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Fang Z, Liu W. Obesity-associated outcomes after ACL reconstruction: a propensity-score-matched analysis of the US Nationwide Inpatient Sample 2005-2018. J Orthop Traumatol 2024; 25:36. [PMID: 39048813 PMCID: PMC11269535 DOI: 10.1186/s10195-024-00779-x] [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: 01/28/2024] [Accepted: 07/07/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries are common among physically active individuals, and obesity may increase the risk of such injuries due to factors like biomechanical stress on the knee. We aimed to determine if obesity affects postoperative outcomes after ACL reconstruction. METHODS Data from adults aged 20 years and older with ACL injuries who underwent inpatient reconstruction from 2005 to 2018 were extracted from the United States (US) Nationwide Inpatient Sample (NIS) database. Patients were divided into two groups based on the presence of co-existing obesity, defined as a body mass index (BMI) ≥ 30 kg/m2. Propensity-score matching (PSM) was employed to balance between-group differences. Associations between obesity and concomitant meniscus injury, length of stay (LOS), post-procedural complications, and non-routine discharge were examined using univariate and multivariable logistic and linear regressions. RESULTS After PSM, data from 1323 patients (representing 6396 individuals in the US) were analyzed. Of these, 441 (33%) were classified as obese, while 882 (67%) were not obese. After adjustment, obesity was significantly associated with a longer LOS (adjusted beta (aBeta) = 0.32, 95% confidence interval (CI) 0.31-0.321) and an increased likelihood of non-routine discharge (adjusted OR (aOR) = 2.18, 95% CI 1.47-3.22). There were no significant associations between obesity and concomitant meniscus injury (aOR = 1.04, 95% CI 0.81-1.32) or post-procedural complications (aOR = 0.97, 95% CI 0.74-1.27). CONCLUSIONS In patients undergoing ACL reconstruction in the US, obesity is independently associated with a longer LOS and a higher risk of non-routine discharge. Nevertheless, obesity does not appear to be associated with concomitant meniscus injury or post-procedural complications.
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Affiliation(s)
- Zhaoyi Fang
- Biodynamics Laboratory, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wenxin Liu
- Department of Sports Medicine, National Center for Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, China.
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Hornung AL, Rudisill SS, McCormick JR, Streepy JT, Harkin WE, Bryson N, Simcock X, Garrigues GE. Preoperative factors predict prolonged length of stay, serious adverse complications, and readmission following operative intervention of proximal humerus fractures: a machine learning analysis of a national database. JSES Int 2024; 8:699-708. [PMID: 39035667 PMCID: PMC11258835 DOI: 10.1016/j.jseint.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Background Proximal humerus fractures are a common injury, predominantly affecting older adults. This study aimed to develop risk-prediction models for prolonged length of hospital stay (LOS), serious adverse complications, and readmission within 30 days of surgically treated proximal humerus fractures using machine learning (ML) techniques. Methods Adult patients (age >18) who underwent open reduction internal fixation (ORIF), hemiarthroplasty, or total shoulder arthroplasty for proximal humerus fracture between 2016 and 2021 were included. Preoperative demographic and clinical variables were collected for all patients and used to establish ML-based algorithms. The model with optimal performance was selected according to area under the curve (AUC) on the receiver operating curve (ROC) curve and overall accuracy, and the specific predictive features most important to model derivation were identified. Results A total of 7473 patients were included (72.1% male, mean age 66.2 ± 13.7 years). Models produced via gradient boosting performed best for predicting prolonged LOS and complications. The model predicting prolonged LOS demonstrated good discrimination and performance, as indicated by (Mean: 0.700, SE: 0.017), recall (Mean: 0.551, SE: 0.017), accuracy (Mean: 0.717, SE: 0.010), F1-score (Mean: 0.616, SE: 0.014), AUC (Mean: 0.779, SE: 0.010), and Brier score (Mean: 0.283, SE: 0.010) Preoperative hematocrit, preoperative platelet count, and patient age were considered the strongest predictive features. The model predicting serious adverse complications exhibited comparable discrimination [precision (Mean: 0.226, SE: 0.024), recall (Mean: 0.697, SE: 0.048), accuracy (Mean: 0.811, SE: 0.010), F1-score (Mean: 0.341, SE: 0.031)] and superior performance relative to the LOS model [AUC (Mean: 0.806, SE: 0.024), Brier score (Mean: 0.189, SE: 0.010), noting preoperative hematocrit, operative time, and patient age to be most influential. However, the 30-day readmission model achieved the weakest relative performance, displaying low measures of precision (Mean: 0.070, SE: 0.012) and recall (Mean: 0.389, SE: 0.053), despite good accuracy (Mean: 0.791, SE: 0.009). Conclusion Predictive models constructed using ML techniques demonstrated favorable discrimination and satisfactory-to-excellent performance in forecasting prolonged LOS and serious adverse complications occurring within 30 days of surgical intervention for proximal humerus fracture. Modifiable preoperative factors such as hematocrit and platelet count were identified as significant predictive features, suggesting that clinicians could address these factors during preoperative patient optimization to enhance outcomes. Overall, these findings highlight the potential for ML techniques to enhance preoperative management, facilitate shared decision-making, and enable more effective and personalized orthopedic care by exploring alternative approaches to risk stratification.
