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Wollenman CC, Cox CL, Schoenecker JG, Wright RW. Venous thromboembolism After Knee Arthroscopy: Incidence, Risk Factors, Prophylaxis, and Management. J Am Acad Orthop Surg 2024; 32:e850-e860. [PMID: 39018574 DOI: 10.5435/jaaos-d-24-00232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/16/2024] [Indexed: 07/19/2024] Open
Abstract
Venous thromboembolism (VTE), comprising pulmonary embolism and deep vein thrombosis, is one of the most common complications after knee arthroscopy. Sequelae of VTE include VTE recurrence, postthrombotic syndrome, and potential for loss of limb or life. Given the increasing volume of knee arthroscopy procedures worldwide and the considerable morbidity and mortality associated with VTE, it is important to prevent, diagnose, and treat VTEs efficiently and effectively. Risk factors such as history of VTE, family history of VTE, genetic coagulopathy, oral contraceptive use, cancer history, and old age increase the risk of postoperative VTE and warrant consideration of prophylaxis. Diagnosis and treatment should be initiated rapidly in the setting of concerning symptoms and positive imaging diagnosis, respectively. The purpose of this review was to provide a framework to individualized VTE risk, weigh prophylaxis options, expedite diagnostic pathways, and implement outpatient treatment algorithms.
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Affiliation(s)
- Colby C Wollenman
- From the Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN (Wollenman, Cox, Schoenecker, and Wright), the Department of Pathology, Microbiology, and Immunology, the Department of Pediatrics, the Center for Bone Biology, and the Department of Pharmacology, Vanderbilt University, Nashville, TN (Schoenecker)
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Looney AM, Chopra A, Elkadi SH, Chau J, Childers DF, Chung J, Postma WF. Association of Symptomatic Venous Thromboembolism and BMI in Patients Undergoing Sports Medicine Knee Procedures: A Retrospective Case-Control Study. Sports Health 2024; 16:429-439. [PMID: 37114797 PMCID: PMC11025512 DOI: 10.1177/19417381231168786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The purpose of this study was to characterize the prevalence of venous thromboembolism (VTE; including deep vein thrombosis [DVT] and pulmonary embolism [PE]) after sports medicine knee procedures by a single surgeon at an academic institution, identify factors associated with increased risk of VTE, and determine risk factor thresholds for beyond which VTE risk is elevated. HYPOTHESIS We hypothesized that the prevalence of VTE after sports medicine knee procedures is low, but that increasing weight and body mass index (BMI) would be associated with elevated risk. STUDY DESIGN Retrospective case-control study. LEVEL OF EVIDENCE Level 3. METHODS A retrospective case-control study analyzing sports medicine knee surgeries from 2017 to 2020 was conducted using current procedural terminology codes to identify cases. Optimal cutoff points for specific continuous patient characteristics were calculated to determine elevated risk of postoperative VTE. Overall VTE-free survival was assessed using Kaplan-Meier analysis and Cox proportional hazard regression models. RESULTS Among the 724 eligible patients, there were 13 postoperative VTE events (1.79% prevalence; 12 DVTs, 1 DVT/PE). Increasing weight and BMI were significant risk factors for postoperative VTE (P = 0.03 and P = 0.04, respectively), with weight >94.7 kg and BMI >27.9 kg/m2 associated with elevated risk in male patients and weight >79.1 kg and BMI >28.1 kg/m2 associated with elevated risk for female patients. Cox regression demonstrated a significantly increased risk of postoperative VTE for male patients with BMI ≥27.9 kg/m2. CONCLUSION Patients who undergo sports medicine knee surgery with increased weight and BMI are at an elevated risk of postoperative VTE. An individualized approach should be considered for chemoprophylaxis in patients with these risk factors. CLINICAL RELEVANCE Consider chemoprophylaxis in patients with increased weight and BMI who undergo sports medicine knee surgery since they are at an elevated risk of postoperative VTE.
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Affiliation(s)
- Austin M. Looney
- Guilford Orthopaedic and Sports Medicine Center, Greensboro, North Carolina
| | - Aman Chopra
- Georgetown University School of Medicine, Washington DC
| | | | - Justin Chau
- Georgetown University School of Medicine, Washington DC
| | | | - Joon Chung
- Georgetown University School of Medicine, Washington DC
| | - William F. Postma
- Department of Orthopaedic Surgery, Georgetown University, Washington DC
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Zou Y, Zhang G, Sun X. Risk factors for venous thromboembolism following knee arthroscopy: A systematic review and meta-analysis of observational studies. Heliyon 2024; 10:e25939. [PMID: 38379989 PMCID: PMC10877282 DOI: 10.1016/j.heliyon.2024.e25939] [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] [Received: 06/29/2023] [Revised: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 02/22/2024] Open
Abstract
Objectives To evaluate the risk factors for increased risk of venous thrombosis after arthroscopic knee surgery. Methods PubMed, EMBASE and Cochrane Library were searched from their inception to April 4, 2023. Observational studies investigated venous thrombosis following arthroscopic knee surgery were included. The Newcastle Ottawa Scale (NOS) was used to evaluate the methodological quality of included studies. The odd ratios (ORs) and 95% confidence intervals (CIs) pertaining to each risk factor were synthesized through a random effects model by STATA 14 software. Results The protocol this meta-analysis has been registered on PROSPERO (CRD42023410283). A total of 22 observational studies were included in the systematic review, all of which were of moderate or high methodological quality. The results of the meta-analysis revealed that several factors were significantly associated with an elevated risk of venous thrombosis following arthroscopic knee surgery. These factors included age (mean age ≥30 years) [OR = 1.08, 95%CI (1.04, 1.13), P = 0.001], overweight or obesity [OR = 1.31, 95%CI (1.13, 1.52), P<0.001], oral contraceptive use [OR = 1.90, 95%CI (1.52, 2.37), P<0.001], and smoking history [OR = 1.35, 95%CI (1.06, 1.71), P = 0.014]. Furthermore, the subgroup analysis indicated that patients with an average age over 50 years [OR = 3.18, 95%CI (1.17, 8.66), P = 0.001] and those who underwent surgery with a tourniquet for ≥90 min [OR = 4.79, 95%CI (1.55, 14.81), P = 0.007] were at a significantly increased risk of venous thrombosis after knee arthroscopy. Conclusion Age, obesity, oral contraceptives, smoking history, and prolonged tourniquet use may increase the risk of venous thrombosis after arthroscopic knee surgery. The incidence of venous thrombosis after knee arthroscopy is on a downward trend, but due to its severity, increasing awareness of risk factors and implementing effective prophylaxis are important tasks for clinicians to prevent the risk of venous thrombosis after knee arthroscopy.
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Affiliation(s)
- Yue Zou
- Department of Articular Surgery, Yantaishan Hospital, Yantai, Shandong, China
| | - Guodong Zhang
- Department of Articular Surgery, Yantaishan Hospital, Yantai, Shandong, China
| | - Xiujiang Sun
- Department of Articular Surgery, Yantaishan Hospital, Yantai, Shandong, China
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Momenzadeh K, Yeritsyan D, Mortensen S, Kheir N, Khak M, Caro D, Kahe F, Abbasian M, Mo C, McNichol M, Paschos N, Nazarian A. While the Incidence of Venous Thromboembolism After Shoulder Arthroscopy Is Low, the Risk Factors Are a Body Mass Index Greater than 30 and Hypertension. Arthrosc Sports Med Rehabil 2024; 6:100815. [PMID: 38149088 PMCID: PMC10749995 DOI: 10.1016/j.asmr.2023.100815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/20/2023] [Indexed: 12/28/2023] Open
Abstract
Purpose This study aims to determine the overall incidence of venous thromboembolism (VTE) following shoulder arthroscopy and to define potential risk factors associated with its development that may help define guidelines for the use of thromboprophylaxis. Methods A systematic review was performed using PubMed, Embase, Web of Science, CINAHL, and Cochrane databases per PRISMA guidelines. The search terms consisted of variations of "Venous Thromboembolism" and "Shoulder Arthroscopy." Information regarding arthroscopy indication, risk factors, outcomes, and patient demographics was recorded and analyzed, and pooled odds ratios were reported for each variable. Results Six hundred eighty-five articles were identified in the initial search, and 35 articles reported DVT, PE, or VTE incidence following shoulder arthroscopy. Seventeen nonoverlapping articles with a unique patient population incidence rates. Four articles were then used for subgroup meta-analysis. The incidence rate of VTE was 0.24%, ranging from 0.01% to 5.7%. BMI >30 (OR = 1.46; 95% CI = [1.22, 1.74]; I2 = 0%) and hypertension (OR = 1.64; 95% CI = [1.03, 2.6]; I2 = 75%) were significant risk factors (P < .05) for developing VTE following shoulder arthroscopy. Diabetes (OR = 1.2; 95% CI = [0.97, 1.48]; I2 = 0%), insulin-dependent diabetes (OR = 5.58; 95% CI = [0.12, 260.19]; I2 = 85%), smoking (OR = 1.04; 95% CI = [0.79, 1.37]; I2 = 12%), male sex (OR = 0.95; 95% CI = [0.49, 1.85]; I2 = 86%) and age over 65 (OR = 4.3; 95% CI = [0.25, 72.83]; I2 = 85%) were not associated with higher VTE risk. Conclusion The VTE incidence following shoulder arthroscopy is low at 0.24%. Patients with BMI >30 and hypertension are at a higher risk for VTE after shoulder arthroscopy. Level of Evidence Level IV, systematic review and meta-analysis of Level I-IV studies.
