Ludwig-Maximilians-University, Munich, Germany
| | - Jörg Lützner
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany
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Boutefnouchet T, Vallières F, Delisle J, Benderdour M, Fernandes JC. Lymphocyte transformation test reveals low prevalence of true metal hypersensitivity among pre-operative total knee arthroplasty patients. Knee Surg Sports Traumatol Arthrosc 2022; 30:4123-4133. [PMID: 35380240 DOI: 10.1007/s00167-022-06951-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/15/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The aims of this study were to determine the prevalence of metal hypersensitivity, and identify pre-operative factors which could predict susceptibility to hypersensitivity reactions among patients scheduled for primary total knee arthroplasty (TKA). The present study used a testing method consistent with the recognised biological response to metals. METHODS A prospective cross-sectional analysis of 220 patients was conducted. All patients received a testing protocol using lymphocyte transformation test to evaluate reactivity to possible contents of orthopaedic implants. Test response is interpreted as stimulation index (SI) values. A comprehensive questionnaire was used to evaluate prior exposure. Patients were categorised according to SI values and the odds ratios (OR) were calculated as comparative effect measure for each predetermined prior exposure factor. RESULTS The prevalence of metal sensitivity response was 28% (n = 61) among patients with susceptibility to at least one agent (SI = 2 to 4.9), and 3.2% (n = 7) among patients with true hypersensitivity (SI ≥ 5). The population-weighted prevalence, adjusted for sampling weights of symptomatic knee osteoarthritis, was SI ≥ 5 = 4.7% (95% CI 0.4-11.8%) and SI ≥ 2 = 35.2% (95% CI 24.8-48.6%). Stimulation index levels of response to materials were markedly varied with the highest being aluminium. Female sex, smoking history, cutaneous reaction to jewellery, occupational exposure, and dental procedures were among factors shown to increase the odds of having higher reactivity response to tested metals. Nevertheless, patients with well-functioning prior contralateral TKA did not appear at greater risk of having either sensitivity or susceptibility with odds ratio (OR) = 0.2 (95% CI 0.01-3.2), p: NS and OR = 0.6 (95% CI 0.3-1.2), p: NS, respectively. Prior positive patch test was neither predictor of susceptibility to hypersensitivity OR = 1.2 (95% CI 0.6-2.6) p: NS nor predictor of true hypersensitivity OR = 0.7 (95% CI 0.08-6.1), p: NS. CONCLUSION Among patients scheduled for primary TKA with no prior clinical features of metal allergy the prevalence of true hypersensitivity to at least one metal is just over 3%. Patients are likely to encounter a material to which they have pre-existing susceptibility to hypersensitivity. With certain prior exposure factors, there was increased susceptibility to metal hypersensitivity reaction evoking an acquired condition. LEVEL OF EVIDENCE Level II, prospective cross-sectional study.
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Affiliation(s)
- Tarek Boutefnouchet
- CIUSSS Nord de L'Ile de Montréal, Hôpital du Sacré-Coeur de Montréal, Jean Talon and Fleury Hospitals, Montreal, QC, Canada.
- University Hospitals Birmingham NHS Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK.
| | - Francis Vallières
- CIUSSS Nord de L'Ile de Montréal, Hôpital du Sacré-Coeur de Montréal, Jean Talon and Fleury Hospitals, Montreal, QC, Canada
| | - Josee Delisle
- CIUSSS Nord de L'Ile de Montréal, Hôpital du Sacré-Coeur de Montréal, Jean Talon and Fleury Hospitals, Montreal, QC, Canada
| | - Mohamed Benderdour
- CIUSSS Nord de L'Ile de Montréal, Hôpital du Sacré-Coeur de Montréal, Jean Talon and Fleury Hospitals, Montreal, QC, Canada
| | - Julio C Fernandes
- CIUSSS Nord de L'Ile de Montréal, Hôpital du Sacré-Coeur de Montréal, Jean Talon and Fleury Hospitals, Montreal, QC, Canada
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Bulaïd Y, Djebara AE, Belhaouane R, Havet E, Dehl M, Mertl P. Beneficial effect of a zirconium-nitride-coated implant in total knee arthroplasty revision for suspected metal hypersensitivity. Orthop Traumatol Surg Res 2022; 108:103320. [PMID: 35577273 DOI: 10.1016/j.otsr.2022.103320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/03/2021] [Accepted: 05/25/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Revision of total knee arthroplasty (rTKA) for suspicion of metal hypersensitivity (MHS) may require hypoallergenic implants. Results for coated implants have not been reported. The aim of the present study was to assess short-term results and survival of rTKA for MHS using a multilayer implant coating. HYPOTHESIS Multilayer implant coating improves functional results in rTKA, with survival comparable to primary coated implants. MATERIAL AND METHODS A single-center retrospective observational study included 28 patients (30 knees) undergoing rTKA for MHS using a coated implant between May 2011 and November 2016. Exclusion criteria comprised implant malpositioning and history of infection in the affected knee. Clinical and radiological results were assessed on the International Knee Society (IKS) and SF-36 functional scores and Ewald radiological score. Survival was calculated on Kaplan-Meier estimation. RESULTS Mean follow-up was 3.8 years. Mean IKS score increased by 40.2 points (40%) [range, 28.1-52.3] (p<0.05). Mean range of motion increased by 17° [range, 9.5-24.5°] (p<0.05). Mean physical and mental SF-36 components were respectively 44.7 and 46.1. Survivorship was 93%. DISCUSSION There was significant functional improvement after rTKA for MHS. There were no short-term complications related to the zirconium nitrate coating. However, studies with longer follow-up will be needed for confirmation. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Yassine Bulaïd
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
| | - Az-Eddine Djebara
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France.
| | - Ramy Belhaouane
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
| | - Eric Havet
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
| | - Massinissa Dehl
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
| | - Patrice Mertl
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
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Lawrie CM, Bartosiak KA, Barrack TN, Nunley RM, Wright RW, Barrack RL. James A. Rand Young Investigator's Award: Questioning the "Nickel Free" Total Knee Arthroplasty. J Arthroplasty 2022; 37:S705-S709. [PMID: 35378232 DOI: 10.1016/j.arth.2022.03.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND A study was performed to measure metal ions present in the knee joint after performing a total knee arthroplasty (TKA) with standard cobalt chromium (CoCr) components as well as with "nickel-free" oxidized zirconium femoral and titanium tibial (OxZr/Ti) components. METHODS Knee joint fluid was collected prior to arthrotomy, and on postoperative day one to determine the amount of metal debris generated when performing a TKA with standard instrumentation from consecutive cases with CoCr components (n = 24) and OxZr/Ti components (n = 16). RESULTS CoCr implant patients had statistically higher levels of nickel (Ni) (29.7%, P = .033), cobalt (Co), (1,100.7%, P < .0001) and chromium (Cr) (118.9%, P < .0001) postoperatively. The cutting blocks and sawblades do not contain Co, which therefore must have come from the components. The metal ions generated from the sawblades and cutting blocks, therefore, could be discerned from the OxZr/Ti whose components don't contain Co, Cr, or Ni. The OxZr patients had significantly higher Cr (9.5×, P < .001) and Ni (5.1×, P < .001) post-TKA vs pre-TKA; Co levels were not significantly different as expected with the absence of Co in the components (P = .60). The Ni levels generated in performing an Oxinium TKA was 3.3 times higher than when performing a CoCr TKA (1.37 vs. 41 ppb, P < .001). CONCLUSIONS The substantial degree of Ni generation resulting from performing a hypoallergenic "nickel-free" TKA calls into questions the rationale of utilizing more expensive lower Ni components on the basis of known or suspected Ni or Cr allergy.