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Affiliation(s)
- Alexander L. Hornung
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | | | - John T. Streepy
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - William E. Harkin
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Noah Bryson
- Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Xavier Simcock
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Grant E. Garrigues
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Li X, Lu J, Su JI, Li H, Liu X, Ding R. High flexion femoral side remnant preservation positioning technique: a new method for positioning the femoral tunnel in anterior cruciate ligament reconstruction. J Orthop Surg Res 2024; 19:189. [PMID: 38500214 PMCID: PMC10949667 DOI: 10.1186/s13018-024-04670-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/07/2024] [Indexed: 03/20/2024] Open
Abstract
PURPOSE The aim of this study is to find a new method for femoral side preservation positioning in anterior cruciate ligament (ACL) reconstruction and test the accuracy and precision of this method. METHOD Fifty patients with isolated ACL rupture (42 males and 8 females) who underwent single-bundle ACL reconstruction in our hospital between July 2022 and July 2023 were included. The lowest point of the cartilage margin of the lateral wall of the intercontinental fossa and the tibial plateau plumb line at 120° of knee flexion were used as the anatomical landmarks for positioning of the femoral tunnel for ACL reconstruction surgery. Femoral side remnant preservation was performed in all cases. Three-dimensional CT was performed 3 days postoperatively to collect the data, which were analyzed using Mimics 21.0 software. We measured the posterior cortical distance of the femoral condyle at 90° of knee flexion and the vertical distance from the center of the bone tunnel to the cortical extension line behind the femur. All femoral tunnel positions were marked on a 4 × 4 grid and visualized using the quadrant method. RESULTS Using the new positioning method in 50 knees, the average distance of x was 25.26 ± 2.76% of t and the average distance of y was 23.69 ± 6.19% of h. This is close to the results of previous studies, where x was 24.2 ± 4.0% of t and the average distance of y was 21.6 ± 5.2% of h. Most femoral tunnel positions were located in the same area. The D values were distributed as follows: 60% in the range of 0 to 2 mm, 24% in the range of 2 to 4 mm, and 16% more than 4 mm. The E values were distributed as follows: 80% in the range of 0 to 4 mm and 20% more than 4 mm. CONCLUSION In arthroscopic ACL reconstruction, the knee was flexed at 120° and the lowest point of the cartilage edge of the lateral wall of the intercondylar fossa and the tibial plateau plumb line were used as anatomical landmarks for the positioning of the femoral bone tunnel, which resulted in more accurate femoral bone tunnel positioning, better reproducibility, and better preservation of the femoral stump compared to traditional positioning methods.
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Affiliation(s)
- Xiaobo Li
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
- Department of Spine, Trauma Surgery, The First People's Hospital of Guangyuan, Guangyuan, Sichuan Province, China
| | - Jiajun Lu
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China
- School of Medicine, Wuhan University of Science and Technology, 2 West Huangjiahu Road, Hongshan District, Wuhan, Hubei Province, China
| | - JIxian Su
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China
- School of Medicine, Wuhan University of Science and Technology, 2 West Huangjiahu Road, Hongshan District, Wuhan, Hubei Province, China
| | - Hanlin Li
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China
- School of Medicine, Wuhan University of Science and Technology, 2 West Huangjiahu Road, Hongshan District, Wuhan, Hubei Province, China
| | - Xiaoying Liu
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Guangyuan, Guangyuan, Sichuan Province, China
| | - Ran Ding
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China.
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China.
- School of Medicine, Wuhan University of Science and Technology, 2 West Huangjiahu Road, Hongshan District, Wuhan, Hubei Province, China.
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Zhong J, Lee NJ, Padaki A, Crutchfield C, Ahmad CS, Trofa D, Sean Lynch T. Increased age and modified fragility index increases risk of short-term complications after anterior cruciate ligament reconstruction surgery. Knee 2024; 46:8-18. [PMID: 37972422 DOI: 10.1016/j.knee.2023.10.014] [Citation(s) in RCA: 1] [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: 07/06/2023] [Revised: 10/12/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Large data analysis of anterior cruciate ligament reconstruction (ACLR) short-term complications on age will help surgeons stratify and counsel at-risk patients. The purpose of this study is to assess if older patients are at greater risk for short-term complications after ACLR. METHODS This retrospective cohort study included patients who underwent elective ACLR with or without concomitant meniscal procedures in the National Surgical Quality Improvement Program from 2005 to 2017. Patients were divided into age groups 16-30, 31-45, and > 45. Modified fragility index-5 (mFI-5), demographics and short-term outcomes were examined with bivariate and multivariate analysis to determine if age was a risk factor for complications. RESULTS A total of 23,581 patients (35.4% female) were included in this analysis. Mean age was 32.1 ± 10.8 years. Older patients had higher mFI-5 scores (p < 0.001), shorter operative times (p < 0.001), lower use of only general anesthesia (p < 0.001). The oldest patients had similar rates of complications as the two younger groups. Older age was an independent risk factor for VTE, but decreased risk of prolonged operations. A mFI-5 > 0 increased risk factors for readmission (Odds ratio 2.2, P = 0.006). Infection was the most common cause 30-day readmissions (40/135, 29.6%). CONCLUSION In the early postoperative period, older age is an independent risk factor for VTE and younger age is a significant factor for prolonged surgeries. Having an mFI-5 > 0 increased risk factors for readmission.
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Affiliation(s)
- Jack Zhong
- Columbia Univ. Dept. of Orthopaedic Surgery, 161 Fort Washington Avenue, New York, NY 10032, United States; New York University Langone Health Dept. of Orthopaedic Surgery, 301 E 17th St, New York, NY 10010, United States.
| | - Nathan J Lee
- Columbia Univ. Dept. of Orthopaedic Surgery, 161 Fort Washington Avenue, New York, NY 10032, United States
| | - Ajay Padaki
- Columbia Univ. Dept. of Orthopaedic Surgery, 161 Fort Washington Avenue, New York, NY 10032, United States
| | - Connor Crutchfield
- Columbia Univ. Dept. of Orthopaedic Surgery, 161 Fort Washington Avenue, New York, NY 10032, United States
| | - Christopher S Ahmad
- Columbia Univ. Dept. of Orthopaedic Surgery, 161 Fort Washington Avenue, New York, NY 10032, United States
| | - David Trofa
- Columbia Univ. Dept. of Orthopaedic Surgery, 161 Fort Washington Avenue, New York, NY 10032, United States
| | - T Sean Lynch
- Columbia Univ. Dept. of Orthopaedic Surgery, 161 Fort Washington Avenue, New York, NY 10032, United States; Henry Ford Health Dept. of Orthopaedic Surgery, 40777 Ann Arbor Rd, Plymouth, MI 48170, United States
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DeGenova DT, Passias BJ, Paulini AS, Myers PM, Dues B, Taylor BC. The Effect of Obesity on Hemiarthroplasty and Total Hip Arthroplasty for Femoral Neck Fractures. J Long Term Eff Med Implants 2024; 34:53-60. [PMID: 38305370 DOI: 10.1615/jlongtermeffmedimplants.2023048120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Obesity is a well-recognized global epidemic that can lead to longer operative times as well as a greater technical demand. Despite this, the available literature evaluating the impact of obesity on hip hemiarthroplasty (HA) and total hip arthroplasty (THA) when treating fractures about the femoral neck is scarce. Between 2015 and 2018, we retrospectively reviewed all patients that had a HA or THA performed as treatment for an isolated fracture of the femoral neck. Patients were classified as obese and nonobese depending on current body mass index (BMI) when the index procedure was performed. Preoperative and postoperative variable were obtained from the electronic medical record. A total of 157 patients underwent hip HA or THA for an isolated fracture of the femoral neck. In those patients undergoing HA, obesity was associated with an increase in operative times (P = 0.021) and was associated with a nonsignificant increase in total operating room time (P = 0.088) and duration of anesthesia (P = 0.14). In those patients undergoing THA, obesity was associated with longer operative times (P = 0.043), total operating room time (P = 0.032), and duration of anesthesia (P = 0.045). There were no significant differences in complication rates postoperatively between obese and non-obese patients undergoing either procedure. The treatment of isolated fractures of the femoral neck with HA or THA leads to an increase in operative time without an increase in postoperative complications in obese patients.