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Affiliation(s)
- Kaveh Momenzadeh
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Diana Yeritsyan
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Sharri Mortensen
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Mohammad Khak
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Daniela Caro
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Farima Kahe
- Cardiovascular Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Mohammadreza Abbasian
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Chen Mo
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Megan McNichol
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Nikolaos Paschos
- Orthopaedic Surgery Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia
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Liu J, Han H, Yang S, Zhan X, Cao B, Peng Y. Esketamine use is associated with shortened postoperative hospital stay in patients after knee arthroscopic surgery: a propensity score-matched cohort study. BMC Anesthesiol 2024; 24:27. [PMID: 38233828 PMCID: PMC10792950 DOI: 10.1186/s12871-023-02376-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/10/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Previous studies have examined anesthetics to improve postoperative prognosis after knee arthroscopic surgery. However, it is currently unknown whether perioperative anesthetics can influence postoperative hospital stay. We investigated the impact of esketamine after knee arthroscopic surgery on post-operative length of stay, fever and surgical site infection. METHODS This study included 455 patients who underwent knee surgery between January2020 and August 2021at a tertiary hospital in China. Patient characteristics, preoperative laboratory values, intra-operative anesthetic data, and postoperative outcomes were collected. Univariate and multivariate logistic regression analyses with or without propensity score matching were performed to identify factors related to post-operative discharge within 3 days(PD3). RESULTS A total of 297 cases met our inclusion criteria. The mean age of patients was 42 ± 14 years, mean body mass index, 24.1 ± 3.5 kg/m2, 157(53%) patients were male. Meniscus-related procedures accounted for the most part of all the procedures with a percentage of 40.4%, followed by combined procedures of 35.4%. After we adjusted for demographic and intraoperative characteristics with propensity score matching, esketamine use was significantly associated with PD3 with the highest odds ratio of 2.28 (95% confidence interval (CI): 1.18-4.41, p = 0.014). CONCLUSION Esketamine use was associated with PD3 in patients underwent knee arthroscopic surgery. The findings of this study will be useful to anesthesiologists in making informed decisions regarding the choice of anesthetics for knee joint diseases. TRIAL REGISTRATION This study was approved by the Ethics Committee (Approval No.:2023-041-01) of the Eighth Affiliated Hospital, Sun Yat-sen University and retrospectively registered.
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Affiliation(s)
- Jing Liu
- Department of Anesthesiology, the Eighth Affiliated Hospital, Sun Yat-sen University, No.3025 Shennan Road, Futian District, Shenzhen City, Guangdong Province, China
| | - Hong Han
- Department of Anesthesiology, the Eighth Affiliated Hospital, Sun Yat-sen University, No.3025 Shennan Road, Futian District, Shenzhen City, Guangdong Province, China
| | - Shangze Yang
- Department of Anesthesiology, the Eighth Affiliated Hospital, Sun Yat-sen University, No.3025 Shennan Road, Futian District, Shenzhen City, Guangdong Province, China
| | - Xiaoxuan Zhan
- Department of Anesthesiology, the Eighth Affiliated Hospital, Sun Yat-sen University, No.3025 Shennan Road, Futian District, Shenzhen City, Guangdong Province, China
| | - Bingbing Cao
- Department of Anesthesiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
| | - Yue Peng
- Department of Anesthesiology, the Eighth Affiliated Hospital, Sun Yat-sen University, No.3025 Shennan Road, Futian District, Shenzhen City, Guangdong Province, China.
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Niehaus R, Zingg PO, Hoch A, Luttenberger M, Stefan R. Hip arthroscopy versus total hip arthroplasty-A study on patients with obesity above 40 years of age. Clin Obes 2023; 13:e12590. [PMID: 36919471 DOI: 10.1111/cob.12590] [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: 07/26/2022] [Revised: 02/06/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
Patients older than 40 years with a body-mass-index (BMI) >30 kg/m2 , a femoroacetabular-impingement (FAI) and little cartilage damage are a challenge for hip surgeons. Hip-arthroscopy (HAS) or conservative therapy until a total hip arthroplasty (THA) is needed are possible treatments. Our research purpose was to compare the clinical results and complication/reoperation rate after HAS and THA in patients with obesity over 40 years. This retrospective study includes a consecutive series of patients with obesity (BMI >30 kg/m2 ) who underwent HAS (19 hips) and THA (37 hips) over 40 years of age between 2007 and 2013 at our institution with a minimum of 12-months follow-up. Outcome measures were WOMAC (Western Ontario und McMaster Universities Arthritis Index), subjective-hip-value (SHV), residual complaints and the reoperation rate. Patient data and scores were collected pre-operative, 12 months post-operatively and at the last follow-up. Both groups showed a comparable age (mean 48 years). Regarding SHV-Scores the THA-group shows continuous significant improvements. Reaching 87% (range 50%-100%), the HAS-group showed in case of the SHV no significant change after 1 year and an improvement from preoperative to the last follow-up reaching 72% (range 30%-100%) at the last follow-up. Residual groin pain was significant higher in the HAS-group. Two deep infections (5.4%) requiring reoperations were reported in the THA-group. The conversion rate to THA after a mean time of 60 months was 26% (5 of 19). Patients with obesity over 40 years demonstrated inferior SHV, more often residual pain and revision surgery after HAS, when compared to THA at short-term, with conversions rate of one fourth. However, THA in this patient group showed high infection rate of 5%. This information is relevant for counselling above-mentioned patients.
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Affiliation(s)
- Richard Niehaus
- Department of Orthopedics, University Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, University Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Armando Hoch
- Department of Orthopedics, University Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Martin Luttenberger
- Department of Orthopedics, University Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Rahm Stefan
- Department of Orthopedics, University Hospital Balgrist, University of Zürich, Zürich, Switzerland
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Sumbal R, Sumbal A, Amir A. Risk factors for 30-day readmission following shoulder arthroscopy: a systematic review. J Shoulder Elbow Surg 2023; 32:2172-2179. [PMID: 37263483 DOI: 10.1016/j.jse.2023.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Recently, there has been a rapid shift from open shoulder surgery to arthroscopic shoulder procedures for treating several shoulder pathologies. This shift is mainly due to reduced postoperative complications and 30-day readmission. Although the 30-day readmission rate is low, the risk still exists. One way to minimize the risk factors is to analyze all the risk factors contributing to the 30-day readmission following shoulder arthroscopy. METHODS Electronic databases such as PubMed, Google Scholar, and Cochrane library were searched. Studies were selected based on predefined inclusion and exclusion criteria. Newcastle-Ottawa score was used for the quality assessment of individual studies. Two reviewers extracted data from the selected studies. Results were evaluated through narrative analysis and presented as an odds ratio with 95% confidence interval. A meta-analysis was not possible due to the heterogeneity in the available data. RESULTS A total of 12 studies evaluating 494,038 patients were selected in our review. All the studies have a low risk of bias (median = 8). Significant factors predicting readmission included age, gender, COPD (chronic obstructive pulmonary disorder), steroid use, smoking, preoperative opioid use, higher American Society of Anesthesiologists (ASA) score (3 or higher), and general and regional anesthesia vs. regional anesthesia alone. CONCLUSION Through our systematic review, we tried to identify risk factors that can predict 30-day readmission following shoulder arthroscopy. These include age > 65 years, COPD, steroid use, opioid use, and OR time > 90 mins. These high-risk patients could be triaged earlier by identifying these parameters, and effective pre and post-operative surveillance could minimize 30-day readmission risk following shoulder arthroscopy.