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Affiliation(s)
- Charles M Lawrie
- Miami Orthopedics and Sports Medicine Institute, Baptist Health South Florida, Miami, Florida
| | - Kimberly A Bartosiak
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Toby N Barrack
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Ryan M Nunley
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Rick W Wright
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert L Barrack
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
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Coxe FR, Wessel LE, Verret CI, Stepan JG, Nguyen JT, Fufa DT. Impact of Patient-Reported Allergies on Early Postoperative Opioid Use and Outcomes Following Ambulatory Hand Surgery. Hand (N Y) 2022; 17:206-213. [PMID: 32507056 PMCID: PMC8984723 DOI: 10.1177/1558944720928483] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Patient-reported allergies (PRAs) are associated with suboptimal orthopaedic surgery outcomes and may serve as a proxy for mental health. While mental health disorders are known risk factors for increased opioid use, less is known about how PRAs impact opioid use after orthopedic surgery. The purpose of this study was to investigate the association between PRAs and postoperative opioid use, pain, and satisfaction following hand surgery. Methods: Patients who underwent ambulatory hand surgery at a single institution from May 2017 to March 2019 were retrospectively reviewed. Various scores, including the Mindfulness Attention Awareness Scale (MAAS), were collected preoperatively. Postoperatively, patients completed a 2-week pain diary, satisfaction, and visual analog scale (VAS) pain scores. Opioid consumption was converted to oral morphine equivalents (OMEs) using standard conversions. Results: A total of 137 patients were divided into 2 groups based on presence (≥1) (n = 73) or absence (0) (n = 64) of PRAs. At baseline, the ≥ 1 PRA group had significantly higher female composition (P < .001) and pain (P < .001) and lower PROMIS mental health scores (P = .044). Postoperative OME consumption averaged 42.5 (range 0-416) in the entire cohort, with no differences between groups. Among patients with ≥ 1 PRA, increasing number of allergies significantly correlated with increasing OME consumption across all time points (week 1, P = .016; week 2, P = .001; total, P = .005). Conclusions: The presence of PRAs did not impact postoperative narcotic usage, pain, or satisfaction. Increasing numbers of PRAs did, however, significantly correlate with higher narcotic use. These results may have implications for postoperative pain management in this population.
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Affiliation(s)
- Francesca R. Coxe
- Hospital for Special Surgery, New York,
NY, USA,Francesca R. Coxe, Department of Orthopedic
Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021,
USA.
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Srikumar S, Feingold JD, Swartwout EL, Roberts SA, Ranawat AS. The predictive value of self-reported allergies for reoperation after index hip arthroscopy. J Hip Preserv Surg 2022; 9:22-27. [PMID: 35651712 PMCID: PMC9142203 DOI: 10.1093/jhps/hnac002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/06/2021] [Accepted: 01/24/2022] [Indexed: 11/14/2022] Open
Abstract
The purpose of this study is to compare the rate of reoperation after index hip arthroscopy for symptomatic femoroacetabular impingement in patients with, and without, at least one self-reported allergy. Data were collected prospectively in 1468 patients whose records were retrospectively reviewed. After the application of inclusion and exclusion criteria, two cohorts were formed: (i) a study cohort (n = 261) composed of patients with a self-reported allergy and (ii) a control cohort. (n = 666). The allergy cohort had a significantly larger [P < 0.001] reoperation rate (24.1% [63/261]) compared to the control cohort (9.6% [64/66]). Univariate analysis (UVA) and multivariate analysis (MVA) were then performed to better understand the implications of allergy status on the arthroscopic outcome. On UVA the presence of an allergy increased the odds of reoperation after index hip arthroscopy by 2.99 [OR (95% CI): 2.99 (2.04, 4.39); P < 0.001] and for each additional allergy a patient reported, their odds of subsequent surgery increased by 1.27 per allergy [OR (95% CI): 1.27 (1.15, 1.39); P < 0.001]. However, on the MVA, allergy status was not an independent risk factor for reoperation. These findings suggest that allergy status is associated with a higher reoperation rate, however, allergy status alone cannot prognosticate the risk of subsequent surgery. Therefore, allergy status and its association with future surgery after hip arthroscopy should be considered in the context of multiple patient-specific factors that influence the surgical outcome. An understanding of this association enables patient-centered care and will strengthen the physician–patient relationship.
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Affiliation(s)
| | - Jacob D Feingold
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Erica L Swartwout
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Sacha A Roberts
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Anil S Ranawat
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Goh GS, Kozaily E, Tan TL, Parvizi J. Patients Who Do Not Receive Aspirin Because of Allergy Have an Increased Risk of Venous Thromboembolism Following Total Joint Arthroplasty. J Bone Joint Surg Am 2022; 104:107-114. [PMID: 34780388 DOI: 10.2106/jbjs.21.00528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patient-reported allergies to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) may preclude certain patients from receiving aspirin as venous thromboembolism (VTE) prophylaxis after total joint arthroplasty (TJA). The purpose of the study was to (1) determine whether the use of non-aspirin agents due to a self-reported aspirin or NSAID allergy was associated with a higher incidence of VTE and (2) determine the rate of true allergic reactions in patients who reported an allergy but still received aspirin. METHODS Prospectively collected data from 45,171 patients who underwent primary TJA between 2000 and 2019 were reviewed. Patients who reported an allergy to aspirin or NSAIDs were identified (n = 823). Using a validated VTE risk calculator, each patient was assigned a risk score based on 26 comorbidities. Bleeding complications, VTEs that occurred within 90 days postoperatively, and allergic reactions were collected as end points. Multivariable logistic regression was performed to determine the factors associated with VTE. RESULTS The overall incidence of aspirin or NSAID allergy was 1.8%. Only 80 of 267 patients (30%) reported an allergy to only aspirin and still received aspirin. Compared with patients who received aspirin without a history of allergy (n = 17,648), patients who received non-aspirin thromboprophylaxis due to allergy (n = 383) had a higher incidence of VTE (2.87% versus 0.24%, p < 0.001). On multivariable regression, these patients had an 8-fold increase in VTE risk (adjusted odds ratio, 7.94; 95% confidence interval, 2.86 to 22.07; p < 0.001). The incidence of true allergic reactions to aspirin among those with a reported allergy was 1.8% (number needed to harm = 55). No patients developed anaphylaxis or severe hypersensitivity reactions. CONCLUSIONS Patients with a self-reported allergy to aspirin or NSAIDs were at a significantly increased risk for VTE if they received non-aspirin thromboprophylaxis agents following TJA. Future research should evaluate the usefulness of preoperative allergy testing when selecting a VTE prophylactic agent in patients with self-reported allergies. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Elie Kozaily
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Timothy L Tan
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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11
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Wright-Chisem JI, Cohn MR, Kunze KN, Wright-Chisem A, Warner T, Hicks JJ, Williams RJ. Do Self-Reported Drug Allergies Influence Clinically Significant Outcome Improvement Following Osteochondral Allograft Transplantation? A Nested Cohort Study. Cartilage 2021; 13:868S-872S. [PMID: 33246361 PMCID: PMC8808784 DOI: 10.1177/1947603520976770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare clinical outcomes for patients who underwent osteochondral allograft transplantation (OCA) based on the presence or absence of one or more self-reported drug allergies. DESIGN Prospective data were collected from 245 consecutive patients after OCA of the knee from one large academic institution. Patient-reported allergies were obtained via chart review. Patient-reported outcome measures, including activities of daily living of the Knee Outcome Survey (KOS-ADL), Marx Activity Scale, International Knee Documentation Committee (IKDC), and visual analogue scale (VAS) pain were all collected. The minimal clinically important difference (MCID) for each outcome was quantified using a distribution-based method. Independent t tests were used to compare patient-reported outcome measures between those with and without self-reported allergies, while chi-square analysis of association was used to compare rates of MCID achievement. RESULTS Of 245 patients included, 83 (33.9%) reported having at least one drug allergy at the time of OCA. There were no statistically significant differences with regard to patient demographics, including age, body mass index, gender, or sports participation between those with and without a reported allergy. Similarly, there were no significant differences found between baseline preoperative patient-reported outcomes. Overall, both cohorts demonstrated a significant improvement from baseline scores at 2 years postoperatively. There were no differences found between any patient-reported outcome at 2 years postoperatively. The presence of at least one self-reported drug allergy was not a significant risk factor for failing to achieve the MCID in any specific outcome measure. CONCLUSIONS The presence of one or more drug allergy was not associated with worse patient-reported outcomes or lower rates of clinically significant outcome improvement after OCA.