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Affiliation(s)
| | - Braden J Passias
- Department of Orthopedic Surgery, Doctors Hospital OhioHealth, Columbus, OH 43228, USA; Department of Orthopedic Surgery, OhioHealth Grant Medical Center, Columbus, OH 43215, USA
| | - Alex S Paulini
- OhioHealth, Department of Orthopedics, Columbus, OH 43228, USA
| | - Philip M Myers
- Singing River Health System, Department of Orthopedics, Gulfport, MS 39503, USA
| | - Boston Dues
- OhioHealth Orthopedic Trauma and Reconstructive Surgeons, Grant Medical Center, Columbus, OH 43215, USA
| | - Benjamin C Taylor
- OhioHealth Orthopedic Trauma and Reconstructive Surgeons, Grant Medical Center, Columbus, OH 43215, USA
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Papalia AG, Romeo PV, Gambhir N, Alben MG, Chowdhury T, Simcox T, Rokito A, Virk MS. Effects of increased body mass index on one year outcomes following soft tissue arthroscopic shoulder instability repair. JSES Int 2023; 7:730-736. [PMID: 37719813 PMCID: PMC10499852 DOI: 10.1016/j.jseint.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background The purpose of this study was to investigate the impact of high body mass index on the 1-year minimal outcome following arthroscopic shoulder stabilization. Methods Patients who underwent arthroscopic Bankart repair (ABR) between 2017 and 2021 were identified and assigned to 1 of 3 cohorts based on their preoperative body mass index: normal (18-25), overweight (25-30), and obese (>30). The primary outcomes assessed were postoperative shoulder instability and revision rates. The 3 groups were compared using the Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity, pain interference, pain intensity, Clinical Global Impression scores, visual analog scale pain scores, and shoulder range of motion at 1 year postoperatively. Results During the study period, 142 patients underwent ABR and had an average age of 35 ± 10 years. Obese patients had a higher percentage of partial rotator cuff tears (60% vs. 27%, odds ratio: 3.2 [1.1, 9.2]; P = .009), longer mean operative time (99.8 ± 40.0 vs. 75.7 ± 28.5 minutes; P < .001), and shorter time to complication (0.5 ± 0 vs. 7.0 ± 0 months; P = .038). After controlling for confounding factors, obesity was associated with a lesser improvement in upper extremity function scores (obese vs. normal: -4.9 [-9.4, -0.5]; P = .029); although this difference exists, found future studies are needed to determine the clinical significance. There were no differences in patient reported outcome measures, recurrence rate, or revision surgery rates between cohorts at any time point (P > .05). Conclusion Obesity is an independent risk factor for longer operative times but does not confer a higher risk of recurrent instability, revision surgery, or lower outcome scores 1 year following ABR.
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Affiliation(s)
- Aidan G. Papalia
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Paul V. Romeo
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Neil Gambhir
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Matthew G. Alben
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Tas Chowdhury
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Trevor Simcox
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Andrew Rokito
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Mandeep S. Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
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Best MJ, Harris AB, Marrache M, Martin SD, Rue JPH, Wilckens JH. Risk Factors for Readmission following Anterior Cruciate Ligament Reconstruction. J Knee Surg 2023; 36:459-464. [PMID: 34610639 DOI: 10.1055/s-0041-1736200] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study is to identify risk factors for readmission after anterior cruciate ligament (ACL) reconstruction and to determine costs associated with readmission. Using a private insurance claims' database, we identified patients who underwent ACL reconstruction from 2010 to 2015 using the International Classification of Diseases, Version 9 (ICD-9) and Current Procedural Terminology (CPT) codes. Univariate analysis was performed on demographic data, surgical characteristics, and comorbidities. Variables with p < 0.10 were added to a multivariate logistic regression model which was created to identify independent risk factors for all-cause readmission within 90 days postoperatively. Significance was considered at p < 0.05. Overall, 90,263 patients were included (average age: 29 ± 13 years, 44% female), and 1,066 (1.2%) of patients had a hospital readmission within 90 days following surgery. Risk factors for hospital readmission included cerebrovascular disease (odds ratio [OR] = 3.4, 95% confidence interval [CI]: 1.9, 6.2), diabetes mellitus (OR = 2.6, 95% CI: 1.9, 3.5), concomitant medial collateral ligament (MCL) or lateral collateral ligament (LCL) reconstruction (OR = 2.5, 95% CI: 1.9, 3.3), concomitant posterior cruciate ligament (PCL) reconstruction (OR = 2.2, 95% CI: 1.4, 3.3), age between 44 and 65 years (OR = 2.1, 95% CI: 1.6, 2.9), and depression (OR = 1.88, 95% CI: 1.49, 2.38, p < 0.001). Female sex was associated with decreased odds of 90-day hospital readmission (OR = 0.8, 95% CI: 0.7, 0.9). Each hospital readmission accounted for an estimated $17,841 (95% CI: $17,173, 18,509) in gross health care payments, and patients with readmissions had substantially higher 1-year cumulative health care costs. Readmission after ACL reconstruction was 1.2%. The strongest risk factors for 90-day readmission include cerebrovascular disease, diabetes mellitus, concomitant MCL/LCL reconstruction, concomitant PCL reconstruction, and age between 44 and 65 years. Readmission was associated with substantial health care costs.