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Affiliation(s)
- Ramish Sumbal
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Anusha Sumbal
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Alina Amir
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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Shankar DS, Bi AS, Lan R, Buzin S, Youm T. Reprint of: Class I Obesity Delays Achievement of Patient-Acceptable Symptom State but Not Minimum Clinically Important Difference or Substantial Clinical Benefit After Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Arthroscopy 2023; 39:1971-1979. [PMID: 37543382 DOI: 10.1016/j.arthro.2023.06.028] [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] [Received: 06/28/2022] [Accepted: 01/31/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE To identify differences in the time taken to achieve the minimum clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) following primary hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS) among patients of different body mass index (BMI) categories. METHODS We conducted a retrospective comparative study of hip arthroscopy patients with minimum 2-year follow-up. BMI categories were defined as normal (18.5 ≤ BMI < 25.0), overweight (25.0 ≤ BMI <30.0), or class I obese (30.0≤BMI<35.0). All subjects completed the modified Harris Hip Score (mHHS) prior to surgery and at 6 months, 1 year, and 2 years postoperative. MCID and SCB cutoffs were defined as pre-to-postoperative increases in mHHS by ≥8.2 and ≥19.8, respectively. PASS cutoff was set at postoperative mHHS ≥74. Time to achievement of each milestone was compared using the interval-censored EMICM algorithm. The effect of BMI was adjusted for age and sex using an interval-censored proportional hazards model. RESULTS 285 patients were included in the analysis: 150 (52.6%) normal BMI, 99 (34.7%) overweight, and 36 (12.6%) obese. Obese patients had lower mHHS at baseline (P = .006) and at 2-year follow-up (P = .008). There were no significant intergroup differences in time to achievement for MCID (P = .92) or SCB (P = .69), but obese patients had longer time to PASS than normal BMI patients (P = .047). Multivariable analysis found obesity to be predictive of longer time to PASS (HR = .55; P = .007) but not MCID (HR = 0.91; P = .68) or SCB (HR = 1.06; P = .30). CONCLUSIONS Class I obesity is associated with delays in achieving a literature-defined PASS threshold after primary hip arthroscopy for FAIS. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Dhruv S Shankar
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Andrew S Bi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Rae Lan
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Scott Buzin
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Thomas Youm
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A..
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Huang X, Guo Y, Fu R, Li H. A nomogram to predict postoperative surgical site infection of adult patients who received orthopaedic surgery: a retrospective study. Sci Rep 2023; 13:8129. [PMID: 37208366 DOI: 10.1038/s41598-023-34926-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 05/10/2023] [Indexed: 05/21/2023] Open
Abstract
Surgical site infection is a common postoperative complication with serious consequences. This study developed a nomogram to estimate the probability of postoperative surgical site infection for orthopaedic patients. Adult patients following orthopaedic surgery during hospitalization were included in this study. We used univariate and multivariate logistic regression analyses to establish the predictive model, which was also visualized by nomogram. To evaluate the model performance, we applied the receiver operating characteristic curve, calibration curve, and decision curve analysis, which were utilized in external validation and internal validation. From January 2021 to June 2022, a total of 787 patients were enrolled in this study. After statistical analysis, five variables were enrolled in the predictive model, including age, operation time, diabetes, WBC, and HGB. The mathematical formula has been established as follows: Logit (SSI) = - 6.301 + 1.104 * (Age) + 0.669 * (Operation time) + 2.009 * (Diabetes) + 1.520 * (WBC) - 1.119 * (HGB). The receiver Operating Characteristic curve, calibration curve, and decision curve analysis presented a good performance of this predictive model. Our nomogram showed great discriminative ability, calibration, and clinical practicability in the training set, external validation, and internal validation.
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Affiliation(s)
- Xu'an Huang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Graduate School of Peking Union Medical College, Beijing, People's Republic of China
| | - Yang Guo
- The School of Clinical Medicine, Fujian Medical University, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361001, Fujian Province, People's Republic of China.
| | - Ribin Fu
- The School of Clinical Medicine, Fujian Medical University, Zhongshan Hospital Xiamen University, No.201-209, Hubinnan Road, Siming District, Xiamen, 361001, Fujian Province, People's Republic of China.
| | - Hongwei Li
- Zhongshan Hospital Xiamen University, Xiamen, China
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Luttwak R, Ibelli TJ, Taub PJ, Melamed E, Wiser I. Predicting early term complications of ORIF distal radius fracture in outpatient settings using NSQIP data. Injury 2023:S0020-1383(23)00353-4. [PMID: 37095046 DOI: 10.1016/j.injury.2023.04.008] [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: 02/13/2023] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE There is no consensus on which risk factors are most predictive for complications following open reduction internal fixation of distal radius fractures (ORIF-DRF) in an outpatient setting. This study is a complication risk analysis for ORIF-DRF in outpatient settings based on data obtained from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). METHODS A nested, case-control study, was conducted in ORIF-DRF cases performed in outpatient settings from 2013 to 2019 obtained from the ACS-NSQIP database. Cases with documented local or systemic complications were age and gender-matched in a 1:3 ratio. The association between patient and procedure-dependent risk factors for systemic and local complications in general and for different subpopulations was examined. Bivariate and multivariable analyses were performed to evaluate the association between risk factors and complications. RESULTS From a total of 18,324 ORIF-DRF, 349 cases with complications were identified and matched to 1047 Controls. Independent patient-related risk factors included a history of smoking, the American Society of Anesthesiologists (ASA) Physical Status Classification 3 and 4, and bleeding disorder. The intra-articular fracture with three or more fragments was found to be an independent risk factor of all procedure-related risk factors. History of smoking was found to be an independent risk factor for all gender populations, as well as for patients younger the 65 years old. For older patients (age ≥65) bleeding disorder was found to be an independent risk factor. CONCLUSION Complications of ORIF-DRF in outpatient settings have many risk factors. This study provides surgeons with specific risk factors for possible complications following ORIF-DRF.
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Affiliation(s)
- Ruth Luttwak
- Division of Plastic and Reconstructive Surgery, Elmhurst Hospital Center, New York, New York, USA; Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Taylor J Ibelli
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter J Taub
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Eitan Melamed
- Division of Plastic and Reconstructive Surgery, Elmhurst Hospital Center, New York, New York, USA; Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Itay Wiser
- Division of Plastic and Reconstructive Surgery, Elmhurst Hospital Center, New York, New York, USA; Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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11
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Teissier V, Pujol N. Unplanned return to the operating room after arthroscopic procedures: a need to consider 12 months after the initial surgery. Arch Orthop Trauma Surg 2023; 143:2055-2062. [PMID: 35778529 DOI: 10.1007/s00402-022-04522-1] [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: 01/07/2022] [Accepted: 06/12/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The purpose of this study was to report the proportion and cause of unplanned revision surgery rates within 1 year following arthroscopic procedures. Our hypothesis was that there is a significant rate of unplanned returns (URs) occurring between 3 and 12 months after the initial procedure and that causes of revision are different when considering the delay after the index surgery. MATERIALS AND METHODS Among 4142 consecutive patients who underwent an arthroscopic procedure in a single department of orthopedics and traumatology, patients undergoing revision surgery for any reasons directly related to the primary procedure were included. Cause for revision, surgical site, delay from index procedure, and number of revisions were screened. RESULTS Seventy-eight patients underwent 97 revision surgeries (2.3%) for reasons directly related to the primary procedure. Most revision surgeries were performed after month 3 following index surgery (59 patients, 60.8%). Mean time to revision surgery was 5.3 ± 4.3 months (range 0-365 days). Usual early-onset (< 3 months) reasons for unplanned revision were surgical site infection (17 patients, 0.41%), wound-healing defect (12 patients, 0.29%), and hemorrhagic complication (7 patients, 0.17%). Reasons for delayed unplanned revision (> 3 months) were index procedure failure (21 patients, 0.51%), stiffness (18 patients, 0.43%), and removal of hardware (16 patients, 0.41%). CONCLUSIONS Reasons for return to the operating room (OR) are different depending on the timepoint from index procedure. Patients should receive relevant information accordingly when scheduling any arthroscopic procedure, including up to 1-year potential complications. LEVEL OF EVIDENCE Prognostic study, Case series, Level IV.
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Affiliation(s)
- Victoria Teissier
- Department of Orthopedic Surgery, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Nicolas Pujol
- Department of Orthopedic Surgery, Centre Hospitalier de Versailles, Le Chesnay, France.