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Affiliation(s)
- Joshua I. Wright-Chisem
- Hospital for Special Surgery, New York,
NY, USA,Joshua I. Wright-Chisem, Hospital for
Special Surgery, 535 East 70th Street, New York, NY 10021-4898, USA.
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12
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Patient-reported drug and latex allergies negatively affect outcomes after total and reverse shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:2753-2761. [PMID: 34087274 DOI: 10.1016/j.jse.2021.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patient-reported allergies (PRAs) have been identified as a risk factor for worse outcomes and less satisfaction in patients undergoing knee and hip arthroplasty. Similar associations have not been elucidated in shoulder arthroplasty patients; however, previous research is sparse. The purpose of this study was to assess the outcomes following shoulder arthroplasty surgery with respect to patient-reported drug allergies. It was hypothesized that a higher number of allergies would be associated with worse patient-reported outcomes (PROs) following shoulder arthroplasty surgery. METHODS Consecutive patients aged 18-89 years at the time of surgery who underwent primary shoulder arthroplasty between October 2005 and March 2018 performed by a single surgeon and had a minimum follow-up period of 1 year were reviewed. PRO scores, including the American Shoulder and Elbow Surgeons score, Single Assessment Numerical Evaluation score, QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score, and 12-Item Short Form Health Survey Physical Component Summary and Mental Component Summary scores, as well as patient satisfaction, were collected preoperatively and postoperatively. Early clinical failures were reported. Subjects were categorized into a 3-level factor based on the number of PRAs (0, 1, or ≥2), and bivariate comparisons of mean postoperative PRO scores were performed using Kruskal-Wallis analyses. Additionally, multivariate regression was performed to assess the effect of PRAs on PROs while controlling for age, sex, arthroplasty type, baseline PRO scores, and Charlson Comorbidity Index. RESULTS Overall, 411 shoulders were included in the final study population (367 patients, 44 of whom were treated bilaterally). The population was predominately male patients (n = 265, 64.5%), and the median age at the time of surgery was 66.5 years (first quartile-third quartile, 61.3-71.4 years). Of the patients, 253 (61.6%) underwent total shoulder arthroplasty (TSA) whereas 158 (38.4%) underwent reverse TSA. Five patients (2 TSA and 3 reverse TSA patients) experienced early clinical failure and required revision surgery. Minimum 1-year PROs were obtained for 345 of 406 patients (85.0%) with a mean follow-up period of 1.9 ± 1.2 years. Nearly all postoperative PROs reflected a trend of worse outcomes with more preoperative PRAs; however, the QuickDASH score was the only score showing a significant difference between allergy groups (P = .004). Pair-wise comparison using Nemenyi post hoc testing showed that the QuickDASH score was significantly higher (worse outcomes) for the group with ≥2 allergies compared with the group with 0 allergies. PRA was found to be a statistically significant predictor of higher postoperative QuickDASH scores (P = .043) and was more influential than the Charlson Comorbidity Index and sex. Additionally, PRA was the only statistically significant predictor of patient satisfaction (P = .016). CONCLUSION An increasing number of preoperative PRAs is associated with worse PROs and patient satisfaction following shoulder arthroplasty. The number of PRAs was the most influential predictor of patient satisfaction.
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13
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Lieberman EG, Hansen EJ, Clohisy JC, Nunley RM, Lawrie CM. Allergies, Preoperative Narcotic Use, and Increased Age Predict Failed Same-Day Discharge After Joint Replacement. J Arthroplasty 2021; 36:S168-S172. [PMID: 33518359 DOI: 10.1016/j.arth.2021.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/25/2020] [Accepted: 01/07/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Identifying predictors of failed same-day discharge (SDD) is critical for patient selection. We evaluated patient factors associated with failure of SDD in patients undergoing elective total joint arthroplasty (TJA) in a hospital setting. METHODS We retrospectively reviewed consecutive patients who underwent primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) between January 31, 2018 and February 1, 2020 by one of the 3 fellowship-trained arthroplasty surgeons. Patient demographics, comorbidities, and clinical data were collected. Analysis was performed to assess risk factors for failed SDD. RESULTS In total, 2615 TJAs (1425 TKAs, 1190 THAs) were performed over the study period. Two hundred seventy-one (10.4%) were SDDs (80 TKAs, 191 THAs). There were fewer TKAs than THAs (5.6% vs 16.1%, P < .001). Forty-five patients failed SDD (16.6%). Failure rates were similar in TKA and THA (18.8%, 15.7%, P = .54). The most common reasons for failure of SDD were hypotension (11, 24.4%), delayed resolution of spinal anesthesia (11, 24.4%), and nausea (5, 11.1%). Age over 70 years (P = .007), greater than 2 self-reported allergies (P < .001), and preoperative narcotic use (P = .01) were associated with failure of SDD. Gender, body mass index, American Society of Anesthesiologists class, and prior TJA were not significantly associated (P > .05). CONCLUSION Success of SDD was greater than 80%. Hypotension, delayed resolution of spinal anesthesia, and nausea accounted for 60% of failures of SDD. Patients >70 years, those with >2 self-reported drug allergies, or patients who used preoperative narcotics were at high risk for failure of SDD after THA or TKA.
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Affiliation(s)
| | - Erik J Hansen
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO
| | - Ryan M Nunley
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO
| | - Charles M Lawrie
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO
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Bovonratwet P, Shen TS, Islam W, Sculco PK, Padgett DE, Su EP. Is There an Association Between Negative Patient-Experience Comments and Perioperative Outcomes After Primary Total Hip Arthroplasty? J Arthroplasty 2021; 36:2016-2023. [PMID: 33551144 DOI: 10.1016/j.arth.2021.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/04/2021] [Accepted: 01/11/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Multiple stakeholders are interested in improving patient experience after primary total hip arthroplasty due to shifts toward patient-centered care. Patient free-text narratives are a potentially valuable but largely unexplored source of data. METHODS The records of 383 patients who underwent primary total hip arthroplasty between August 2016 and August 2019 were combined with vendor-supplied patient satisfaction data, which included patient free-text comments and the Press Ganey satisfaction survey. A total of 1295 patient comments were analyzed for sentiment, and negative comments were categorized into nine themes. Postoperative outcomes, patient-reported outcome measures, and traditional measures of satisfaction were compared between patients who provided a negative comment vs those who did not. Multivariable regression was used to determine perioperative variables associated with providing a negative comment. RESULTS Of the 1295 patient comments: 54% were positive, 24% were negative, 10% were mixed, and 12% were neutral. Top two themes of negative comments were room condition (25%) and inefficient communication (23%). There were no differences in studied outcomes (eg. peak pain intensity, length of stay, or improvements in hip injury and osteoarthritis outcome scores Jr. and pain visual analog scale scores at 6-week follow-up) between those who provided negative comments vs those who did not (P > .05). However, patients who made negative comments were less likely to recommend their hospital care to peers (P < .001). Finally, patients who had >2 allergies (P = .024) were more likely to provide negative comments. CONCLUSION The present study demonstrates that patient satisfaction appears not to be a reliable sole proxy for traditional objective outcome measures of pain relief and functional improvement.