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Affiliation(s)
- Matthew J Best
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew B Harris
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Majd Marrache
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Scott D Martin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - John-Paul H Rue
- Department of Orthopaedic Surgery, Mercy Medical Center, Baltimore, Maryland
| | - John H Wilckens
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland
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Lopez CD, Gazgalis A, Peterson JR, Confino JE, Levine WN, Popkin CA, Lynch TS. Machine Learning Can Accurately Predict Overnight Stay, Readmission, and 30-Day Complications Following Anterior Cruciate Ligament Reconstruction. Arthroscopy 2023; 39:777-786.e5. [PMID: 35817375 DOI: 10.1016/j.arthro.2022.06.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aimed to develop machine learning (ML) models to predict hospital admission (overnight stay) as well as short-term complications and readmission rates following anterior cruciate ligament reconstruction (ACLR). Furthermore, we sought to compare the ML models with logistic regression models in predicting ACLR outcomes. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent elective ACLR from 2012 to 2018. Artificial neural network ML and logistic regression models were developed to predict overnight stay, 30-day postoperative complications, and ACL-related readmission, and model performance was compared using the area under the receiver operating characteristic curve. Regression analyses were used to identify variables that were significantly associated with the predicted outcomes. RESULTS A total of 21,636 elective ACLR cases met inclusion criteria. Variables associated with hospital admission included White race, obesity, hypertension, and American Society of Anesthesiologists classification 3 and greater, anesthesia other than general, prolonged operative time, and inpatient setting. The incidence of hospital admission (overnight stay) was 10.2%, 30-day complications was 1.3%, and 30-day readmission for ACLR-related causes was 0.9%. Compared with logistic regression models, artificial neural network models reported superior area under the receiver operating characteristic curve values in predicting overnight stay (0.835 vs 0.589), 30-day complications (0.742 vs 0.590), reoperation (0.842 vs 0.601), ACLR-related readmission (0.872 vs 0.606), deep-vein thrombosis (0.804 vs 0.608), and surgical-site infection (0.818 vs 0.596). CONCLUSIONS The ML models developed in this study demonstrate an application of ML in which data from a national surgical patient registry was used to predict hospital admission and 30-day postoperative complications after elective ACLR. ML models developed performed well, outperforming regression models in predicting hospital admission and short-term complications following elective ACLR. ML models performed best when predicting ACLR-related readmissions and reoperations, followed by overnight stay. LEVEL OF EVIDENCE IV, retrospective comparative prognostic trial.
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Affiliation(s)
- Cesar D Lopez
- New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, U.S.A.
| | - Anastasia Gazgalis
- New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Joel R Peterson
- New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Jamie E Confino
- New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, U.S.A
| | - William N Levine
- New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Charles A Popkin
- New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, U.S.A
| | - T Sean Lynch
- New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, U.S.A
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Ang ACH, Wong D, Lui PPY. Increased Risk of Concomitant Meniscal Injuries in Adolescents With Elevated Body Mass Index After Anterior Cruciate Ligament Tear: A Systematic Review. Arthroscopy 2022; 38:3209-3221. [PMID: 35660518 DOI: 10.1016/j.arthro.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/03/2022] [Accepted: 05/12/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate existing studies examining the association between body mass index (BMI) and outcomes of anterior cruciate ligament reconstruction (ACLR) in adolescent patients. METHODS A literature search was conducted on PubMed and Embase. Studies examining associations between BMI and outcomes after ACLR in adolescents were included. Quality assessment was performed. Data on patient age, sex, study design, time of follow-up, sample size, graft type, concomitant injuries (meniscal injury, surgical procedures), clinical outcomes (revision ACLR, postoperative weight gain, post-traumatic osteoarthritis [PTOA], range of motion [ROM]), and functional outcome (muscle strength) were extracted. RESULTS Eleven papers of Levels II-IV evidence were included. Five studies found positive correlations between BMI and risk of concomitant meniscal injuries. Two of them reported young patients with elevated BMI having 1.6 times greater odds of requiring meniscectomy (P < .01) and 1.031 times greater odds of requiring concomitant surgeries (P = .011). One study showed significant positive association of postoperative weight gain by time (r = 0.28, P < .01), with smaller increase in the overweight and obese groups compared with the normal-weight group. One study demonstrated greater cartilage breakdown in young patients with overweight and obesity postsurgery, contributing to PTOA (r = 0.42, P = .009). There was no clinically important difference in postoperative ROM and muscle strength. Four studies reviewed the association between BMI and revision ACLR risk, but results were heterogeneous and a firm conclusion cannot be drawn. CONCLUSIONS Adolescents with elevated BMI are more likely to have concomitant meniscal injuries and surgical procedures after ACL tear. There is some weak evidence of the association of elevated BMI with PTOA and slight postoperative weight gain post-ACLR. There may not be any clinically significant association of obesity with post-operative muscle strength and ROM, and current studies are inconclusive regarding the impact of BMI on revision ACLR risk. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Ashley Cheuk Hei Ang
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Doris Wong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Pauline Po Yee Lui
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Center for Neuromusculoskeletal Restorative Medicine, Hong Kong SAR, China.