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12
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Class I Obesity Delays Achievement of Patient-Acceptable Symptom State but not Minimum Clinically Important Difference or Substantial Clinical Benefit After Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Arthroscopy 2023:S0749-8063(23)00173-1. [PMID: 36809817 DOI: 10.1016/j.arthro.2023.01.106] [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: 06/28/2022] [Revised: 01/16/2023] [Accepted: 01/31/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE The aim of our study was to identify differences in the time taken to achieve the minimum clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) following primary hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS) among patients of different body mass index (BMI) categories. METHODS We conducted a retrospective comparative study of hip arthroscopy patients with minimum 2-year follow-up. BMI categories were defined as normal (18.5 ≤ BMI < 25.0), overweight (25.0 ≤ BMI <30.0), or class I obese (30.0≤BMI<35.0). All subjects completed the modified Harris Hip Score (mHHS) prior to surgery and at 6 months, 1 year, and 2 years postoperative. MCID and SCB cutoffs were defined as pre-to-postoperative increases in mHHS by ≥8.2 and ≥19.8, respectively. PASS cutoff was set at postoperative mHHS ≥74. Time to achievement of each milestone was compared using the interval-censored EMICM algorithm. The effect of BMI was adjusted for age and sex using an interval-censored proportional hazards model. RESULTS 285 patients were included in the analysis: 150 (52.6%) normal BMI, 99 (34.7%) overweight, and 36 (12.6%) obese. Obese patients had lower mHHS at baseline (P = .006) and at 2-year follow-up (P = .008). There were no significant intergroup differences in time to achievement for MCID (P = .92) or SCB (P = .69), but obese patients had longer time to PASS than normal BMI patients (P = .047). Multivariable analysis found obesity to be predictive of longer time to PASS (HR = .55; P = .007) but not MCID (HR = 0.91; P = .68) or SCB (HR = 1.06; P = .30). CONCLUSIONS Class I obesity is associated with delays in achieving a literature-defined PASS threshold after primary hip arthroscopy for FAIS. However, future research should consider incorporating PASS anchor questions to determine whether obesity truly carries a risk of delayed achievement of a satisfactory state of health as it pertains to the hip. LEVEL OF EVIDENCE III, retrospective comparative study.
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13
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Inoue G, Miyagi M, Saito W, Shirasawa E, Uchida K, Hosogane N, Watanabe K, Katsumi K, Kaito T, Yamashita T, Fujiwara H, Nagamoto Y, Nojiri K, Suzuki S, Okada E, Ueda S, Hikata T, Shiono Y, Watanabe K, Terai H, Tamai K, Matsuoka Y, Suzuki H, Nishimura H, Tagami A, Yamada S, Adachi S, Ohtori S, Furuya T, Orita S, Inage K, Yoshii T, Ushio S, Funao H, Isogai N, Harimaya K, Okada S, Kawaguchi K, Yokoyama N, Oishi H, Doi T, Kiyasu K, Imagama S, Ando K, Kobayashi K, Sakai D, Tanaka M, Kimura A, Inoue H, Nakano A, Ikegami S, Shimizu M, Futatsugi T, Kakutani K, Yurube T, Nakanishi K, Oshima M, Uei H, Aoki Y, Takahata M, Iwata A, Endo H, Seki S, Murakami H, Kato S, Yoshioka K, Hongo M, Abe T, Tsukanishi T, Takaso M, Ishii K. Effect of low body mass index on clinical recovery after fusion surgery for osteoporotic vertebral fracture: A retrospective, multicenter study of 237 cases. Medicine (Baltimore) 2022; 101:e32330. [PMID: 36595994 PMCID: PMC9803438 DOI: 10.1097/md.0000000000032330] [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] [Indexed: 12/31/2022] Open
Abstract
A retrospective multicenter study. Body mass index (BMI) is recognized as an important determinant of osteoporosis and spinal postoperative outcomes; however, the specific impact of BMI on surgery for osteoporotic vertebral fractures (OVFs) remains inconclusive. This retrospective multicenter study investigated the impact of BMI on clinical outcomes following fusion surgery for OVFs. 237 OVF patients (mean age, 74.3 years; 48 men and 189 women) with neurological symptoms who underwent spinal fusion were included in this study. Patients were grouped by World Health Organization BMI categories: low BMI (<18.5 kg/m2), normal BMI (≥18.5 and <25 kg/m2), and high BMI (≥25 kg/m2). Patients' backgrounds, surgical method, radiological findings, pain measurements, activities of daily living (ADL), and postoperative complications were compared after a mean follow-up period of 4 years. As results, the proportion of patients able to walk independently was significantly smaller in the low BMI group (75.0%) compared with the normal BMI group (89.9%; P = .01) and the high BMI group (94.3%; P = .04). Improvement in the visual analogue scale for leg pain was significantly less in the low BMI group than the high BMI group (26.7 vs 42.8 mm; P = .046). Radiological evaluation, the Frankel classification, and postoperative complications were not significantly different among all 3 groups. Improvement of pain intensity and ADL in the high BMI group was equivalent or non-significantly better for some outcome measures compared with the normal BMI group. Leg pain and independent walking ability after fusion surgery for patients with OVFs improved less in the low versus the high BMI group. Surgeons may want to carefully evaluate at risk low BMI patients before fusion surgery for OVF because poor clinical results may occur.
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Affiliation(s)
- Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University, Sagamihara City, Kanagawa, Japan
- * Correspondence: Gen Inoue, Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitazato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan (e-mail: )
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Kitasato University, Sagamihara City, Kanagawa, Japan
| | - Wataru Saito
- Department of Orthopaedic Surgery, Kitasato University, Sagamihara City, Kanagawa, Japan
| | - Eiki Shirasawa
- Department of Orthopaedic Surgery, Kitasato University, Sagamihara City, Kanagawa, Japan
| | - Kentaro Uchida
- Department of Orthopaedic Surgery, Kitasato University, Sagamihara City, Kanagawa, Japan
- Shonan University of Medical Sciences Research Institute, Chigasaki City, Kanagawa, Japan
| | - Naobumi Hosogane
- Department of Orthopaedic Surgery, Kyorin University, Mitaka City, Tokyo, Japan
| | - Kei Watanabe
- Department of Orthopaedic Surgery, Niigata University, Chuo-ku, Niigata City, Japan
| | - Keiichi Katsumi
- Department of Orthopaedic Surgery, Niigata University, Chuo-ku, Niigata City, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University, Suita City, Osaka, Japan
| | - Tomoya Yamashita
- Department of Orthopaedic Surgery, Osaka University, Suita City, Osaka, Japan
| | - Hiroyasu Fujiwara
- Department of Orthopaedic Surgery, Osaka University, Suita City, Osaka, Japan
| | - Yukitaka Nagamoto
- Department of Orthopaedic Surgery, Osaka University, Suita City, Osaka, Japan
| | - Kenya Nojiri
- Department of Orthopaedic Surgery, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopaedic Surgery, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Seiji Ueda
- Department of Orthopaedic Surgery, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Tomohiro Hikata
- Department of Orthopaedic Surgery, Spine Center, Kitasato Institute Hospital, Minato-ku, Tokyo, Japan
| | - Yuta Shiono
- Department of Orthopaedic Surgery, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka City University, Abeno-ku, Osaka City, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Osaka City University, Abeno-ku, Osaka City, Japan
| | - Yuji Matsuoka
- Department of Orthopaedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Orthopaedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hirosuke Nishimura
- Department of Orthopaedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Atsushi Tagami
- Department of Orthopaedic Surgery, Nagasaki University, Nagasaki City, Japan
| | - Shuta Yamada
- Department of Orthopaedic Surgery, Nagasaki University, Nagasaki City, Japan
| | - Shinji Adachi
- Department of Orthopaedic Surgery, Nagasaki University, Nagasaki City, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Chiba University, Chuo-ku, Chiba City, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Chiba University, Chuo-ku, Chiba City, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Chiba University, Chuo-ku, Chiba City, Japan
- Center for Medical Engineering, Chiba University, Inage-ku, Chiba City, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Chiba University, Chuo-ku, Chiba City, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Shuta Ushio
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, International University of Health and Welfare, Narita City, Chiba, Japan
- Spine and Spinal cord Center, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo, Japan
| | - Norihiro Isogai
- Spine and Spinal cord Center, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo, Japan
| | - Katsumi Harimaya
- Department of Orthopaedic Surgery, Kyushu University, Higashi-ku, Fukuoka City, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Kyushu University, Higashi-ku, Fukuoka City, Japan
| | - Kenichi Kawaguchi
- Department of Orthopaedic Surgery, Kyushu University, Higashi-ku, Fukuoka City, Japan
| | - Nobuhiko Yokoyama