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Affiliation(s)
- Patawut Bovonratwet
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY; Department of Orthopaedic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
| | - Tony S Shen
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY; Department of Orthopaedic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
| | - Wasif Islam
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Douglas E Padgett
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Edwin P Su
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
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15
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Swartwout EL, Feingold JD, Wright-Chisem JI, Apostolakos JM, Roberts SA, Ranawat AS. Self-reported allergies correlate with a worse patient-reported outcome after hip arthroscopy: a matched control study. J Hip Preserv Surg 2021; 7:670-676. [PMID: 34377510 PMCID: PMC8349586 DOI: 10.1093/jhps/hnab022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/27/2021] [Accepted: 03/15/2021] [Indexed: 11/24/2022] Open
Abstract
Patient-reported outcome measures (PROMs) in patients with and without at least one self-reported allergy undergoing hip arthroscopy were compared. Data on 1434 cases were retrospectively reviewed, and 267 patients were identified with at least one self-reported allergy and randomly matched to a control group on a 1:2 ratio. Four PROMs [Modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports (HOS-Sport) and 33-item International Hip Outcome Tool (iHOT-33)] were collected preoperatively, and at 5–11, 12–23 and 24–35 months postoperatively. Significant PROM differences were found 5–11 months postoperative on mHHS (P < 0.001), HOS-ADL (P = 0.002), HOS-Sport (P < 0.001) and iHOT-33 (P < 0.001). At 12–23 months postoperative, the allergy cohort had significantly worse scores on mHHS (P = 0.002), HOS-ADL (P = 0.001), HOS-Sport (P < 0.001) and iHOT-33 (P < 0.001). They also had significantly worse measures 24–35 months postoperative on mHHS (P = 0.019), HOS-Sport (P = 0.006) and iHOT-33 (P < 0.001). Multivariable logistic regression showed that each additional allergy reported significantly increased the risk of failing to meet the minimal clinically important difference 5–11 months after surgery on mHHS by 1.15 [OR (95% CI): 1.15 (1.03, 1.30), P = 0.014], on HOS-ADL by 1.16 [OR (95% CI): 1.16 (1.02, 1.31), P = 0.021] and on iHOT-33 by 1.20 [OR (95% CI): 1.20 (1.07, 1.36), P = 0.002]. Results suggest self-reported allergies increase the likelihood of a patient-perceived worse outcome after hip arthroscopy. An understanding of this association by the physician is essential during presurgical planning and in the management of postoperative care.
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Affiliation(s)
- Erica L Swartwout
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Jacob D Feingold
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Joshua I Wright-Chisem
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - John M Apostolakos
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Sacha A Roberts
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Anil S Ranawat
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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16
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Ferrer T, Hinarejos P, Goicoechea N, Leal-Blanquet J, Sanchez-Soler J, Torres-Claramunt R, Monllau JC. Anxiety is the cause of the worse outcomes of allergic patients after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2020; 28:3135-3141. [PMID: 31722034 DOI: 10.1007/s00167-019-05780-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/28/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The presence of allergies has been proposed as a risk factor for worse outcomes in total knee arthroplasty surgery. The aim of this study is to evaluate if the presence of some psychiatric disorders is more frequent in patients who report allergies and if they could be the main cause for the worse outcomes. METHODS A prospective study, including patients undergoing a primary total knee arthroplasty, was designed. In the preoperative visit, all the patients completed a questionnaire about the presence of allergies and also psychiatric tests for anxiety (State-Trait Anxiety Inventory-STAI-), depression (Remission from Depression Questionnaire-RDQ-), somatization disorder (Patient Health Questionnaire-15-PHQ-15-), pain catastrophizing syndrome (Pain Catastrophizing Scale-PCS), and personality disorder (Reduced NEO-Inventory of Five Factors-NEO-FFI-). In the preoperative and at 6 months of follow up, the functional results of the surgery were assessed by the WOMAC, the SF-12, and the KSS scores. RESULTS A total of 209 patients was included: 136 (65%) did not have reported allergies and 73 (35%) did report some allergies. The psychiatric questionnaires showed that the presence of anxiety was more prevalent in the group of patients with reported allergies (STAI-T: no allergies 24.08 points vs. allergies 19.18 points, p = 0.039). When comparing the functional outcomes at 6 months of follow up, most of the analyzed scores improved less in the group of patients with reported allergies than in the no allergy-referred group: WOMAC-total score (34.37 vs. 40.10 points, p = 0.023), WOMAC-pain score (6.03 vs. 7.50 points, p = 0.018), WOMAC-function score (22.97 vs. 27.24 points, p = 0.023), KSS-knee score (25.37 vs. 33.79 points, p = 0.002), and SF-12 physical score (7.89 vs. 11.15 points, p = 0.046). The significance of the difference in the outcomes scores in this group was lost after adjusting for anxiety (p > 0.05). CONCLUSION Allergies reported by patients are confirmed as a risk factor for worse results after TKA surgery. The relationship with anxiety disorder seems to explain the association between self-reported allergies and sub-optimal outcomes. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Túlia Ferrer
- Department of Orthopedic Surgery, Parc de Salut Mar. Hospital de l' Esperança, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain.
| | - P Hinarejos
- Department of Orthopedic Surgery, Parc de Salut Mar. Hospital de l' Esperança, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - N Goicoechea
- Department of Orthopedic Surgery, Parc de Salut Mar. Hospital de l' Esperança, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - J Leal-Blanquet
- Department of Orthopedic Surgery, Parc de Salut Mar. Hospital de l' Esperança, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - J Sanchez-Soler
- Department of Orthopedic Surgery, Parc de Salut Mar. Hospital de l' Esperança, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - R Torres-Claramunt
- Department of Orthopedic Surgery, Parc de Salut Mar. Hospital de l' Esperança, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - J C Monllau
- Department of Orthopedic Surgery, Parc de Salut Mar. Hospital de l' Esperança, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
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17
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Lyons KW, Borsinger TM, Lucas AP, McGuire KJ, Pearson AM, Abdu WA. Patient-Reported Allergies, a Marker of Preoperative Pain and Disability in Elective Spine Surgery. Global Spine J 2020; 10:592-597. [PMID: 32677571 PMCID: PMC7359683 DOI: 10.1177/2192568219865188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE Previous literature demonstrates mixed results regarding the relationship between patient-reported allergies and pain, function, and satisfaction scores. The objective of this study was to investigate the correlation between patient-reported allergies and preoperative Oswestry Disability Index (ODI), Neck Disability Index (NDI), and Patient-Reported Outcomes Measurement System (PROMIS) scores. METHODS All patients undergoing elective cervical, lumbar procedures between May 2017 and October 2018 were included. Baseline demographic information was recorded, as well as all reported allergies or adverse reactions. Preoperative PROMIS, ODI, and NDI scores were recorded. Hierarchical multiple linear regressions were used to assess the relationship between total number of allergies and the preoperative pain and function scores. RESULTS A total of 570 patients were included (476 lumbar, 94 cervical). The mean number of allergies reported was 1.89 ± 2.32. The mean preoperative ODI and NDI scores were 46.39 ± 17.67 and 43.47 ± 16.51, respectively. The mean preoperative PROMIS Physical Health and PROMIS Mental Health scores were 37.21 ± 6.54 and 43.89 ± 9.26, respectively. Hierarchical multiple linear regression showed that total number of reported allergies shared a statistically significant negative relationship with all of the following scores: ODI (B = 0.83, P = .02), NDI (B = 1.45, P = .02), PROMIS Physical Health (B = -0.29, P = .013), and PROMIS Mental Health (B = -0.38, P = .024). CONCLUSIONS Patient-reported allergies share a statistically significant negative relationship with preoperative pain and function scores; as patients have increasing total number of allergies, the ODI/NDI scores become worse (increase) and the PROMIS scores become worse (decrease).