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Crutchfield CR, Zhong JR, Lee NJ, Fortney TA, Ahmad CS, Lynch TS. Operative Time Less Than 1.5 Hours, Male Sex, Dependent Functional Status, Presence of Dyspnea, and Reoperations Within 30 days Are Independent Risk Factors for Readmission After ACLR. Arthrosc Sports Med Rehabil 2022; 4:e1305-e1313. [PMID: 36033184 PMCID: PMC9402418 DOI: 10.1016/j.asmr.2022.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/10/2022] [Accepted: 04/12/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose The purposes of this study are to use a large, patient-centered database to describe the 30-day readmission rate and to identify predictive risk factors for readmission after elective isolated ACLR. Methods The National Surgical Quality Improvement Program Database was retrospectively queried for isolated ACLR procedures between 2011 and 2017. Current Procedural Terminology (CPT) codes were used to identify isolated ACLR patients. Those undergoing additional procedures such as meniscectomy or multi-ligamentous reconstruction were excluded. Readmissions were analyzed against demographic variables with bivariate analysis. Multivariate logistic regression was used to find independent risk factors for 30-day readmissions after ACLR. Results A total of 11,060 patients (37.2% female) were included with an average age of 32.2 ± 10.6 years and mean body mass index (BMI) of 27.9 ± 6.5 kg/m2 (29.2% were >30). The overall readmission rate was 0.59%. The most reported reason for readmission was infection 0.22 (24 out of 11,060). The following variables were associated with significantly higher readmission rates: male sex (P = .001), history of severe chronic obstructive pulmonary disease (COPD) (P = .025), cardiac comorbidity (P = .034), operative time >1.5 hours (P <.001), partially dependent functional health status (P = .002), high preoperative creatinine (P = .009), normal preoperative albumin (P = .020), hypertension (P = .034), and reoperations (P < .001). Operative time >1.5 hours, male sex, dependent functional status, the presence of dyspnea, and undergoing a reoperation were identified as independent risk factors for 30-day readmissions (P < .05 for all). Conclusions Isolated ACLR is associated with low 30-day readmission rates. Operative time >1.5 hours, male sex, dependent functional status, the presence of dyspnea, and 30-day reoperations are independent risk factors for readmission that should be considered in patient selection and addressed with preoperative counseling. Level of Evidence Level III, retrospective cohort study.
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11
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Condron NB, Cotter EJ, Naveen NB, Wang KC, Patel SS, Waterman BR, Cole BJ, Dodds JA. Increasing Patient Age, Ambulatory Surgery Center Setting, and Surgeon Experience Are Associated With Shorter Operative Duration for Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2022; 4:e1323-e1329. [PMID: 36033177 PMCID: PMC9402419 DOI: 10.1016/j.asmr.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/16/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To identify variables associated with operative duration and intraoperative or perioperative complications after primary anterior cruciate ligament reconstruction (ACLR). Methods Surgeons who performed a minimum of 20 arthroscopic cases per month were recruited for participation through the Arthroscopy Association of North America from 2011 through 2013. All participants agreed to voluntarily submit data for 6 months of consecutive knee and shoulder arthroscopy cases. Only subjects coded for ACLR were analyzed, whereas revision cases were excluded. ACLRs were subdivided into isolated ACLR, ACLR with minor concomitant procedures, and ACLR with major concomitant procedures. Patient, surgeon, and surgical variables were analyzed for their effect on operative duration and complications. Results One hundred thirty-five orthopaedic surgeons participated, providing 1,180 primary ACLRs (399 isolated ACLRs, 441 ACLRs plus minor procedures, and 340 ACLRs plus major procedures). Most surgeons were in private practice (72.8%). Most patients were male patients (58.8%), and the mean body mass index (BMI) was 26.2 ± 5.1. The overall mean operative duration was 95.9 ± 42.0 minutes (isolated ACLRs, 88.4 ± 36.8 minutes; ACLRs plus minor concomitant procedures, 90.1 ± 37.6 minutes; and ACLRs plus major concomitant procedures, 118.5 ± 112.4 minutes; P < .001). Patient age was inversely correlated with operative duration (ρ = –0.221, P < .001). Surgical procedures performed in an ambulatory surgery center had a shorter mean operative duration (91.5 ± 40.4 minutes) compared with those performed in a hospital setting (105.0 ± 43.8 minutes, P < .001). There were 22 intraoperative and 47 early postoperative complications, with the most common being deep vein thrombosis (n = 15). Surgical volume (knee arthroscopy cases per month) correlated inversely with operative time (ρ = –0.200, P = .001) and complication rate (ρ = –0.112, P < .001). Patient BMI was associated with increased odds of early postoperative complications on multivariate analysis (odds ratio, 1.060; P = .044; 95% confidence interval, 1.002-1.121). Conclusions Increasing patient age, private practice, ambulatory surgery center setting, and surgeon experience are associated with a shorter operative duration for ACLR. Although an increasing number of arthroscopic knee procedures performed by surgeons correlated with fewer complications, only increasing patient BMI significantly predicted odds of complications. Level of Evidence Level IV, prognostic case series.
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12
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Saengpetch N, Watcharopas R, Kujkunasathian C, Limitloahaphan C, Lertbutsayanukul C, Vijittrakarnrung C, Sa-ngasoongsong P, Arnuntasupakul V, Sangkum L. Predicting surgical factors for unplanned overnight admission in ambulatory arthroscopic surgery of the knee: a prospective cohort in one hundred and eighty four patients. INTERNATIONAL ORTHOPAEDICS 2022; 46:1991-1998. [PMID: 35578111 PMCID: PMC9110279 DOI: 10.1007/s00264-022-05436-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/07/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Unplanned overnight admission (UOA) is an important indicator for quality of care with ambulatory knee arthroscopic surgery (AKAS). However, few studies have explored the factors related to the UOA and how to predict UOA after AKAS. This study aimed to evaluate the effectiveness of a standardized peri-operative protocol for the AKAS and identify whether a correlation exists between the peri-operative surgical factors and UOA in the patients undergoing AKAS. We hypothesized that more surgical invasiveness and prolong tourniquet time increase the risk of UOA after AKAS. METHOD A prospective cohort study was conducted between October 2017 and March 2021. All 184 patients operated on standard AKAS protocol. The UOA is defined as overnight hospitalization of a patient undergoing AKAS. Demographic and peri-operative data were recorded, and the procedure was categorized based on the surgical invasiveness based on less invasive (intra-articular soft tissue surgery) (n = 65) and more complex surgery (involving extra-articular soft tissue surgery or ligamentous reconstruction) (n = 119). The clinical risk factors for UOA were identified and analyzed with multivariate analysis. RESULTS The incidence of UOA in the more complex group (n = 7, 14.3%) was significantly higher than in the less invasive group (n = 3, 4.6%) (p = 0.049). The peri-operative factors significantly associated with UOA were age, more complex surgery, and longer tourniquet time (p < 0.10 all). However, the multivariate analysis revealed that longer tourniquet time was the only significant predictor for UOA (OR = 1.045, 95% CI = 1.022-1.067, p = 0.0001). The optimal cut-off points of tourniquet time for predicting UOA with the highest Youden index in the less invasive and more complex groups were 56 minutes and 107 minutes, respectively. CONCLUSION The UOA after AKAS is more common in more complex surgery compared to less invasive surgery. This study showed that unplanned admission significantly associated with many factors-as patient factors, surgical invasiveness, and tourniquet time. However, tourniquet time is the only independent predictor for UOA. Therefore, strict perioperative management protocol must be applied in AKAS, and all patients having these risk factors should be prepared for UOA.