- Department of Orthopaedic Surgery, Kyushu University, Higashi-ku, Fukuoka City, Japan
| | - Hidekazu Oishi
- Department of Orthopaedic Surgery, Kyushu University, Higashi-ku, Fukuoka City, Japan
| | - Toshio Doi
- Department of Orthopaedic Surgery, Kyushu University, Higashi-ku, Fukuoka City, Japan
| | - Katsuhito Kiyasu
- Department of Orthopaedic Surgery, Kochi University, Oko-cho Kohasu, Nankoku City, Kochi, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University, Showa-ku, Nagoya City, Aichi, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University, Showa-ku, Nagoya City, Aichi, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University, Showa-ku, Nagoya City, Aichi, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Tokai University, Isehara City, Kanagawa, Japan
| | - Masahiro Tanaka
- Department of Orthopaedic Surgery, Tokai University, Isehara City, Kanagawa, Japan
| | - Atsushi Kimura
- Department of Orthopaedic Surgery, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Hirokazu Inoue
- Department of Orthopaedic Surgery, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Atsushi Nakano
- Department of Orthopaedic Surgery, Osaka Medical College, Takatsuki City, Osaka, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University, Matsumoto City, Nagano, Japan
| | - Masayuki Shimizu
- Department of Orthopaedic Surgery, Shinshu University, Matsumoto City, Nagano, Japan
| | - Toshimasa Futatsugi
- Department of Orthopaedic Surgery, Shinshu University, Matsumoto City, Nagano, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University, Chuou-ku, Kobe City, Hyogo, Japan
| | - Takashi Yurube
- Department of Orthopaedic Surgery, Kobe University, Chuou-ku, Kobe City, Hyogo, Japan
| | - Kazuyoshi Nakanishi
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan
| | - Masashi Oshima
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan
| | - Hiroshi Uei
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane City, Chiba, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University, Kita-ku, Sapporo City, Hokkaido, Japan
| | - Akira Iwata
- Department of Orthopaedic Surgery, Hokkaido University, Kita-ku, Sapporo City, Hokkaido, Japan
| | - Hirooki Endo
- Department of Orthopaedic Surgery, Iwate Medical University, Yahaba-cho, Iwate, Japan
| | - Shoji Seki
- Department of Orthopaedic Surgery, University of Toyama, Toyama City, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Nagoya City University, Mizuho-ku, Nagoya City, Aichi, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Kanazawa University, Kanazawa City, Japan
| | - Katsuhito Yoshioka
- Department of Orthopaedic Surgery, Kanazawa University, Kanazawa City, Japan
| | - Michio Hongo
- Department of Orthopaedic Surgery, Akita University, Akita City, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba City, Ibaraki, Japan
| | - Toshinori Tsukanishi
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba City, Ibaraki, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University, Sagamihara City, Kanagawa, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, International University of Health and Welfare, Narita City, Chiba, Japan
- Spine and Spinal cord Center, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo, Japan
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Triplet JJ, Schuette HB, Cheema AN, Marigi EM, Hassett LC, Barlow JD, Camp CL, Morrey ME, Sperling JW, Sanchez-Sotelo J. Venothromboembolism following shoulder arthroscopy: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:464-468. [PMID: 37588470 PMCID: PMC10426627 DOI: 10.1016/j.xrrt.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Venous thromboembolic events (VTEs) following orthopedic surgery may lead to serious morbidity and mortality. Fortunately, VTEs following upper extremity procedures are uncommon. However, the true incidence is likely underreported. The aim of this study is to provide a systematic review, excluding large database studies, to report on the incidence of VTEs following shoulder arthroscopic procedures. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a systematic review of multiple databases was performed. A comprehensive search of several databases from inception to September 1, 2021, limited to English language and excluding animal studies, was designed and conducted. Studies were screened by 2 independent reviewers. A decision to exclude studies from large surgical or insurance claim databases was made to minimize the risk of including overlapping data points in this systematic review. Results Thirteen studies met inclusion and exclusion criteria and form part of this systematic review. A total of 32,407 patients were included in this study. Among these patients, the deep vein thrombosis, pulmonary embolism, and overall VTE rates were 0.15%, 0.08%, and 0.21%, respectively. Among the patients specified to have undergone arthroscopic rotator cuff repair, the rate of deep vein thrombosis, pulmonary embolism, and overall VTE was 0.71%, 0.37%, and 1.04%, respectively. Conclusion While symptomatic VTEs are rare following shoulder arthroscopic procedures, surgeons must be aware that they still account for a certain number of postoperative complications. Factors such as operative time, open procedures, obesity, and altitude may increase the risk of postoperative VTE although conflicting data exist. Current literature supports the idea that chemical antithrombotic prophylaxis likely provides no significant advantage over early mobilization in reducing VTEs following shoulder arthroscopy in low-risk patients.
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15
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Berlinberg EJ, Forlenza EM, Patel HH, Ross R, Mascarenhas R, Chahla J, Nho SJ, Forsythe B. Increased Readmission Rates but No Difference in Complication Rates in Patients Undergoing Inpatient Versus Outpatient Hip Arthroscopy: A Large Matched-Cohort Insurance Database Analysis. Arthrosc Sports Med Rehabil 2022; 4:e975-e988. [PMID: 35747635 PMCID: PMC9210381 DOI: 10.1016/j.asmr.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/08/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Methods Results Conclusions Level of Evidence
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Affiliation(s)
- Elyse J. Berlinberg
- Midwest Orthopedics at Rush, Chicago, Illinois, U.S.A
- NYU Grossman School of Medicine, New York, New York, U.S.A
| | | | | | - Ruby Ross
- NYU Grossman School of Medicine, New York, New York, U.S.A
| | | | - Jorge Chahla
- Midwest Orthopedics at Rush, Chicago, Illinois, U.S.A
| | - Shane J. Nho
- Midwest Orthopedics at Rush, Chicago, Illinois, U.S.A
| | - Brian Forsythe
- Midwest Orthopedics at Rush, Chicago, Illinois, U.S.A
- Address correspondence to Brian Forsythe, M.D., Midwest Orthopedics at Rush, 1611 W Harrison St, Ste 360, Chicago, IL 60621, U.S.A.
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16
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Koh DTS, Tan MWP, Zhan X, Li Z, Tay KS, Tan SM, Yeo NEM, Rikhraj Singh I. Association of Elevated Body Mass Index and Outcomes of Arthroscopic Treatment for Osteochondral Lesions of the Talus. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221103263. [PMID: 35722174 PMCID: PMC9201327 DOI: 10.1177/24730114221103263] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Osteochondral lesions of the talus (OLTs) are a common condition found in patients with chronic ankle pain after previous ankle sprains. Surgical management is indicated after conservative management has failed. Hypothesis/Purpose: This study evaluates the influence of body mass index (BMI) on the early clinical outcomes of arthroscopic debridement and microfracture of OLTs. Methods: A total of 252 patients with symptomatic OLTs who failed conservative management underwent arthroscopic debridement and microfracture of OLTs over the affected ankle between 2007 and 2017. Patients from this cohort were divided into 2 groups based on BMI: the normal BMI group (NB Group) (BMI 18.5-25.0) and overweight and obese BMI group (OB Group) (BMI ≥25). Visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, and the physical and mental component summaries of the 36-Item Short-Form Health Survey (PCS and MCS, respectively) were prospectively collected from the cohort during their standard postoperative outpatient follow-up. Results: The NB Group (n=105) and OB Group (n=147) were well matched demographically. The operative duration was significantly shorter for the NB Group compared to the OB Group. Patients from both groups had significant improvements in VAS, AOFAS, and PCS scores postoperatively at 6 and 24 months after surgery ( P < .05). Between both groups, patients had comparable VAS, AOFAS, and PCS scores at preoperation, 6 months postoperation, and 24 months postoperation ( P > .05). However, MCS in the OB Group was lower at 24 months postoperatively compared with the NB Group ( P < .05). The OB Group reported better satisfaction scores (82.4% vs 72.6%, P < .05), and a greater proportion had their expectations met (88.2% vs 77.9%, P < .05). Conclusion: A BMI ≥25 was not associated with worse postoperative pain and functional outcomes, but rather was found to be associated with greater satisfaction and fulfillment. However, patients with BMI ≥25 required longer procedure duration and had poorer MCS scores at 24 months after surgery. Level of Evidence: Level III, retrospective cohort study.