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Affiliation(s)
- Keith W. Lyons
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Keith Lyons, Dartmouth-Hitchcock Medical Center, Department of Orthopaedics, One Medical Center Drive, Lebanon, NH 03756, USA.
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18
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Moore MG, Brigati DP, Crijns TJ, Vetter TR, Schultz WR, Bozic KJ. Enhanced Selection of Candidates for Same-Day and Outpatient Total Knee Arthroplasty. J Arthroplasty 2020; 35:628-632. [PMID: 31685394 DOI: 10.1016/j.arth.2019.09.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/23/2019] [Accepted: 09/30/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Medicare removed total knee arthroplasty (TKA) from its inpatient-only list and private insurers created ambulatory surgical codes; these changes bring about logistical challenges for TKA episode planning. We identified preoperatively determined factors associated with hospital length of stay for (1) same-day discharge (SDD) and (2) inpatient TKA defined by Medicare's 2-midnight rule benchmark. METHODS We retrospectively reviewed 325 consecutive unilateral primary TKAs performed on patients completing the Perioperative Surgical Home preoperative optimization pathway within a single hospital system. Stepwise logistic regression modeling was performed to identify preoperatively determined factors associated with (1) SDD and (2) inpatient TKA. We compared these models' ability to discern the length of stay category to the Risk Assessment and Prediction Tool (RAPT) score alone. RESULTS The cohort included 32 (10%) SDD, 189 (58%) next-day discharges, and 104 (32%) inpatients. Lower body mass index (BMI; odds ratio [OR], 0.92; 95% CI, 0.85-0.1.0; P = .04) and fewer self-reported allergies (OR, 0.66; 95% CI, 0.46-0.95; P = .03) were associated with SDD. The SDD model outperformed the RAPT alone (C-statistic, 0.73 vs 0.52; P < .01). Older age (OR, 0.96; P = .04), higher BMI (OR, 0.93; P 0.01), lower RAPT score (OR, 1.2; P = .04), and later surgery start time (OR, 0.80; P < .01) were associated with inpatient discharge. The inpatient model outperformed the RAPT alone (C-statistic, 0.74 vs 0.62; P < .01). CONCLUSION We identified preoperatively determined factors associated with (1) SDD as BMI and allergies and (2) inpatient TKA as age, BMI, RAPT score, and surgery start time. Hospitals, providers, patients, families, and payers can use this information for TKA episode planning.
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Affiliation(s)
- Meredith G Moore
- Department of Surgery and Perioperative Care, Dell Medical School, Austin, TX
| | - David P Brigati
- Department of Surgery and Perioperative Care, Dell Medical School, Austin, TX
| | - Tom J Crijns
- Department of Surgery and Perioperative Care, Dell Medical School, Austin, TX
| | - Thomas R Vetter
- Department of Surgery and Perioperative Care, Dell Medical School, Austin, TX
| | - William R Schultz
- Department of Surgery and Perioperative Care, Dell Medical School, Austin, TX
| | - Kevin J Bozic
- Department of Surgery and Perioperative Care, Dell Medical School, Austin, TX
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19
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The Impact of Patient-Reported Penicillin Allergy on Risk for Surgical Site Infection in Total Joint Arthroplasty. J Am Acad Orthop Surg 2019; 27:854-860. [PMID: 30829986 DOI: 10.5435/jaaos-d-18-00709] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Penicillin (PCN) allergy is reported in 10% to 20% of the population; studies show that only 1% to 3% of patients have a true allergy. Most patients reporting a PCN allergy receive second-line antibiotic prophylaxis preoperatively, which raises concerns about antimicrobial efficacy. Studies also suggest that second-line antibiotics may increase the rate of surgical site infection (SSI). In this study we aim to analyze the effect of PCN allergy on antibiotic type prescribed and SSI in our total joint arthroplasty population. METHODS A retrospective review of 4,903 primary total hip and total knee arthroplasty performed from January 2015 to June 2017 in a single institution. A detailed chart review was performed to identify reported reactions and antibiotic prescribed. RESULTS Seven hundred ninety-six patients (16.2%) reported a PCN allergy; the reactions were classified into three tiers. Six hundred fifteen patients (12.5%) reported an IgE-mediated allergy, hypersensitivity, or a possible allergy; 89 (1.8%) reported an adverse effect; and 92 (1.9%) had an unknown reaction. Patients reporting a PCN allergy were less likely to receive cefazolin (94.9 versus 6.9%; P < 0.001) and more likely to receive clindamycin (1.1 versus 80.7%; P < 0.001) or vancomycin (4.0 versus 12.4%; P < 0.001). There was no difference in infection rate by reported PCN allergy (0.6 versus 0.4%; P = 0.473) or antibiotic prescribed (0.5 versus 0.6%; P = 0.4817). CONCLUSION No patient with a PCN allergy and given cefazolin experienced a reaction; based on reported reactions, most patients with a PCN allergy can safely receive first-line antibiotic therapy. In this population, PCN allergy and second-line antibiotic therapy did not influence the rate of SSI.
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Xiong DD, Ye W, Xiao R, Miller JA, Mroz TE, Steinmetz MP, Nagel SJ, Machado AG. Patient-reported allergies predict postoperative outcomes and psychosomatic markers after spine surgery. Spine J 2019; 19:121-130. [PMID: 29800707 DOI: 10.1016/j.spinee.2018.05.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/13/2018] [Accepted: 05/17/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Prior studies have shown that patient-reported allergies can be prognostic of poorer postoperative outcomes. PURPOSE The objective of this study was to investigate the correlation between self-reported allergies and outcomes after cervical or lumbar spine surgery. STUDY DESIGN/SETTING This is a retrospective cohort study at a single tertiary care institution. PATIENT SAMPLE The patient sample included all patients undergoing cervical or lumbar spine surgery from 2009 to 2014. OUTCOME MEASURES The primary outcome measure was change in the EuroQol-5 Dimensions (EQ-5D) after surgery. Secondary outcomes included changes in the Pain Disability Questionnaire (PDQ) and in the Patient Health Questionnaire-9 (PHQ-9), achievement of the minimal clinically important difference (MCID) in these measures, and cost of admission. METHODS Before and after surgery, EQ-5D, PDQ, and PHQ-9 were recorded for patients with available data. Paired Student t tests were used to compare changes in these measures after surgery. Multivariable linear and logistic regressions were used to assess the relationship between the log transformation of the total number of allergies and outcomes. RESULTS A total of 592 cervical patients and 4,465 lumbar patients were included. The median number of reported allergies was two. The EQ-5D index increased from 0.539 to 0.703 for cervical patients and from 0.530 to 0.676 for lumbar patients (p<.01 for both). Patients experienced significant pain improvement by the PDQ (80.1-58.2 for cervical patients and 79.4-58.1 for lumbar patients, p<.01). Using multivariable logistic regression, the log transformation of the number of allergies predicted significantly higher odds of achieving the PDQ MCID (odds ratio [OR]=2.09, 95% confidence interval [CI] 1.05-4.15, p=.02, for cervical patients; OR=1.30, 95% CI 1.03-1.68, p=.03, for lumbar patients). However, this relationship was not durable for patients with follow-up exceeding 1 year. The log transformation of the number of allergies for lumbar patients predicted a significantly increased cost of admission (β=$3,597, p<.01) and trended toward significance among cervical patients (β=$1,842, p=.10). CONCLUSIONS Patient-reported allergies correlate with subjective improvement in pain and disability after spine surgery and may serve as a marker of postoperative outcomes. The relationship between allergies and PDQ improvement may be secondary to the short-term expectation-actuality discrepancy, as this relationship was not durable beyond 1 year.