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Affiliation(s)
- Nadhaporn Saengpetch
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Ratthapoom Watcharopas
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Chusak Kujkunasathian
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Chalermchai Limitloahaphan
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Chatchawan Lertbutsayanukul
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Chaiyanun Vijittrakarnrung
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Paphon Sa-ngasoongsong
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Vanlapa Arnuntasupakul
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Lisa Sangkum
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
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Devana SK, Solorzano C, Nwachukwu B, Jones KJ. Disparities in ACL Reconstruction: the Influence of Gender and Race on Incidence, Treatment, and Outcomes. Curr Rev Musculoskelet Med 2022; 15:1-9. [PMID: 34970713 PMCID: PMC8804118 DOI: 10.1007/s12178-021-09736-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Anterior cruciate ligament (ACL) rupture is a common injury that has important clinical and economic implications. We aimed to review the literature to identify gender, racial and ethnic disparities in incidence, treatment, and outcomes of ACL injury. RECENT FINDINGS Females are at increased risk for ACL injury compared to males. Intrinsic differences such as increased quadriceps angle and increased posterior tibial slope may be contributing factors. Despite lower rates of injury, males undergo ACL reconstruction (ACLR) more frequently. There is conflicting evidence regarding gender differences in graft failure and ACL revision rates, but males demonstrate higher return to sport (RTS) rates. Females report worse functional outcome scores and have worse biomechanical metrics following ACLR. Direct evidence of racial and ethnic disparities is limited, but present. White athletes have greater risk of ACL injury compared to Black athletes. Non-White and Spanish-speaking patients are less likely to undergo ACLR after ACL tear. Black and Hispanic youth have greater surgical delay to ACLR, increased risk for loss to clinical follow-up, and less physical therapy sessions, thereby leading to greater deficits in knee extensor strength during rehabilitation. Hispanic and Black patients also have greater risk for hospital admission after ACLR, though this disparity is improving. Females have higher rates of ACL injury with inconclusive evidence on anatomic predisposition and ACL failure rate differences between genders. Recent literature has suggested inferior RTS and functional outcomes following ACLR in females. Though there is limited and mixed data on incidence and outcome differences between races and ethnic groups, recent studies suggest there may be disparities in those who undergo ACLR and time to treatment.
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Affiliation(s)
- Sai K. Devana
- Department of Orthopaedic Surgery, University of California, Los Angeles, USA
| | - Carlos Solorzano
- Department of Orthopaedic Surgery, University of California, Los Angeles, USA
| | - Benedict Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, University of California, Los Angeles, USA
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KARANTH DIVYA, KARANTH VEENAL. Obesity: is it an additional risk factor in analyzing surgical outcomes in the South Indian population? JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E200-E205. [PMID: 34322637 PMCID: PMC8283646 DOI: 10.15167/2421-4248/jpmh2021.62.1.1696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/24/2020] [Indexed: 11/16/2022]
Abstract
Aim This study aims to determine whether obesity impacts surgical outcomes among patients undergoing surgery at the Surgery Unit in a tertiary care hospital. Methods This is a retrospective study. Data were retrieved from the medical records of patients who underwent surgery at a tertiary care hospital. Patient demographics, co-morbidities, intraoperative and postoperative pain scores and complications, if occurring, were compiled for each patient. Patients were subdivided into four subsets based on their disease profile. Each subset was divided into two groups based on their body mass index (BMI). Preoperative BMI greater than or equal to 25 kg/m2 was classified as obese. Results The study showed that there is a considerable increase in the duration of surgery in obese when compared to non-obese. 30 days readmission rate was higher among obese in all the subsets. We find that in the subset of non-infective conditions, post operative pain mean ranking score is greater among obese (128.8 vs 109.6). Conclusions In conclusion, the impact of obesity resulted in increased duration of surgery and post-operative pain. The association between obesity and surgical outcome shows the importance to further research to find a way to prevention of some of the complications of surgery that could occur in patients with high BMI.
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Affiliation(s)
- DIVYA KARANTH
- Department of Medical Education Kasturba Medical College MAHE, Karnataka, India
| | - VEENA L. KARANTH
- Department of General Surgery Kasturba Medical College MAHE, Karnataka, India
- Correspondence: Veena L. Karanth, Professor and Unit Head, Department of General Surgery, Kasturba Medical College, MAHE, Manipal 576104 - Tel.: +919845417715 - E-mail:
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Gulledge CM, Koolmees D, Smith DG, Pietroski A, Franovic S, Moutzouros V, Makhni EC. The PROMIS CAT Demonstrates Responsiveness in Patients After ACL Reconstruction Across Numerous Health Domains. Orthop J Sports Med 2021; 9:2325967120979991. [PMID: 33553461 PMCID: PMC7841687 DOI: 10.1177/2325967120979991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022] Open
Abstract
Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) has emerged as a dynamic, efficient, and validated patient-reported outcome measure in the field of orthopaedics. However, the responsiveness, which is defined as the ability to detect changes in scores over time, of PROMIS computer adaptive tests (CATs) after anterior cruciate ligament reconstruction (ACLR) has not been well documented. Purpose: To investigate the responsiveness up to 1 year postoperatively of multiple PROMIS CAT domains in patients undergoing ACLR. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: All patients who underwent ACLR by 1 of 2 fellowship-trained sports medicine orthopaedic surgeons, with preoperative and at least 6 months postoperative visits, were included in this study. PROMIS CAT physical function (PF), pain interference (PI), and depression (D) scores from each visit were collected and analyzed. Preoperative patient-centric factors, including demographic factors and meniscal pathology, were analyzed for associations with improvements in PROMIS scores. Results: A total of 100 patients (62 male patients and 38 female patients; mean age, 27.6 ± 11.8 years) with an average follow-up of 338.5 ± 137.5 days were included in this study. Preoperative PF, PI, and D scores improved significantly from 38.5 ± 7.3, 60.3 ± 7.0, and 47.9 ± 9.1, respectively, to 53.6 ± 10.3, 48.1 ± 8.5, and 41.0 ± 9.9, respectively (P < .001 for each domain). Lower preoperative PF scores, PI scores, and a lower body mass index (BMI) were predictive for greater improvements in PF. Higher preoperative PI scores and a lower BMI were predictors for greater improvements in PI. Meniscal pathology was not predictive of improvement in PROMIS scores. Conclusion: PROMIS CAT assessments of PF, PI, and D demonstrated responsiveness in patients undergoing ACLR up to 1 year. Worse preoperative PROMIS scores and a lower BMI were predictive of greater improvements in PROMIS scores.