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Affiliation(s)
| | | | - Xia Zhan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Zongxian Li
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Kae Sian Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Shi Ming Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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17
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Lameka M, Mabry S, Montgomery T, Wilson AL, Fellows K, McGwin G, Spitler CA. Systemic Complications of Obesity in Operative Acetabular Fractures. J Orthop Trauma 2022; 36:184-188. [PMID: 34456314 DOI: 10.1097/bot.0000000000002253] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effect of obesity on rates of systemic complications in operatively treated acetabular fractures. DESIGN Retrospective Case-Control study. SETTING Level 1 Trauma Center. PATIENTS/PARTICIPANTS All patients with acetabular fractures managed operatively from January 2015 to December 2019. Patients were divided into groups based on their body mass index (BMI) (normal weight = BMI <25 kg/m2, overweight = BMI 25-30, obese = BMI 30-40, and morbidly obese = BMI >40). INTERVENTION Operative management of an acetabular fracture. MAIN OUTCOME MEASUREMENT Systemic complications, including mortality, sepsis, pneumonia, acute respiratory distress syndrome, deep vein thrombosis, pulmonary embolism, or venous thrombotic event. RESULTS A total of 428 patients were identified. One hundred nine patients (25.4%) were in normal weight, 133 (31.1%) were overweight, 133 (31.1%) were obese, and 53 (12.4%) were morbidly obese. The rate of systemic complications was 17.5%, and overall mortality rate was 0.005%. There were no significant differences between the different BMI groups in all-cause complications or any individual complications. When the morbidly obese group was compared with all other patients, there were also no significant differences in all-cause complications or any individual complications. CONCLUSION In conclusion, in this study, there was no association with increasing BMI and inpatient systemic complications after operative management of acetabular fractures. As we continue to refine our understanding of how obesity affects outcomes after acetabular fracture surgery, other indices of obesity might prove more useful in predicting complications. In the obese population, there are well-documented risks of postoperative infections and challenges in obtaining an anatomic reduction, but the fear of postoperative systemic complications should not deter surgeons from undertaking operative management of acetabular fractures in the obese population. Because the prevalence of obesity in trauma patients continues to increase, it is incumbent on us to continue to improve our understanding of optimal treatment for our patients. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Megan Lameka
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
| | - Scott Mabry
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
| | - Tyler Montgomery
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
| | - Anthony L Wilson
- University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Kenneth Fellows
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
| | - Gerald McGwin
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
| | - Clay A Spitler
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
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Pang L, Li P, Li H, Tang X, Zhu J. Does anterior cruciate ligament reconstruction increase venous thromboembolism risk compared with knee meniscectomy under arthroscopy? BMC Musculoskelet Disord 2022; 23:268. [PMID: 35303852 PMCID: PMC8933879 DOI: 10.1186/s12891-022-05216-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/14/2022] [Indexed: 02/05/2023] Open
Abstract
Background This study compared the incidence of postoperative venous thromboembolism (VTE) between meniscectomy and anterior cruciate ligament reconstruction (ACLR) under arthroscopy and assessed whether ACLR increases the VTE risk compared with meniscectomy. Methods A retrospective study of prospectively collected clinical data, including data on 436 patients ranging in age from 18 to 60 years who underwent ACLR or meniscectomy surgery, was performed between October 2018 and October 2019 in our hospital. All patients underwent routine VTE screening by venous ultrasonography in postoperative week 2 and then clinical follow-up at 4 and 6 weeks post-surgery. The incidence of VTE was calculated, and clinical factors such as age, sex, body mass index (BMI), smoking, concomitant procedure, Caprini score, and duration of tourniquet use were evaluated in relation to the risk factors for VTE. Results A total of 320 patients who underwent arthroscopic ACLR or meniscectomy were available for analysis. Of these patients, 130 (40.6%) underwent ACLR, and 190 (59.4%) underwent meniscectomy. No cases of pulmonary embolism (PE) or femoral deep vein thrombosis (DVT) were reported in either group. Fourteen patients (10.8%) developed VTE in the ACLR group compared with 10 (5.3%) in the meniscectomy group, with no significant difference (p = 0.066). Among these patients, 4 (3.1%) patients in the ACL reconstruction group and 2 (1.1%) patients in the meniscectomy group had DVT confirmed by Doppler ultrasound (p > 0.05). ACLR, age, and BMI (OR = 3.129; 1.061; 1.435) tended to increase the risk of VTE, but the results were not statistically significant (p = 0.056, 0.059, 0.054). Conclusions The incidence of VTE after ACLR and meniscectomy within 6 weeks post-surgery was 10.8 and 5.3%, respectively. ACLR, age, and BMI had a tendency to increase the risk of VTE.
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Affiliation(s)
- Long Pang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Pengcheng Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hui Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xin Tang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jing Zhu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Easwaran R, Khan M, Sancheti P, Shyam A, Bhandari M, Ranawat AS, Thakkar S, Parikh S, Musahl V, Joglekar S, J Deshmukh A, Plancher K, Verma N, McAllister D, Verdonk P, Lustig S, Chandrateya A, Smigleiski R, Solayar G, Chernchujit B, Yung P, Budhiparama N, Hoshino Y, White N, Parker D, Clatworthy M, Brown C, Manzary M, Rajan D, Narvekar A, Tapasvi S, Pardiwala D, Panigrahi R, Arumugam S, Kapoor V, Mody B, Maheshwari J, Dahiya V, Joseph C, Laddha M, Rajgopal A. Prophylaxis for preventing venous thromboembolism in knee arthroscopy and soft tissue reconstruction: consensus statements from an international panel of experts. Knee Surg Sports Traumatol Arthrosc 2022; 30:3634-3643. [PMID: 35435469 PMCID: PMC9013735 DOI: 10.1007/s00167-022-06973-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE There is a lack of consensus regarding need for Venous Thrombo Embolism (VTE) prophylaxis following arthroscopic knee surgery and open soft tissue knee reconstruction. Clear cut guidelines like ones for trauma surgery and arthroplasty do not exist and the published literature is limited to case reports with a few society guidelines. Given this lack of consensus, we conducted a modified Delphi questionnaire of international experts to provide recommendations on this topic. METHODS The consensus statements were generated using an anonymised 3 round modified Delphi questionnaire, sent to an international panel of 38 knee surgeons, with an 80% agreement being set as the limit for consensus. The responses were analysed using descriptive statistics with measures like mode, median and box plots. Feedback was provided to all panelists based on responses from the previous rounds to help generate the consensus. RESULTS Six consensus statements were generated after the three rounds of Delphi. Patient factors, prolonged surgery duration and family history of thrombogenic events emerged as the main points to be taken into consideration for prophylaxis. CONCLUSION It was established through this study, that there exists a select group of patients undergoing arthroscopic surgery that justify the usage of VTE prophylaxis. The expert responses to most of the questions in different scenarios favoured usage of VTE prophylaxis based on patient factors like advanced age, past history of VTE, smoking, oral contraceptive use etc. LEVEL OF EVIDENCE: Level V.
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Affiliation(s)
- Raju Easwaran
- Shree Meenakshi Orthopedics and Sports Medicine Clinic, B H 41 East, Shalimar Bagh, New Delhi, 110088, India.
- Department of Arthroscopy and Sports Injuries, Max Super-Speciality Hospital Shalimar Bagh, New Delhi, India.