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Affiliation(s)
- David D Xiong
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Wenda Ye
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Roy Xiao
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Jacob A Miller
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA; Department of Radiation Oncology, Stanford Medicine, Stanford, CA, USA
| | - Thomas E Mroz
- Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-31, Cleveland, OH 44195, USA; Center for Spine Health, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Michael P Steinmetz
- Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-31, Cleveland, OH 44195, USA; Center for Spine Health, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Sean J Nagel
- Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-31, Cleveland, OH 44195, USA; Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Andre G Machado
- Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-31, Cleveland, OH 44195, USA; Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
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Ihekweazu UN, Sohn GH, Laughlin MS, Goytia RN, Mathews V, Stocks GW, Patel AR, Brinker MR. Socio-demographic factors impact time to discharge following total knee arthroplasty. World J Orthop 2018; 9:285-291. [PMID: 30598872 PMCID: PMC6306518 DOI: 10.5312/wjo.v9.i12.285] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/06/2018] [Accepted: 12/10/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To determine social, logistical and demographic factors that influence time to discharge in a short stay pathway (SSP) by following total knee arthroplasty (TKA).
METHODS The study included primary TKA’s performed in a high-volume arthroplasty center from January 2016 through December 2016. Potential variables associated with increased hospital length of stay (LOS) were obtained from patient medical records. These included age, gender, race, zip code, body mass index (BMI), number of pre-operative medications used, number of narcotic medications used, number of patient reported allergies (PRA), simultaneous bilateral surgery, tobacco use, marital status, living arrangements, distance traveled for surgery, employment history, surgical day of the week, procedure end time and whether the surgery was performed during a major holiday week. Multivariate step-wise regression determined the impact of social, logistical and demographic factors on LOS.
RESULTS Eight hundred and six consecutive primary SSP TKA’s were included in this study. Patients were discharged at a median of 49 h (post-operative day two). The following factors increased LOS: Simultaneous bilateral TKA [46.1 h longer (P < 0.001)], female gender [4.3 h longer (P = 0.012)], age [3.5 h longer per ten-year increase in age (P < 0.001)], patient-reported allergies [1.1 h longer per allergy reported (P = 0.005)], later procedure end-times [0.8 h longer per hour increase in end-time (P = 0.004)] and Black or African American patients [6.1 h longer (P = 0.047)]. Decreased LOS was found in married patients [4.8 h shorter (P = 0.011)] and TKA’s performed during holiday weeks [9.4 h shorter (P = 0.011)]. Non-significant factors included: BMI, median income, patient’s living arrangement, smoking status, number of medications taken, use of pre-operative pain medications, distance traveled to hospital, and the day of surgery.
CONCLUSION The cost of TKA is dependent upon LOS, which is affected by multiple factors. The clinical care team should acknowledge socio-demographic factors to optimize LOS.
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Affiliation(s)
- Ugonna N Ihekweazu
- Fondren Orthopedic Group, Houston, TX 77030, United States
- Fondren Orthopedic Research Institute, Fondren Orthopedic Group, Houston, TX 77030, United States
| | - Garrett H Sohn
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX 77030, United States
| | - Mitzi S Laughlin
- Fondren Orthopedic Research Institute, Fondren Orthopedic Group, Houston, TX 77030, United States
| | - Robin N Goytia
- Fondren Orthopedic Group, Houston, TX 77030, United States
- Fondren Orthopedic Research Institute, Fondren Orthopedic Group, Houston, TX 77030, United States
| | - Vasilios Mathews
- Fondren Orthopedic Group, Houston, TX 77030, United States
- Fondren Orthopedic Research Institute, Fondren Orthopedic Group, Houston, TX 77030, United States
| | - Gregory W Stocks
- Fondren Orthopedic Group, Houston, TX 77030, United States
- Fondren Orthopedic Research Institute, Fondren Orthopedic Group, Houston, TX 77030, United States
| | - Anay R Patel
- Fondren Orthopedic Group, Houston, TX 77030, United States
- Fondren Orthopedic Research Institute, Fondren Orthopedic Group, Houston, TX 77030, United States
| | - Mark R Brinker
- Fondren Orthopedic Group, Houston, TX 77030, United States
- Fondren Orthopedic Research Institute, Fondren Orthopedic Group, Houston, TX 77030, United States
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Identifying Reasons for Failed Same-Day Discharge Following Primary Total Hip Arthroplasty. J Arthroplasty 2018; 33:3624-3628. [PMID: 30172415 DOI: 10.1016/j.arth.2018.08.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/29/2018] [Accepted: 08/01/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND As total hip arthroplasty (THA) gains popularity in ambulatory surgery centers, it is important to understand the causes of failed same-day discharge (SDD). The purpose of this study is to (1) identify reasons for an overnight stay among patients selected as candidates for SDD following THA and (2) determine what pre-operative factors are more common among patients who fail SDD. METHODS This is a prospective cohort study of patients undergoing THA who were identified as candidates for SDD (<75 years, ambulate without walker, American Society of Anesthesiologists score 1-3, body mass index <40 kg/m2, and agreed to SDD pre-operatively). The primary outcome was the reason for not discharging home on the same day of surgery. Secondary outcomes included the proportion of patients who failed SDD and any pre-operative patient characteristics that could be linked to failed SDD. RESULTS Seventy-eight of 106 (74%) patients pre-selected for SDD were successfully discharged per protocol. Of the 28 (26%) patients who failed SDD, the most common reasons for failure were patient preference (12), dizziness or hypotension (8), failure to clear physical therapy (5), urinary retention (2), and pain management (1). There was a higher percentage of patients in the failed SDD group who reported multiple allergies (P = .02), anxiety/depression (P = .24), obstructive sleep apnea (P = .38), and rheumatoid arthritis (P = .02). CONCLUSION SDD is a viable option for surgeons interested in rapid recovery THA. In a pool of patients selected for SDD, the main cause of SDD failure was a change in patient preference post-operatively, despite having agreed to SDD pre-operatively and meeting all discharge criteria.