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16
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Min CJ, Partan MJ, Koutsogiannis P, Iturriaga CR, Katsigiorgis G, Cohn RM. Risk factors for hospital admission in patients undergoing outpatient anterior cruciate ligament reconstruction: A national database study. J Orthop 2020; 22:436-441. [PMID: 33071518 PMCID: PMC7548946 DOI: 10.1016/j.jor.2020.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/17/2020] [Accepted: 09/27/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Anterior Cruciate Ligament Reconstructions (ACLR) are routinely performed in an outpatient setting with low 90-day readmission rates (2.3%); however, admissions rates in the immediate perioperative period have been previously reported as high as 13.1%. Despite the surprisingly high number of patients requiring immediate perioperative admission, there has been a lack of recent literature specifically examining the associated risk factors for admission. METHODS Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, a query for patients who underwent ACLR from 2011 through 2018 was performed using Current Procedural Terminology codes. The following concomitant procedures were included: meniscectomy, meniscal repair, diagnostic arthroscopy, loose body removal, synovectomy, chondroplasty, abrasion chondroplasty, drilling for osteochondritis dissecans. Demographics including age, sex, race, body mass index (BMI) and comorbidities were collected. Perioperative factors collected were anesthesia type and operative times. Patient demographic and perioperative data were compared using Fisher's exact test and Pearson's chi-square test. Multivariate logistic regressions were used to calculate odds ratios (OR) and 95% confidence intervals (CI) of independent risk factors for postoperative admission. Holm-Bonferroni method yielded adjusted p-value thresholds for significance. RESULTS Of the 20,819 patients undergoing ACLR with and without concomitant procedures, 3.8% of patients were admitted to the hospital in the immediate postoperative period. Following multivariate regression analysis, increased odds of admission were demonstrated with the use of regional anesthesia alone (OR = 2.77, 95%CI: 2.22-3.44; p < 0.001), increasing concurrent procedures (Table 1), and obesity classes II (OR = 1.62, 95%CI: 1.26-2.10; p < 0.001) and III (OR = 1.81, 95%CI: 1.33-2.47; p < 0.001). Subsequent subgroup analysis of the isolated ACLR procedures (N = 9,423) demonstrated a 3.3% postoperative admission rate. Multivariate regressions demonstrated increased odds of admission with regional anesthesia use only (OR = 2.62, 95%CI: 1.90-3.60; p < 0.001), obesity class II (OR = 2.22, 95%CI: 1.51-3.26; p < 0.001), and increasing minutes of operative time (OR = 1.01, 95%CI: 1.01-1.01; p < 0.001). Table 2 demonstrates increasing rates and odds of admission with increasing operative time in hours. CONCLUSION Anterior Cruciate Ligament Reconstructions are routinely performed in an outpatient setting; nevertheless, a subset of ACLR patients is admitted postoperatively. We found an increased risk of admission with the use of regional anesthesia alone, increasing concurrent procedures and obesity classes II and III. A further understanding of patient risk factors for those undergoing ACLR allows orthopedic surgeons to better develop a preoperative plan and discuss patient expectations, which will lead to more efficient resource allocation and improved patient satisfaction.
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Affiliation(s)
- Cris J. Min
- Northwell Health Plainview Hospital, Department of Orthopaedic Surgery, Plainview, NY, USA
- Northwell Health Huntington Hospital, Department of Orthopaedic Surgery, Huntington, NY, USA
| | - Matthew J. Partan
- Northwell Health Plainview Hospital, Department of Orthopaedic Surgery, Plainview, NY, USA
- Northwell Health Huntington Hospital, Department of Orthopaedic Surgery, Huntington, NY, USA
| | - Petros Koutsogiannis
- Northwell Health Plainview Hospital, Department of Orthopaedic Surgery, Plainview, NY, USA
- Northwell Health Huntington Hospital, Department of Orthopaedic Surgery, Huntington, NY, USA
| | - Cesar R. Iturriaga
- Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, NY, USA
| | - Gus Katsigiorgis
- Northwell Health Plainview Hospital, Department of Orthopaedic Surgery, Plainview, NY, USA
- Northwell Health Long Island Jewish Valley Stream, Department of Orthopaedic Surgery, Valley Stream, NY, USA
| | - Randy M. Cohn
- Northwell Health Plainview Hospital, Department of Orthopaedic Surgery, Plainview, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, NY, USA
- Northwell Health Long Island Jewish Valley Stream, Department of Orthopaedic Surgery, Valley Stream, NY, USA
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Shao L, Wu D, Li JY, Wu XD, Zhou X, Qiu GX, Luo C, Xiao PC, Liu JC, Huang W. Hospital readmission after anterior cruciate ligament reconstruction: protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e037888. [PMID: 33067283 PMCID: PMC7569989 DOI: 10.1136/bmjopen-2020-037888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) injury is one of the most common injuries of the knee. ACL reconstruction (ACLR) has been widely performed as a safe and effective treatment for ACL injuries. As there is an increasing trend in the incidence of ACL injury, hospital readmission after ACLR has attracted renewed attention for the financial burden to both patients and the healthcare system. However, information about hospital readmission after ACLR remains fragmented. Therefore, we plan to systematically review the literature to investigate the rate of, causes and risk factors for hospital readmission after ACLR, and summarise interventions to reduce hospital readmission. This article is to provide the protocol for an upcoming systematic review and meta-analysis on this important issue. METHODS AND ANALYSIS Reporting of this protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) checklist. Electronic databases, including PubMed, Embase and the Cochrane Library, will be systematically searched from inception to June 2020. No language restrictions will be applied. Studies will be included if they reported hospital readmission or explored the associated potential causes and risk factors for hospital readmission after ACLR. The primary outcome will be the number and time frame of hospital readmission after ACLR. Secondary outcomes will be reasons for readmission, number and types of complications, risk factors for readmission and preventive measures for readmission after ACLR. Quality assessments will be performed by using the Newcastle-Ottawa Scale (NOS). If possible, study results will be summarised in a forest plot, and heterogeneity will be tested by using the Cochran's Q and I2 statistics. ETHICS AND DISSEMINATION No ethical approval is required because our study is not related to patients or animals. The results will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020058624.