| | - Moin Khan
- Sports Medicine and Shoulder Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - Parag Sancheti
- Sancheti Institute for Orthopaedics and Rehabilitation and PG College, Pune, India
| | - Ashok Shyam
- Sancheti Institute for Orthopedics and Rehabilitation, Pune, India
| | - Mohit Bhandari
- Chair, Department of Surgery, McMaster University, Hamilton, Canada
| | - Anil S Ranawat
- Knee Division of SMI, Hospital for Special Surgery, New York, USA
| | - Savyasachi Thakkar
- Johns Hopkins Orthopaedics, Hip and Knee Reconstruction Surgery, Columbia, USA
| | - Shital Parikh
- Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Volker Musahl
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Siddharth Joglekar
- Orthopedic Service, VA Central California Health Care System, Fresno, CA, USA
- UCSF Fresno Orthopedic Residency Program, Fresno, USA
| | | | - Kevin Plancher
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, NY, USA
- Weill Cornell Medical College, New York, USA
- Orthopaedic Foundation, Stamford, CT, USA
- Plancher Orthopaedics and Sports Medicine, New York, USA
| | - Nikhil Verma
- Division of Sports Medicine, Sports Medicine Fellowship, Rush University Medical Center, Midwest Orthopedics at Rush, Chicago, USA
| | - David McAllister
- Sports Medicine Service, Vice Chair of Academic Affairs, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
- UCLA Department of Athletics, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Peter Verdonk
- Orthopaedic Center Antwerp, Antwerp, Belgium
- Department of Orthopaedic Surgery, Antwerp University, Antwerp, Belgium
| | - Sebastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, Lyon, France
| | - Amit Chandrateya
- Princess of Wales Hospital Bridgend, Cwm Taf Morgannwg University Health Board, Bridgend, UK
| | - Robert Smigleiski
- Orthopaedics and Sports Medicine, Department at LIFE Institute, LIFE Institute Biological Treatment Centre, Warsaw, Poland
| | - Gandhi Solayar
- Orthopaedic Specialist Centre, Subang Jaya, Selangor, Malaysia
| | - Bancha Chernchujit
- Department of Orthopedics, Thammasat University Hospital, Khlong Nueng, Thailand
| | - Patrick Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong, China
| | - Nicolaas Budhiparama
- School of Vocational Studies and Department of Orthopaedics and Traumatology, School of Medicine, University of Airlangga, Jl. Mayjend. Prof. Dr. Moestopo, Jawa Timur, Indonesia
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Medistra Hospital, Jakarta, Indonesia
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, School of Medicine, Kobe University, Kobe, Japan
| | | | - David Parker
- Sydney Orthopaedic Research Institute, Chatswood, Australia
| | | | - Charlie Brown
- International Knee and Joint Centre, Abu Dhabi, United Arab Emirates
| | - Mojieb Manzary
- Orthopedic Services, Johns Hopkins Aramco Health Care Center, Dhahran, Saudi Arabia
- Department of Orthopedics, Johns Hopkins University School of Medicine, Dhahran, Saudi Arabia
| | - David Rajan
- Ortho One-Orthopaedic Speciality Centre, Coimbatore, India
| | - Abhay Narvekar
- P D Hinduja Hospitals Mumbai, Global Hospital Parel, Mumbai, India
| | | | - Dinshaw Pardiwala
- Arthroscopy Service, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - Ranjit Panigrahi
- PG Dept of Orthopaedics, Hitech Medical College and Hospital, Bhubaneswar, Odisha, India
- Kalinga Super Speciality Hospital, Bhubaneswar, Odisha, India
| | - S Arumugam
- Centre for Sports Science, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Chennai, India
| | - Vikash Kapoor
- Medica Superspeciality Hospital, Medica Hospitals, Kolkata, India
| | - Bharat Mody
- Welcare Hospital, Atladra-Vadsar Ring Road, Atladra, Vadodara, Gujarat, India
| | - Jitender Maheshwari
- Knee and Shoulder Service, Department of Orthopaedics, Sitaram Bharatiya Hospital, New Delhi, India
| | - Vivek Dahiya
- Adult Reconstruction Lower Limb, Institute of Musculoskeletal Disorders and Orthopaedics, Medanta, Gurugram, India
| | - Clement Joseph
- Arthroscopy and Sports Medicine, Asian Joint Reconstruction Institute, SIMS, Chennai, India
| | | | - Ashok Rajgopal
- Institute of Musculoskeletal Diseases and Orthopaedics, Medanta Medicity, Gurugram, Haryana, India
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Zheng H, Duan G, Shen S, Zhang X. Association of Nutritional Risk Index With Postoperative Pain Outcomes in Elderly Patients Undergoing Gastrointestinal Surgeries: A Retrospective Cohort Study. Front Med (Lausanne) 2021; 8:535627. [PMID: 34568349 PMCID: PMC8458734 DOI: 10.3389/fmed.2021.535627] [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] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Malnutrition is a major health problem, which is common in hospitalized elderly patients and is associated with an increased risk of morbidity and mortality. However, studies on malnutrition and its effect on postoperative pain outcomes in elderly patients have been largely neglected. Here we investigated the relationship between nutritional risk and postoperative pain outcomes in elderly patients. Methods: Between April 1, 2012, and August 31, 2015, 734 elderly patients (≥65 years) who underwent gastrointestinal surgeries were recruited and assigned into two groups according to geriatric nutritional risk index (GNRI). All patients received standard anesthesia procedures and postoperative patient-controlled analgesia for 48 h. The preoperative epidemiology data and postoperative outcome data including pain intensities at rest and movement, the cumulative consumption of analgesics and its common side effects were recorded. Results: The total number of patients with high nutritional risk (GNRI < 92) was 533 out of 734 (72.62%). When compared with low nutritional risk individuals (GNRI ≥ 92), the incidence of inadequate analgesia was significantly higher in elderly patients with GNRI < 92 at different time points. In addition, the cumulative consumption of analgesics was also significantly higher in elderly patients with GNRI < 92 at 0–6 h postoperatively. Through logistic regression analysis, high nutritional risk (OR = 3.113, 95% CI: 1.661–5.834, P < 0.001) and female gender (OR = 0.606, 95% CI: 0.394–0.932, P = 0.023) were identified as significant predictors for postoperative inadequate analgesia. Further sensitivity analyses showed high nutritional risk as a predictor for postoperative inadequate analgesia was more prominent in female patients and early elderly patients. Moreover, 88 was determined as an optimal cut-off value of GNRI for postoperative inadequate analgesia using receiver operating characteristic curve analysis. Conclusion: High nutritional risk is associated with poor postoperative pain outcomes in gastrointestinal elderly patients. Preoperative nutritional evaluation using simple nutritional screening instruments (e.g., GNRI) with the new suggested cut-off value (GNRI = 88) might be included as a standard procedure in routine clinical practice among these patients for postoperative analgesia.
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Affiliation(s)
- Hua Zheng
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guangyou Duan
- Department of Anesthesiology, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Shiqian Shen
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Xianwei Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Operating room architecture is not a risk factor for surgical site infections. Sci Rep 2021; 11:13391. [PMID: 34183687 PMCID: PMC8238929 DOI: 10.1038/s41598-021-90574-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/30/2021] [Indexed: 12/18/2022] Open
Abstract
Surgical site infection (SSI) may cause a substantial burden for patients and healthcare systems. A potential risk of different architectures of the operating room for SSI is yet unknown and was subject of this study. This observational cohort study was performed in a university hospital and evaluated patients, who underwent a broad spectrum of orthopedic surgeries in 2016 (open-plan operating room architecture) versus (vs) 2017 (closed-plan operating room architecture). Patients, who underwent surgery in the transition time period from the open-plan to the closed-plan operating room architecture and those, who were treated e.g. for osteomyelitis as index procedure were excluded. The primary outcome was revision surgery for early SSI within 30 (superficial) or 90 (deep or organ/space) days of surgery. Age, gender, American society of anesthesiologists (ASA) classification, and the body mass index (BMI) were considered as potential interacting factors in a logistic regression analysis. The incidence of revisions for SSI was 0.6 percent (%) (n = 45) in the 7'740 included surgical cases (mean age of 52 (standard deviation (SD) 19) years; n = 3'835 (50%) females). There was no difference in incidences of revision for SSI in the open- vs closed-plan operating room architecture (0.5% vs 0.7%; adjusted odds ratio (OR) = 1.34 (95% confidence interval (CI) 0.72-2.49, P = 0.35)). Age and gender were not a risk factor for revision for SSI. However, ASA classification and BMI were identified as risk factors for the incidence of revision for SSI (OR = 1.92 (95% CI 1.16- 3.18, P = 0.01) and OR = 1.05 (95% CI 1.00-1.11, P = 0.05)). The overall incidence of revisions for early SSI after a broad spectrum of orthopedic surgeries was relatively low (0.6%) and independent from the operating room architecture. An increase in ASA classification and possibly BMI, however, were identified as independent risk factors for revision for SSI.
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Zhou J, Cao X, Du Y, Shi Y, Pan W, Jia S. Risk factors for acute pulmonary embolism in patients with off-pump coronary artery bypass grafting: implications for nursing. J Int Med Res 2021; 48:300060520971445. [PMID: 33249970 PMCID: PMC7708707 DOI: 10.1177/0300060520971445] [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: 11/20/2022] Open
Abstract
Objective Acute pulmonary embolism (APE) is a serious complication after off-pump coronary artery bypass grafting (OPCABG). We aimed to analyze the risk factors for APE in patients with OPCABG. Methods In this retrospective, observational study, patients with OPCABG who were treated in our hospital from 1 January 2018 to 31 March 2020 were included. The basic characteristics of patients and results of preoperative laboratory examinations were collected and analyzed. Results A total of 707 patients with OPCABG were included and the incidence of APE was 3.21%. Left ventricular ejection fraction (LVEF), a history of smoking, number of bypass grafting, duration of surgery, and age were significant risk factors for APE in patients with OPCABG. The areas under the curves of LVEF, number of bypass grafting, duration of surgery, and age were 0.773, 0.759, 0.738, and 0.723, respectively. The cutoff values of LVEF, number of bypass grafting, duration of surgery, and age were 59.84, 3.18, 237.42, and 73.28, respectively. Conclusions LVEF, a history of smoking, number of bypass grafting, duration of surgery, and age may be risk factors for APE in patients with OPCABG. Early measures should be taken to target these risks to prevent APE.