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Nixon DC, Cusworth BM, McCormick JJ, Johnson JE, Klein SE. Patient-Reported Allergies Do Not Predict Poorer PROMIS Function, Pain, and Depression Scores Following Foot and Ankle Surgery. Foot Ankle Int 2018; 39:949-953. [PMID: 29648889 DOI: 10.1177/1071100718769667] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Identifying preoperative risk factors that may portend poorer operative outcomes remains a topic of current interest. In hip and knee arthroplasty patients, the presence of patient-reported allergies (PRAs) has been associated with worse pain and function after joint replacement. However, these results have not been replicated across studies, including in shoulder arthroplasty cases. The impact of PRAs on foot and ankle outcomes has yet to be studied. The purpose of our study was to evaluate whether PRAs influence patient-reported outcome in foot and ankle surgery. METHODS To determine if PRAs are linked to poorer operative outcomes, we retrospectively identified 159 patients who underwent elective foot and ankle surgery. PRA data were obtained via chart review, and patient-reported outcomes were assessed preoperatively and postoperatively via multiple domains, including Patient Reported Outcome Measurement Information System (PROMIS) physical function, pain interference, and depression measures. Consistent with prior methodology, we compared outcome measures (preoperative, postoperative, and the change in outcome scores) between patients without self-reported allergies to patients with at least 1 PRA. RESULTS There were 159 patients studied; 79 patients had no allergies listed, and 80 patients had at least 1 PRA. Of the 80 patients with at least 1 PRA, there were a total of 170 possible allergies. There were no differences in preoperative, postoperative, or the change in outcome scores for all PROMIS measures (physical function, pain interference, and depression; P > .05) between patients with at least 1 PRA and those patients without any listed PRAs. CONCLUSIONS We were unable to prove our hypothesis that PRAs were linked to poorer patient-reported outcomes following foot and ankle surgery. Closer review of the published reports linking PRAs to worse total joint arthroplasty outcomes revealed data that, while statistically significant, are likely not clinically relevant. Our negative findings, then, may in fact parallel prior studies on hip, knee, and shoulder arthroplasty patients. The presence of PRAs does not appear to be a risk factor for suboptimal outcomes in foot and ankle surgery. LEVEL OF EVIDENCE Level III, comparative series.
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Affiliation(s)
- Devon C Nixon
- 1 Department of Orthopedic Surgery, Washington University in St Louis, St Louis, MO, USA
| | - Brian M Cusworth
- 1 Department of Orthopedic Surgery, Washington University in St Louis, St Louis, MO, USA
| | - Jeremy J McCormick
- 1 Department of Orthopedic Surgery, Washington University in St Louis, St Louis, MO, USA
| | - Jeffrey E Johnson
- 1 Department of Orthopedic Surgery, Washington University in St Louis, St Louis, MO, USA
| | - Sandra E Klein
- 1 Department of Orthopedic Surgery, Washington University in St Louis, St Louis, MO, USA
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Levin JM, Boyle S, Winkelman RD, Tanenbaum JE, Abdullah KG, Steinmetz MP, Mroz TE. Patient-reported Allergies are Associated With Preoperative Psychological Distress and Less Satisfying Patient Experience in a Lumbar Spine Surgery Population. Clin Spine Surg 2018; 31:E368-E374. [PMID: 29864076 DOI: 10.1097/bsd.0000000000000665] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The main objectives of this study were: (1) to determine whether patient-reported allergies (PRAs) are associated with patient satisfaction scores, and (2) to clarify the association between PRAs and preoperative anxiety and depression in a lumbar spine surgery population. SUMMARY OF BACKGROUND DATA Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is currently used to measure the patient experience and there is concern that psychosocial factors are unaccounted for. Interestingly, PRAs have been linked to concurrent mood and other psychiatric disorders, as well as poor clinical outcomes in the orthopedic surgery setting. METHODS HCAHPS survey data, patient demographics, surgical characteristics, and preoperative health status were obtained for each patient. Allergies were categorized as medical (ie, medications) and environmental (ie, food, animals). Univariable and multivariable logistic regression models were used to determine whether the number of medical and environmental PRAs are associated with HCAHPS scores. In addition, multivariable logistic regression was used to analyze the association between PRAs and psychological distress. RESULTS In 421 patients included, PRAs were associated with lower HCAHPS scores under several dimensions of the patient experience of care, including: nursing communication, pain management, communication about medicines, and transition of care. Medical PRAs was an independent predictor of low satisfaction with communication about a medication's side effects [odds ratio (OR), 0.88; P=0.03] and understanding the purpose for new medications (OR, 0.90; P=0.03). Environmental PRAs was an independent predictor of low satisfaction with both communication about a medication's side effects (OR, 0.68; P=0.03), and pain control (OR, 0.67; P=0.01). Moreover, having a PRA (OR, 1.64; P=0.04) was associated with EuroQol-5 Dimensions anxiety/depression and having an environmental PRA (OR, 2.13; P=0.03) was associated with depression. CONCLUSIONS These findings highlight the potential utility of PRAs to help identify patients with psychological distress who are at risk for a poor experience of lumbar spine surgery.
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Affiliation(s)
- Jay M Levin
- Center for Spine Health, Cleveland Clinic.,Case Western Reserve University School of Medicine.,Departments of Neurosurgery.,Orthopaedic Surgery, Cleveland Clinic
| | - Spencer Boyle
- Center for Spine Health, Cleveland Clinic.,Case Western Reserve University School of Medicine.,Departments of Neurosurgery.,Orthopaedic Surgery, Cleveland Clinic
| | - Robert D Winkelman
- Center for Spine Health, Cleveland Clinic.,Case Western Reserve University School of Medicine.,Departments of Neurosurgery.,Orthopaedic Surgery, Cleveland Clinic
| | - Joseph E Tanenbaum
- Center for Spine Health, Cleveland Clinic.,Case Western Reserve University School of Medicine.,Orthopaedic Surgery, Cleveland Clinic.,Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH
| | - Kalil G Abdullah
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA
| | | | - Thomas E Mroz
- Center for Spine Health, Cleveland Clinic.,Departments of Neurosurgery.,Orthopaedic Surgery, Cleveland Clinic
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25
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Sochacki KR, Jack RA, Bekhradi A, Delgado D, McCulloch PC, Harris JD. Are Self-Reported Medication Allergies Associated With Worse Hip Outcome Scores Prior to Hip Arthroscopy? Arthroscopy 2018; 34:1856-1861. [PMID: 29477606 DOI: 10.1016/j.arthro.2018.01.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 01/09/2018] [Accepted: 01/15/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if there are significant differences in preoperative patient-reported outcome (PRO) scores in patients with and without self-reported medication allergies undergoing hip arthroscopy. METHODS Consecutive subjects undergoing hip arthroscopy for femoroacetabular impingement (FAI) syndrome by a single surgeon were retrospectively reviewed. PROs were collected within 6 weeks of the date of surgery. PROs included International Hip Outcome Tool (iHOT-12), Hip Outcome Score (HOS), and Short-Form (SF-12) scores. Allergies to medications were self-reported preoperatively within 6 weeks of the date of surgery. Patient demographics were recorded. Bivariate correlations and multivariate regression models were calculated to identify associations with baseline hip outcome scores. RESULTS Two hundred twelve subjects were analyzed (56% female, mean age 35.1 ± 13.2 years). Seventy-two subjects (34%) self-reported allergies (range 1-10; 41 subjects had 1 allergy; 14 subjects had 2; 8 subjects had 3; 2 subjects had 4; 7 subjects had 5 or more). The most commonly reported allergies included penicillin (18), sulfa (13), and codeine (11). Female gender was significantly correlated with number of allergies (Pearson correlation coefficient, 0.188; P < .001). SF-12 Mental Component Score (MCS) was significantly correlated with HOS-ADL (Pearson correlation coefficient, 0.389; P < .001), HOS-SSS (Pearson correlation coefficient, 0.251; P < .001), and iHOT-12 (Pearson correlation coefficient, 0.385; P < .001). There was no significant correlation between number of allergies and all hip PROs. In all multivariate models, the SF-12 MCS had the strongest association with HOS-ADL, HOS-SSS, and iHOT-12 (P < .001 for all). Allergies were not significantly associated with any hip PROs. CONCLUSIONS In patients undergoing hip arthroscopy for FAI syndrome, self-reported medication allergies are not significantly associated with preoperative patient-reported hip outcome scores. LEVEL OF EVIDENCE Level III, retrospective comparative case series.