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Affiliation(s)
- Long Shao
- Department of Orthopaedic Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, China
| | - Di Wu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jia-Ying Li
- Departments of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiang-Dong Wu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xi Zhou
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Gui-Xing Qiu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Changqi Luo
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peng-Cheng Xiao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia-Cheng Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Su C, Kuang SD, Liu WJ, Li YS, Xiong YL, Zhao X, Gao SG. Clinical Outcome of Remnant-Preserving and I.D.E.A.L. Femoral Tunnel Technique for Anterior Cruciate Ligament Reconstruction. Orthop Surg 2020; 12:1693-1702. [PMID: 32975048 PMCID: PMC7767774 DOI: 10.1111/os.12791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/09/2020] [Accepted: 08/02/2020] [Indexed: 12/03/2022] Open
Abstract
Objective To assess the clinical results of the remnant‐preserving and I.D.E.A.L. femoral tunnel technique in the arthroscopic treatment of anterior cruciate ligament (ACL) injuries. Methods This was a retrospective single‐center, single‐surgeon study reviewing data from November 2016 to March 2019. Based on our inclusion/exclusion criteria, a total of 31 patients (18 males, 13 females; mean age, 23.6 years) who underwent arthroscopic ACL reconstruction with the remnant preservation and I.D.E.A.L. femoral tunnel technique were recruited and had a minimum follow‐up of 12 months. Clinical data and status of knee stability were recorded. The International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity scale were collected both preoperatively and at a minimum of 1‐year follow‐up. Results Statistically significant differences were detected between the preoperative and postoperative values for Lachman test and pivot‐shift test (P < 0.01). The mean postoperative Lysholm score was 89.6 ± 9.4, whereas the mean preoperative Lysholm score was 47.3 ± 12.8 (P < 0.01). The mean Tegner activity score was significantly higher at postoperative evaluation than at preoperative evaluation (6.5 ± 2.1 vs 2.6 ± 1.8; P < 0.01). The mean IKDC score was significantly improved from 49.5 ± 10.6 preoperatively to 88.2 ± 10.7 postoperatively (P < 0.01). No case of infection was reported. No radiograph showed any joint space narrowing or degenerative change at the last postsurgical follow‐up. Conclusion The anatomical remnant‐preserving and I.D.E.A.L. femoral tunnel technique achieves a satisfactory clinical outcome and provides an effective option for the treatment of ACL injuries.
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Affiliation(s)
- Chao Su
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Shi-da Kuang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Wei-Jie Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yu-Sheng Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yi-Lin Xiong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Xin Zhao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Shu-Guang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China.,Hunan Engineering Research Center of Osteoarthritis, Changsha, China.,National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Wang Y, Lei G, Zeng C, Wei J, He H, Li X, Zhu Z, Wang H, Wu Z, Wang N, Ding X, Li H. Comparative Risk-Benefit Profiles of Individual Devices for Graft Fixation in Anterior Cruciate Ligament Reconstruction: A Systematic Review and Network Meta-analysis. Arthroscopy 2020; 36:1953-1972. [PMID: 32360701 DOI: 10.1016/j.arthro.2020.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 04/05/2020] [Accepted: 04/10/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To compare the efficacy and safety of individual devices for femoral and/or tibial graft fixation in anterior cruciate ligament (ACL) reconstruction. METHODS The PubMed, Embase, Cochrane Library, and Web of Science databases were searched from inception to December 12, 2018. Randomized controlled trials comparing individual devices for ACL graft fixation were included. Bayesian network meta-analysis was performed to assess the efficacy profile using the following outcomes: Lysholm score, International Knee Documentation Committee (IKDC) category, laxity, range of motion, and Tegner score. The incidence of infection, effusion, and graft rupture for each device was reported. RESULTS We included 57 randomized controlled trials involving 4,304 patients aged 23.8 to 40.9 years. The female proportion ranged from 0% to 100%. The length of follow-up ranged from 6 to 144 months. Of the 13 studied femoral fixation devices, none was significantly different from the others regarding the Lysholm score, IKDC category, range of motion, and Tegner score. Bioabsorbable interference screws (standardized mean difference, 1.3; 95% credible interval, 0.0-2.5) showed higher laxity than the EndoPearl at a borderline level of statistical significance, but the difference varied substantially within multiple sensitivity analyses. Infection (2.0%) was most commonly seen with the EndoPearl, whereas the bone mulch screw had the highest incidence of effusion (5.5%) and graft rupture (5.5%). For the 9 studied tibial fixation devices, no significant difference was observed in the aforementioned efficacy measurements. Bioabsorbable interference screws with staples had the highest incidence of infection (11.1%) and effusion (15.6%), whereas graft rupture was most commonly seen with the bone plug (4.0%). CONCLUSIONS Graft fixation devices in ACL reconstruction share a similar efficacy profile in terms of the Lysholm score, IKDC category, range of motion, and Tegner score but not laxity. On the other hand, safety profiles seem to vary among different devices. These findings can support surgeons, alongside their experience and preference, as well as the relative cost of each device, in delivering an individualized plan for an optimal operation. LEVEL OF EVIDENCE Level II, meta-analysis of Level I and II studies.
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Affiliation(s)
- Yilun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Osteoarthritis, Changsha, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.; The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jie Wei
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.; The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.; Health Management Center, Xiangya Hospital, Central South University, Changsha, China
| | - Hongyi He
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoxiao Li
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
| | - Zhenglei Zhu
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
| | - Haochen Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Ziying Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Ning Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Ding
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Hui Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.
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