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Affiliation(s)
- Jinli Zhou
- Jiangsu College of Nursing, Jiangsu, China
| | - Xiuhong Cao
- Department of Critical Care Medicine, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, Jiangsu, China
| | - Yeping Du
- Department of Critical Care Medicine, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, Jiangsu, China
| | - Yan Shi
- Department of Critical Care Medicine, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, Jiangsu, China
| | - Weiwei Pan
- Department of Critical Care Medicine, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, Jiangsu, China
| | - Suhong Jia
- Department of Critical Care Medicine, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, Jiangsu, China
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Agarwalla A, Gowd AK, Liu JN, Amin NH, Werner BC. Rates and Risk Factors of Revision Arthroscopy or Conversion to Total Knee Arthroplasty Within 1 Year Following Isolated Meniscectomy. Arthrosc Sports Med Rehabil 2020; 2:e443-e449. [PMID: 33134979 PMCID: PMC7588599 DOI: 10.1016/j.asmr.2020.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 04/17/2020] [Indexed: 02/01/2023] Open
Abstract
Purpose To identify the rates of and risk factors for revision arthroscopy and conversion to total knee arthroplasty (TKA) within 1 year of isolated meniscectomy. Methods Humana and Medicare national insurance databases were queried for patients who underwent isolated meniscectomy. Patients who underwent revision arthroscopy or TKA within 1 year postoperatively were identified by International Classification of Diseases Procedural Codes, Ninth Revision, and Current Procedural Terminology codes. Multivariate binomial logistic regression analysis was used to identify risk factors, and adjusted odds ratios (ORs) and 95% confidence intervals (Cis) were calculated, with P < .05 considered significant. Results A total of 13,142 patients and 407,888 patients underwent isolated meniscectomy in the Humana and Medicare databases, respectively. Of the patients, 395 (3.01%) and 3,770 patients (0.92%) underwent revision arthroscopy, and 629 patients (4.79%) and 38,630 patients (9.47%) underwent TKA within 1 year of meniscectomy in the Humana and Medicare databases, respectively. Obesity (Humana: OR = 1.33, P = 0.003; Medicare: OR = 1.10, P < 0.001) and age < 20 years (Humana: OR = 2.64, P = 0.022), 20-29 years (Humana: OR = 3.30, P = 0.002), 40-49 years (Humana: OR = 3.80, P < 0.001), 50-59 years (Humana: OR = 1.99, P = 0.027), and < 64 years (Medicare: OR = 1.74, P < 0.001) were risk factors for revision arthroscopy. Obesity (Humana: OR = 1.64, P < 0.001; Medicare: OR = 1.37, P < 0.001), morbid obesity (Medicare: OR = 1.20, P < 0.001), age 70-74 (Medicare: OR = 1.12, P < 0.001), 75-79 (Medicare: OR = 1.25, P < 0.001), 80-84 (Medicare: OR = 1.20, P < 0.001), and concomitant osteoarthritis (Humana: OR = 1.42, P < 0.001; Medicare: OR = 1.46, P < 0.001) were risk factors for conversion to TKA. Conclusions Medicare and Humana databases showed that 0.92%-3.01% and 4.79%-9.47% of patients undergo revision arthroscopy or conversion to TKA within a year of isolated meniscectomy. Obesity was a risk factor for early revision arthroscopy and conversion to TKA, whereas concomitant osteoarthritis was a risk factor for conversion to TKA. Level of Evidence Level III, retrospective comparative trial.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, New York, U.S.A
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Joseph N Liu
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, California, U.S.A
| | - Nirav H Amin
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, California, U.S.A
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
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Kuroda Y, Saito M, Çınar EN, Norrish A, Khanduja V. Patient-related risk factors associated with less favourable outcomes following hip arthroscopy. Bone Joint J 2020; 102-B:822-831. [PMID: 32600150 DOI: 10.1302/0301-620x.102b7.bjj-2020-0031.r1] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This paper aims to review the evidence for patient-related factors associated with less favourable outcomes following hip arthroscopy. METHODS Literature reporting on preoperative patient-related risk factors and outcomes following hip arthroscopy were systematically identified from a computer-assisted literature search of Pubmed (Medline), Embase, and Cochrane Library using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and a scoping review. RESULTS Assessment of these texts yielded 101 final articles involving 90,315 hips for qualitative analysis. The most frequently reported risk factor related to a less favourable outcome after hip arthroscopy was older age and preoperative osteoarthritis of the hip. This was followed by female sex and patients who have low preoperative clinical scores, severe hip dysplasia, altered hip morphology (excess acetabular retroversion or excess femoral anteversion or retroversion), or a large cam deformity. Patients receiving workers' compensation or with rheumatoid arthritis were also more likely to have a less favourable outcome after hip arthroscopy. There is evidence that obesity, smoking, drinking alcohol, and a history of mental illness may be associated with marginally less favourable outcomes after hip arthroscopy. Athletes (except for ice hockey players) enjoy a more rapid recovery after hip arthroscopy than non-athletes. Finally, patients who have a favourable response to local anaesthetic are more likely to have a favourable outcome after hip arthroscopy. CONCLUSION Certain patient-related risk factors are associated with less favourable outcomes following hip arthroscopy. Understanding these risk factors will allow the appropriate surgical indications for hip arthroscopy to be further refined and help patients to comprehend their individual risk profile. Cite this article: Bone Joint J 2020;102-B(7):822-831.
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Affiliation(s)
- Yuichi Kuroda
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Mobius Hip and Knee Clinic, Cambridge Nuffield Hospital, Cambridge, UK
| | - Masayoshi Saito
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Mobius Hip and Knee Clinic, Cambridge Nuffield Hospital, Cambridge, UK
| | - Ece Nur Çınar
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Mobius Hip and Knee Clinic, Cambridge Nuffield Hospital, Cambridge, UK
| | - Alan Norrish
- Department of Academic Orthopaedics, Trauma and Sports Medicine, Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Mobius Hip and Knee Clinic, Cambridge Nuffield Hospital, Cambridge, UK
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Li NY, DeFroda SF, Durand W, Reid DBC, Owens BD, Daniels AH. Risk of Revision Shoulder Surgery, Complications, and Prolonged Opioid Use in Patients Undergoing Shoulder Arthroscopy Who Have Previously Undergone Anterior Cervical Discectomy and Fusion. Arthroscopy 2020; 36:367-372.e2. [PMID: 31864815 DOI: 10.1016/j.arthro.2019.08.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/08/2019] [Accepted: 08/14/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare postoperative complications, rates of revision, and opioid use of those who undergo shoulder arthroscopy with and without previous anterior cervical discectomy and fusion (ACDF). METHODS The PearlDiver database from 2007 to 2017 was used to query all patients who underwent shoulder arthroscopy as determined by Current Procedural Terminology (CPT). Patients were then separated among those who had a previous instance of ACDF and those who did not as filtered by CPT. Postoperative complications within 30 days, readmission rates, opioid use, and revision procedures were assessed for each cohort using a mix of International Classification of Diseases Ninth and Tenth Revision Clinical Modification codes, CPT, as well as generic drug codes. RESULTS A total of 91,029 patients undergoing shoulder arthroscopy were identified, of whom 1,267 (1.4%) had a history of ACDF. Compared with patients without previous ACDF, patients with a history of ACDF had significantly greater respiratory complication rates (1.3% vs 0.5%: adjusted odds ratio [aOR] 2.16, 95% confidence interval [CI]1.30-3.59, P = .003), 30-day complication rates (3.7% vs 2.2%: aOR 1.48, 95% CI 1.10-1.99, P = .011), 1-year revision rates (15.2% vs 7.7%: aOR 2.00, 95% CI 1.71-2.33, P < .0001), and greater opioid use at 1 month, 3 months, 6 months, and 12 months (P < .0001). CONCLUSIONS This study revealed that patients who undergo shoulder arthroscopy with a history of ACDF are twice as likely to undergo revision arthroscopy within 2 years of surgery and are at an increased risk of complications within 30 days postoperatively as well as prolonged opioid use compared with those without a history of ACDF. With these findings, both spine and shoulder surgeons should aim to be more aware of surgical history, especially of the cervical spine, to better counsel patients' clinical course and expected outcomes following shoulder arthroscopy. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Neill Y Li
- Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island, U.S.A.; Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Steven F DeFroda
- Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island, U.S.A.; Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Wesley Durand
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Daniel B C Reid
- Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island, U.S.A.; Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Brett D Owens
- Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island, U.S.A.; Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island, U.S.A.; Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A..
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Editorial Commentary: Complications and Readmission After Elective Arthroscopy-Is Body Mass Index a Trustworthy Measure of Risk? Arthroscopy 2019; 35:883-884. [PMID: 30827440 DOI: 10.1016/j.arthro.2018.12.027] [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] [Received: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 02/02/2023]
Abstract
A multivariate analysis of the American College of Surgeons National Surgical Quality Improvement Program database indicates that body mass index is not predictive of complications after elective arthroscopy; however, further analysis reveals underweight and obese patients may be at risk of 30-day morbidity or readmission after shoulder arthroscopy. These findings are consistent with previous reports yet conflict with others, raising concern over the utility of body mass index as a measure of the risk of morbidity and readmission after elective arthroscopy.
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