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Affiliation(s)
- Kyle R Sochacki
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Robert A Jack
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Arya Bekhradi
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Domenica Delgado
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | | | - Joshua D Harris
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A..
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Hypothyroidism Increases 90-Day Complications and Costs Following Primary Total Knee Arthroplasty. J Arthroplasty 2018; 33:1003-1007. [PMID: 29174407 PMCID: PMC6383647 DOI: 10.1016/j.arth.2017.10.053] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 10/19/2017] [Accepted: 10/29/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Thyroid disease is common and often remains undetected in the US population. Thyroid hormone has an array of metabolic, immunologic, and musculoskeletal functions crucial to well-being. The influence of thyroid disease on perioperative outcomes following primary total knee arthroplasty (TKA) is poorly understood. We hypothesized that hypothyroidism was associated with a higher risk of postoperative complications and 90-day costs following primary TKA. METHODS The Medicare standard analytical files were queried using International Classification of Disease codes between 2005 and 2014 to identify patients undergoing primary TKA. Patients with a diagnosis of hypothyroidism were matched by age and gender on a 1:1 ratio. Ninety-day postoperative complication rates, day of surgery, and 90-day global period charges and reimbursements were compared between matched cohorts. RESULTS A total of 2,369,594 primary TKAs were identified between 2005 and 2014. After age and gender matching, each cohort consisted of 98,555 patients. Hypothyroidism was associated with greater odds of postoperative complications compared to matched controls (odds ratio 1.367, 95% confidence interval 1.322-1.413). The 90-day incidence of multiple postoperative medical and surgical complications, including periprosthetic joint infection, was higher among patients with hypothyroidism. Day of surgery and 90-day episode of care costs were significantly higher in the hypothyroidism cohort. CONCLUSION This study demonstrated an increased risk of multiple postoperative complications and higher costs among patients with hypothyroidism following primary TKA. Surgeons should counsel patients on these findings and seek preoperative optimization strategies to reduce these risks and lower costs in this patient population.
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Gibon E, Goodman MJ, Goodman SB. Patient Satisfaction After Total Knee Arthroplasty: A Realistic or Imaginary Goal? Orthop Clin North Am 2017; 48:421-431. [PMID: 28870303 DOI: 10.1016/j.ocl.2017.06.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article summarizes the current literature regarding patient satisfaction after total knee arthroplasty. In 10% to 15% of cases, the operation has not met the patients' expectations. The causes of this dissatisfaction are multifactorial, and include patient-related factors, details related to the surgical procedure and prosthesis chosen, perioperative factors, and factors associated with nursing and general medical care. However, surgeons must bear the brunt of patients' dissatisfaction. This dissatisfaction erodes the doctor-patient relationship, and may have implications in an emerging health care economy in which doctors and hospitals are reimbursed based on both clinical outcome and patient satisfaction.
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Affiliation(s)
- Emmanuel Gibon
- Department of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Edwards Building R116, Stanford, CA 94305, USA
| | - Marla J Goodman
- Department of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Edwards Building R116, Stanford, CA 94305, USA
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Edwards Building R116, Stanford, CA 94305, USA.
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Kahlenberg CA, Nwachukwu BU, Schairer WW, Steinhaus ME, Cross MB. Patient Satisfaction Reporting After Total Hip Arthroplasty: A Systematic Review. Orthopedics 2017; 40:e400-e404. [PMID: 28135370 DOI: 10.3928/01477447-20170120-04] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 06/17/2016] [Indexed: 02/03/2023]
Abstract
This review evaluated the quality of patient satisfaction reporting after total hip arthroplasty. The initial search of the MEDLINE database yielded 755 studies. Twenty-four met the inclusion criteria. Most studies provided level III or IV evidence (n=15, 62.5%). The most common method used to assess satisfaction was the 10-point visual analog scale (7 studies, 29.2%), followed by an ordinal satisfaction scale (6 studies, 25.0%). The quality of evidence was poor, and the methods used to assess satisfaction were not standardized. Further research is needed to define the factors that affect patient satisfaction after total hip arthroplasty and how satisfaction is best measured. [Orthopedics. 2017; 40(3):e400-e404.].
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Abstract
BACKGROUND There is little data on whether preexisting allergies to implant materials and bone cement have an impact on the outcome of TKA. QUESTIONS/PURPOSES This review article analyzes the current literature to evaluate the prevalence and importance of metal and cement allergies for patients undergoing total knee arthroplasty. METHODS A review of the literature was performed using the following search criteria: "knee," "arthroplasty," and "allergy" as well as "knee," "arthroplasty," and "hypersensitivity." RESULTS One hundred sixteen articles were identified on PubMed, Seventy articles could be excluded by reviewing the title and abstract leaving 46 articles to be included for this review. The majority of the studies cited patch testing as the gold standard for screening and diagnosis of hypersensitivity following TKA. There is consensus that patients with self-reported allergies against metals or bone cement and positive patch test should be treated with hypoallergenic materials or cementless TKA. Treatment options include the following: coated titanium or cobalt-chromium implants, ceramic, or zirconium oxide implants. CONCLUSION Allergies against implant materials and bone cement are rare. Patch testing is recommended for patients with self-reported allergies. The use of special implants is recommended for patients with a confirmed allergy.
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Otero JE, Graves CM, Gao Y, Olson TS, Dickinson CC, Chalus RJ, Vittetoe DA, Goetz DD, Callaghan JJ. Patient-Reported Allergies Predict Worse Outcomes After Hip and Knee Arthroplasty: Results From a Prospective Cohort Study. J Arthroplasty 2016; 31:2746-2749. [PMID: 27600302 DOI: 10.1016/j.arth.2016.07.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/16/2016] [Accepted: 07/21/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Retrospective analyses have demonstrated correlation between patient-reported allergies and negative outcomes after total joint arthroplasty. We sought to validate these observations in a prospective cohort. METHODS One hundred forty-four patients undergoing total hip arthroplasty and 302 patients undergoing total knee arthroplasty were prospectively enrolled. Preoperatively, patients listed their allergies and completed the Medical Outcomes Study Short Form 36 (SF-36) and the Charlson Comorbidity Index (CCI) Questionnaire. At a mean of 17 months (range 12-25 months) postoperatively, SF-36, CCI, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were obtained by telephone survey. Regression analysis was used to determine the strength of correlation between patient age, comorbidity burden, and number of allergies and outcome measurements. RESULTS In 446 patients, 273 reported at least 1 allergy. The number of allergies reported ranged from 0 to 33. Penicillin or its derivative was the most frequently reported allergy followed by sulfa, environmental allergen, and narcotic pain medication. Patients reporting at least 1 allergy had a significantly lower postoperative SF-36 Physical Component Score compared to those reporting no allergies (51.3 vs 49.4, P = .01). The SF-36 postoperative Mental Component Score was no different between groups. Multivariate regression analysis showed that age and patient reported allergies, but not comorbidities, were independently associated with worse postoperative SF-36 Physical Component Summary (PCS) and WOMAC score. Patients with allergies experienced the same improvement in SF-36 PCS as those without an allergy. Comorbidities did not correlate with patient-reported function postoperatively. CONCLUSION Patients who report allergies have lower postoperative outcome scores but may experience the same increment in improvement after total joint arthroplasty.
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Affiliation(s)
- Jesse E Otero
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Christopher M Graves
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Yubo Gao
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Tyler S Olson
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | | | | | | | | | - John J Callaghan
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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